A&A practice
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Harvesting of iliac crest bone graft for alveolar cleft repair in children is associated with significant postoperative pain. Transversalis fascia plane block has emerged as an alternative to local wound infiltration for iliac crest bone graft harvesting and has been used with good effect in adult patients requiring bone graft for orthopedic surgery. Little is known about the use of the transversalis fascia plane block in children or the feasibility of placing a continuous infusion catheter. In this report, we describe our experience using a continuous transversalis fascia plane infusion catheter in the management of a 6-year-old girl undergoing alveolar cleft repair with iliac crest bone graft.
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Ex utero intrapartum treatment procedures are mainly indicated to secure the airways of fetuses featuring a risk of obstruction at birth while ensuring uteroplacental circulation. This report documents a successful intubation case with a C-MAC video laryngoscope during an ex utero intrapartum treatment procedure in a newborn featuring an infiltrative neck mass. Despite technical challenges faced in this procedure, the C-MAC video laryngoscope allowed an optimal view of airway structures. This novel approach, where laryngoscopy relies on the usage of C-MAC to optimize intubation conditions, may lead to increased chances of success in this particular scenario.
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Complex abdominal wall hernia repairs can have high failure rates. Many surgical techniques have been proposed with variable success. ⋯ Toxin was administered into the 3 abdominal wall muscle layers under ultrasound guidance at multiple sites 2 weeks before surgery. The resulting flaccid paralysis of the abdominal musculature facilitated a successful primary surgical closure with no postoperative complications.
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The Accreditation Council for Graduate Medical Education (ACGME) is moving toward competency-based medical education. This educational framework requires the description of educational outcomes based on the knowledge, skills, and behaviors expected of competent trainees. An assessment program is essential to provide formative feedback to trainees as they progress to competency in each outcome. This article describes the development of 2 model curricula for airway management training (basic and advanced) using a competency-based framework.
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Placement of a pulmonary artery catheter (PAC) is associated with complications such as entrapment or knotting. PAC entrapment in the heart, vena cava, or pulmonary artery is serious, potentially life-threatening, particularly if they are unrecognized. ⋯ Surgical exploration requiring cardiopulmonary bypass revealed that the PAC had passed through the tricuspid valve orifice and knotted itself around the anterior leaflet chordal structure. The catheter was unknotted, with the patient subsequently recovering without long-term sequelae.