BackgroundGeneral anesthesia is commonly used for surgery in the neck region. Superficial cervical plexus block is adequate to produce anesthesia in the anterior and anterolateral aspects of the neck. Our aim was to observe the effectiveness of bilateral cervical plexus block for surgery in this region of the neck.MethodsA total of 136 neck surgery cases were enrolled in this prospective uncontrolled study. All patients were administered ropivacaine 0.5% as a bilateral cervical plexus block. The incision line was infiltrated with lignocaine 1% and adrenaline 1:100,000. For thyroglossal cyst and thyroglossal fistula, an additional 1.5 mL of LA solution was deposited over the hyoid bone on both sides of the midline. Any anesthetic inadequacy was corrected using ketamine 25 mg intravenously and repeated if necessary.ResultsOf 37 patients with thyroglossal cyst, the block was sufficient in 36 patients, and one patient required ketamine. Block was adequate in 23 of 24 patients with thyroglossal fistula, and one patient required ketamine. Among the branchial cyst and branchial fistula cases, six of 16 patients required ketamine supplementation. Of three thyroidectomy patients, one required ketamine supplementation, and one was converted to conventional general anesthesia. For lymph node excision and lymph node biopsy patients, LA block was sufficient in all 31 cases. In the last group, one of 25 patients required ketamine supplementation.ConclusionThe overall success of bilateral cervical plexus block as a sole method of anesthesia in these selected neck surgeries was 91.9% and with low-dose ketamine supplementation it approached more than 99%. However, cervical plexus block was not a good method of anesthesia for thyroid surgery in this study. For the remainder of cases, bilateral cervical plexus block alone or in conjunction with ketamine appeared to be a cheap, safe, and effective alternative to conventional general anesthesia.

Purpose:Patients undergoing middle ear surgery experience variable degrees of postoperative nausea and vomiting (PONV) despite prophylaxis and treatment with ondansetron or other 5HT3 receptor antagonists. Furthermore vertigo or dizziness are not well controlled perioperatively. Role of betahistine was tested as an add-on to ondansetron in control of PONV and vertigo in middle ear surgery cases.Materials and Methods:We conducted a prospective, randomized, double-blind, placebo controlled study, enrolling one hundred patients undergoing middle ear surgery under local anesthesia into two groups consisting of fifty (n = 50) patients each. Group A patients were given betahistine 16 mg plus ondansetron 8 mg and placebo plus ondansetron 8 mg were given to group B or placebo group, orally 3 hours before starting operation. The incidence of nausea, vomiting, and dizziness was noted during the intraoperative and postoperative 24 hours period. Chi-square test, unpaired ‘t’ test, and Fisher’s exact tests were performed for statistical analysis using SPSS version 16 and Open Epi version 2.3.1 softwares.Results:Complete response was obtained in 90% patients in the betahistine group as compared to 66% in the placebo group. Vomiting in the intraoperative and postoperative period was noted in 4% and 8% cases, respectively, in the betahistine group as compared to 18% and 26%, respectively, in the placebo group. Overall, vertigo was 10% versus 32% in betahistine group and placebo group, respectively.Conclusion:Betahistine as an add-on to ondansetron can significantly attenuate PONV and perioperative vertigo, following middle ear surgeries.

Abstract:Objective : To evaluate the effectiveness of nasal endoscopy in cases of epistaxis. within an emergency setting, some are complex and may require specialist intervention. In most of the patients proper diagnosis is not possible without nasal endoscopy. Majority of the patients attending emergency department with this symptom are managed conservatively to control bleeding. Thorough clinical examination (including anterior and posterior rhinoscopy) do not reveal any abnormality in most of the cases. Significant pathology can be detected in quite a sizeable number of cases if nasal endoscopy is done.

Accidental foreign body aspiration represents a common problem in India, especially in the pediatric population. The main challenges facing an otolaryngologist in rural tertiary care Centre's of developing countries include the significant delays in referral, the relative lack of sophisticated equipment at the surgeons' disposal and the mortality associated with loss of airway. MATERIALS AND METHODS: All patients who underwent bronchoscopy for suspected aspiration of foreign bodies in North Bengal Medical College, Darjeeling, between June, 2012 and May, 2014 were included in the study. All patients underwent rigid bronchoscopy under general anesthesia. Foreign bodies, when found, were removed using conventional grasping forceps. RESULTS: Thirty-six patients were admitted for suspected tracheobronchial foreign body (TFB) during the study period. The presentation pattern was highly variable between the patients although the predominant presenting complaint was that of respiratory distress (63.9%). The interval between suspected accidental inhalation and presentation ranged from 1 to 31 days. The foreign bodies retrieved were classified into four broad groups. Seeds and nuts were the most common foreign body. The site of lodgment of the foreign body in the tracheobronchial tree was also variable. CONCLUSION: Our experience in a rural tertiary care centre in West Bengal has shown that a high index of suspicion must be present to diagnose such cases as early as possible. Digital radiographs might be normal in a considerable number of cases and any suspicion of a TFB should warrant a bronchoscopic examination. Symptoms like choking and cough may not be always present and even a definite history of accidental foreign body aspiration may be absent.