Transformation of a "block rotation" to "LIC" medical student education in a tertiary academic teaching hospital has many challenges, many of which can be anticipated, but some are unexpected.

This study measures the learning curve for accomplishing sub-Tenon blocks for ophthalmic surgery applicable to anaesthetists skilled in peribulbar techniques. We defined criteria for a good block in terms of chemosis, subconjunctival haemorrhage, globe movement and the need for additional peribulbar block. The overall success rate, by our definitions, was 72% and 56% for the two operators. The overall requirement for an additional peribulbar block was 10%. The rate of additional blocks and reduction in globe movement reached a plateau after about 60 procedures for both operators. The rates of chemosis (6% and 12% overall) and subconjunctival haemorrhage (6% and 12% overall) did not trend with increased experience. The results applied to both a cataract and a vitreo-retinal surgery casemix.

Functional disorders of the vocal cords can present with acute, dramatic upper airway obstruction, with features mimicking asthma or functional dysphonia. We report the case of an eighteen-year-old female with acute airway obstruction initially misdiagnosed as asthma. Laryngoscopy, bronchoscopy and psychiatric assessment confirmed a diagnosis of functional disorder of the vocal cords. Although a diagnosis of exclusion, it must be borne in mind in order to reduce unnecessary medical therapy and surgical intervention. It is only with the correct diagnosis that patients can receive appropriate therapy.

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