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Klippel-Trenaunay Syndrome (KTS) is a sporadic condition characterised by the clinical triad of capillary malformation, atypical varicosity, and soft-tissue and bony hypertrophy. This triad was observed in the current case. Despite being initially described over a century ago, the exact incidence of this syndrome remains unestimated. The clinical presentation of KTS is highly diverse, ranging from asymptomatic cases to severe instances involving life-threatening bleeding and embolism. The authors present a case report of a 10-year-old girl with complaints of a cystic swelling in her left temporal region. She exhibited distinct features such as facial asymmetry, a high-arched palate, a prominent mandible, a port-wine stain on her cheeks, nasal bridge depression, and right-sided body hypertrophy. The child showed delayed developmental milestones, including holding her neck at 1.5 months, a bidextrous approach at seven months, and social smiling at six months, indicating global developmental delay. The patient was scheduled for excision of the swelling. Following the successful excision of the cyst, the child was extubated. The extubation was uneventful. In the postoperative period, the patient remained haemodynamically stable. Managing such a patient for a surgical procedure requires a meticulous approach involving accurate anaesthetic preparation and the prevention of complications. [ABSTRACT FROM AUTHOR]

Byline: Sheetal. Jagtap, Rochana. Bakhshi, Sonal. Khatavkar, Sourabh. Phadtare, Shubha. Mohite Introduction Carotid body tumours (CBTs) are extremely rare arising from chemoreceptor cells at bifurcation of carotid artery. Reported incidence [...]

Byline: Varsha. Vyas, Shubha. Mohite, Sonal. Khatavkar, Sheetal. Jagtap Sir, Anaphylactic reaction to antacid-ranitidine hydrochloride is very rare but can be life threatening. We are reporting a very rare adverse [...]

Byline: Sonal. Khatavkar, S. Jagtap Eight year old girl, weighing 14 kg with VACTERL syndrome V: Vertebral anomalies, A: Anal malformation, C: Cardiovascular defect, TE: Tracheal and esophageal malformation, R:Renal [...]

Hereditary spherocytosis (HS) is a familial hemolytic disorder with marked heterogeneity of clinical features ranging from asymptomatic condition to a fulminant hemolytic anemia. HS is characterized by the strong family history of anemia, jaundice, splenomegaly and cholelithiasis. Anesthetic Management of HS with liver dysfunction is very challenging since most of the anesthetic drugs are metabolized by the liver. Hereby, we report anesthetic management in a case of HS with splenomegaly and gall stones for elective splenectomy and cholecystectomy. [ABSTRACT FROM AUTHOR]

Objective: Caudal block has gained much popularity in the past few decades to provide analgesia in pediatric population. Although local anesthetic agents remain the mainstay for caudal blocks, addition of additives to the solution improves quality and duration of analgesia and reduces the toxicity by allowing lower concentrations of the local anesthetic agents. In this regard opioids have been studied extensively, but there is not much comparative research about caudal clonidine. The aim of our current study was to compare the caudal block characteristics of ropivacaine 0.25% with clonidine 1 μg/ kg versus ropivacaine 0.25% with fentanyl 1μg/kg in pediatric patients. Methodology: A total of 60 ASA 1 children of either gender, age from 2 to 10 years, weighing 10 to 30 kg, scheduled for lower abdominal or limb surgery, were enrolled for this study. Children were randomly allocated into 2 equal groups. Group RF received 1 ml/kg of ropivacaine 0.25% plus fentanyl 1μg/kg via caudal route. Group RC received 1 ml/ kg of ropivacaine 0.25% plus clonidine 1 μg/kg via same route. All children were administered general anesthesia followed by caudal block for postoperative analgesia. Duration of analgesia, sedation score and any side effects were noted. Calculation of sample size was done by using power analysis. The non-parametric data comparison was done by Student's t-test. Results: Duration of analgesia was significantly prolonged in RC group. Dose requirement for rescue analgesia was significantly lesser in group RC. There was no significant difference between both groups for hemodynamic response after caudal block. The incidence of side effects were not significant. Conclusion: In conclusion clonidine and fentanyl, both improve the quality of analgesia when used with ropivacaine in caudal block in pediatric patients, but the quality of analgesia and duration with clonidine plus ropivacaine is superior to fentanyl plus ropivacaine. [ABSTRACT FROM AUTHOR]

