Background: In spite of thorough preoperative assessment, unanticipated difficult airway poses a great challenge to the anesthesiologist for airway management in the perioperative period. Many airway adjuncts have been introduced into practice till date and has undergone rapid evolution but still, intubating stylets remain to be the” Gold standard “in managing such situations in majority of the medical centers in developing countries. Case Report: 42 year old female patient posted for elective laparoscopic cholecystectomy under general anesthesia with airway examination finding of  3 finger breadth mouth opening, Mallampatti grade  2 on preoperative assessment landed up in unanticipated difficult airway on operation table with Cormack lehane grade 4 laryngeal view. Even though, endotracheal intubation was performed using intubating stylet the possibility of breakage of stylet fragment was suspected and managed efficiently. Conclusion: Precautionary measures taken during our day to day anesthesia practice goes a long way in preventing iatrogenic or equipment related mishaps, thus emphasizing the importance of eternal vigilance for patient safety.

Introduction: As US guidance offers real-time view of the block needle, the brachial plexus, and its spatial relationship with the critical structures surrounding it; it not only boosted the success rates, but also decreased the complication rates. Aims: To compare Time taken for performing blockade, onset of blockade and complete blockade between PNS and USG guided techniques for the supraclavicular approach of brachial plexus block. Materials and methods: This study is an observational cross-sectional randomized study done for a period of 6 months. A total of 60 patients who were posted for elective upper limb surgeries in tertiary care center were chosen for the study and categorized into group A and B by computerized randomization. Group A - patients who underwent US guided supraclavicular block. Group B - patients who underwent PNS guided supraclavicular block. Results: In study, most of the patients fall in the age category of 20-50 years. The groups were similar in-patient characteristics like age, sex, department to which the patient belonged and ASA grading. By comparing the time taken for onset of blockade and complete blockade in patients belonging to both groups, in whom blockade was performed within 5 min, which is statistically significant. In group A patients, no complications occurred. In group B, 6.67 % (2 out of 30) patients had accidental vascular puncture, though the difference is not statistically significant (p-Value = 0.492). Conclusions: we conclude that ultrasonography guided supraclavicular brachial plexus block Is quick to perform, offers improved safety, ensures good quality of blockade and accurate in identifying the position of the nerves to be blocked.

Postoperative nausea and vomiting (PONV) is a significant problem in anesthesia practice. The risk of PONV can be assessed using a scoring system such as Apfel simplified scoring system, which is based on four independent risk predictors with each being given one point. We took this scoring system one step ahead and allocated PONV risk score according to their individual weightage and developed a cumulative risk index. We aimed to identify if the cumulative score of six different predictors in patients undergoing general anesthesia would correlate with the incidence of PONV.The result of this small study based on 24 patients did not show ant correlation between cumulative risk score and actual incidence of PONV. However, we did observe the highest incidence of PONV in patients who were female and had history of PONV. A multimodal approach with combination of pharmacological and non-pharmacological prophylaxis may be advocated in female patients and those having history of PONV undergoing elective surgery under general anesthesia. 

The overall incidence of the Sinus of Valsalva aneurysm (SOVA) is 0.09% in the general population and comprise 0.1% to 3.5% of all congenital cardiac defects. It is associated with only 2% of Tetralogy of Fallot (TOF) patients, thus making this combination of unruptured SOVA with TOF unique. We present the case of a 4½- year-old West African boy who developed exertional dyspnea and frequent squatting episodes since the age of ten months. He was not having any other major medical/ genetic history or phenotypically syndromic features. Preoperative diagnosis was confirmed with Trans Esophageal Echocardiography (TEE) features of TOF with SOVA arising from right coronary cusp (RCC) bulging but not distorting Right Ventricular Outflow Tract (RVOT). The narrowest portion of the aneurysm being 0.65 cm. Postoperative Adequacy of TOF repair was demonstrated by ruling out residual Ventricular Septal Defect (VSD), morphological distortion as stenosis/ regurgitation across both Left Ventricular Outflow Tract (LVOT) and RVOT. The measurements of RVOT and LVOT at different levels were compared with the Z- scores provided by the Detroit data. TEE was useful not only in pointing out the adequacy of repair but also predicted not requiring additional intervention especially to aortic valve in the near future.

Background: Surgical operations constitute a significant aspect of treatment administered in hospitals. The situations where patients’ surgical appointments are cancelled are an unfortunate occurrence within medical practice. The main objective of this study was to survey cancellation rate, reasons, and its psychological effect on patients at Komfo Anokye Teaching Hospital (KATH) in Ghana. Methods: A prospective, descriptive cross-sectional study involving a self-administered questionnaire conducted at KATH over a period of three months from May 2018 to July 2018. The purposive sampling (total population) technique was used for patient recruitment. Results:  During the study, 1078 elective surgical operations were booked and 74.2% elective operations were performed over the study period. 278 cases were cancelled representing 25.78%. The study found the lowest rate of 3% for cardio-thoracic and the highest (28.1%) for trauma orthopaedics. Medical /work-up, patient-related, administrative-related, and others accounted for 16.3, 54.1, 30.7 and 18.9% of the cancelled surgeries respectively. The most common patient-related reason for the cancellation was patients not turning up (40.7%). The majority of the patients expressed their feeling of disappointment (46.7%). The women in the cancellation group had a significantly higher degree of anxiety and depression as per the Hospital Anxiety and Depression (HAD) Scale.  Conclusions: The patients reacted negatively to the cancellation of scheduled elective surgery. It has long term emotional effects on patients as anxiety and depression even after hospital discharge. Patients who visited a preadmission clinic experienced less anxiety and depression.