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Context: Awake craniotomy is increasingly performed the world over. We share our experience of performing craniotomy awake with our anesthetic protocol., Aims: To evaluate and analyze the anesthesia records of the patients who underwent awake craniotomy at our institution., Settings and Design: University teaching hospital, Retrospective study., Materials and Methods: We reviewed records of the 42 consecutive patients who underwent awake craniotomy under conscious sedation using Fentanyl and Propofol infusion until December 2005. The drugs were titrated (Bispectral monitoring was used in 16 patients) to facilitate intermittent intraoperative neurological testing. All patients received scalp blocks with a mixture of bupivacaine and lignocaine with adrenaline. Haloperidol and ondansetron were administered in all patients at induction of anesthesia., Results: All patients completed the procedure. One patient each needed endotracheal intubation and LMA for airway control during closure, while another required CPAP perioperatively because of desaturation to <80%. There was significantly decreased use of anesthetics (P<0.001) and a trend towards reduction in complications (e.g. respiratory depression and deep sedation) (P>0.05) with the use of BIS as compared to without BIS. Intraoperative complications were hypertension (19%), tight brain (14.2%), focal seizure (9.5%) respiratory depression (7.1%), deep sedation (7.1%), tachycardia (7.1%) and bradycardia. Two patients desaturated to <95%. 23.8% patients developed transient neurological deficits. The most frequent postoperative complications were PONV (19%) and seizures (16.6%)., Conclusions: With the use of advanced monitoring and newer anesthetics, awake craniotomy is a relatively safe procedure with an accepted rate of complications.

Anesthetic management of intracranial arteriovenous malformation (AVM) poses multiple challenges to the anesthesiologist in view of its complex and poorly understood pathophysiology and multiple modalities for its treatment involving different sub-specialties. The diagnosis of AVM is based on clinical presentation as well as radiological investigation. Pregnant patients with intracranial AVM and neonates with vein of Galen malformation may also pose a special challenge and require close attention. Despite technological advancement, reported morbidity or mortality after AVM treatment remains high and largely depends on age of the patient, recruitment of perforating vessels, its size, location in the brain, history of previous bleed and post-treatment hyperemic complication. Anesthetic management includes a thorough preoperative visit with meticulous planning based on different modalities of treatment including anesthesia for radiological investigation. Proper attention should be directed while transporting the patient for the procedure. Protection of the airway, adequate monitoring, and maintaining neurological and cardiovascular stability, and the patient's immobility during the radiological procedures, appreciation and management of various complications that can occur during and after the procedure and meticulous ICU management is essential.

Objective: This study was designed to assess the use of 100% oxygen or 50% oxygen in air or nitrous oxide after cardiopulmonary bypass (CPB) on atelectasis, as evidenced by the oxygenation index (PaO2/FIO2), after coronary artery bypass graft (CABG) surgery. Design: Prospective, randomized clinical study. Setting: University teaching hospital. Participant: Thirty-six adult patients undergoing CABG surgery. Interventions: Patients either received 50% O2 in air (50% O2 group), 50% O2 in N2O (50% N2O group), or 100% O2 (100% O2 group) after CPB. Measurements and Main Results: Apart from demographic and perioperative clinical data, extubation time, mediastinal drainage, and pulmonary complications were also recorded. After CPB, arterial blood gases done at various time points until 3 hours postextubation and oxygenation index were calculated. No significant differences were noted in demographic and perioperative data except preoperative hemoglobin and fluid use. Significant deterioration in arterial oxygenation was noted in the 100% O2 group from the baseline value, whereas significant improvement was seen in the 50% O2 group at 4 time points from baseline value and at all time points from the 100% O2 group. After initial deterioration in oxygenation, no further change was evident in the 50% N2O group. Furthermore, there was a greater increase in the oxygenation index as compared with the 100% O2 group. Time to extubation was also longer in the 100% O2 group than the 50% O2 group. Conclusion: Significant deterioration in arterial oxygenation and an increase in the extubation time occurred with the use of 100% O2 after CPB, whereas better oxygenation was evident with the use of 50% O2 in air. [Copyright &y& Elsevier]

This article presents a case study of incidental internal jugular vein (IJV) thrombosis in a patient presenting for aneurysm clipping. The patient was a 67-year-old female who presented with sudden onset throbbing headache and vomiting. The clinical management of the patient is discussed as well as the implications of the case for anesthesiologists.

Discusses the abstract of the article "Analysis of Circuit Hypoxia With Aestiva/5 Anaesthesia Machine-- A Retrospective Study," by Ramesh C. Rathod and colleagues submitted at the 27th Congress of The Scandinavian Society of Anesthesiology and Intensive Care Medicine.