One lung ventilation (OLV) can be a real challenge in the paediatric population, as the margin of errors is minimum, the time to adapt and make decisions lessens, and stress levels increase. The anesthetic management of a 5 year old girl with pneumatocele and bronchopleural fistula posted for thoracotomy is described. Right sided endobronchial intubation with uncuffed PVC endotracheal tube (ETT) was used for OLV. Thoracic epidural was given for perioperative analgesia and to facilitate postoperative physiotherapy. [ABSTRACT FROM AUTHOR]

Background: This study was done to compare effects of intranasal midazolam and intranasal midazolam with ketamine for premedication of children aged 1-12 yrs undergoing intermediate and major surgeries. Aims: Midazolam and Ketamine have already been used as premedicants in children. Our aim was to find out advantage of combination of midazolam with ketamine over midazolam by nasal route. Methods: Sixty children of age group 1-12 yrs of American Society of Anesthesiologists (ASA) grade 1 and 2 were selected. Group A- midazolam (0.2 mg/kg), Group B- midazolam (0.15 mg/kg + ketamine 1 mg/kg). Both groups received drug intranasally 30 min before surgery in recovery room with monitored anesthesia care. Onset of sedation, sedation score, emotional reaction, intravenous cannula acceptance, and mask acceptance were studied. Statistical Analysis: Unpaired t test and chi square test. Results: Sedation score, anxiolysis, attitude, reaction to intravenous cannulation, face mask acceptance, and emotional reaction were significantly better in midazolam with ketamine group. Intra operatively, in both groups, pulse rate, oxygen saturation, and respiratory rate had no significant difference; also, post operatively, no significant difference was observed in above parameters, post operative analgesia was significantly better in midazolam with ketamine group. Conclusions: Intra nasal premedication allows rapid and predictable sedation in children. Midazolam as well as combination of Midazolam with ketamine gives good level of sedation and comfort. But quality of sedation, analgesia, and comfort is significantly better in midazolam with ketamine group. No significant side effects were observed in both groups. [ABSTRACT FROM AUTHOR]

Lingual thyroid (LT) gland is a rare clinical entity which occurs due to failure of thyroid gland to descend to its normal cervical location during embryogenesis. Maternal antithyroid immunoglobulins may impair gland descent during early fetal life and cause lingual thyroid. This condition is associated with increase in levels of thyroid stimulating harmone (TSH). As the ectopic thyroid grows, requirement of thyroid harmone increases thus many patients with ectopic thyroid are associated with hypothyroid and require treatment. Ectopic thyroid gland is located at base of tongue and can present with dysphagia, dysphonia, upper airway obstruction and hemorrhage. Oropharyngeal mass can lead to difficult intubation and failure of ventilation. Evaluation of airway and indirect laryngoscopy may hint towards need of fiberoptic intubation. We present a case of 11 years old child of LT for appendectomy under general anesthesia. [ABSTRACT FROM AUTHOR]

Treacher Collins Syndrome (TCS) is an autosomal dominant disorder of craniofacial development. It is characterized by bilateral and symmetric abnormalities of the structures derived from the first and second branchial arch region. The patients with TCS can have difficult intubation because of retrognathia and severe facial deformity. Here we report a case of 11 months old boy with TCS with anticipated difficult airway posted for cheiloplasty under general anesthesia which was successfully managed. [ABSTRACT FROM AUTHOR]

The article discusses a case of bladder paraganglioma of the urinary bladder without typical symptoms. In the case, a 29-year-old woman was presented for transurethral bladder tumor resection (TURBT). Based on ultrasonography abdomen, a polypoidal solid lesion arising from her right lateral wall of bladder was seen. She was also diagnosed with pheochromocytoma.

A letter to the editor is presented regarding the case of a 30-year-old primigravida, who had acromegaly with diabetes mellitus (DM), underwent elective cesarean section and radiotherapy for residual tumor.

