Erector spinae plane block for thoracoscopy in a paediatric patient.

We present the case of a 9 year old patient with a clinical history of epilepsy and various hospitalizations due to aspirative broncopneumonia among others, who was admitted to our hospital because of septic shock secondary to pneumonia of the lower left lobule associated with a parapneumonic pleural effusion and a complicated clinical course. During her stay, the patient undergoes surgical debridement using video assisted thoracoscopic surgery (VATS) under general anaesthesia and the hydropneumothorax is drained. For the procedure an ecoguided erector spinae plane block is performed and combined with general anaesthesia. On one hand this block permitted reduction of perioperative opioid administration and improved the patient's respiration, on the other hand it permitted avoiding the use of drugs, which can lower seizure threshold and increase the risk of convulsions. This case illustrates the importance of locoregional anaesthesia, a technique on the rise in the field of paediatric anaesthesia.

[Comparison of methodologies to reach 'dry weight']. / Metodiche a confronto per il raggiungimento del peso secco.

BACKGROUND: In clinical practice it is very difficult to determine a final weight that is the expression of normovolemia. In hemodialysis (HD), 'dry weight' is conventionally defined as the weight reached by the patient at the end of that hemodialytic session when the maximum quantity of fluids is removed without inducing any symptomatology. The determination of dry weight has been based on the application of clinical criteria. The use of artificial kidneys with blood volume (BV) sensors has allowed the determination of dry weight through the interpretation of changes in the intradialytic BV curve. Conventional bioimpedance analysis (BIA), or better, the vectorial BIA (BIVA) is a new method for determining dry weight. This study evaluated the use of the above-mentioned method for the proper governing of dry weight. PATIENTS AND METHODS: Twenty HD patients were observed for 4 weeks. In the 1st week, the clinical symptomatology of every patient was monitored during both HD sessions and interdialytic periods. During the 2nd week, intradialytic changes in the BV of each patient were observed on artificial kidneys. In the 3rd week, a cardiologist monitored patients before and after hemodialytic treatments. In the 4th week, the body composition of each patient was analyzed through bioelectrical bioimpedance. RESULTS: Patients, who had clinically shown symptoms of hyperhydration, to the contrary at BIA were dehydrated. Conversely, patients who had dehydration symptoms presented signs of hyperhydration at BIA. CONCLUSIONS: BIVA is the diagnostic instrument that more accurately demonstrates the hydration state of hemodialytic patients. It contributes in defining dry weight more efficiently.

Bloqueo del plano del músculo erector de la espina para toracoscopia en el paciente pediátrico / Erector spinae plane block for thoracoscopy in a paediatric patient

Presentamos el caso de una paciente de nueve años, con antecedentes de epilepsia y múltiples ingresos por bronconeumonía aspirativa, entre otros, que ingresa en nuestro centro por shock séptico secundario a una neumonía en el lóbulo inferior izquierdo y derrame pleural paraneumónico, con mala evolución. Durante su ingreso, se interviene bajo anestesia combinada para desbridamiento quirúrgico por videotoracoscopia y colocación de drenaje en hidroneuomotórax izquierdo complicado. Para la intervención, se realiza un bloqueo del plano del músculo erector de la espina ecoguiado, junto con una anestesia general. Este bloqueo, permitió, por un lado, disminuir la dosis de opioides postoperatorios, mejorando la ventilación de la paciente y, por otro lado, evitó el uso de diversos fármacos que podían disminuir el umbral epileptógeno y aumentar el riesgo de sufrir una convulsión. Este caso demuestra la importancia de la anestesia locorregional en el paciente pediátrico, un arma anestésica en auge.(AU)

We present the case of a 9 year old patient with a clinical history of epilepsy and various hospitalizations due to aspirative broncopneumonia among others, who was admitted to our hospital because of septic shock secondary to pneumonia of the lower left lobule associated with a parapneumonic pleural effusion and a complicated clinical course. During her stay, the patient undergoes surgical debridement using video assisted thoracoscopic surgery (VATS) under general anaesthesia and the hydropneumothorax is drained. For the procedure an ecoguided erector spinae plane block is performed and combined with general anaesthesia. On one hand this block permitted reduction of perioperative opioid administration and improved the patient's respiration, on the other hand it permitted avoiding the use of drugs, which can lower seizure threshold and increase the risk of convulsions. This case illustrates the importance of locoregional anaesthesia, a technique on the rise in the field of paediatric anaesthesia.(AU)