Continuous Erector Spinae Plane Block in Paediatric VATS: A Case Series.

Decortication and stripping of infected pleura by video-assisted thoracoscopic surgery or thoracotomy is the treatment of choice in cases of empyema. The stripping is associated with intense post-operative pain. Erector spinae block is an excellent and safe alternative to thoracic epidural block. The experience in paediatric erector spinae plane block is very limited. We present our experience of continuous erector spinae block and one single-shot erector spinae plane block in paediatric video-assisted thoracoscopic surgeries. We had 5 patients aged 2-8 years with right-sided empyema, who were taken up for video-assisted thoracoscopic surgery decortication, and 2 patients aged 1-4 years with congenital diaphragmatic hernia (CDH) for video-assisted thoracoscopic surgery CDH repair. After induction and intubation, using high-frequency straight ultrasound probe, an erector spinae plane catheter was inserted and the local anaesthetic agent was administered. The patients were monitored for signs of effective analgesia. Post-extubation continuous erector spinae plane block was continued for 48 hours using bupivacaine and fentanyl. All patients had excellent postoperative analgesia for more than 48 hours. There were no side effects like motor block, nausea, vomiting, or respiratory depression. Continuous erector spinae plane block provides excellent analgesia in paediatric patients undergoing video-assisted thoracoscopic surgery, causing minimal side effects. Further, a prospective randomized control trial is suggested to establish the efficacy of this block in paediatric video-assisted thoracoscopic surgeries.

The troublesome triumvirate: Temporomandibular joint ankylosis, Pierre Robin syndrome and severe obstructive sleep apnoea.

Managing the paediatric airway with a multitude of issues, poses a unique anaesthetic challenge. Thorough understanding of implications of the associated co-morbidities, meticulous planning to counter the anticipated difficulties with back-up plans and optimal utilisation of modern anaesthesia techniques are the cornerstones in ensuring success in such tricky situations.

A novel use of ultrasound for the extraction of a fractured umbilical arterial catheter.

A 7-day-old 600 grams baby with a post-conceptual age of 29 weeks presented with features suggestive of hollow viscous perforation, and was posted for an emergency laparotomy. In addition, she had a fractured indwelling umbilical arterial catheter which was planned for extraction in the same sitting. Radiological imaging showed that the catheter extended into the stump of the umbilical cord. She underwent exploratory laparotomy and ileal resection anastomosis, following which the stump was explored. However, the catheter could not be identified, and we suspected that it had embolised into the aorta. Using ultrasound guidance, we identified the catheter within the aorta. The aorta was cross-clamped, and the catheter extracted through an aortotomy which was later sutured.

Effect of preoperative education on anxiety in children undergoing day-care surgery.

BACKGROUND AND AIMS: There have been various methods tested for reducing preoperative anxiety in children, but very limited literature is available in the Indian scenario. Our aim was to analyse the effect of an informative video about the anaesthetic technique on preoperative anxiety in children. METHODS: In all, 94 children were randomly allotted into two groups. Children in the study group were shown a peer modelling video depicting induction of general anaesthesia and recovery during the preanaesthetic check (PAC). Patients in the control group were given only verbal information during PAC. Anxiety was assessed on visual analog scale (VAS) for anxiety at two times. Baseline VAS score was recorded during PAC and preoperative VAS score was assessed prior to induction of anaesthesia. The VAS score was represented as median value. Data were analysed using the Mann-Whitney U-test for ordinal data and skewed quantitative data. Categorical data was analysed by using Chi-square test and t-test was applied for quantitative data. The significance threshold of P value was set at <0.05. RESULTS: The median (interquartile range) preoperative VAS score was significantly lower in the study group [1 (0-1.3)] when compared with the control group [5 (3-5)] (P < 0.001). The mean preoperative pulse rate, mean preoperative systolic blood pressure and mean preoperative diastolic blood pressure were significantly lower in the study group when compared with the control group (P < 0.001). CONCLUSION: Multimedia information in the form of a peer modelling video helped reduce preoperative anxiety in children between 7 and 12 years of age.

Comparison of ultrasound-guided transversus abdominis plane (TAP) block versus local infiltration during paediatric laparoscopic surgeries.

