We proudly present the third issue of Volume four of Chettinad Health City Medical Journal which is a special edition on Anesthesia and its subspecialties. Advances in science and technology has had an impact on the field of medicine which has grown in leaps and bounds. This has been extrapolated to the specialty of Anesthesiology. All the latest developments in surgical specialties could be attributed to this exponential growth and advancement of Anesthesiology as a specialty.

To observe the immotile spermatozoa over a period of time in semen samples to find out if they are immotile or resting.

To evaluate if weight gain is a risk factor for the development of polycystic ovarian syndrome (PCOS) in a genetically susceptible patient, irrespective of the BMI.

Pulmonary embolism is a potentially lethal complication and accounts for many cases of post operative deaths each year. The signs and symptoms of pulmonary embolism are not specific; it is difficult to be diagnosed in elderly population. One-thirds of the deaths due to pulmonary embolism occur within an onset of 20 minutes, and if untreated embolic episode occurs in most of the patients.

Trauma during pregnancy, including head injury is a leading cause of maternal death and morbidity and complicates 6%-7% of all pregnancies. Early aggressive maternal resuscitation is the main priority. The specific anatomic and physiologic changes that occur during pregnancy may alter the response to injury and hence necessitate a modified approach to the resuscitation process.

Perioperative hypotension is a common problem, however its incidence is largely unknown. There are evidences suggesting that incidence of myocardial adverse events in the postoperative period may be linked to the prolonged episodes of perioperative hypotension.

Von Haller was the first to describe carotid body tumor in 1743. Carotid body tumors (CBT) are extremely rare, arising from chemoreceptor cells at the bifurcation of carotid artery. Reported incidence is 1-2 per 1000001. Frequently these tumors have tendency to turn malignant. Hence operative intervention is the treatment of choice. Removal of tumor poses several anesthetic challenges and is associated with perioperative morbidity of 20 -40 %2 .This case report highlights the anesthetic management and the problems encountered during CBT excision.

Snake bite envenomation is a life threatening emergency. Cellulitis at the local wound site of bite leads to compartment syndrome which requires urgent surgical intervention and fasciotomy. Though there are many reviews for medical management of snake bite, reviews for anaesthetic implications are scarce.

Pyogenic granuloma although a common oral lesion, has a particular significance, because of its unexpected clinical course. Here we report a gigantic pyogenic granuloma of the left maxillary alveolus extending to involve the hard palate.The lesion was excised under general anaesthesia. This demonstrates an extreme and unusual presentation of a definitely benign lesion

Eagle’s syndrome was first proposed by an otorhinolaryngologist Watt Weems Eagle in the year 1937. Eagle’s syndrome occurs due to the ossification of the stylohyoid chain and patients with Eagle’s Syndrome may present with a history of pain in the tonsillar region, dysphagia and pain on turning the head, foreign body sensation in the throat and referred otalgia. Extra oral radiographs like panoramic radiographs, lateral head and neck radiographs aid in the diagnosis of this syndrome, followed by surgical management to relieve the clinical symptoms.

John Hutchinson (1846), a surgeon, described various subdivisions of lung volume after his experiments on 2130 individuals. He gave the first pressure - volume curves for the lungs in the year 1849 and coined the term vital capacity and described timed vital capacity. In 1864, Nester Grehant determined the functional residual capacity and coefficient of ventilation (inspired volume/FRC). Pulmonary dead space was described by Haldane and Priestly in 1882. Fritz Rohrer, in his doctoral thesis, calculated the pressures required to overcome laminar and turbulent airflows in 1915, which was the first description of the physics of the flow in the airway.

Fluid resuscitation is one of the cornerstones of management of patients with severe sepsis. However considerable controversy remains when it comes to deciding the targets and endpoints of resuscitation, hemodynamic and microcirculatory goals to be achieved , and nature and amount of fluid to be administered. The article briefly addresses the various aspects of fluid resuscitation in sepsis,and attempts to highlight the recent evidences and areas which hold promise for future research.

Fluid management in the perioperative period is of vital importance to both anaesthesiologists and surgeons to optimize the health and to prevent complications in children. It is similar to a drug prescription whose composition and volume must be tailored to patient’s physiological status, the extent of surgical procedure with ongoing losses and fluid shifts and postoperative course of events. Recent literature and studies have challenged the perioperative routine use of hypotonic fluid and glucose supplementation due to their side effects. This review focuses the basics of perioperative fluid management in children and the limitations of previously used fluid guidelines and provides recent recommendations.

Sperm associated oocyte activating factor (SAOAF) activates the oocyte to initiate embryogenesis1 . Oocyte activation involves a rise in Ca+ release and followed by a series of Ca+ oscillations1 . Ca+ oscillations modulate multifaceted events which include cortical granule exocytosis, release of meiotic arrest,regulate gene expression, recruit maternal mRNA and initiate embryogenesis.