Postoperative cerebrospinal fluid (CSF) rhinorrhea after septoplasty is a known entity resulting from errors in surgical technique and improper handling of the perpendicular plate of the ethmoid bone. When these occur, urgent management is necessary to prevent deleterious sequelae such as meningitis, intracranial abscess, and pneumocephalus. Encephaloceles are rare occurrences characterized by herniation of intracranial contents through a skull base defect that can predispose patients to CSF rhinorrhea. In this report, we present a case of CSF rhinorrhea occurring 2 weeks after septoplasty likely from manipulation of an occult anterior skull base encephalocele. To our knowledge, no previous similar case has been reported in the literature. Otolaryngologists should be aware of the possibility of occult encephaloceles while performing septoplasties because minimal manipulation of these entities may potentially result in postoperative CSF leakage.

BACKGROUND AND AIMS: Intravenous regional anaesthesia is used for short procedures for upper limb and hand surgery. IVRA with adjuvants like opioids, NSAIDS, muscle relaxants increases the efficacy in terms of analgesic duration and quality of anaesthesia. We conducted this study for evaluation of adding clonidine with dexmedetomidine during bier's block in upper limb orthopedic surgeries. MATERIAL AND METHODS: Sixty patients of American society of anaesthesiologist (ASA) class I, II, III patients undergoing upper limb surgeries were enrolled. IVRA was established using 3mg/kg of 0.5% lignocaine diluted with saline to a total volume of 40ml to which 1µg/kg of clonidine in group I or 1µg/kg dexmedetomidine in group II was added. The sensory block and motor block onset and recovery, hemodynamic parameters sedation score, VAS score, doses of analgesic requirement, patient satisfaction score, surgeon satisfaction score were noted and recorded at 15min, 30min, 1hr, 2hr, 3hr, 12hr and 24hr time interval. RESULTS: Both like groups were comparable with respect to age, sex, weight, ASA grade, baseline hemodynamic vitals, duration of surgery and intra-operative and post-operative hemodynamic variables. Sensory block onset and recovery was 4.85 ±0.49 min and 5.9±0.66 min in group II (LD). Motor block onset and recovery was 10.91±0.6 min and 6.83±0.69 min in group I (LC) and 11.2±0.59 min and 7.13±0.57 min respectively in group II (LD). CONCLUSION: The addition of 1µg/kg of clonidine or 1µg/kg or 1µg/kg of dexmedetomidine to 3mg/kg of 0.5% of lignocaine is found to be effective, comparable in terms of onset and recovery of sensory and motor blockade, hemodynamically stable and without any side effects and complications.

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Limb girdle muscle dystrophy (LGMD) is group of rare hereditary disorders primarily involving hip and shoulder muscles. Due to scarcity of literature, definite anesthetic management strategy is lacking. We, report the successful management of 28 yr parturient with LGMD for elective caesarian delivery under spinal anesthesia. The anesthetic management is discussed with brief review of literature.

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