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Introduction: Moyamoya disease is a rare form of the chronic cerebrovascular disorder. Patients develop progressive stenosis or occlusion of the terminal portion of the internal carotid arteries and a proximal portion of the anterior and middle cerebral arteries. The compensatory collateral circulation that develops is weak and small, prone to hemorrhage, aneurysm, and thrombosis. Case Report: We report a case of a six-year-old boy with Moyamoya disease, presenting with complaints of seizures and weakness of the left side of the body. A bilateral encephalo-myo-synangiosis (EMS) was successfully performed on the child under general anesthesia without any perioperative complications. Conclusion: Revascularization surgery in a patient with Moyamoya disease is a high-risk procedure with an increased incidence of perioperative neurological sequelae. However, patients can be successfully perioperatively managed by ensuring adequate cerebral blood flow and minimizing cerebral metabolic oxygen consumption rates.

Background: Classically subclavian vein catheterization is done in neutral arm position; recently, it has been done in different arm positions to compare success rate and catheter misplacement. There is a paucity of literature for comparing abducted and neutral arm position for right infraclavicular subclavian vein cannulation. Aim: Comparison of success rate of abducted and neutral arm position for right infraclavicular subclavian vein cannulation under real-time ultrasound guidance in patients undergoing elective neurosurgery under general anesthesia. Design: Randomized comparative study. Materials and Methods: After approval from Institutional Review Board and Ethical Committee, 100 patients of 18–70 years of age, of either sex, posted for elective neurosurgery under general anesthesia, requiring right subclavian vein cannulation were included in our study. They were randomly divided into two groups: abducted arm position (group 1-AG) and neutral arm position (group 2-NG) using sealed envelope technique. Results: First attempt success rate was higher in AG group compared to NG group (P value- 0.741). Times taken (seconds) for cannulation in NG and AG group, catheter misplacement and hematoma (P value- 0.37, P value- 0.37, P value- 1, respectively) were lesser in AG Group. Conclusion: For USG-guided infraclavicular subclavian vein cannulation, abducted arm position, and neutral arm position in terms of first attempt success rate, number of attempts and associated complications has comparable results; however, further studies with larger group of patients are required to assess the overall advantage of abducted arm position over neutral arm position. [ABSTRACT FROM AUTHOR]

Byline: Tanvir. Samra, Neerja. Banerjee, Arushi. Gupta Introduction: Caloric intake of critically ill patients are usually calculated using predictive equations. Recent advances in gas exchange measurements have the potential to [...]

Byline: Nita. Hazarika, Neerja. Banerjee, Rajesh. Sood Sir, Congenital duplications can occur anywhere in the gastrointestinal tract and one-third of all duplications are foregut duplications. [sup][1] A 6-month-old male child [...]

Byline: Arushi. Gupta, Tanvir. Samra, Neerja. Banerjee, Rajesh. Sood Sir, An observational study was conducted on 100 nurses with minimum 6 months of experience in various intensive care units (trauma, [...]

Byline: Tanvir. Samra, Neerja. Banerjee A 15-year-old boy with Noonan's syndrome was admitted for emergency ventriculo-peritoneal shunt. Intraoperative course was complicated by hypertensive urgency, which was effectively managed with high [...]

Byline: Arushi. Gupta, Neerja. Banerjee Sir, Trendelenberg position is routinely applied during subclavian vein cannulation. [sup][1],[2] However, in patients with pleural effusion, Trendelenberg position is to be applied with great [...]

Byline: Tanvir. Samra, Amlendu. Yadav, Neerja. Banerjee, Mridula. Pawar, Desh. Deepak A 17-year-old H1N1-positive patient was successfully extubated after 25 days of ventilatory support for treatment of viral pneumonia which [...]

Objective: Desflurane causes sympathetic stimulation at high end-tidal concentrations. We conducted this study to compare the haemodynamic response to inhalational bolus with desflurane in normotensive and hypertensive patients undergoing laparoscopic cholecystectomy. Methods: In this prospective, clinical trial, 40 patients aged 18-60 years and undergoing laparoscopic cholecystectomy were divided into normotensives (Group N; n=20) and hypertensives (Group H; n=20). Heart rate (HR), mean arterial pressure (MAP) and bispectral index (BIS) were measured at baseline and every 60 s for 5 min after induction, intubation, initiation and inhalational bolus of desflurane. The primary objective was to compare haemodynamic response, and the secondary objective was to assess the need for inhalational boluses and to compare the number of overcorrections and undercorrections in BIS value after each inhalational bolus. An independent t-test was used to compare the means of the study parameters between the groups, and a dependent t-test was used to compare the percentage change in the means of the study parameters within the same group. Statistical significance was defined as p<0.05. Results: No statistically significant difference in the percentage of patients responding with a decrease, increase or no change of HR or MAP were seen between the two groups after inhalational bolus of desflurane. An overcorrection of BIS (value <45) was seen in 60% of the patients in Group H and 15% of the patients in Group N (p=0.003). None of the patients in either group had an undercorrection (BIS>55). Conclusion: BIS-guided desflurane administration and BIS-triggered inhalational boluses of desflurane is safe, feasible and does not cause sympathetic stimulation in either normotensive or hypertensive patients. [ABSTRACT FROM AUTHOR]

