Abstract Background: Cerebral vasospasm is defined as a delayed anaesthetic considerations in various neurosurgeries. but reversible narrowing of the cerebral blood vessels. Methods: We reviewed all neurosurgical cases (n = 43) Stellate ganglion block (SGB) causes sympathetic which required IONM in the last 3 months (since the denervation, which may lead to dilatation of intracerebral inception of IONM services in our hospital). This included vessels and an improvement in cerebral blood flow. cerebellopontine angle tumours (n = 15), compressive Our study assessed the efficacy of ultrasound guided spinal cord myelopathies (n = 10), spinal cord tumours SGB in relieving symptomatic cerebral vasospasm (n = 4), tumours of caudaequina (n = 3), brain tumours following aneurysmal clipping using digital subtraction in the vicinity of speech area (n = 4), brain tumours angiography (DSA) technology. Materials and Methods: in the vicinity of motor area (n = 3), sellar-parasellar Twenty patients who underwent clipping for cerebral tumours (n = 2), trigeminal neuralgia (n = 1) and spinal aneurysm and developed cerebral vasospasm later were nerve root tumour (n = 1). Various neurophysiological included in the study. DSA was performed. Vasospasm techniques used in these cases for neuromonitoring was classified with respect to diameter at the mid A1 included transcranial electrical motor evoked potentials and mid M1 segment of anterior cerebral artery (ACA) (MEPs), somatosensory evoked potentials (SSEPs), and middle cerebral artery (MCA) respectively. Location free-run and triggered electromyography (EMG), of vasospasm, parenchymal filling, and venous sinus direct cranial and peripheral nerve stimulation, motor filling time were calculated. Ultrasound guided SGB was mapping, language mapping, bulb cavernous reflex given using 10 ml of 0.5% injection bupivacaine on the testing, raw and processed electroencephalography same side of vasospasm or the side contralateral to the (EEG). In cases requiring MEPs and SSEPs, we used deficit. The neurological condition and DSA parameters total intravenous anaesthesia and avoided relaxants. were reassessed after 30 min. Results: Five patients had Soft bite block helped avoid tongue bites. In cases where neurological improvement; among these, four patients EMG alone was monitored, only muscle relaxants had had vasospasm involving a single vessel. The mean to be avoided and inhalational agents could be used. vessel diameter measured at the mid A1 segment of Awake craniotomy under local anaesthesia with an ACA (P = 0.002) and mid M1 segment of MCA (P = 0.003) ‘asleep‑awake‑asleep’ technique was used for language increased significantly. Twelve patients had an increase mapping. Systemic blood pressure and core body in vessel diameter. Vasospasm grade improved in three temperature also had to be maintained for optimal patients. The mean parenchymal filling time and mean neurophysiologic signals. EEG and bispectral index venous sinus filling time did not decrease significantly monitoring were used to assess the depth of anaesthesia. after SGB (P = 0.163/0.104 respectively). Conclusion: Results: By customising anaesthesia according to Our study shows that SGB results in improvement in neurophysiological requirements, we achieved good vessel diameter of large cerebral blood vessels. It had no baseline monitor ability in 42/43 cases (one patient had impact on the cerebral microvasculature as evidenced by severe neurological deficit that baseline signals could lack of significant changes in parenchymal filling time not be recorded). Monitoring was successful in all 42 and venous sinus filling time. Thus, SGB has a limited cases except one (monitoring had to be discontinued in a role in management of patients with cerebral vasospasm. case, as inhalational agent was kept above 0.5 minimum alveolar concentration). Conclusion: Good signal ISNACC-S-11 acquisition for a reliable neuromonitoring is teamwork Anaesthetic considerations for intraoperative between neurosurgeons, surgical neurophysiologists and neurophysiological monitoring in neurosurgical cases anaesthesiologists. Inhaled anaesthetics are to be used frugally/not at all, in cases requiring MEP monitoring. Sudhakar Subramaniam B., Nishanth Sampath, Senthil Kumar, ISNACC-S-12 Roopesh Kumar, Senthil kumar, Vijay Sankar, Comparison of awake endotracheal intubation using Suresh Bapu intubating laryngeal mask airway and fibreoptic bronchoscope in patients with unstable cervical spine Institute of Neurosciences, SRM Institute of Medical Sciences, Chennai, Tamil Nadu, India Tanmaye Jadhav, Madhusudan Reddy, Sriganesh Kamath, B. Indira Devi Introduction: Intraoperative neurophysiological monitoring (IONM) is the standard of care