Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Two cases with rib injuries are reported where intercostal nerve block without rib palpation was safely and successfully performed on six separate occasions using a Doppler blood-flow detector ultrasound stethoscope. A third case studied by a radiologist using a pulsed Doppler flowmeter, determined the source of the Doppler signals as originating from the intercostal artery. The significance of these findings is discussed.
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Patients with the mucopolysaccharidoses show widespread, progressive involvement and derangement of many organs and tissues which can have profound implications for the anaesthetist. These disorders are uncommon and few anaesthetists care for these patients on a regular basis although individual patients often undergo multiple anaesthetics for procedures intended to improve their quality of life. There is a relative paucity of literature dealing with clinical anaesthetic experience with these patients. ⋯ The establishment and maintenance of an adequate airway represents the most commonly encountered anaesthetic-related problem in these patients. We found an overall incidence of airway-related problems of 26 per cent. In patients with the Hurler or Hunter syndromes the incidence of airway-related problems was 53 per cent.