Mitral stenosis in pregnancy is poorly tolerated because of the pregnancy induced physiological changes in the cardiovascular system. Our patient had presented with cardiac failure in 5 ^th month of gestation due to valve area of 0.8 cm ² . She underwent commissurotomy and was asymptomatic with valve area of 1.6 cm ² until term when she developed lower respiratory tract infection. Anesthetic management of emergency caesarean section in this patient is discussed where neuraxial block is not well-tolerated, and general anesthesia is associated with increased morbidity in the presence of reactive airways.

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Posterior reversible encephalopathy syndrome is a clinicoradiological entity characterized clinically by headache, hypertension, altered sensorium and visual disturbances. It is usually seen in the setting of toxemia of pregnancy, hypertension, severe infection or in patients receiving immunosuppressant's. The magnetic resonance imaging of the brain in such patients reveals bilateral symmetrical subcortical edema in the occipitoparietal region. The treatment is primarily supportive and involves removing the underlying cause. The condition if not identified in time may lead to irreversible damage to the brain such as hemorrhage or infarction.

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Context: Combined spinal epidural (CSE) analgesia technique is effective for labor analgesia and various concentrations of bupivacaine and lipophilic opioids like fentanyl have been studied. Dexmedetomidine is a highly selective alpha 2 adrenoreceptor agonist with analgesic properties and has been used intrathecally with bupivacaine for prolonged postoperative analgesia. Recent reviews have shown that it is highly lipophilic and does not cross placenta significantly. Aim: The aim of this study is to compare the duration and quality of analgesia, maternal and neonatal outcomes after CSE labor analgesia with intrathecal dexmedetomidine and intrathecal fentanyl followed by epidural bupivacaine. Settings and Design: A randomized observational study with 112 parturients in a tertiary care hospital. Materials and Methods: 112 parturients were randomly divided to two groups. Group D (n = 58) received dexmedetomidine 10 μg and group F (n = 54) received fentanyl 20 μg intrathecally for labor analgesia. The time of onset, time to maximum analgesia, duration and quality of analgesia were noted. Maternal parameters of heart rate, noninvasive blood pressure, motor block and side-effects of pruritus, nausea and vomiting were recorded. Neonatal outcome in terms of mode of delivery, neonatal APGAR score, time to first cry, need for resuscitation, umbilical cord blood pH, initiation of breast feeding, Neurologic and Adaptive Capacity Score at 24 h and exclusivity of breast feeding at 6 weeks were recorded. Results: Duration of analgesia was 160.54 ± 52.4 min with dexmedetomidine and 124.1 ± 46.93 min with fentanyl (P < 0.001). Visual analog score (VAS) recorded at maximal analgesia was significantly lesser in the fentanyl group compared to dexmedetomidine group, denoting a significantly deeper level of analgesia with fentanyl. However, all the mothers in the dexmedetomidine group achieved a VAS <3 and were satisfied with the quality of analgesia. About 74% patients in the fentanyl group experienced pruritus after intrathecal injection whereas none of the mothers in dexmedetomidine group experienced pruritus (P < 0.001). There were no significant differences in neonatal outcome between the two groups. Conclusion: 10 μg dexmedetomidine intrathecally provides a longer duration of analgesia with lesser incidence of pruritus compared to 20 μg fentanyl intrathecally for CSE labor analgesia with comparable neonatal side-effects.

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Pregnant patients with kyphoscoliosis present a unique challenge during their anesthetic management due to the physiologic changes of pregnancy and deformity of the spine leading to pulmonary abnormalities. We present a case report of a 29-year-old second gravida with kyphoscoliosis who successfully underwent elective caesarean section under repeat spinal block after failure of first spinal anesthesia.

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Pregnancy in chronic kidney disease is rare and is associated with high incidence of maternal and fetal morbidity. More women with chronic renal failure, due to better management and treatment modalities are able to conceive and carry on their pregnancy and delivery. The case report describes anesthesia for caesarean section in a parturient with chronic renal failure and reviews the literature.

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Objective: The aim of this study was to compare two spinal needles with different bevel designs regarding their technical handling capacities and complication rates. Materials and Methods: After the clinical trials Ethics Committee approval and informed consents from the patients, 220 pregnant female patients undergoing elective cesarean delivery under spinal anesthesia were recruited in the study. Patients were divided into two groups as, Group A (n = 110) and Group Q (n = 110); who received spinal anesthesia via 26 gauge (26-G) atraumatic spinal needle (Atraucan^® , B. Braun Melsunger, Germany) and via 26-G Quincke spinal needle (Spinocan^® , B. Braun Melsunger, Germany), respectively. Procedure duration, puncture attempts and postdural puncture headache (PDPH) incidence were recorded. The costs of the spinal needles were also noted. Results: There were no significant differences between the two groups in spinal puncture attempts and procedure durations. Similarly, incidence, severity, onset time and duration of headache were not found to be significantly different between the two groups. Ten patients (9.2%) in Group A and 11 (10.3%) in Group Q had developed PDPH. Conclusion: Both spinal needles offer good handling characteristics with comparable incidence of PDPH. Taking into account economical factors 26-G Quincke needle may be preferred to 26-G Atraucan^® .

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We report a case of fetal bradycardia immediately following the maternal administration of an intravenous bolus of dexmedetomidine for transesophageal echocardiography. Dexmedetomidine, a central acting selective alpha-2 agonist is increasingly being used for sedation. Little is known regarding placental transfer of dexmedetomide with most reports suggesting minimal transfer. A case of fetal bradycardia resulting from its administration has not been previously reported.

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