Anaesthesia reports
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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.
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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.
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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.
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Anaesthesia reports · Jul 2020
Case ReportsManagement of tracheostomy-related tracheomegaly in a patient with COVID-19 pneumonitis.
Acquired tracheomegaly is a rare condition associated with pulmonary fibrosis, connective tissue disease and the use of cuffed tracheal tubes. We describe the urgent tracheal re-intubation and subsequent tracheal repair of a previously well 58-year-old man who developed tracheostomy-related tracheomegaly during prolonged mechanical ventilation for coronavirus disease 2019 pneumonitis. Urgent tracheal re-intubation was required due to a persistent cuff leak, pneumomediastinum and malposition of the tracheostomy tube. ⋯ We present a stepwise approach to tracheal re-intubation past a large tracheal dilatation, including the use of an Aintree catheter inserted via the existing tracheal stoma for oxygenation or tracheal re-intubation if required. Computed tomography imaging was valuable in characterising the defect and developing a safe airway management strategy before starting the procedure. This report emphasises the role of planning, teamwork and the development of an appropriate airway strategy in the safe management of complex cases.