Introduction Regional anesthesia, particularly caudal blocks, is increasingly used in pediatric surgeries for effective post-operative pain management. However, the duration of analgesia with agents such as ropivacaine alone can be limited. This study investigates the effects of adding clonidine to ropivacaine in caudal blocks for pediatric patients undergoing infra-umbilical surgeries, with the purpose of enhancing the duration and quality of analgesia. Methods We conducted a randomized, double-blind study including 50 children aged one to eight years, divided equally into two groups: group R received 0.2% ropivacaine and group RC received 0.2% ropivacaine with 2 mcg/kg clonidine. Intraoperative and post-operative monitoring included heart rate, blood pressure, and respiratory parameters. Analgesia duration, sedation scores, and the need for rescue analgesia were assessed. Results Group RC exhibited significantly longer analgesia duration (18.4 ± 2.31 hours) compared to group R (10.56 ± 2.27 hours, P < 0.0001). Fewer patients in group RC required a second dose of rescue analgesia (4% vs. 32%, P = 0.023), with no significant differences in sedation scores or adverse effects between the groups. Conclusion Adding clonidine to ropivacaine in caudal blocks significantly prolongs analgesia and reduces the need for additional post-operative pain management in pediatric surgeries without increasing the risk of side effects. This study supports the use of clonidine as an effective adjuvant in pediatric pain management., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Subcommittee issued approval IESC/PGS/2022/158. The synopsis was approved by institutional ethics sub-committee in its meeting held on 28/09/2022. The CTRI registration number for this trial is CTRI/2023/09/058101. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Khatavkar et al.)

Ameloblastoma is a rare, locally aggressive benign tumor primarily affecting the mandible, with an incidence of 0.92 cases per million person-years and a male predominance. A two-year-old male presented with a right mandibular mass. CT imaging and histopathology confirmed ameloblastoma. He underwent wide local excision, mandibulectomy, and pectoralis major myocutaneous flap reconstruction under general anesthesia. Preoperative assessment revealed potential airway challenges; intubation was achieved with the backward, upward, rightward pressure (BURP) maneuver, and tracheostomy was performed to secure postoperative airway patency. The surgery was uneventful, and the patient was successfully weaned off ventilatory support by postoperative day four. This case underscores the importance of careful planning and expertise in pediatric ameloblastoma management, highlighting the effectiveness of direct laryngoscopy with BURP maneuver and prophylactic tracheostomy., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Khatavkar et al.)

Managing mediastinal masses during anesthesia presents formidable challenges, particularly in pediatric patients undergoing procedures such as tru-cut biopsy. These masses, both benign and malignant, can compress vital structures, leading to life-threatening complications. This article explores the complexities of managing anesthesia in patients with mediastinal masses, emphasizing the importance of meticulous preoperative assessment, understanding the relationship between the mass and surrounding anatomy, and employing lifesaving techniques such as inhalation induction and awake intubation. In the first case, a seven-year-old boy with a large heterogeneous mediastinal mass causing left lung collapse and compression of major vessels underwent a tru-cut biopsy under spontaneous general anesthesia. The procedure was uneventful, and the mass was diagnosed as neuroblastoma. In the second case, a 13-year-old boy with a mediastinal mass causing compression of the trachea and major vessels presented with respiratory distress and was managed with a tru-cut biopsy under local anesthesia with ultrasound guidance. The mass was diagnosed as acute T-cell lymphoblastic lymphoma. In the third case, a 14-year-old girl with a large mediastinal mass causing compression of the pulmonary trunk and major vessels experienced airway compromise during the biopsy, necessitating emergency intubation and repositioning. The mass was diagnosed as Hodgkin lymphoma. Mediastinal masses can cause significant compression of the trachea, bronchi, and major vessels, leading to a range of clinical symptoms. Effective management requires thorough preoperative evaluation, planning for potential airway emergencies, and collaboration with surgical teams. Case reviews highlight the variability of airway dynamics and the necessity of positive pressure ventilation and vigilant postoperative monitoring. Comprehensive pre-procedural assessment, preparedness for airway emergencies, and skilled anesthesia teams are crucial for managing pediatric patients with mediastinal masses. These cases underscore the complexities and emphasize the importance of careful planning and proactive measures to ensure successful outcomes and minimize risks during anesthesia induction and diagnostic procedures., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Khatavkar et al.)

Competing Interests: There are no conflicts of interest.