Background: Cranial meningocele represents herniation of the cranial meninges containing cerebrospinal fluid through a congenital neural defect in the cranium. A meningocele poses many challenges to the anaesthesiologists when presents for surgical excision and repair. Difficult or failed intubation frequently happen due to improper positioning and limited head excursion. Case Report: We encountered a giant bilobulated occipital meningocele in an 8-day male neonate weighing 3.8 kilogram. We placed the baby supine on a firm pillow. The meningocele sac was beyond the edge of the pillow supported by appropriately sized padded "doughnut". We encountered difficult intubation as anticipated due to restricted head and neck movement.. The laryngoscopic view of the glottis initially was Cormack-Lehane Grade 3. Once the assistant pressed over the larynx the Cormack-Lehane Grade became 2 and the tracheal intubation was possible. Then the baby was placed in lateral position carefully as surgery was planned to be performed in this position. Conclusion: Anaesthetic management of a case of a giant occipital meningocele demands identification of the problems and a management plan accordingly. Anaesthesiologist sometimes may need to adopt unconventional and innovative ideas to handle such cases.

Introduction: Tracheostomy is one of the most common and ancient surgical procedure performed in  the world but it is like a double-edged sword which not only facilitates respiration, but also impairs the natural resistant barrier, therebyaugmenting the colonization of other secondary pathogenic micro-organisms. Hence, it is important to know the patternof microbiological colonizers in tracheostomized patients, so that adequate empiric antimicrobial coverage can preventdevelopment of hospital acquired pneumonia. This study aims to identify various micro-organisms colonizing lower airway in tracheostomized patients. Materials and Methods: An observational cross-sectional study was conducted in a tertiary based teaching hospital in North Bengal, India during July 2021 to July 2022. A total of 56 patients were included in the study. Results: Positive Cultures on day 0 were found in 20.8% & 65.6% of patients in wards and ICUs respectively. Out of the positive cultures isolated on day 0, Staphylococcus aureus was the most common organism (80%) obtained from ward patients whereas, Acinetobacter baumannii was most common organism (47.61%) in ICU admitted patients. On day 7, positive cultures were found in 66.6% & 84.4% of admitted patients in wards and ICUs respectively. Staphylococcus aureus was again the most common organism obtained (56.25%) in wards whereas, Pseudomonas aeruginosa was the most common organism (44.44%) obtained in ICU admitted patients followed by Acinetobacter baumannii (33.33%). Conclusion: Culture positivity rates were higher in patients who were previously intubated in Intensive care unit, which establishes the fact that any procedure which warrants airway manipulations, increases the chance of hospital acquired infections.  Antibiotic resistance is very common in ICU admitted patients and has a tendency to increase over time. Hence, upscaling of antibiotics is recommended only after proper sensitivity check of the tracheal aspirates.

No abstract

Introduction The occurrence of isolated spheno-choanal polyps are not very common and can be very well confused with antro-choanal polyps or adenoids in adolescents and children. Appropriate diagnosis and prompt surgical intervention are essential for its removal.   Case Report We report one such case of a 16 year old female who presented with complaints nasal obstruction and reduced hearing. Endoscopic polypectomy was done with complete removal of the polyp.   Discussion Sphenochoanal Polyp is often misdiagnosed and proper investigations are thus essential for its diagnosis. Surgical Approach is the mainstay form of treatment with complete excision of the polyp.

<p>Primary mucosal melanoma of the nasal cavity and paranasal sinuses is a very aggressive and rare disease with only about 0.5 % of malignant melanoma arising from the nasal cavity. There are only few reports from India. We report a rare case of sino-nasal mucosal malignant melanoma in a 58 years old female who presented with blackish coloured sino-nasal mass involving right nasal cavity, spontaneous and recurrent epistaxis and obliteration of the right naso-labial fold with occasional pain in the past 10 months. Contrast enhanced computed tomography scan showed a heterogenous mass involving right nasal cavity, right maxillary antrum and right ethmoidal area. A positron emission tomography computed tomography was also done which showed increased uptake in the region mentioned above. Initial biopsy, the mass was diagnosed as malignant melanoma. Total maxillectomy was performed with plan of post-operative radiotherapy.</p>