Thoracosopic repair of tracheoesophageal fistula and esophageal atresia (TREAT) is an advanced endoscopic procedure which requires a skilled approach in minimally invasive surgeries. TREAT is considered as a superior technique in achieving cosmesis and avoiding complications when compared to open thoracotomy. It requires a team of surgeons, anesthesiologists, and assistants and neonatal intensivists to look after the neonate in the perioperative period. Recent meta-analysis has shown no significant difference in outcome and functional evaluation in open thoracotomy and thoracoscopic approach to TEF repair. Anesthesiologists should be well versed with knowledge and ability to anticipate challenges in managing neonates under thoracoscopic TEF repair which plays an important role in the management and survival of these kids. We searched PubMed and Google Scholar databases with the following keywords anesthetic management, tracheoesophageal repair, surgical repair, non-intubated video-assisted thoracoscopic surgery, video-assisted thoracoscopic surgery, video-assisted thoracoscopic surgery, pediatric one-lung ventilation, and pediatric regional anesthesia. The last search was made on July 31, 2018.

Background: Right internal jugular vein (RIJV) is the most commonly used site for central venous cannulation. Ultrasound guidance has increased success rate and reduced complications of central venous cannulation. The main aim before cannulation is to increase the size of the vein by optimal positioning. We used ultrasound to assess changes in right internal jugular diameter with use of a head pillow and shoulder roll and their effect on the degree of overlap between RIJV and carotid. Methodology: 106 patients were recruited in the study. After intubation the patients were placed in the following 3 positions (i) P1 -without head pillow or shoulder roll, (ii) P2 - with head pillow and (iii) P3- with shoulder roll. All measurements were made in 15 degree Trendelenberg tilt and head turned to the left by 30 degree. The following measurements were recorded in all 3 positions. (a) Transverse and Antero-Posterior diameter of the RIJV. (b) Transverse diameter of the right carotid. (c) Overlap between RIJV and carotid. Results: In our study the mean transverse diameter of RIJV was 1.87cm in P1 and P2 and 1.72 cm in P3respectively. The mean antero-posterior diameter was 1.39cm, 1.37cm and 1.13 cm in P1, P2 and P3 respectively. The increase in diameter in P1 was statistically significant (P < 0.001). The mean overlap percentage between right carotid and RIJV was 49.41%, 50.97% and 35.7% in P1, P2 and P3 respectively. This difference between P3 and other two position was also statistically significant (P < 0.00). Conclusion: We conclude that placing the patient supine in 15 degree Trendelenberg tilt and a30 degree head rotation to the opposite side with or without use of a head pillow would lead to greater chance of first pass success during R IJV cannulation as the diameter was found to be maximum in this position. We do not recommend use of a shoulder roll as there was significant reduction in diameter though the overlap between RIJV and carotid was found to be minimal. Use of ultrasound and proper positioning of the patient will reduce the possible catastrophic complications associated with RIJV cannulation.

Background: Practicing anesthesia clinicians are aware that tracheal intubation increases resistance and alters pulmonary mechanics; thus, comparison of bronchodilating effects of volatile agents is desirable. This study was aimed to compare the respiratory mechanics during isoflurane, sevoflurane, and desflurane anesthesia at 1 minimum alveolar concentration (MAC) and 2 MAC. Materials and Methods: Seventy patients undergoing moderate duration surgery were sequentially allocated into one of the three groups: Group I (Isoflurane; n = 23), Group S (Sevoflurane; n = 24), and Group D (Desflurane; n = 23). Peak inspiratory pressure (PIP), dynamic lung compliance (C_dyn), and airway resistance (R_aw) values at three different time points were noted: 3 breaths after the start of mechanical ventilation (T1), 5 min after 1 MAC (T2), and 2 min after 2 MAC (T3). Results: PIP increased significantly in the desflurane group by 6% at 1 MAC and 8.06% at 2 MAC from the baseline. Statistically significant increase in C_dyn by 1.59% at 1 MAC and 9.9% at 2 MAC was found in sevoflurane group. R_aw decreased significantly by 24.28% at 1 MAC and by 45.65% at 2 MAC from the baseline in sevoflurane group. Conclusions: We conclude that increasing concentrations from 1 MAC to 2 MAC show more consistent bronchodilating effect of Sevoflurane compared to isoflurane and desflurane. Sevoflurane increased C_dyn and reduced R_aw from 1 MAC to 2 MAC.

Background: Percutaneous vertebroplasty is a minimally invasive procedure, usually performed under local anesthesia with either general anesthesia or conscious sedation. In this study, we compared the efficacy and safety of propofol versus the combined use of meperidine and midazolam for conscious sedation in percutaneous vertebroplasty. Methods: This prospective randomized study was conducted within 6 months on sixty patients undergoing percutaneous vertebroplasty. The patients were divided into two equal groups: Group I received propofol, while Group II received meperidine and midazolam. The time required to achieve sufficient sedation, emergence time, recovery time, hemodynamic monitoring throughout the procedure, patient's and surgeon's satisfaction, and incidence of postprocedural complications were all recorded. Bispectral index and end-tidal carbon dioxide measurement were used to assess sedation level and to ensure patient safety throughout the procedure. Results: Demographic data from both groups were comparable. The time taken to reach sufficient sedation, emergence time, and recovery time were shorter in Group I than that in Group II (P = 0.001). Patients in both groups were hemodynamically stable throughout the procedure. Surgeon's satisfaction was higher in Group I (96%) than that in Group II (80%), while patient's satisfaction was nearly equal in both groups, without significant postoperative complications. Conclusions: Propofol was superior to the combined use of midazolam and meperidine for conscious sedation in percutaneous vertebroplasty. It helped in achieving a moderate sedation level in less time and offered rapid emergence from sedation, with shorter recovery time.

