Correspondence 865 contrast invariably brief, and reflects both its rapid redistribution from the brain and its short elimination half-life (64 minute^).^ Thus, a continuous infusion of naloxone is indicated for the treatment of severe fentanyl overdose.We followed the recommendations of Tenenbein, who managed two cases of narcotic overdose in infants using naloxone infu~ions.~ Our choice of 24 hours for the infusion time was based on the work of Koehntop and colleague~.~ These authors found that four neonates given 25 or 50 pg/kg of fentanyl during major surgery required ventilatory support for an average of 24 hours after operation. We were also influenced by the fact that the infusion would be terminated at a time when medical staff would be readily available to deal with any recurrence of respiratory depression. We consider, in view of the successful outcome, that continuous naloxone infusion is an alternative to mechanical ventilation in the management of severe fentanyl overdose in the neonate. Coughing and laryngospasm with the laryngeal maskWe read with interest the recent article of Brodrick,Webster and Nunn (Anaesthesia 1989; 44: 23841) on the appraisal of the laryngeal mask airway (LMA). Consistent with our experience, two problems predominated with insertion: firstly, respiratory obstruction attributed to the backward folding of the epiglottis;' and secondly, coughing and laryngospasm attributed to inadequate depth of anaesthesia.* The former problem was resolved by the use of an introducer; this letter is about the latter problem. Brodrick and colleagues reported that laryngospasm and (or) coughing complicated insertion in 10% of patients and that similar problems were encountered during recovery. We presume that this arises from stimulation of the laryngeal inlet at light levels of anaesthesia. The supraglottic area of the larynx is simply and safely anaesthetised with superior laryngeal nerve (SLN) block.3 We have performed this block under light anaesthesia since before the introduction of the laryngeal mask and have encountered no episode of laryngospasm or troublesome coughing. It is useful in the provision of a patent airway in patients who otherwise require light levels of general anaesthesia in combination with regional blockade. Other advantages may include reduced trauma and cardiovascular response during insertion, and fewer problems during recovery and removal of the laryngeal mask. It may also be useful for induction of anaesthesia in patients in whom airway difficulties are anticipated and therefore general anaesthesia contraindicated before the airway is secured.2Superior laryngeal nerve block appears to be a simple and safe procedure with little or short-lived impairment of motor function of the laryngeal inlet. We are currently planning a formal study. The use of the fibreoptic laryngoscope to confirm the position of the laryngeal maskThe article by Brodrick, Webster and Nunn (Anaesthesia 1989; 44: 238-41) describes a 10% incidence of respiratory obstruction, which was deemed to b...

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Background:The hemifacial spasm (HFS) defined as involuntary intermittent twitching of the muscles of the face (usually unilateral). The spasms characteristically begin around the eye and then extend to affect other muscles of the ipsilateral face. It is caused by vascular element compressing the facial nerve that may be either the anterior or the posterior inferior cerebellar arteries in most cases. Objective of our work: to describe the operative technique (pearls and common mistakes), the efficacy and morbidity of microvascular decompression technique for hemifacial spasm through mini craniotomy, determine the prognostic factors affecting success rate of the surgery. Material & method:A retrospective study of 23 cases of hemifacial spasm treated by mini craniotomy retro sigmoid approach and microvascular decompression at neurosurgery dept., Mansoura University Hospital in last 10 years was investigated. This include Epidemiological, clinical and imaging details, selected treatment options and patients' outcome. Results: complete resolving of symptoms was conducted in 19 cases 82.6% while reoperated in 2 cases with improvement in one case. Facial palsy appeared postoperative in 6 cases 4 of them improved in 3 months, transient hearing loss in 4 cases17.4% which improved later, cerebrospinal fluid leak appeared in 3 cases 13% which managed conservatively. Conclusions: MVD relieves symptoms of HFS in about 80% of patients while recurrence still in low percentage. The study reported low permanent Complications and generally transient.