Patients with a congenital single ventricular chamber, survives only because the systemic and pulmonary venous blood mixes. However such an arrangement has two major disadvantages of arterial desaturation and chronic volume overload to the single ventricle. In 1971, Francis Fontan from France, reported a new approach to the operative treatment of these malformations, separating the systemic and pulmonary circulations. The advancement of surgical techniques and medical management have resulted in greater than 90% survival rate of about 10 years after Fontan palliation. As a result, patients with Fontan physiology are increasingly presenting in the adult perioperative setting for various noncardiac surgeries. Understanding the Fontan physiology is essential for the successful anaesthetic management of these patients. We report a case of 22 year female with fontan physiology posted for elective laparoscopic cholecystectomy. [ABSTRACT FROM AUTHOR]

Background: Hyperbaric oxygen therapy (HBOT) is a treatment option for chronic nonhealing wounds. Transcutaneous oximetry (TCOM) is used for wound assessment. We undertook a randomized prospective controlled trial to evaluate the role of HBOT in healing of chronic nonhealing wounds and to determine whether TCOM predicts healing. Materials and Methods: This study was conducted in 30 consenting patients with nonhealing ulcer. The patients were randomized into group HT (receiving HBOT in addition to conventional treatment) and group CT (receiving only conventional treatment). Duration of treatment in both the groups was 30 days. Wound ulcer was analyzed based on size of the wound, exudates, presence of granulation tissue, and wound tissue scoring. Tissue oxygenation (TcPO2) was measured on 0, 10th, 20th, and 30th day. Results: There was 59% reduction in wound area in group HT and 26% increase in wound area in group CT. Ten patients in group HT showed improvement in wound score as compared to five patients in group CT. Complete healing was seen in three patients in group HT as compared to none in group CT. Surgical debridement was required in 6 patients in group HT and 10 patients in group CT. One patient in group HT required amputation as compared to five patients in group CT. A positive correlation was found between TcPO2 value and various markers of wound healing. Conclusion: HBOT has a definitive adjunctive role in the management of chronic nonhealing ulcers. It decreases the amputation rate and improves patient outcome. Periwound TcPO2 may be used as a predictor of response to HBOT and has a positive correlation with wound healing. [ABSTRACT FROM AUTHOR]

Wolff-Parkinson-White syndrome is an electrophysiological disorder of heart. Patients with such disorder may be asymptomatic or present with cardiac symptoms like palpitation and dyspnea. These patients may present with serious cardiac complication like atrial fibrillation and PSVT intraoperatively. We report a case of a 30-year-old female with WPW syndrome posted for laparoscopic cholecystectomy under general anesthesia. We took all the precautions necessary to avoid tachycardia and arranged drugs necessary to treat any complications together with stringent monitoring which is very important for favorable outcome in these patients. Management of the case offers an opportunity to relearn the important considerations on WPW syndrome. [ABSTRACT FROM AUTHOR]

Behçet's disease is a multisystem inflammatory disorder of unknown etiology characterized by vasculitis of large and smaller vessels. Most common features are appearance of oral ulcers which later heal by scarring and ocular involvement leading to glaucoma requiring surgical treatment. Here, we report a case of child suffering from Behçet's disease undergoing repeated ocular surgery for uncontrolled glaucoma and found that with the usual risk involved in such patients there are important changes in the airway when the patient is exposed to repeated surgery under general anesthesia.

Pathogenesis of dengue involves suppression of immune system leading to development of characteristic presentation of haematological picture of thrombocytopenia and leucopenia. Sometimes, this suppression in immune response is responsible for deterioration in clinical status of the patient in spite of all specific and supportive therapy. Certain drugs like steroids are used for rescue therapy in conditions like sepsis. We present a novel use of filgrastim as a rescue therapy in a patient with dengue hemorrhagic fever (DHF) with acute respiratory distress syndrome (ARDS), myocarditis, and febrile neutropenia and not responding to standard management.