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Non-valvular heart disease is an important cause of cardiac disease in pregnancy and presents a unique challenge to the anesthesiologist during labor and delivery. A keen understanding of the underlying pathophysiology, in addition to the altered physiology of pregnancy, is the key to managing such patients. Disease-specific goals of management may help preserve the hemodynamic and ventilatory parameters within an acceptable limit and a successful conduct of labor and postpartum period

Complete tracheal resection is extremely rare after blunt chest trauma. A high degree of suspicion is essential to identify these cases and early intervention is associated with better outcome. We report a patient with complete tracheal resection, in whom the airway was secured whilst the patient remained awake, breathing spontaneously under fibreoptic bronchoscopic guidance. As a precautionary measure, we had kept cardiopulmonary bypass set up in readiness. Anaesthetic management needed to be modified during repair of the trachea, by using total intravenous anaesthesia with propofol and rocuronium infusion and insertion of a separate endotracheal tube into the distal portion of the trachea whilst reconstruction of the trachea took place. The usual inhalational technique could not be used. The anaesthesiologist managing such a case should be aware of the difficulties during securing the airway and during repair of the trachea. Proper planning and keeping back-up plans ready helps in successful management of these patients.

Background: The Bispectral Index (BIS) helps in the assessment of the depth of hypnosis. N-methyl-D-aspartic acid antagonist, ketamine, has been used in various doses to decrease postoperative morphine consumption. The purpose of our study was to compare the effects of two different doses (0.5 mg/kg and 0.2 mg/kg) of ketamine on BIS values., Methods: Forty-five ASA I or II patients undergoing general anesthesia were included in this double-blind, prospective, control trial and randomly allocated into three groups. After induction of anesthesia and tracheal intubation, a propofol infusion was started and titrated to attain BIS values of around 40. After five minutes of stable BIS values and in the absence of any surgical stimulus, patients received either 0.5 mg/kg of ketamine (Group K1) or 0.2 mg/kg of ketamine (Group K2) or normal saline (Group N) as bolus intravenously. BIS values were recorded for the next 15 minutes, at five-minutes interval., Results: Mean BIS values were significantly increased in Group K1 (63.5) while Group K2 (42.0) failed to show any significant rise. BIS values in Group K2 were comparable to those in Group N., Conclusion: Thus, under stable propofol anesthesia, a bolus ofketamine 0.5 mg/kg increases BIS values while ketamine 0.2 mg/kg does not.

Major obstetric hemorrhage is an extremely challenging obstetric emergency associated with significant morbidity and mortality. Pharmacological treatment of uterine atony has not altered much in recent years apart from the increasing use ofmisoprostol, although controversy surrounds its advantages over other uterotonics. Placenta accreta is becoming more common, a sequel to the rising caesarean section rate. Interventional radiology may reduce blood loss in these cases. Uterine compression sutures, intrauterine tamponade balloons and cell salvage have been introduced in the last decade.