Background: Postdural puncture headache (PDPH) is an iatrogenic complication associated with spinal anesthesia. Median and paramedian are two common techniques used for spinal anesthesia. Female pregnant patients are important risk factors for PDPH. The present study was conducted to compare the incidence of PDPH in female pregnant patients undergoing cesarean section using median versus paramedian approach. Materials and Methods: A total of 200 obstetric patients, having physical status I or II, undergoing cesarean section were included in the study. Patients were randomly allocated into two groups. Group I (n = 100) – Median approach and Group II (n = 100) – Paramedian approach. Results: Single attempt was successful in 75 patients (75%) in group I and 80 patients (80%) in group II. Two attempts were used in 20 patients (20%) in group I and 19 patients (19%) in group II. PDPH was not observed in any patient with one or two attempts including both groups. Six patients presented with PDPH out of total 200 patients. In group I, five patients (5%) developed PDPH out of 100 patients while in group II, only one patient (1%) developed PDPH out of 100 patients; however, the difference was not significant statistically. Conclusion: There is no difference regarding the incidence of PDPH in obstetric patients between median and paramedian approach.

Background and Aims: Postoperative sore throat (POST), cough (C), and hoarseness of voice (H) are common, uncomfortable, and frequently ignored sequel after endotracheal intubation. They are likely to be the consequences of local irritation and inflammation so may be amenable to locally administered steroids. Systemic corticosteroids have been shown to prevent the postextubation upper airway obstruction after long-term intubation. Various reports about the efficacy of pharmacological and nonpharmacological measures on complications of intubation have been published. Materials and Methods: A prospective, randomized, hospital-based experimental study including 180 patients (American Society of Anesthesiologists physical status I and II; age group 18–45 years; and scheduled for elective surgery requiring general endotracheal anesthesia were randomly allocated into three groups – Group I, II, and C). Incidence and severity of POST, C, and H were compared using betamethasone gel, lignocaine jelly, or when nothing was applied. Incidence of coughing or bucking and hemodynamic variability was also compared between groups. Quantitative variables in various groups were expressed as mean ± standard deviation and compared using ANOVA and/or unpaired t-test between the groups and paired t-test within each group. Qualitative variables were expressed as frequencies/percentages and compared using Chi-square test. Results: Incidence and severity of POST, C, H, and coughing/bucking was maximum in Group C, followed by Group II and least in Group I (P < 0.05). Conclusion: Betamethasone gel applied over tracheal tube effectively reduces the incidence and severity of POST, C, and H as compared to lignocaine jelly or when nothing was applied.

Introduction: Subcostal transversus abdominis plane (TAP) block involves nerves of anterior abdominal wall. In the present study, the primary objective was to find out whether subcostal TAP block reduces the requirement of rescue analgesics following laparoscopic cholecystectomy. Materials and Methods: Fifty patients scheduled for laparoscopic cholecystectomy under general anesthesia were randomly divided into two groups. Twenty-five patients in Group B received subcostal TAP block with 0.25% bupivacaine 20 mL on each side and 25 patients in Group A received 0.9% normal saline 20 mL on each side after completion of surgery. Each patient's pain was assessed using visual analog scale (VAS) score at 0, 2, 4, 8, 16, and 24 h. The primary outcome measure was to compare the requirement of rescue analgesia, whereas secondary outcome measure was to compare satisfaction grades between the two groups. Comparison of quantitative and qualitative variables between groups was done using unpaired student's t-test and Chi-square test, respectively, using Statistical Package for the Social Sciences. Results: Percentage of patients who required paracetamol (P < 0.002) and nalbuphine (P < 0.001) as rescue analgesic was significantly less in Group B as compared to Group A. In all, 92% of Group B and 4% of Group A patients had a satisfactory overall quality of postoperative analgesia which was statistically significant (P < 0.002). Conclusion: Subcostal TAP block is an effective method of providing postoperative analgesia in patients undergoing laparoscopic cholecystectomy.

In this case report, we report the anesthetic management of an emergency cesarean section of a parturient who presented with preterm labor and had inadvertently received rapid intravenous administration of ritodrine.

Congenital lobar emphysema (CLE) is a rare cause of sudden respiratory distress in infants. It poses a diagnostic and therapeutic dilemma. Hyperinflation and progressive air trapping causes expansion of the affected lobe leading to compression of other lung tissue, mediastinal shifting, and impaired venous return. We report a case of a 5 weeks old male infant with CLE. The left upper lobectomy was performed under general anesthesia with intercostal nerve block and pressure control ventilation. The anesthetic challenges and various management options are discussed here.

Ellis–Van-Creveld syndrome (EVC), otherwise known as chondroectodermal or mesoectodermal dysplasia, is an autosomal recessive disorder found in the Amish population of Pennsylvania in the USA, with the incidence of 1:244,000 for the general population. The classical syndrome encompasses a tetrad of clinical manifestations, including di sproportionate dwarfism, postaxial polydactyly, ectodermal dysplasia (mainly affecting the teeth, nails, and hair), and congenital heart disease (CHD). Additional involvement may occur in organs of endodermal origin, such as the pulmonary, renal, gastrointestinal (hepatic and pancreatic), hematologic, and central nervous systems. The perioperative care of a 2-year girl who underwent surgical correction of supernumerary digits is presented here.