Anaesthesia and airway management of occulo auricular vertebral dysplasia: A rare case report

A 12 year old girl child from the department of Ophthalmology posted for right eye limbal dermoid excision. Opthlamic examination and history revealed bilateral restricted eye movements, limbal dermoids, and decreased vision since birth. Fundus examination showed pathological myopia. There were multiple preauricular appendages in front of both ears. The lateral X-ray of cervical spine showed fused second and third cervical vertebra with loss of intervertebral disc space. Chest X-ray showed scoliosis of Cervico-Thorasic vertebra with convexity to right. Clinical examination of the airway revealed restricted head and neck movements with Mallampatti class II which indicates difficult intubation. The history, clinical examination and radiological findings confirmed her to be a case of Goldenhar syndrome. Difficult airway continues to be a major cause of anaesthesia related complications. Therefore fibre optic intubation under regional nerve block and sedation was planned for the surgery. Lack of associated cardiac and neurological anomalies encouraged us to present the advantage of fibre optic intubation. The larynx was adequately relaxed because of regional nerve block which helped us by decreasing the number of attempt of scopy and vocal cords injury. The intraoperative and postoperative period was uneventful

Comparison of Bupivacaine Alone and in Combination with Fentanyl or Pethidine for Bilateral infraorbital Nerve Block for Postoperative Analgesia in Paediatric Patients for Cleft Lip Repair: A Prospective Randomized Double Blind Study

Background: Cleft lip repair is one of the common surgeries performed in India and the usual method used for post operative analgesia is perioperative opioids and NSAIDs. There has been an increase in use of regional techniques and Opioids are the common adjuvants but their efficacy and safety have not been studied extensively in children. Patients & Methods: A prospective, randomized, double blind study was done to compare the efficacy, duration and safety of intraoral infraorbital nerve block on post operative pain relief using bupivacaine alone or in combination with fentanylor pethidine in paediatric cleft lip repair. 45 children between the age group 5 - 60 months undergoing cleft lip surgery randomly allocated into 3 groups of 15 each received bilateral intraoral infraorbital nerve block with 0.75ml of solution. Group B received 0.25% bupivacaine; group P received 0.25% bupivacaine with 0.25mg kg -1 pethidine, group F received 0.25% bupivacaine with 0.25microgm kg -1 fentanyl. Sedation after recovery, post operative pain intensity and duration of post operative analgesia were assessed using Modified Hannallah Pain Score. Results : The mean duration of analgesia was 17.8 hrs in Group B, 23.53 hrs in Group F and 35.13 hrs in Group P. There was statistically significant difference between the means of the three groups- ANOVA (p < 0.05). Conclusion: Thus we conclude that addition of fentanyl or pethidine to bupivacaine for Bilateral Intraoral Infraorbital Nerve Block prolong the duration of analgesia with no complications and can be used safely in paediatric patients