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1.  Review Articles
Role of Ultrasound in Airway Assessment and Management
Payal Kajekar, Cyprian Mendonca, Vandana Gaur
[Year:2010] [Month:May-August] [Volume:1 ] [Number:2] [Pages:50] [Pages No:97-100]
Full Text HTML | Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10014-1015 | FREE

ABSTRACT

Ultrasound has gained widespread popularity in several aspects of perioperative and intensive care management. There is now growing evidence of it being a useful tool in the assessment and management of potentially difficult airway. With advances in technology and greater understanding of sonographic clinical anatomy, a greater insight into its uses has been gained. This article gives an overview of the possible clinical applications of ultrasound in day to day airway management in anaesthesia and intensive care.
Keywords: Airway, Ultrasound, Intubation, Tracheostomy.

 
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2.  Original Articles
Posterior Transversus Abdominis Plane (TAP) Catheters in Lower Abdominal Surgery
Niraj G, Aditi Kelkar, Anil Darbar, Elaine Hart
[Year:2010] [Month:May-August] [Volume:1 ] [Number:2] [Pages:50] [Pages No:79-81]
Full Text HTML | Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10014-1011 | FREE

ABSTRACT

Objective: Single shot transversus abdominis plane (TAP) blocks have gained popularity as an analgesic tool after abdominal surgery. We present two cases where catheters were placed in the posterior transversus abdominis plane for providing continuous analgesia after lower abdominal surgery. Patient one was admitted for laparoscopy assisted left hemicolectomy and bilateral posterior catheters under ultrasound guidance provided excellent analgesia over 72 hours. Patient two had laparoscopy assisted right hemicolectomy. He was given continuous TAP bilateral block by posterior catheters that provided adequate analgesia for 72 hours. Posterior TAP catheters placed posteriorly was effective for postoperative pain management in patient.
Keywords: Regional anaesthesia, Ultrasound guided TAP block, Continuous TAP catheter analgesia.

 
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3.  Pictorial Review
Comprehensive Transoesophageal Echocardiography Examination
Ravi Hebballi, Ann Ngui
[Year:2010] [Month:May-August] [Volume:1 ] [Number:2] [Pages:50] [Pages No:89-96]
Full Text HTML | Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10014-1014 | FREE

ABSTRACT

Transoesophageal echocardiography (TEE) use has become an integral part in the care of cardiac surgical patients. This is evolving to be used in other subspecialties. The purpose of this article is to introduce the novice echocardiographer to a stepwise approach in image orientation and acquisition.
Keywords: Transoesophageal echocardiography, Comprehensive examination.

 
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4.  Review Articles
Paediatric Ultrasound-Guided Regional Anaesthesia: Peripheral Techniques
Steve Roberts, Helen Neary
[Year:2010] [Month:May-August] [Volume:1 ] [Number:2] [Pages:50] [Pages No:101-107]
Full Text HTML | Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10014-1016 | FREE

ABSTRACT

The accessibility of portable ultrasound machines has resulted in a rise in popularity of peripheral nerve block techniques within paediatric anaesthesia. This use of ultrasound within regional anaesthesia will continue to expand and be accompanied by an expectation of familiarity and competence with these techniques. This review details the techniques reported for performing the main trunk, upper and lower limb blocks with accompanying images to aid the reader.
Keywords: Children, Nerve block, Ultrasound, Brachial plexus, Lower limb block, Abdominal block, Local anaesthetic technique.

 
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5.  Comments and Commentaries
Ultrasound-Guided Neuraxial Blocks: Recent Developments
Pawan Kumar, Satya Francis
[Year:2010] [Month:May-August] [Volume:1 ] [Number:2] [Pages:50] [Pages No:109-111]
Full Text HTML | Full Text PDF | DOI : 10.5005/jp-journals-10014-1017 | FREE

 
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6.  Case Reports
Percutaneous Endovascular Retrieval of Intravenous Catheter Fragment
Rajiv Lakhotia, Shivprakash, Vijay Sai, Shio Priye, Durgaprasad Reddy, Amit Kiran
[Year:2010] [Month:May-August] [Volume:1 ] [Number:2] [Pages:50] [Pages No:127-129]
Full Text HTML | Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10014-1020 | FREE

ABSTRACT

Central venous access is an increasingly frequent procedure and intravenous catheter fractures and fragments embolisation, although being rare, corresponds to common intravascular foreign bodies with potential catastrophes especially in patients with congenital heart defects. A case report is presented with a fracture migration of venous catheter, its endovascular retrieval and suggestions to reduce the incidence of this complication.
Keywords: Vascular access catheter, Foreign bodies, Fracture, Embolism.

