Definitive guide to ultrasound-guided peripheral nerve blocks (PNBs) and interventional analgesia injections.
BuyGuía definitiva de los bloqueos de nervios periféricos (BNP) guiados por ecografía y otras técnicas de analgesia intervencionista.
Comprar ahora!Guia definitivo para bloqueios de nervos periféricos (PNBs) guiados por ultrassom e injeções de analgesia intervencionista.
Compre agora!Today’s case was a real challenge,but very interesting. A preterm neonate born at 30 weeks, now 44 days old and weighing just 900g, presents for ileostomy necessitated by intestinal hypomotility. Medical history also indicates coarctation of the aorta with notable difference in arterial pressures between upper and lower extremities, invasive arterial access was established.
Induction was performed with Thiopental 5mg iv and Rocuronium 1mg iv. A 2.5 ETT was used, and maintenance was achieved with Sevoflurane 0.3vol%.
We opted for performing a right sided subcostal TAP block, using 2% Lidocaine 0.2ml, and 0.1% Levobupivacaine 1ml. After US distinction of the liver and overlaying abdominal muscles a 25G needle was placed in-plane and local anesthetic was injected successfully.
For the duration of the surgery (2.5h) the patient maintained hemodynamic and respiratory stability, without the need for opioids, repeat rocuronium, or vasoactive/inotropic support.
This case highlights the importance of regional anesthesia and its effective applicability even in premature LBW neonates. Additionally, opioid free anesthesia enables quicker establishment of spontaneous breathing, better ventilatory mechanics, and ultimately sooner extubation.
What strategies have proven most effective for you when administering a paravertebral block using ultrasound guidance? Share your experiences and insights in the comments below.
A couple of years ago, just for the kicks we published a video on difficult IV access on NYSORA’s YouTube channel. I remember it like it was today: We actually hesitated to release the video because our channel was, at the time, watched mostly by anesthesiologists. Therefore – why “How TO IV” access on NYSORA’s channelYT, when we anesthesiologists are uniquely trained to be the best at IVs? Besides, in an era of ultrasound, who needs traditional techniques for an IV, right?
Wrong! To our surprise, we watched the Difficult IV videos, which hit nearly 2 million views. We then released another one and then another one… Watching the views of IV techniques videos soar, we looked up what was available for education on the topic of IV, and we realized that nearly all books on IV access are mostly theoretical. Therefore, in response to our viewers’ quest for better learning tools on difficult IV access, NYSORA Press just published a hands-on manual packed with real-world advice that textbooks just don’t offer. The manual features over 400 real-life clinical pictures and step-by-step instructions. Plus, we added videos of IV techniques in difficult patients accessible with a quick QR code scan that comes with the Manual. The videos feature a range of little-known tricks I learned during the AIDS pandemic in patients in whom IV access was nearly impossible, such as reverse Esmarch, double tourniquet, triple tourniquet, bending IV catheters, and more.
While ultrasound guidance has been immensely helpful in securing an IV in patients with difficult IVs, nothing beats quick traditional IV access with a pair of experienced hands equipped with tips and tricks featured by pros.
I believe that everyone should see what we created and have one at their clinic for generations to come. https://www.youtube.com/watch?v=w_04O-3Tg5A&ab_channel=NYSORA-Education
Greetings!