for a National Institute of Mental Health and Neurosciences, wide range of surgeries where neurological insult is Bengaluru, Karnataka, India anticipated. The choice of anaesthesia depends on the signals being monitored, patient’s comorbidities and the Background: Anaesthetists often encounter patients at intraoperative course of physiological parameters. We their initial resuscitation phase after acute spinal cord report here a retrospective case series to highlight the injury. Therefore, they are ideally placed to influence Journal of Neuroanaesthesiology and Critical Care | Vol. 3 • Issue 2 • May-Aug 2016 | 169 Abstract the degree of functional recovery that may take place. compared the effects of iso-osmolar plasmalyte A and The selection of airway management technique must be hypo-osmolar 0.45% saline infused perioperatively on carefully considered. Clinical experiences in intubating perioperative serum osmolality, serum sodium level patients with cervical spine injuries via the intubating and incidence of DI. Methodology: A prospective laryngeal mask airway (ILMATM, Fastrach) encouraged randomised double-blind study was conducted us to undertake a prospective, randomised controlled in 28 patients undergoing transcranial excision of study to compare upper cervical spine excursion during craniopharyngioma. The patients received either oral tracheal intubation using fibreoptic intubating plasmalyte A or 0.45% normal salineintraoperatively and scope with that during intubation via the ILMATM till 7th post-operative day. Serum and urine osmolality, (Fastrach). Methodology: Thirty-two patients aged serum and urine sodium, urine specific gravity, Glasgow between 18 and 65 years, belonging to American coma scale and total dose of desmopressin required Society of Anesthesiologists status I–III physical were measured in the perioperative period and for up status were included in the study. Patients who were to 7 days post-operatively. Results: Demographic data morbidly obese or with oropharyngeal pathology or were comparable. A statistically significant difference mouth opening <2 cm and those who refused to give was found between the two groups in serum osmolality the consent were excluded from the study. Patients at 2 h (P = 0.033), 3 h (P = 0.009) after the start of surgery, were randomly assigned to one of two groups. Group at the end of surgery (P = 0.013) and on post-operative fibreoptic bronchoscope: patients in whom trachea was day 0 (P = 0.015) with 0.45% saline group having serum intubated using fibreoptic intubating scope and group osmolality <300 mosm/kg as compared to plasmalyte ILMA: patients in whom intubation was performed group. The urine osmolality at 2 h (P = 0.03), at post- via the ILMATM (Fastrach). Three lateral cervical spine operative day 0 (P = 0.015) and post-operative day 1 (P X-rays were taken. In each group, during the different = 0.010) was more than 300 mosm/kg in 0.45% saline intubating procedures, excursion of the cervical spine group as compared to plasmalyte A group. Plasmalyte was radiographically documented. Results: Cervical A group had hypernatremia (P = 0.015) as compared to spine excursion during intubation with ILMATM was 0.45% saline group on post-operative day 1. Discussion: more as compared to that during intubation with 0.45% saline has better effect than plasmalyte A on serum fibreoptic intubation at C1–C2. There was no neurological osmolality in patients undergoing transcranial resection deterioration in either group post-intubation. Patients of craniopharyngioma. in both the group tolerated the procedure well. The incidence of sore throat was more in patients intubated ISNACC-S-14 with ILMATM. Discussion/Conclusion: In conclusion, Quest for the Holy Grail: Assessment of dynamic findings of our study suggests that ILMATM is not inferior parameters of fluid responsiveness in patients with to fibreoptic scope for awake intubation in patients with acute aneurysmal subarachnoid haemorrhage unstable cervical spine with respect to success rate of intubation, post-intubation neurological function, degree Ajay Prasad Hrishi P., Manikandan S., Girish M.1 of cervical spine motion on fluoroscopy, haemodynamic changes and patient satisfaction. Departments of Anesthesia and 1Neurosurgery, Division ISNACC-S-13 of Neuroanesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India Effect of 0.45% saline and plasmalyte A used during intraoperative and post-operative period on serum Introduction: Delta down (DD) >5 mmHg, superior osmolality in patients undergoing craniopharyngioma vena cava collapsibility index (SVCCI) >36% and aortic surgery velocity time integral variability (VTI AoV) >20% are reliable predictors of fluid responsiveness in critically Pranshuta,