Anxiety is an emotional state characterized by apprehension and fear resulting from the anticipation of a threatening event. The incidence of preoperative anxiety ranges from 11% to 80% in adult patients and also varies among different surgical groups. Preoperative anxiety may lead to various problems and a wide range of physiological and psychological responses. A variety of objective and subjective methods are available for measuring preoperative anxiety. Every patient scheduled for surgery should be assessed for the presence of anxiety in their routine preoperative anesthesia assessment, and counseling should be done by anesthesiologist in patients with a high level of anxiety. Surgery information reduces anxiety in the preoperative period.

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Anesthetic management of patients having immune thrombocytopenic purpura (ITP) remains a challenge for the anesthesiologist. Surgeries such as knee arthroplasty are associated with significant bleeding. Neuraxial anesthesia is often preferred for knee arthroplasty. However, in patients with bleeding diathesis such as ITP, neuraxial anesthetic management remains controversial as there are no specific guidelines, and there is a risk of spinal hematoma. There are numerous case reports of safe regional anesthesia administered in parturients suffering from thrombocytopenia, but no explanation has been given. A new emerging concept of "rebalanced hemostasis" is now being used to explain the discrepancies observed in the laboratory reports versus the actual bleeding. In our case report, we have reviewed the literature and described the anesthetic management of a patient having chronic ITP and chronic obstructive pulmonary disease undergoing knee arthroplasty under neuraxial technique.

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Takayasu's arteritis (TA) is found commonly in young women presenting for cesarean section. A 24-year-old woman with a history of cerebrovascular disease and known case of Type I TA was managed successfully without perioperative complications under general anesthesia.

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Drug-induced dysrhythmias are frequently encountered with several drugs that are routinely used in the practice of medicine. However, it is difficult to predict in which group of patients the rhythm disturbances can happen. The clinician should try to identify the cause of the new onset rhythm disturbance (electrolyte imbalance, ongoing cardiac insult, hypoxia, hemodynamic disturbance, cerebrovascular event, etc.). Once a drug is suspected, it should be documented on medical case record and everyone involved in the patients care should be informed.

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The major benefit of awake craniotomy is to enable a tailored resection that can theoretically maximize the extent of the tumor resection and can minimize the neurological damages. There is still no consensus as to the best anesthetic technique. We describe here a case report where a combination of propofol infusion and dexmedetomidine along with intermittent doses of fentanyl, and fentanyl patch was used with entropy monitoring to assess the depth of sedation in a patient for awake craniotomy.

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Williams-Beuren syndrome, commonly known as Williams syndrome (WS), is a multi-organ disorder. The principal anomalies of the syndrome are developmental delay, unusual craniofacial dysmorphic features, and cardiovascular anomalies such as valvular or supravalvular aortic stenosis, pulmonary artery stenosis, and coronary insufficiency. Sudden cardiac death during minor procedures even in the absence of gross cardiovascular pathology is the most dreaded complication in these patients. A 7-year-old child with WS was posted for left-sided inguinal hernia repair under general anesthesia. Our article describes the uneventful perioperative course of the patient and highlights the concerns and complications that may be an integral part with the syndrome.

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Objective: The goal of this study was to assess the reliability of different tension and saturation-based oxygen indices with traditional oxygenation index (OI) in the assessment of disease severity and its progress in adult patients with acute respiratory distress syndrome (ARDS) when compared to the standard arterial oxygen tension (PaO₂)/inspired fraction of oxygen (FiO₂) (PF) ratio included in the Berlin definition of ARDS; the primary objective was assessed by the correlation of different OIs to the standard PF index. Design: This was a prospective, observational study. Setting: This study was carried out in Intensive Care Unit (ICU) in a university hospital. Patients and Methods: Sixty adult patients with different grades of ARDS severity according to Berlin definition were enrolled in this study. Measurements: The following indices were measured: (1) PF, (2) OI = FiO₂ × mean airway pressure [MAP] × 100/PaO₂ , (3) oxygen saturation index (OSI) = FiO₂ × MAP × 100/oxygen saturation by pulse oximeter. The primary outcome measurement was the correlation of different OIs to the standard PF index. The secondary outcome measurements were sensitivity and specificity of each index. Results: There were a strong significant negative correlation between OI and OSI with the PF (r = −0.9 and −0.91, respectively) and a significant positive correlation between OI and OSI (r = 0.93). Total mortality rate was 36% (22 patients). The PF, OI, and OSI were sensitive and specific (sensitivity: 0.63, 0.77, and 0.81, respectively, and specificity: 0.76, 0.86, and 0.78, respectively). Conclusion: OSI can be used as a noninvasive index for the assessment of ARDS severity in adults as it correlates significantly with PF ratio and OI with high sensitivity and specificity to predict ICU mortality.

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