The management of patients with posterior epistaxis remains a challenging problem for the ENT surgeon. In most units, failure of conservative management results in more invasive techniques, involving either major artery ligation or percutaneous embolization of the internal maxillary artery. However, there are complications in more than 25% of patients undergoing these techniques. Endoscopic ligation of the sphenopalatine artery (ELSPA) is emerging as a minimally invasive alternative. We report our experience of ELSPA in 13 patients with a mean follow-up of 13 months. Epistaxis was controlled in 92% and to date no complications have been associated with the procedure. We conclude that ELSPA is a treatment option that is easy to perform and is safe and effective for patients with refractory posterior epistaxis.

An anaesthetic technique for laryngeal microsurgery is described and evaluated using intravenous propofol infusion and topical lignocaine with the patient breathing spontaneously without an endotracheal tube. Eighty adult patients divided into two groups according to their ASA status (Group A; 58 ASA I and Il; Group B; 22 ASA III and IV) were analysed. Operating conditions were good in all but one case. Good anaesthesia was achieved in about 70% of patients. The requirement for propofol was less in Group B. Blood pressures decreased signifcantly following induction (P < 0.001) but returned towards the preoperative values after ten minutes in Group A patients whereas the recovery was slower in Group B. Apnoea occurred on induction in about 40% of patients overall. P aeo2 showed a similar small increase in both groups. Oxygenation was adequate. The results show that propofol as an infusion in this simple tubeless technique is satisfactory. As the technique was considered potentially hazardous in those patients with upper airway obstruction, such patients were not included in this study.

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