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Pediatric Atlas of Ultrasound and Nerve Stimulation-Guided Regional Anesthesia
Enhanced by the PocketEDU e-Learning system: Simply the best Atlas on ultrasound and nerve stimulation regional anesthesia and nerve block techniques in children. Sequential, highly illustrated format with step-by-step guidance. Includes clinical cases, pearls, and troubleshooting tips. Read or Listen.
Material from: Ban C.H. Tsui, Santhanam Suresh, Pediatric Atlas of Ultrasound and Nerve Stimulation-Guided Regional Anesthesia, published in 2020 by Springer reproduced with permission of SNCSC.
Author: Ban C.H. Tsui, Santhanam Suresh
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E-book content
Differences Between the Pediatric and Adult Populations That Affect Regional Blocks
Block Area and Monitoring
General Equipment
Emergency Drugs and Resuscitating Equipment
Resuscitation Equipment
Resuscitation Drugs (Intravenous Doses)
Monitoring
Nerve Block and Catheter Equipment
Needles - Needle Tip Design
Needle Lengths
Needle Gauges
Other Needle Designs
Peripheral Nerve Catheters
Neuraxial Nerve Blocks/Catheters
Additional Equipment
Suggested Reading
Nerve Stimulation Procedure
Electrophysiology
Characteristics of Electrical Impulses
Current Intensity and Duration
Rate of Current Change
Polarity of Stimulating and Returning Electrodes
Distance-Current Relationship
Current Density of Electrodes and Injectates
Electrodes
Injectates
Electrical Impedance
Electrical Epidural Stimulation
Test Equipment and Procedure
Mechanisms of the Epidural Stimulation Test
Stimulating Epidural Catheter Requirements
Effective Conduction of Electrical Current
Advancement of the Catheter
Considerations for Test Performance and Interpretation
Limitations of Epidural Stimulation
Useful Equipment Features in Nerve Stimulation
Constant Current Output and Display
Variable Pulse Width and Frequency
Other Features
Practical Considerations - Documentation
Population Considerations
Does Nerve Stimulation Make a Difference?
References
Basic Ultrasound Physics and Technology
Transducers
Types of Ultrasound Transducers
Sound Wave Properties in Tissue
Speed of Sound
Reflection
Scattering
Resolution
Refraction
Absorption
Optimization of Image Quality: Knobology - Frequency
Depth
Gain
Time Gain Compensation
Focal Zone
Doppler Ultrasound
Anisotropy
Artifacts
Echogenic Appearance of Various Tissues
Nerves and tendons
Muscle
Bone
Vascular structure
Fat
Fascial tissue
Pleura and air
Equipment Selection
Current Advances for Future Developments
Suggested Reading
Image Acquisition
Probe Preparation
Image Optimization
Probe Alignment
Practical Approach: Traceback Method
Control of Needle Trajectory: Visibility of Needles
Hand-Eye Coordination
Needling Technique: In-Plane Technique
Out-of-Plane Technique: Walkdown Approach
References
Indications, Contraindications, and Safety of Peripheral Nerve Catheter Placement
Equipment Required: Types of Catheters
Sterile Transducer Preparation
Choice of Injectates: During Catheter Insertion
Technique
Confirming Catheter Tip Location with Ultrasonography
Confirming Catheter Tip Location with Nerve Stimulation
Catheter-Over-Needle Assembly Insertion
Securing the Catheter
Examples of Common Peripheral Nerve Catheterization Procedures Used in Children: Infraclavicular Nerve Block Catheterization
Principles of Pain Assessment in Infants and Children
Assessing Pain in Neonates and Infants
The Premature Infant Pain Profile (PIPP)
Neonatal Pain Agitation and Sedation Scale (N-PASS)
CRIES
Assessing Postoperative Pain in Infants and Young Children
FLACC (Faces, Limb, Activity, Cry, and Consolability)
Parents’ Postoperative Pain Measure (PPPM)
Assessing Pain in Children and Adolescents
Faces Pain Scale-Revised
Numeric Rating Scales (NRS)
Oucher
Pieces of Hurt/Poker Chip Scale
Wong-Baker FACES Pain Scale
Visual Analogue Scale (VAS)
Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS)
Assessing Postoperative Pain in Critically Ill Children
Assessing Postoperative Pain in Children with Cognitive Impairments
Summary
Developmental, Familial, and Psychological Factors: Age
Developmental Delays
Psychological Factors
Gender
Cultural Factors
Conclusion
References
Introduction
Structure and Physiochemical Properties
Onset of Action, Potency, and Duration
Sodium Channel
Physiological Considerations
Pharmacokinetics
Absorption
Absorption from Epidural Space
Absorption from Other Routes of Administration
Distribution
Plasma Protein Binding
Hepatic Metabolism
Toxicity
Central Nervous System Toxicity
Cardiac Toxicity
Treatment of Toxicity
Prevention of Toxicity
Dosing
References
General Principles
Adverse Events Related to Local Anesthetics - Allergic Reactions
Prevention
Management
Systemic Toxic Reactions
Prevention
Nervous System Toxicity and Management
Cardiovascular Toxicity and Management
Summary
Complications Related to Regional Anesthesia Equipment
Adverse Events Caused by Needles - Needle Trauma to the Peripheral Nerve
Needle Trauma to the Spinal Cord
Needle Trauma to Pleura
Adverse Events Caused by Nerve Stimulators
Adverse Events Caused by Ultrasound Probes
Summary
Block Complications
Complications of Peripheral Nerve Blocks - Phrenic Nerve Paralysis and Paresis
Hematoma and Subsequent Sequelae
Bacterial Infection
Complications of Neuraxial Blocks - Hematoma
Infection
Total Spinal Anesthesia
Subdural Injections
Post-Dural-Puncture Headache
Hypotension
Summary
References
Clinical Anatomy of Trigeminal Nerve
Ophthalmic Nerve (V1 Division of the Trigeminal Nerve, Pure Sensory)
Maxillary Nerve (V2 Division of the Trigeminal Nerve, Pure Sensory)
Mandibular Nerve (V3 Division of the Trigeminal Nerve, Sensory and Motor to Muscles of Mastication)
Clinical Anatomy of the Cervical Plexus
Clinical Anatomy of Occipital Nerves
Lesser Occipital Nerve (C2)
Greater Occipital Nerve (C2)
Clinical Anatomy of the Nerve of Arnold
Suggested Reading
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