Anaesthesia reports
-
Anaesthesia reports · Jan 2021
Case ReportsPericapsular nerve group (PENG) block for hip fracture in the emergency department: a case series.
Guidelines for the management of hip fractures recommend timely identification, analgesia and optimisation, in order to facilitate prompt surgical repair. In achieving these aims, multidisciplinary care is essential. In this case series, we present five patients who received bedside pericapsular nerve group (PENG) blocks by emergency physicians in collaboration with the anaesthesia team for pain management following hip fracture. ⋯ All patients reported a clinically important reduction in pain scores. Patients with hip fracture are often medically complex, and while early surgery is not always possible, pain management should be addressed from an early point in their hospital admission. Multidisciplinary input into peri-operative pathways can enhance the provision of analgesia in the emergency department, by allowing anaesthetists and emergency physicians to work together for the benefit of these often-frail patients.
-
Anaesthesia reports · Jan 2021
Case ReportsTransnasal sphenopalatine ganglion block for post-dural puncture headache and associated tinnitus.
Lumbar epidurals are frequently inserted for women in labour as they provide excellent analgesia. One of the more common procedural complications is post-dural puncture headache which can be associated with auditory symptoms such as hearing loss and tinnitus and can be treated with an epidural blood patch. ⋯ We report a case where postural neck pain and tinnitus from an accidental dural puncture during lumbar epidural insertion for labour analgesia was treated successfully with a sphenopalatine ganglion block. Further, we explore the literature on the cause of tinnitus in post-dural puncture headache and the possible mechanism by which a sphenopalatine ganglion block relieves both post-dural puncture headache and the associated tinnitus.
-
Anaesthesia reports · Jul 2020
Case ReportsThe erector spinae plane block for obstetric analgesia: a case series of a novel technique.
The management of pain during labour is central to obstetric anaesthetic practice. While epidural analgesia has long been considered the gold standard for intrapartum analgesia, neuraxial techniques can be challenging to perform, are contra-indicated in circumstances such as coagulopathy. The erector spinae plane block is an interfascial plane block that has generated interest because of a needle tip position away from the neuraxis. ⋯ All experienced a reduction in pain, ranging from 3 to 6 points measured on a 10-point numerical rating scale. The duration of analgesia ranged from 60 to 120 min. In this report, we discuss potential for using the erector spinae plane block in the management of obstetric pain.
-
Anaesthesia reports · Jul 2020
Awake proning of a 2-year-old extubated child with severe COVID-19 pneumonitis.
With the progress of the coronavirus disease 2019 (COVID-19) pandemic, available data suggest lower complications and disease severity in children and young patients. Despite most paediatric cases being mild in severity, some children require intensive care and mechanical ventilation due to the development of paediatric severe acute respiratory distress. The use of adjuvant therapies in severely ill paediatric patients has not been reported widely in the literature. ⋯ Awake prone position was employed as a rescue therapy for the management of post-extubation hypoxia, resulting in a dramatic improvement in oxygenation. Prone positioning in the paediatric patient may improve oxygenation and can be a useful adjuvant for respiratory therapy either before, during or after invasive mechanical ventilation. Awake prone position may be considered as an option for the management of COVID-19 in paediatric patients, but it requires patient cooperation.
-
Anaesthesia reports · Jul 2020
Case ReportsAwake tracheostomy in a child with respiratory distress due to retropharyngeal abscess.
Awake tracheostomy in a child with respiratory distress is an emergency life-saving procedure when risk of airway loss after induction of general anaesthesia is greater due to difficult anatomy. A 10-year-old boy presented three days after removal of a foreign body in the throat under general anaesthesia. Over the subsequent days, the patient had a progressively increasing visible swelling in the neck, stridor and respiratory distress. ⋯ Topicalisation was achieved by administering glycopyrrolate, nebulisation with lidocaine 4%, and the skin was prepared with lidocaine 2% with 1:200,000 adrenaline. After the awake tracheostomy was successfully performed, general anaesthesia was induced and the retropharyngeal abscess was drained. Effective communication and building rapport is essential for safe awake tracheostomy in a child with respiratory distress when impending airway loss may occur at any moment.