BACKGROUND AND AIMS: The purpose of this study was to compare the analgesic efficacy of ultrasonography-guided transversus abdominis plane (TAP) blocks with local port site infiltration in children undergoing laparoscopic surgeries. METHODS: After ethics committee approval and informed consent, 92 children aged 2-12 years posted for laparoscopic surgeries were randomly divided into Group T and Group L. Port site infiltration was performed in Group L by the surgeon at the time of port placement and end of surgery with 0.4mL/kg of 0.25% bupivacaine. Bilateral TAP block was performed in Group T after induction of anaesthesia, under ultrasonographic guidance with a Logiq E7 GE portable ultrasound unit and a linear 5-10 MHz probe. A 22G hypodermic needle and 0.4 mL/kg of 0.25% bupivacaine were used on each side for the TAP block. The parameters recorded were intraoperative haemodynamics, opioid requirements, postoperative pain scores and the need for rescue analgesia in the first 6 h postoperatively. RESULTS: The median (interquartile range) pain scores were significantly lower in the TAP block group than the local infiltration group at 10 min [2 (0-2.5) vs 2 (3-4); P = 0.011], 30 min [1.5 (0-3) vs 3 (2-5);P < 0.001], 1 h [1.5 (0-2) vs 2 (2-3);P < 0.001] and 2 h [2 (0-2) vs 2 (1.5-2.5); P = 0.010] postoperatively. The need for intraoperative opioids and rescue analgesia was also significantly lower in the TAP block group (P < 0.001). CONCLUSION: TAP block is superior to local infiltration for intra- and immediate postoperative analgesia in paediatric laparoscopic surgeries.

[Gastroschisis repair under caudal anesthesia: a series of three cases]. / Correção de gastrosquise sob anestesia caudal: uma série de três casos.

Gastroschisis is a congenital anomaly characterized by a defect in the anterior abdominal wall with protrusion of abdominal viscera. Perioperative mortality is very high in these patients. Traditionally gastroschisis repair has been performed under general anesthesia with endotracheal intubation, requiring postoperative intensive care admission and mechanical ventilation. Caudal block is an attractive alternative to general anesthesia. We present a series of three neonates with gastroschisis, repaired solely under caudal anesthesia.

A randomised comparative study of Miller laryngoscope blade versus Oxiport® Miller laryngoscope blade for neonatal and infant intubations.

BACKGROUND AND AIMS: Neonates and infants are prone to oxygen desaturation during the induction of general anaesthesia. Pharyngeal oxygen insufflation has been shown to delay the onset of desaturation and hypoxaemia during apnoea. We tested the hypothesis that deep laryngeal oxygenation with Oxiport® Miller blade would delay the onset of desaturation compared to laryngoscopy without supplemental oxygen (Miller blade). METHODS: One hundred neonates and infants undergoing general anaesthesia with endotracheal intubation for surgery were recruited and randomly assigned to one of the two groups: Miller or Oxiport group (laryngoscopy performed with Miller or Oxiport® blade, respectively). Primary outcome measure was the lowest oxygen saturation (SpO2) attained during intubation. Secondary outcomes were the incidence of severe desaturation (SpO2< 85%), correlation between SpO2and time to intubation in each group. Pearson's correlation coefficient was used to measure the correlation between time to intubation and desaturation in each group. P < 0.05 was considered statistically significant. RESULTS: Data from 95 patients were available for the final analysis: Miller group (n = 48) and Oxiport group (n = 47). Mean lowest SpO2was 95.9% ± 5.75% in Miller group and 97.55% ± 2.93% in Oxiport group (P = 0.049). Correlation between time to intubation and SpO2was -0.110; P = 0.459 in Miller group and -0.468; P = 0.001 in Oxiport group. Severe desaturation occurred in 12.5% patients in Miller group and none in Oxiport group. CONCLUSION: Apnoeic laryngeal oxygen insufflation with Oxiport® laryngoscope blade decreases the incidence of severe desaturation during neonatal and infant intubations.

Gastroschisis repair under caudal anesthesia: a series of three cases / Correção de gastrosquise sob anestesia caudal: uma série de três casos

Abstract Gastroschisis is a congenital anomaly characterized by a defect in the anterior abdominal wall with protrusion of abdominal viscera. Perioperative mortality is very high in these patients. Traditionally gastroschisis repair has been performed under general anesthesia with endotracheal intubation, requiring postoperative intensive care admission and mechanical ventilation. Caudalblock is an attractive alternative to general anesthesia. We present a series of three neonates with gastroschisis, repaired solely under caudal anesthesia.

Resumo Gastrosquise é uma anomalia congênita caracterizada por um defeito da parede abdominal anterior com protrusão de vísceras abdominais. A mortalidade no período perioperatório é muito elevada nesses pacientes. Tradicionalmente, a correc¸ão de gastrosquise tem sido feita sob anestesia geral com intubac¸ão orotraqueal, o que requer internac¸ão em unidade de terapia intensiva e ventilac¸ão mecânica no pós-operatório. O bloqueio caudal é uma opc¸ão atraente à anestesia geral. Apresentamos uma série de três casos de recém-nascidos com gastrosquise corrigida unicamente sob anestesia caudal.