Background:Postoperative nausea and vomiting (PONV) is a frequent complication of middle ear surgery. Ondansetron has been shown to be effective for early PONV and dexamethasone has been shown to be effective for late PONV. Therefore, a combination of dexamethasone and ondansetron is commonly used for middle ear surgery. This study was conducted to compare the combination of ondansetron and dexamethasone with ramosetron for early and late PONV up to 48 h after middle ear surgery.Methods:One hundred and twenty adults scheduled for middle ear surgery were allocated to receive either dexamethasone 8 mg and ondansetron 4 mg (n=60) or ramosetron 0.3 mg (n=60). General anesthesia with inhalation agents was used for all the patients. The incidence and severity of PONV, administration of rescue antiemetic, and the side effects of the antiemetic were documented during the first 48 h after surgery.Results:The incidence of nausea was significantly lower in the dexamethasone and ondansetron group compared to the ramosetron group between 2 and 24 h. The complete response, which is patients with no nausea or vomiting, was significantly more in dexamethasone and ondansetron group compared to ramosetron group between 2 and 24 h and between 24 and 48 h (76% vs. 56%, P=0.02, 93% vs. 81%, P=0.05, respectively). Overall, complete response was more in dexamethasone and ondansetron group compared to ramosetron group (71% vs. 40%, P=0.01).Conclusion:The combination of dexamethasone and ondansetron is superior to ramosetron for prevention of PONV after middle ear surgeries.

Supraclavicular brachial plexus block is commonly performed for upper limb surgeries. In patients with compromised respiratory function or in the elderly it may be preferred over general anaesthesia. Bronchospasm, albeit a rare complication of this procedure, may turn the advantages of regional anaesthesia in these patients into a disadvantage. Bronchospasm following interscalene approach has been previously reported. However, the same following the supraclavicular approach has not yet been reported. A 70-year-old woman presented with cellulitis of the left upper limb. A successful left brachial plexus block was performed uneventfully via the supraclavicular approach for an emergency debridement. She developed bronchospasm in the post-operative care unit (1 hour after the performance of the block) which responded to the standard treatment and rest of her hospital stay was uneventful. Awareness of possibility of this less known complication is necessary, especially in patients of compromised respiratory function to initiate prompt treatment and avoid further complications.

Peripartum cardiomyopathy (PPCM) is a relatively rare disease occurring most commonly in the postpartum period. A small subset of patients with PPCM present at later stages of pregnancies. The management of PPCM involves guideline-based treatment of cardiac failure. There is a paucity of data regarding timing of delivery and final outcome. Patients presenting with decompensated failure or progressively worsening symptoms need emergent termination of pregnancy along with stabilisation. We present a 35-week pregnant patient in cardiac failure in whom early delivery and effective postoperative management resulted in a favourable outcome for both mother and child.