Anatomic and anaesthetic considerations of greater palatine nerve block in Indian population

Background: Greater palatine nerve block holds its importance for anaesthesia and analgesia in different maxillofacial surgical procedures. Accuracy in localization of greater palatine foramen is required for its successful implication in regional block, although racial variations exist in various population groups

Aims: To study the morphometry of greater palatine foramen and its location with nearby anatomical landmarks in Indian population. Material and Methods: A total of one hundred dry skulls [60 males and 40 females] were collected and observed for the study. Various parameters were noted from greater palatine foramen on both sides, together with its location with respect to maxillary molar tooth. Along with that the angle between midline maxillary suture and Incisive foramen-Greater palatine foramen is measured

Results: 198 sides were measured and the most common location of greater palatine foramen was found to be medial to third molar tooth [71.21%]. The mean distance from greater palatine foramen to midline maxillary suture on right and left sides were 14.82 +/- 1.34 mm and 14.79 +/- 1.57 mm, statistically insignificant. The angle between midline maxillary suture and incisive foramen-greater palatine foramen was 20.81 degree +/- 2.47 degree on right side and 20.58 degree +/- 2.69 degree on left side.The direction of the opening of greater palatine canal onto the hard palate was observed to be antero-medial in 60.10% of cases

Conclusions: Our study reveals the importance of usage of various anatomical parameters for precise location of greater palatine foramen, establishment of specific measurements in each population group and thereby applying such measurements for successful greater palatine nerve block

Anaesthetic challenges in a patient presenting with huge neck teratoma

Paediatric airway management is a great challenge even for an experienced anaesthesiologist. Difficult airway in huge cervical teratoma further exaggerates the complexity. This case report is intended at describing the intubation difficulties that were confronted during the airway management of a three year old girl presenting with huge neck teratoma and respiratory distress. This patient was successfully intubated with uncuffed endotracheal tubes in second attempt under inhalational anaesthesia with halothane and spontaneous ventilation. This case exemplifies the importance of careful preoperative workup of an anticipated difficult airway in paediatric patients with neck swelling to minimize any perioperative complications

randomized trial of epidural volume extension by sequential combined spinal epidural anesthesia using three different techniques

Sequential combined spinal epidural anesthesia [SCSEA] is gaining popularity in ASA grade III / IV, elderly, low cardiac output state and high risk patients. In view of contradicting results related to sensorimotor characteristics, we undertook this study with the null hypothesis that epidural volume extension [EVE] with local anesthetic or normal saline results in augmentation of initial intrathecal block. Prospective, randomized, double blind study. J N Medical College, Aligarh Muslim University, Aligarh, India. Seventy-five ASA I/II patients divided into three groups and operated upon from September 2007 to January 2009. Group I received 1.5 ml bupivacaine [0.5%] + 25 microg fentanyl in subarachnoid space and epidural catheter was inserted without any top ups. In group II and III with the same technique top ups were given after 10 minutes of the intrathecal block in the form of either 10 ml NS or 10 ml of 0.125% bupivacaine. Augmentation of initial intrathecal block. Significant increase in height of block was seen after EVE by different techniques of epidural top up [T4.64 +/- 0.86 and T3.92 +/- 0.99 in group II and III respectively, p-value < 0.05] as compared to group I [T7.12 +/- 0.83]. The average increase was 3.12 +/- 0.97 and 3.48 +/- 1.35 segments in group II and III respectively as compared to 0.48 +/- 0.51 segments in group I.. Height of low-dose intrathecal block can be enhanced by SCSE using EVE effect even with normal saline