P Pu ur rp po os se e: : The laryngeal mask airway (LMA) is used in nasal surgery but there is some concern of tracheal or laryngeal contamination with blood and secretions. We have evaluated the ability of the LMA to prevent airway contamination until full emergence from anesthesia.

Objectives:To study clinical and radiological outcomes in patients who had undergone the procedure of anterior cervical discectomy and fusion with titanium or PEEK (polyetheretherketone) cages for cervical disc prolapse.Methods:This is a retrospective/non-randomized study which was conducted at the Combined Military Hospital Peshawar. Study interval was four years from 1st October, 2010 to 31st September, 2014. Total number of included patients were 149. All of the patients had undergone the procedure of anterior cervical discectomy and fusion with titanium or PEEK (polyetheretherketone) cages. All of the patients had plain MRI cervical spine done for diagnosis of anterior cervical disc prolapse.Results:Most of the patients had stenosis at the C5 / C6 (PEEK cage group 63% and titanium cage group 47.6%) and C6 / C7 (PEEK cage group 15.38% and titanium cage group 19.04%) cervical level. Bi-level involvement was also seen. In the patients who complained of brachialgia, total resolution of symptoms was seen after the operation. Three (2.01%) of the patients in titanium cage group, who presented with axial neck pain, continued to complain of pain after the operation. Four (2.6%) of the patients in PEEK (polyetheretherketone) cage group and 2 (1.3%) in titanium cage group complained of pain at the donor site (iliac crest). Fusion rate was 100% with both titanium and PEEK (polyetheretherketone) cages at one year.Conclusion:Results with titanium and PEEK (polyetheretherketone) cages are excellent. There was no significant difference in clinical and radiological outcome between two groups of patients (p > 0.05). Fusion rate was 100% at one year with both cages.

Objective:This study was conducted to assess outcomes in patients with hydrocephalus who underwent ventriculoperitoneal shunting at Keen’s point.Methods:This retrospective study was conducted in Combined Military Hospital (CMH) Peshawar. Time frame was four years from January 2011 to January 2015. The presenting complaints, clinical findings, investigations, treatment plans and surgical outcomes were noted. Ventriculo-Peritoneal (VP) shunting was done at Keen’s point. The presence of shunt complications in the first week post-surgery was noted and at a three-month follow up in the outpatient department. General condition of the patient, shunt complications, presence of seizure and worsening of vision were noted.Results:Study included 143 patients, out of whom 46 were females and 95 were male patients. Most common causes of hydrocephalus were congenital (79). Majority of adults had hydrocephalus due to central nervous system tumors while congenital hydrocephalus in children was most frequently due to aqueductal stenosis. Good clinical improvement was seen in 114 patients after shunt placement, satisfactory in 20 patients, 7 patients died while we observed no change in two patients.Conclusion:Our experience with VP shunting at Keen’s point resulted in excellent outcomes. It can be used for the management of hydrocephalus both in pediatric as well as adult population.

Objective To prove Inguinal mesh hernioplasty under L/A is safe and acceptable. Helps with post-operative pain and enables rapid recovery as a day case. Method All patients who underwent inguinal hernia repair under local anaesthesia were retrospectively analysed in our hospital between July 2014- July 2017. Clinical judgement was used for inclusion and exclusion parameters. Results From July 2014- July 2017, 260 patients were included in study who underwent Inguinal mesh hernioplasty under L/A. ASA grade for all patients ranged between I-III. The mean age was 37 (20-65). Intraoperatively (9.1) 3.5% patients had problems such as pain, hypotension or sweating. About (86.3%) 224 patients were discharged home the same day and remaining stayed overnight for less than 24 hours. Hematoma was seen in 5 (1.92%) patients, Urinary retention in 2 (0.7%) patients, Wound infection seen in 24(9.2%) patients, Readmission in 10 (3.8%) patients. Chronic groin pain was seen in 10 (3.9%) patients and no recurrence on 6 months follow up. Conclusions Our results showed that this procedure is feasible under L/A and can be performed safely. It showed satisfactory acceptance by the operating surgeon and patient, without significant perioperative issues. It is reliable and showed shorter hospital stay.

We read with interest the recent publication by Ahmed and Vohra 1 and we agree with their conclusions that the laryngeal mask airway (LMA) provides a safe and reliable airway, although our findings of LMA contamination were rather different.Following a personal communication with one of the authors (Vohra) we incorporated their scoring system into a study that we were conducting involving the use of laryngeal masks in outpatient pediatric dental surgery.We recruited 71 patients (ASA I or II, age range 2-15 yr) who were undergoing routine extractions for carious teeth under general anesthesia. The patients were anesthetized with propofol (3-4 mg·kg -1 ), or via an inhalational induction (O 2 /N 2 O/sevoflurane) depending on the ease of venous access and patient preference/compliance. Anesthesia was maintained by spontaneous ventilation with O 2 /N 2 O/sevoflurane. Following the extraction of teeth by experienced dental surgeons the LMA was removed when the patients were fully awake. The LMA was immediately examined by one of the authors (Dolling) and scored accordingly. 1 Our results are markedly different (Table). Shortlived desaturations below 94% were seen in ten of our patients during recovery [three with score 1, four with score 2, three with score 3 (no statistical significance)]. All patients uneventfully met our discharge criteria.Several articles 2,3 have shown that the LMA protects the larynx from fluids above but this may not always be the case. We used standard, rather than reinforced LMAs, which may be associated with increased movement of the LMA during surgery and subsequent reduction in the integrity of the protective seal. Also, our surgeons used only dental packs to stem the flow of blood. This is likely to result in more blood in the airway than in nasal or septal surgery, with subsequently increased pooling above the cuff. An alternative explanation, of the differing results, could simply be that the LMAs were contaminated by intra-oral blood on removal (unlike the Ahmed/Vohra study, no intra-oral suction was performed prior to removal to minimize stimulation).It would be interesting to clarify the reasons for our different results using reinforced LMAs or a fibreoptic scope to examine the underside of the LMA prior to its removal. Airway protection by the laryngeal mask airway in children. Middle East J Anaesthesiol 1995; 13: 107-13. R E P LY :We 8.4% (6) 0% LMA = laryngeal mask airway. *0 = no blood; 1 = staining on the cuff; 2 = staining on inside of mask; 3 = blood in the tube.