Awake craniotomy: a qualitative review and future challenges

Neurosurgery in awake patients incorporates newer technologies that require the anesthesiologists to update their skills and evolve their methodologies. They need effective communication skills and knowledge of selecting the right anesthetic drugs to ensure adequate analgesia, akinesia, along with patient satisfaction with the anesthetic conduct throughout the procedure. The challenge of providing adequate anesthetic care to an awake patient for intracranial surgery requires more than routine vigilance about anesthetic management

Use of oral tramadol to prevent perianesthetic shivering in patients undergoing transurethral resection of prostate under subarachnoid blockade

Under regional anesthesia, geriatric patients are prone to shivering induced perioperative complications that Anesthesiologists should prevent rather than treat. We investigated the prophylactic efficacy of oral tramadol 50 mg to prevent the perioperative shivering after transurethral resection of prostate [TURP] surgery under subarachnoid blockade [SAB]. Shivering is usually overlooked in patients undergoing urological surgery under spinal anesthesia and may result in morbidity, prolonged hospital stay and increased financial burden. Use of prophylactic measures to reduce shivering in geriatric patients who undergo urological procedures could circumvent this. Oral formulation of tramadol is a universally available cost-effective drug with the minimal side-effects. Prospective, randomized, double-blinded, placebo-controlled study. A total of 80 patients who were scheduled for TURP surgery under subarachnoid block were randomly selected. Group I and II [n = 40 each] received oral tramadol 50 mg and placebo tablet respectively. After achieving subarachnoid block, the shivering, body temperature [tympanic membrane, axillary and forehead], hemodynamic parameters and arterial saturation were recorded at regular intervals. T-test, analysis of variance test, Z-test and Fisher exact test were utilized while Statistical Product and Service Solutions, IBM, Chicago [SPSS statistics [version 16.0]], software was used for analysis. Incidence of shivering was significantly less in patients who received tramadol [7.5% vs. 40%; P < 0.01]. The use of tramadol was associated with clinically inconsequential side-effects. We conclude that the use of oral tramadol 50 mg is effective as a prophylactic agent to reduce the incidence, severity and duration of perioperative shivering in patients undergoing TURP surgery under SAB

Anesthetic considerations in pemphigus vulgaris: case series and review of literature

A case series of the anesthetic management of 4 patients with pemphigus vulgaris [PV] undergoing emergency/elective surgery is presented. PV presents serious concerns for anesthesiologist, when present, in a surgical patient but handling of these patients with care and taking all the due precautions can decrease morbidity and airway-related complications. Various clinical presentations and precautions, which should be ensured during anesthesia in patients suffering from PV, are discussed