The success rate of free flap revascularization is affected by multiple factors. We did a retrospective study of 162 patients who underwent free flap reconstructive surgery over a period of approximately 4 years in the BYL Nair Hospital, a premier tertiary care public health center in Mumbai, Maharashtra, India. All the surgeries were performed by the same group of surgeons. A brief history of free flap surgery is presented, followed by a description of the anesthetic technique used and the results of the study. The various ways in which anesthetic management may influence the results of surgery are discussed. The data from 162 patients were collected and analyzed.

Background and aims: The transversus abdominis plane (TAP) block is a recently described approach which blocks the nerves of the anterior abdominal wall. We compared the duration of analgesia and efficacy of ultrasound-guided vs conventional block on immediate postoperative pain in patients undergoing gynecological abdominal surgeries. Materials and methods: Eighty-two patients undergoing gynecological abdominal surgeries under spinal anesthesia were randomized to undergo ultrasound-guided (n = 41) vs anatomical landmark-guided TAP block (n = 41). The pain severity using the visual analog scale (VAS) score at rest and on movement were noted at various time intervals up to 24 hours. We compared the total duration of analgesia (TDA) and the total consumption of analgesics (TCA) in both groups. SPSS version 21 was used. Demographic data were analyzed using the Student's t-test and other parameters using paired t-test. Results: Mean VAS scores both at rest and on movement were significantly higher in the anatomical landmark-guided TAP block in the first 8 hours postoperatively. The TDA was prolonged significantly (18.88 ± 6.18 hours) and TCA was less (0.95 ± 0.67 g) in the ultrasound group as compared to the other group with TDA of 8.38 ± 2.58 hours and TCA of 2.54 ± 0.71 g. Conclusion: Ultrasound-guided TAP block provided a significantly longer duration of analgesia as compared to the anatomical landmark-guided TAP block and a significant decrease in consumption of rescue analgesics.

Aims and objectives: To monitor the depth of anesthesia using entropy monitor during off-pump coronary bypass graft surgery and to assess memories or recall of intraoperative awareness using Modified Version of Brice Questionnaire after 48 hours of surgery. Materials and methods: It is a cross-sectional observational study. After approval by the institutional ethics committee, the study was conducted in 100 patients posted for cardiac surgery involving off-pump coronary bypass surgery fulfilling the inclusion criteria. After written valid consent, general anesthesia was given as per the protocol. Entropy indices are calculated and displayed in real-time. The indices were manually recorded at various cardiac events. Controlled mechanical ventilation was continued in the ICU. Tracheal extubation was performed when hemodynamic and respiratory parameters remained stable. All patients were interviewed 48 hours after surgery about any memories or recall of intraoperative awareness using the modified Brice questionnaire. Results: In our study, the hemodynamic parameters like pulse rate, systolic, and diastolic blood pressure were well maintained. Three patients reported awareness during the procedure. One of them had vivid dreams which the patient was not able to recall the nature of the dream and the other two patients who had woken up during the procedure heard some noises during the surgery. None of the patients reported being in pain when awake. Conclusion: An entropy monitor might aid off-pump coronary artery bypass graft surgery (OPCABG) in preventing intraoperative awareness and monitoring the depth of anesthesia. It also aids in reducing anesthetic dosage and hence avoids untoward side effects of anesthesia. Clinical significance: Our study suggested that the incidence of awareness is high during the OPCABG, hence modification in anesthesia technique is needed at present.

