Manual Palpation versus Ultrasound to Identify the Intervertebral Space for Spinal Anesthesia in Infants.

Purpose: Awake spinal anesthesia continues as an alternative to general anesthesia for infants. Standard clinical practice includes the manual palpation of surface landmarks to identify the desired intervertebral space for lumbar puncture (LP). The current study investigates the accuracy of manual palpation for identifying the intended intervertebral site for LP, using ultrasonography for confirmation and to determine the interspace where the ends.

Update on Local Anesthetic Toxicity, Prevention and Treatment During Regional Anesthesia in Infants and Children.

Local anesthetic agents play a key role in the treatment and prevention of pain in children. Although generally safe and effective, as with any pharmacologic agent, adverse effects may occur with the administration of these medications. Systemic absorption or inadvertent systemic injection during bolus dosing or continuous infusion can result in local anesthetic systemic toxicity with life-threatening neurological and cardiac complications.

The Role of Interfascial Plane Blocks in Paediatric Regional Anaesthesia: A Narrative Review of Current Perspectives and Updates.

Regional anaesthesia has been increasingly used for analgesia in the perioperative period in paediatric anaesthesia for better pain control and improved patient outcomes. Interfascial plane blocks are considered as a subgroup of peripheral nerve blocks. The advent of ultrasound in modern regional anaesthesia practice has led to the evolution of various interfascial plane blocks.

Persistent Left Superior Vena Cava Suggested by an Unusual Central Venous Pressure Waveform.

 A persistent left superior vena cava (PLSVC) is the most common congenital anomaly of the thoracic venous return.  During atrial septal defect repair, a pulmonary artery (PA) catheter was placed via the left internal jugular vein. Although placement of the PA catheter in the main PA was confirmed by transesophageal echocardiography, the central venous pressure (CVP) waveform was abnormal.

Myasthenia gravis and sugammadex: A case report and review of the literature.

Anesthesia care during surgical procedures in patients with myasthenia gravis (MG) can be challenging, as these patients have increased sensitivity to neuromuscular blocking agents (NMBAs) and may be at high risk for postoperative weakness and respiratory failure. Even intermediate-acting NMBAs may have a prolonged effect resulting in residual weakness after reversal with acetylcholinesterase inhibitors (neostigmine). Sugammadex (Bridion®, Merck and Co, Whithouse Stations, New Jersey) is a novel pharmacologic agent that reverses neuromuscular blockade by encapsulating rocuronium or vecuronium.

Phrenic Nerve Blockade to Diagnose and Treat Diaphragmatic Pain After Surgical Repair of Congenital Diaphragmatic Eventration.

A 46-year-old woman presented with pain in the lateral side of the left chest wall and a sensation of fullness and pulling in the epigastric region, which started 4 weeks following diaphragmatic plication for left diaphragmatic eventration. The patient was diagnosed as suffering from post-thoracotomy pain syndrome (PTPS). A diagnostic intercostal nerve block relieved the chest wall pain, but not the epigastric pain.

Buried bumper syndrome revisited: a rare but potentially fatal complication of PEG tube placement.

Percutaneous endoscopic gastrostomy (PEG) has been used for providing enteral access to patients who require long-term enteral nutrition for years. Although generally considered safe, PEG tube placement can be associated with many immediate and delayed complications. Buried bumper syndrome (BBS) is one of the uncommon and late complications of percutaneous endoscopic gastrostomy (PEG) placement.