Saudi journal of anaesthesia
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Case Reports
A novel out plane technique of midpoint transverse process to pleura block in breast surgery: A case report.
Regional anesthetic techniques have gradually revolutionized the perioperative analgesia in breast surgeries. Recently, midpoint transverse process to pleura block has been described and found to provide excellent opioid-sparing analgesia. We performed the block in a novel out-of-plane technique to decrease the patient-needle interaction time and at the same time achieving good analgesia. The immediate postoperative Numeric Pain Rating Scale score was 0/10 both at rest and on movement, and patient reported a score of 5/10 after 12 h, which get subsided with single dose of nonopioid analgesic.
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Anteroposterior (AP) diameter of internal jugular vein (IJV) and its relative position with carotid artery (CA) varies in the triangle formed by two heads of sternocleidomastoid muscle, which is the site of insertion of needle for IJV cannulation. This study assessed the maximum AP diameter of the IJV in supine and Trendelenburg positions and during Valsalva maneuver (supine position) at the apex, middle, and base of the triangle and to study the relationship of the IJV with the CA. ⋯ Trendelenburg and Valsalva increase diameter of IJV on both right and left side. Diameter of IJV is greater at the base of the triangle. IJV is lateral or anterolateral when the head is either neutral or turned 30° to the contralateral side.
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Rapid sequence induction and intubation (RSII) with application of "Cricoid pressure" and avoidance of "facemask ventilation" (FMV) is believed to minimize the risk of pulmonary aspiration of gastric contents during general anesthesia. However, some patients may be at risk of developing hypoxemia and may benefit from FMV during RSII. The purpose of this study was to assess the effectiveness of "cricoid pressure" in preventing gastric insufflation during FMV using gastric ultrasonography. ⋯ Cricoid pressure is effective in preventing gastric insufflation during FMV at P aw less than 20 cmH2O. Observation of comet tail artifacts in gastric antrum along with measurement of change in antral CSA on ultrasound examination is a feasible and reliable method to detect gastric insufflation.
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The concept of fast-track or ambulatory surgery appeared to facilitate early recovery and discharge from the hospital and early resumption of normal daily activities after elective surgical procedures as well to reduce the health-care costs. Multimodal/balanced analgesia is an increasingly popular approach for this. The use of conventional modalities including central neuraxial blockade and opioids cannot be extended to patients undergoing fast-track surgery. ⋯ The use of perineural, incisional, and intra-articular catheters and local anesthetic administration through elastomeric and electronic pumps is promising approach for effective pain management at home. The key to successful pain management of such procedures requires individually tailored education to patients or caregivers including information on treatment options for postoperative pain and use of multimodal analgesia. This review provides an overview of the current armamentarium of drugs and modalities available for effective management of patients undergoing day care surgeries and sheds light on newer modalities available.
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Thoracolumbar interfascial plane (TLIP) block involves injection of local anesthetics between multifidus and longissimus muscles at the 3rd lumbar vertebral level assuming that it can block the dorsal rami of thoracolumbar nerves. ⋯ TLIP block is an effective and safe method for postoperative analgesia after lumbar discectomy.