Ventral hernia repair remains one of the common procedures performed by general surgeons. Laparoscopic ventral hernia repair with intraperitoneal on lay mesh (IPOM) PLUS technique has become standard care in hernia repair surgery. Postoperative pain management is the key factor in enhanced recovery after surgery (ERAS). Transversus abdominis plane (TAP) blocks and rectus blocks have succeeded in reducing the opioid analgesics consumption as well as the pain score after ventral hernia repairs. Anesthetic drugs can be delivered into this plane by the conventional blind, USG-guided, or assisted with laparoscopy direct vision. USG-guided blocks require an ultrasound machine, an expert sonologist in operation theater which may not be available. Case presentation/Context: We performed laparoscopic TAP block with rectus block in 70 patients undergoing laparoscopic ventral hernia repair by IPOM, IPOM-Plus, and EACS-IPOM plus and observed the efficacy and effectiveness of the procedure in relieving postoperative pain using VAS scoring system as well as multiple parameters that indicate faster postoperative recovery of the patient. Conclusion: Laparoscopy-guided TAP block and rectus block provide a promising modality of postoperative analgesia in laparoscopic ventral hernia repair. Key messages: With a significantly low postoperative pain score, it can be used as a modality of drug delivery in the areas where intraoperative USG machines, expert sonologist, or anesthetist specialized in ultrasound are not available due to cost issues or issues of PCPNDT.

Aims and objectives: To highlight the need to formulate a difficult airway pathway for post-cancer treated patients posted for high-risk cardiac surgery. Airway protection is mandatory for surgery. Cancer patients, especially oral, are difficult airway candidates as are cardiac patients. Cancer patients pose anatomical challenges, while cardiac patients pose physiological and/or anatomical challenges. However, when a cancer-treated patient comes for cardiac surgery with compromised cardiac status, the risk and complication probability increases. With cardiac disease and cancer being interrelated and incidence rising with newer treatment modalities, cases are varied requiring impromptu innovation. We present a case of post-surgery, chemo, and radiotherapy oral cancer posted for coronary artery bypass graft (CABG) with left main disease and low ejection fraction.

Perioperative anesthesia management of pediatric patients with congenital heart disease (CHD) coming for non-cardiac surgery is challenging. Tetralogy of Fallot (TOF) is a cyanotic CHD with the right to left shunt. The challenge for anesthesiologists in handling patients with CHD coming for non-cardiac surgery relies on the patient's age, the complexity of heart lesion, the patient's capacity to compensate, and the urgency of surgery. We report a case of uncorrected TOF posted for open reduction and internal fixation of left radius–ulna fracture.

Intraoperative arrhythmias are frequently seen. Mostly during cardiac surgeries and general anesthesia. Ventricular premature complexes (VPCs) constitute 15% of these arrhythmias and are benign in nature. However, if VPCs are persistent and not treated on time, can lead to life-threatening arrhythmia. We discussed a case report of 37-year-old woman with no preexisting comorbidities, when administered regional anesthesia for abdominal hysterectomy, had repeated VPCs. Arrhythmias were related to abdominal retractor position and were aborted when the retractor was removed from the surgical area.

Aim and objective: We report our experience with anesthesia management of craniosynostosis surgeries at a tertiary care children's hospital. Materials and methods: We conducted a retrospective analysis of craniosynostosis surgeries performed at our institute over the last 3 years. Review results: Twelve children underwent reconstructive surgery over a period of 3 years. Eight patients underwent IV induction with propofol followed by atracurium. In four patients where difficult airway was anticipated, an inhalational induction with sevoflurane was performed. Anesthesia was maintained using air, oxygen, and sevoflurane delivered through a closed circuit, and dexmedetomidine @ 0.5 μg/kg/hour. Fentanyl and paracetamol were used for analgesia. Monitoring included standard ASA monitors and additionally, arterial blood pressure and urine output monitoring. Tranexamic acid was used to reduce bleeding. There was no incidence of major intraoperative complications viz. venous air embolism, massive hemorrhage, or hemodynamic instability. No patient needed vasoactive infusion support. Conclusion: Surgery for craniosynostosis poses several challenges for anesthesia. Having a protocolized approach to anesthesia management and transfusion can result in good outcomes. Clinical significance: Raised intracranial pressure, obstructive sleep apnea, syndromic associations are common in craniosynostosis. Surgery in infancy poses additional challenges of massive blood loss. The anesthetist has to be vigilant and step up monitoring to detect and manage perioperative complications.