Life threatening post-operative apnea is a known complication of general anesthesia in premature infants. Neuraxial anesthesia has been associated with reduced risk of post-operative apnea. We report two cases, presen...Life threatening post-operative apnea is a known complication of general anesthesia in premature infants. Neuraxial anesthesia has been associated with reduced risk of post-operative apnea. We report two cases, presenting for bilateral inguinal hernia repair, where we used a caudal/epidural catheter for the neuraxial block combined with dexmedetomidine for sedation in preterm infants at high risk for postoperative respiratory complications. Dexmedetomidine assisted in providing both favorable surgical conditions via its well proven sedative effects without respiratory comprised and decreased the discomfort and stress to the child during placement of the epidural catheter and the neuraxial anesthesia provided excellent analgesia and surgical conditions.展开更多
Transverse abdominis Plane blocks (TAP) provide effective postoperative analgesia following surgical incisions of the lower and middle abdominal wall, including those associated with cesarean section. This study inves...Transverse abdominis Plane blocks (TAP) provide effective postoperative analgesia following surgical incisions of the lower and middle abdominal wall, including those associated with cesarean section. This study investigated the efficacy of liposomal bupivacaine diluted with 0.25% bupivacaine administered in bilateral TAP blocks for post-operative analgesia after Ce-sarean section preformed under neuraxial anesthesia. The patients who received the TAP blocks with liposomal bupivacaine had noticeably low pain scores of 1.0 ± 1.4, 1.4 ± 2.1, 1.7 ± 1.9, 1.9 ± 3.3 and 1.9 ± 2.3 at 6, 12, 24, 48 and 72 hours respectively. Only 3 patients used oxycodone (5 mg)/acetaminophen (325 mg) postoperative. One patient took two tables of oxycodone (5 mg)/acetamino-phen (325 mg) after 24 hours, a second patient used oxycodone (5 mg)/aceta-minophen (325 mg) after 72 hours and the third patient was transferred to the intensive care unit (ICU) since she developed postpartum cardiac complications, and was give oxycodone (5 mg)/acetaminophen (325 mg) despite having a 0 pain score. These results suggest that patients treated bilateral TAP blocks with a mixture of liposomal and regular bupivacaine will have low pain scores, high patient satisfaction and reduce the use of postoperative narcotics.展开更多
NTI is included in the ASA difficult airway algorithm. However, even with the assistance of a Magill forceps, it might be difficult to place the endotracheal (ET) tube in the trachea because of the angle at which the ...NTI is included in the ASA difficult airway algorithm. However, even with the assistance of a Magill forceps, it might be difficult to place the endotracheal (ET) tube in the trachea because of the angle at which the tube approaches the glottis opening and the inability to bend the tube secondary to the ET-tubes compliance. By placing a soft suction catheter thru the ET-tube, and placing the suction catheter into the trachea first and sliding the tube over the catheter this problem can be avoided. In addition, grabbing the suction catheter rather than the ET-tube, also prevents the rupturing of the ET-tube balloon by the Magill forceps.展开更多
文摘Life threatening post-operative apnea is a known complication of general anesthesia in premature infants. Neuraxial anesthesia has been associated with reduced risk of post-operative apnea. We report two cases, presenting for bilateral inguinal hernia repair, where we used a caudal/epidural catheter for the neuraxial block combined with dexmedetomidine for sedation in preterm infants at high risk for postoperative respiratory complications. Dexmedetomidine assisted in providing both favorable surgical conditions via its well proven sedative effects without respiratory comprised and decreased the discomfort and stress to the child during placement of the epidural catheter and the neuraxial anesthesia provided excellent analgesia and surgical conditions.
文摘Transverse abdominis Plane blocks (TAP) provide effective postoperative analgesia following surgical incisions of the lower and middle abdominal wall, including those associated with cesarean section. This study investigated the efficacy of liposomal bupivacaine diluted with 0.25% bupivacaine administered in bilateral TAP blocks for post-operative analgesia after Ce-sarean section preformed under neuraxial anesthesia. The patients who received the TAP blocks with liposomal bupivacaine had noticeably low pain scores of 1.0 ± 1.4, 1.4 ± 2.1, 1.7 ± 1.9, 1.9 ± 3.3 and 1.9 ± 2.3 at 6, 12, 24, 48 and 72 hours respectively. Only 3 patients used oxycodone (5 mg)/acetaminophen (325 mg) postoperative. One patient took two tables of oxycodone (5 mg)/acetamino-phen (325 mg) after 24 hours, a second patient used oxycodone (5 mg)/aceta-minophen (325 mg) after 72 hours and the third patient was transferred to the intensive care unit (ICU) since she developed postpartum cardiac complications, and was give oxycodone (5 mg)/acetaminophen (325 mg) despite having a 0 pain score. These results suggest that patients treated bilateral TAP blocks with a mixture of liposomal and regular bupivacaine will have low pain scores, high patient satisfaction and reduce the use of postoperative narcotics.
文摘NTI is included in the ASA difficult airway algorithm. However, even with the assistance of a Magill forceps, it might be difficult to place the endotracheal (ET) tube in the trachea because of the angle at which the tube approaches the glottis opening and the inability to bend the tube secondary to the ET-tubes compliance. By placing a soft suction catheter thru the ET-tube, and placing the suction catheter into the trachea first and sliding the tube over the catheter this problem can be avoided. In addition, grabbing the suction catheter rather than the ET-tube, also prevents the rupturing of the ET-tube balloon by the Magill forceps.
