Functional Abdominal Pain in a Pediatric Patient After Resolution of Acute Pancreatitis: A Case Report.

Children with acute pancreatitis may develop chronic abdominal wall pain after resolution of clinical, laboratory, and radiographic signs of disease. We describe a 13-year-old boy who underwent an unrevealing, complex diagnostic evaluation for persistent abdominal pain after resolution of acute pancreatitis. His pain required an extended leave of absence from school and nasogastric tube feeds. After receiving abdominal nerve blocks and trigger point injections, he experienced near-complete resolution of pain with normalization of eating habits and daily function. Pain practitioners should think critically about the signs and symptoms of visceral versus somatic pain and try newer diagnostic interventions that may be therapeutic.

Anterior Cutaneous Nerve Entrapment Syndrome in a Pediatric Patient Previously Diagnosed With Functional Abdominal Pain: A Case Report.

Chronic abdominal pain is common in children and adolescents but challenging to diagnose, because practitioners may be concerned about missing serious occult disease. Abdominal wall pain is an often ignored etiology for chronic abdominal pain. Anterior cutaneous nerve entrapment syndrome causes abdominal wall pain but is frequently overlooked. Correctly diagnosing patients with anterior cutaneous nerve entrapment syndrome is important because nerve block interventions are highly successful in the remittance of pain. Here, we present the case of a pediatric patient who received a diagnosis of functional abdominal pain but experienced pain remittance after receiving a trigger-point injection and transverse abdominis plane block.

Ultrasound Guided In-Plane Penile Nerve Block for Circumcision: A New, Modified Technique Suggests Lower Anesthetic Volume and Narcotic Use.

Context: Circumcision is one of the most common surgical procedures in pediatric males. Anesthesia is often the classic dorsal penile nerve block (DPNB), which is based on landmark identification and tactile feel of tissue resistance during needle advancement. However, this technique is associated with technical failures and vascular complications. Objective: We used an ultrasound-guided in-plane technique to avoid injury of penile vascular and neural tissues during DPNB. The aims of this retrospective study were to compare the success rate and efficacy of these two penile block techniques. Methods: Male pediatric patients undergoing circumcision received general anesthesia before the penis and surrounding area were prepared with 0.5% chlorhexidine in 70% alcohol. Sixteen patients underwent classic DPNB, and 16 underwent the modified ultrasound-guided inplane technique. The ultrasound machine was adjusted to the musculoskeletal setting, and a linear ultrasound probe with a frequency range of 5 to 10 MHz was placed transversely along the base of the penis, which received gentle traction. Results: Though not statistically significant, patients who underwent the classic DPNB were approximately 1.8 times more likely to require rescue analgesia and approximately 2 times more likely to have a complication than those in the ultrasound-guided group. Results also showed lower volume requirements for local anesthetic and intraoperative narcotics, longer time until rescue analgesic, and lower incidence of vomiting in the ultrasound-guided group than in the landmark-guided group. Conclusions: The ultrasound-guided DPNB technique appears to offer advantages over classic DPNB and warrants a prospective controlled trial to confirm these findings.

Non-Trigger Anesthesia Management in a Patient With Leigh's Syndrome Presenting for Dental Rehabilitation.

INTRODUCTION: Usually presenting in infancy, Leigh's syndrome is an inherited condition often manifesting with seizures, ataxia, developmental delay, and dysarthria. The disorder is rare, appearing in approximately 1 in 40,000 live births. Consequently, providing these patients with a suitable plan by which to administer anesthetics remains problematic. CASE PRESENTATION: We report a male patient with Leigh's syndrome and a family history suggestive of unknown hypotonia and malignant hyperthermia presenting for dental rehabilitation. CONCLUSIONS: Dexmedetomidine with remifentanil can be used with no complication in this senerio.

A SHARED OPERATIVE FIELD AND THE DISPUTE--IS THERE A WAY OUT?

Submental intubation is an alternative to tracheostomy in patients requiring surgical access to both oral and nasal cavities. It is relatively safe, simple, and low morbidity procedure and requires only basic surgical equipment to perform. We successfully performed a submental intubation in a young patient with maxillofacial hypoplasia undergoing Le Fort I maxillary advancement without any intra- and post-operative complications.