 
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7.  Case Reports
Ultrasound-Guided Thoracic Paravertebral Block: The Direction of Local Anaesthetic Spread
Abdelazeem El-Dawlatly, Wasim Hajjar, Ahmed Abodonya, Reem Alsafar
[Year:2010] [Month:May-August] [Volume:1 ] [Number:2] [Pages:50] [Pages No:123-125]
Full Text HTML | Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10014-1019 | FREE

ABSTRACT

Chest wall trauma following motor vehicle accident can lead to prolonged ventilator support with subsequent pulmonary complications and delayed weaning off the mechanical ventilation. Patients with multiple rib fractures usually present with severe pain which impairs their respiratory mechanics. There are different methods of pain relief for patients with rib fractures. In this report, we present a case of rib fractures where pain was treated successfully with continuous local anaesthetic infusion using ultrasound guided thoracic paravertebral block (TPVB). A 28-year-old male was brought to Accident and Emergency department. The patient was resuscitated and as he was irritable and presented with poor GCS (Glasgow coma scale) score, so the trachea was intubated and he was put on mechanical ventilator. Following failed multiple attempts to wean off from the ventilator mainly due to patient getting restless coupled with desaturations at each attempt the insertion of TPVB catheter with continuous bupivacaine infusion to facilitate weaning off ventilator process was planned. Under ultrasound (US) guidance, a catheter was placed at D5-6 vertebrae level. It was noticed that most of the local anaesthetics (mixed with Omnipaque dye) spreaded towards caudal than the cephalad direction. Continuous infusion of bupivacaine 0.25%, 4-6 ml/hour was started to provide pain relief. The trachea was extubated on 5th post-admission day in SICU. In conclusion, continuous local anaesthetic infusion via US guided TPVB catheter technique proved very effective in pain relief following multiple rib fractures. Also in contrary to other reports, we have noticed more caudal than cephalad spread of the TPVB injectate.
Keywords: Ultrasound paravertebral block, Rib fractures, Pain relief.

 
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8.  Special Article
Use of Non-invasive Imaging in Gastrointestinal Critical Care
Vishwanath Sathyanarayanan, Ashwin M Polnaya
[Year:2010] [Month:May-August] [Volume:1 ] [Number:2] [Pages:50] [Pages No:113-121]
Full Text HTML | Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10014-1018 | FREE

ABSTRACT

Gastrointestinal emergencies are quite common and life-threatening. The role of non-invasive imaging is of paramount importance in clinching an early diagnosis. The biggest challenge is to decide on the best imaging modality which would give maximum yield in a given clinical scenario.
Conventional radiography has been replaced by ultrasound (US), computed tomography (CT), sometimes magnetic resonance imaging (MRI) and occasionally nuclear scintigraphy in the evaluation of most critical care conditions. Abdomen quadrant based approach for deciding the imaging modality of choice has been very well-accepted.
This article focuses on the various imaging options, their merits and demerits and followed by current concepts of imaging in various gastrointestinal (GI) emergencies, GI trauma and perioperative situations.
Detailed radiological findings in individual conditions are outside the scope of this article. However, certain important imaging findings, which have to be looked for, have been outlined where necessary.
Keywords: Gastrointestinal, Non-invasive imaging, Critical care, MDCT, Ultrasound, MRI.

 
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9.  Editorial
TRAINING AND EDUCATION IN ULTRASOUND-GUIDED REGIONAL ANAESTHESIA
Michael J Jones
[Year:2010] [Month:May-August] [Volume:1 ] [Number:2] [Pages:50] [Pages No:v-vi]
Full Text PDF | FREE

 
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10.  Original Articles
The Development and Use of a Phantom to Aid Training in Depth Measurement with Ultrasound for Epidural Procedures
A Morris, P Sharpe, R Leighton
[Year:2010] [Month:May-August] [Volume:1 ] [Number:2] [Pages:50] [Pages No:83-85]
Full Text HTML | Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10014-1012 | FREE

ABSTRACT

Background: Within obstetric anaesthesia, the use of ultrasound to measure the depth of epidural space is increasing. There are, however, clinical governance issues surrounding its use and teaching of ultrasound skills.
Method: We have developed a model for use in training anaesthetists in the skill of measuring depth using ultrasound.
Results: The mean ultrasound measured depths ranged between 0.36 and 5.86 cm, which correlates well with the direct depth measurements. Bland-Altman analysis was carried out. The range of differences between ruler measured and ultrasound measured depths was – 0.31 to 1.87 cm.
Conclusions: The results gained from depth measurements on the model were comparable to both our local clinical data and published literature. The model is easy to produce and a useful training aid for ultrasound skills, in particular measurement of depth.
Keywords: Ultrasound, Epidural, Epidural space depth measurement.

 
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11.  Clinical Study
A Service Evaluation of Ultrasound Assessment of the Epidural Space: A Retrospective Audit
P Sharpe
[Year:2010] [Month:May-August] [Volume:1 ] [Number:2] [Pages:50] [Pages No:87-88]
Full Text HTML | Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10014-1013 | FREE

ABSTRACT

Interest in the ultrasound assessment of the epidural space prior to regional anaesthesia is becoming extremely popular. The published data to date comes mainly from single operators performing scans in clinical trial settings. The clinical data from a busy teaching unit has been examined to see how it compares with standards in the published literature. 114 scans were performed by a total of 6 consultant anaesthetists as part of their normal clinical work. The majority of scans were performed for either maternal obesity (72%) or training (18%). The difference between the ultrasound assessed depth and needle depth was 0.25 +/– 0.7 (mean +/– sd) cm. The correlation coefficient (r) for these two variables was 0.86. This data suggests that the ultrasound reliably measure depth of epidural space in a routine clinical setting.
Keywords: Ultrasound, Epidural space, Epidural block, Obesity, Parturients.

 
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