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Byline: Unnikrishnan. Prathapadas, Smita. Vimala, Karen. Lionel, Ajay. Hrishi Sir, Intraoperative bradycardia and asystole is one of the most dreaded anesthetic emergencies. We report a case of intraoperative bradycardia and [...]

Byline: Smita. Vimala, Nilima. Muthachen, Karen. Lionel Sir, Transfusion-associated acute lung injury (TRALI) is a rare but potentially fatal complication of transfusion of blood products. We report a case where [...]

Byline: George. Vilanilam, H. Easwer, Smita. Vimala, Ashalatha. Radhakrishnan, B. Devi, Suresh. Nair Sir, Dubey et al .,'s article [sup][1] analyzing gender and nationality authorship trends in neuroscience literature made [...]

Byline: Smita. Vimala, Madhusudan. Reddy, Umamaheswara. Rao Sir, Non-awakening after intracranial surgery though described, is rare. [sup][1] We describe non-awakening after anesthesia following posterior fossa surgery due to tension pneumocephalus [...]

Byline: K. Madhusudan Reddy, Smita. Vimala, G. Umamaheswara Rao Sir, Vascular injury during lumbar disc surgery is rare but can be catastrophic. We report the occurrence of iliac artery injury [...]

Hurler’s syndrome is a rare genetic disease characterized by progressive multiorgan accumulation of glycosaminoglycans. It is associated with progressive craniofacial, skeletal, and cardiac involvement, which increases the risk of anesthesia. Patients with Hurler’s syndrome could present as the worst airway management problem an anesthesiologist could deal with due to abnormal upper airway anatomy and limited neck manipulation, owing to the atlantoaxial instability. We report a case of difficult airway scenario of a child with Hurler’s syndrome, leading to an apparent cannot ventilate cannot intubate scenario, which was managed successfully with the help of a C-MAC video laryngoscope with unique D-blade. In Hurler’s syndrome, C-MAC with D-blade is an excellent tool in establishing an airway in a pediatric difficult airway scenario. Moreover, D-blade C-MAC could be considered as the primary tool for establishing an airway in pediatric patients with Hurler’s syndrome. [ABSTRACT FROM AUTHOR]

Introduction: Mannitol is widely used in neurosurgical units to mitigate raised intracranial pressure and cerebral edema, crucial in postoperative management. Its hyperosmolar properties reduce brain extracellular fluid, thereby altering cerebral perfusion and cardiac dynamics. However, the temporal and combined effects of mannitol on cardiovascular and cerebrovascular parameters remain inadequately explored in postoperative settings., Methods: This prospective observational study enrolled 20 adult patients who underwent elective craniotomies for tumor excision. Mannitol was administered to the patients at a dose of 0.5 mg/kg/dose as a bolus dose over 20 to 30 minutes. The time interval was eight hours between the doses (scheduled dosing). Patients received their first dose of mannitol in the ICU after eight hours of intraoperative dose. The patients were given mannitol for two postoperative days and followed up for two days in the postoperative period. Transthoracic echocardiography and transcranial color Doppler were used to assess cardiovascular and cerebrovascular parameters at multiple intervals post-mannitol administration., Results: Significant increases in mean flow velocities were observed bilaterally immediately post-mannitol administration on the first postoperative day, indicative of improved cerebral blood flow. However, these changes were transient, with no significant variations noted on the second postoperative day. Cerebrovascular resistance, as measured by the pulsatility index, showed non-significant changes bilaterally across both days. Cardiovascular parameters, including stroke volume and cardiac output, remained stable throughout the study period., Conclusion: Mannitol administration at 0.5 g/kg in postoperative neurosurgical patients transiently improves cerebral perfusion without causing significant hemodynamic instability. This study underscores the importance of monitoring both cerebrovascular and cardiovascular parameters post-mannitol administration to optimize patient management and outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethical Committee of Sree Chitra Tirunal Institute for Medical sciences and Technology issued approval SCT/IEC/843/December-2015. 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, Madhusudan et al.)