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The Cardiac Arrest in Elective Neurosurgery, is complex and different from other types, as it’s influenced by the patient’s position, the surgical procedure, and the equipment used to fix the skull; we report a case of a patient admitted for lumbar spine surgery in prone position who presented an intraoperative cardiac arrest. chest compressions can be started immediately for prone patients; some studies confirmed the efficacy of back compressions but patients should be turned supine if possible. When defibrillation were necessary in patients ventilated in the prone position, defibrillation should be attempted, as placing the patient in the supine position would take precious minutes and would reduce the chances of successful defibrillation. Evidence is rare when dealing with neurosurgical patients, and more efforts are needed in understanding the etiologies, mechanisms and the specificities of its management.

Introduction:Hysteroscopy is a commonly used surgical procedure several anesthetic techniques are used. The objective of our study was to compare spinal anesthesia and general anesthesia with laryngeal mask for the realization of hysteroscopy. Materiel and Methods:This is a prospective randomized study conducted in the operating theater of Mohamed V Instructional Hospital, including all patients classified ASA I and II, scheduled for hysteroscopy. Patients were randomized into two groups: spinal anesthesia (SA) and general anesthesia (GA) with laryngeal mask. The comparison between the two groups focused on the incidence of anesthesia-related side effects, satisfaction rate and length of stay in the recovery room. Results:During the six months of the study (from July to December 2022), 76 patients were include.The incidence of hypotension was higher in the SA group than GA group (p = 0.024). Satisfaction of patients and surgeons was higher in the SA group (p = 0.04). The recovery room stay was shorter in the SA group compared with the GA group (p = 0.04). Patients preferred SA much more than GA (p = 0.001). Conclusion:Several anesthetic techniques are available for performing hysteroscopy. Spinal anesthesia is easy to perform with lower cost and acceptable side effects with better satisfaction.

Acute severe pain is the most common condition for emergency consultations. opioids are the cornerstone of the treatment. However, they expose to various adverse effects. We describe a case of a 22-year-old woman with severe pain to her right hand, after a domestic fall, successfully managed by nebulized ketamine. Ketamine administration via nebulized route might be an attractive and non-invasive alternative to opioids use in acute pain management.

Introduction: Sinking skin flap syndrome is a rare complication of craniectomy, which is performed as a treatment of severe intracranial hypertension. Cases Reports: The first case is a 55 year old man. Admitted with Glascow score of 13/15, rapid neurological deterioration was noted with a GCS of 9/15, and then anisocoria. CT scan had objectified hemorrhagic contusions, subdural hematoma measured 11 mm and deviation of the median line. The patient was operated with evacuation of the subdural hematoma through a large decompressive craniectomy. In the second month, he presented a cranial deformation with a deepening of the cutaneous plane, with deterioration of the neurological status and a generalized convulsive crisis. The second case is that of a 32 year old man, admitted to the emergency room with 8/15 of GCS with anisocoria. CT scan was showing an 11 mm right subdural hematoma with a hemorrhagic contusion opposite, a 12 mm midline deviation and diffuse cerebral edema. The patient was operated with evacuation of the subdural hematoma through a large craniectomy. The neurological examination after the extubation showed a GCS of 14. Two days later, the patient presented a depression of the right scalp with an aspect of skin flap syndrome on CT scan without significant neurological deterioration. Conclusion: The role of decompressive craniectomy in neurological improvement in still uncertain, and timing of cranioplasty is more debate: early with unclear neurologic status and preventing the skin flap syndrome or delete after final outcome.