A four-year-old female white-bellied caique (Pionites leucogaster) was presented with lens opacification and blindness in the right eye (OD) following a history of head trauma. The left eye (OS) was normal. The bird underwent general anesthesia. Intracameral atracurium was administered to induce pupil dilation. Following corneal incision, ophthalmic viscoelastic devices (OVDs) were injected, and an anterior capsulotomy was performed. The lens material was removed using a manual aspiration and irrigation technique with balanced salt solution. Systemic enrofloxacin and meloxicam were prescribed, along with topical tobramycin. Vision returned postoperatively by Day 1, as indicated by a positive dazzle reflex and third eyelid incursion in response to an approaching stimulus. Transient intraocular hypertension was observed immediately after surgery, but responded well to topical hypotensive medication. At the two-year follow-up, vision remained, as evidenced by accurate landing and normal interaction with her owner and mate. To the best of the authors' knowledge, this is the only report describing successful cataract extraction in the smallest companion bird reported to date, using a manual irrigation and aspiration technique.

Becker muscular dystrophy (BMD) is a rare X-linked dystrophinopathy caused by dystrophin gene (DMD gene) variants, resulting in reduced or dysfunctional dystrophin. Despite a milder course than Duchenne muscular dystrophy, patients face significant perioperative risk from skeletal muscle degeneration, respiratory weakness, cardiomyopathy, and conduction abnormalities. Succinylcholine and volatile anesthetics have been associated with life-threatening hyperkalemia, rhabdomyolysis, and malignant hyperthermia-like reactions in dystrophinopathies. Clinically manifest BMD in females is exceptionally rare due to skewed X-inactivation, and perioperative data in this population remain scarce. We report a 39-year-old woman with genetically confirmed, clinically manifested BMD who underwent elective left salpingo-oophorectomy with surgical staging for a large adnexal mass. She had severe proximal weakness and was non-ambulatory but had no respiratory, swallowing, or aspiration symptoms. Multidisciplinary preoperative evaluation (neurology, cardiology, hepatology, anesthesiology, gynecologic oncology, intensive care) confirmed preserved cardiac function (ejection fraction >70%), normal conduction, no respiratory compromise evidenced by normal pulmonary function tests, and adequate hepatic reserve. A trigger-free anesthetic strategy was used: the workstation was prepared to eliminate residual volatile agents, and total intravenous anesthesia was maintained with propofol, dexmedetomidine, and midazolam, avoiding succinylcholine and volatile agents. Reduced-dose atracurium provided neuromuscular blockade, and multimodal opioid-sparing analgesia included bilateral rectus sheath blocks and non-opioid analgesics. Surgery was uneventful, with no hemodynamic instability, arrhythmias, hyperkalemia, or rhabdomyolysis. The patient was extubated in the operating room after full neuromuscular recovery, then electively admitted to the ICU for observation given the risk of delayed respiratory compromise. Her postoperative course was uncomplicated, with stable cardiorespiratory function and effective analgesia. Histopathology confirmed an adult granulosa cell tumor of the ovary. This case suggests that major gynecologic surgery can be safely performed in clinically manifest female BMD patients through multidisciplinary planning, trigger-free total intravenous anesthesia, careful neuromuscular blockade, opioid-sparing analgesia, and planned ICU surveillance, offering valuable guidance for this rare, high-risk population.

BACKGROUND Perioperative anaphylaxis is a life-threatening anesthetic emergency most commonly triggered by neuromuscular blocking agents (NMBAs). Although international guidelines recommend performing skin testing 4 to 6 weeks after the event, this delay is often impractical for patients requiring semi-urgent surgery. Delaying surgery can risk disease progression, while unguided re-exposure poses life-threatening allergic recurrence. This case report illustrates the diagnostic utility and clinical relevance of early skin testing in guiding anesthetic management when timely reoperation is necessary. CASE REPORT A 36-year-old man scheduled for laparoscopic resection of a splenic lesion experienced immediate cardiovascular collapse following administration of cisatracurium (15 mg) during anesthesia induction. He developed profound hypotension (62/34 mm Hg), tachycardia (139 bpm), and a diffuse erythematous maculopapular rash over the chest. Rapid intravenous epinephrine administration led to prompt hemodynamic stabilization. Considering the need for timely surgical completion, skin prick testing was conducted on postoperative day 6, which revealed a positive reaction to cisatracurium and a negative response to rocuronium, indicating absence of cross-reactivity. Rocuronium was subsequently used for reinduction on postoperative day 7, allowing successful completion of surgery without further adverse reactions. CONCLUSIONS This case report shows that early skin testing following perioperative anaphylaxis can be both feasible and clinically informative in urgent surgical settings. It offers a time-efficient diagnostic solution to balance safety and surgical urgency in high-risk patients. Prompt identification of the causative NMBA enables safe substitution, minimizes surgical delay, and facilitates evidence-based anesthetic management decisions.

Patients with cerebral palsy are known to present with numerous anaesthetic challenges due to spasticity, joint deformities, cognitive dysfunction, and behavioural abnormalities. Our patient was an eight-year-old girl with severe spastic quadriplegic cerebral palsy (SQCP) posted for cataract surgery with IOL (intraocular lens) placement under general anaesthesia. A thorough preanaesthetic checkup (PAC) was performed, after which the family members were counselled, and appropriate medications based on the patient's condition were prescribed to prepare her for the anaesthetic and surgical procedures. We encountered initial challenges with cannulation and patient positioning, but apart from that, we successfully managed the patient throughout the surgical procedure, and recovery was smooth. We conclude that every patient may respond differently, but meticulous assessments and comprehensive planning, along with a multidisciplinary approach, can certainly ensure a smooth and comfortable experience for the patient and pose fewer challenges for the anaesthesiologist.

Non-depolarizing neuromuscular blocking agents (NMBAs) are commonly used in human anesthesia but remain uncommon in veterinary medicine. This study evaluated the effects of 0.5 mg/kg cisatracurium IV on muscle relaxation, cardiovascular variables and postoperative pain in cats undergoing orthopedic surgery. Twenty-four cats were randomly assigned to a control group (Group C) or a treatment group receiving cisatracurium (Group M) immediately after induction. Neuromuscular function was monitored using a calibrated train-of-four (TOF) device. Postoperative pain was assessed with the short form of the Glasgow Feline Composite Measure Pain Scale (CMPS-Feline). The mean time to suppression of muscle contraction was 2.6 ± 0.8 min, with peak suppression (90%) at 3.0 ± 0.7 min, a mean duration of 23.3 ± 4.4 min, and complete recovery at 27.3 ± 8.6 min. Group M required lower sevoflurane concentrations to maintain anesthesia compared to Group C (p < 0.001) and had a shorter mean surgical time (25.3 ± 3 min vs. 31.5 ± 4 min; p < 0.001). Pain scores were also lower in Group M (p = 0.01). These findings demonstrate that cisatracurium effectively induces neuromuscular block (NMB) and improves surgical conditions, resulting in lower postoperative pain scores in cats undergoing femoral fracture repair.