Wiggles, Squiggles, and Drugs: Neuromonitoring with Michael Puglia

Low Tidal Volume Ventilation: Lung protective effect

Forced Care During Pregnancy with Julie Cantor

The Pediatric Difficult Airway

Pulmonary Hypertension and Liver Transplantation

Neonatal Respiratory Distress Syndrome with Aditee Ambardekar

Does Adherence to World Health Organization Hand Hygiene Protocols in the Operating Room Have the Potential to Produce Irritant Contact Dermatitis in Anesthesia Providers?

and 

Vasopressin; Arginine Vasopressin: Mechanism of Action; CV Effects of Vasopressin

Arginine Vasopressin

Obstetric Critical Care with Jennifer Hofer

Placental transfer: anesthetic drugs

Rescue TEE and Pulmonary Embolus

Caring for Patients with Congenital Heart Disease

Congenital Heart Disease Associated with Genetic Syndromes with Faith Ross

ABA Manuscript Series November 2019

Transfusion-related Immunomodulation (TRIM); Transfusion: Leukoreduction

Neurologic Complications in Obstetric​ Anesthesia with Christine Warrick

Global health

Laryngomalacia with Debnath Chatterjee

Pregnancy: DIC

Red Blood Cell Transfusion in Pediatric Orthotopic Liver Transplantation: What a Difference a Few Decades Make

Non-Compaction Cardiomyopathy

Pregnancy: DIC

Building a Career in Academia with Arvind Palanisamy

Heart Failure and Mechanical Circulatory Support

Anesthetic Implications for Pediatric Patients Undergoing Scoliosis Repair with Denise P. Chang

One-lung ventilation in children

Post-op Cardiac Event: Risk Factors; Pre-anesthesia Eval: Cardiac

Necrotizing enterocolitis (NEC) with Aditee Ambardekar

Do You Really Mean It? Assessing the Strength, Frequency, and Reliability of Applicant Commitment Statements During the Anesthesiology Residency Match

ACC/AHA Guidelines: Stents; Old MI: Perioperative Risk Assessment

Impacting the Labor and Delivery Floor Using Quality and Patient Safety Metrics with Klaus Kjaer

Pediatric One-lung ventilation with Debnath Chatterjee

Perioperative management of sickle cell disease

Lambert-Eaten Physiology; Myasthenic Syndrome vs Myasthenia Gravis: Sx

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Perioperative Opioid Minimization in Opioid-Naive Patients

Intracardiac Mass

Erector Spinae Plane Block

A novel inter-fascial plane block first described in 2016. This technique has been used for analgesia for the following procedures:

- Video-assisted thoracoscopic surgery (VATS)

- Pulmonary lobectomy

- Thoracic rib and sternal fractures

- Mastectomy

- Axillary sentinel lymph node biopsy

- Abdominal surgery

- Hip surgery

- Thoracic neuropathic pain relief

Unique Contraindications:

- Localized active infectious process at injection site

- Extensive tissue depth between skin and transverse process limiting visualization of transverse process

Unique Complications:

- Pneumothorax

- Lower extremity motor weakness if performed at lower thoracic level

Technique:

- Transverse probe at midline of the spine and identify spinous process, lamina, transverse process and rib

- Slide probe laterally and center view over transverse process

- Rotate probe 90 degrees to parasagittal view of transverse process

- Insert needle from cranial to caudal direction and contact transverse process

- Inject local anesthetic aiming for pooling above transverse process and lifting of erector spinae muscle.  For this video, 30 ml of Ropivacaine 0.5% was used.

Tips:

- Other postural positions (i.e. prone or lateral) may facilitate placement

- Although the T5 transverse process had been the traditional plane of insertion, the block can be performed at any level

- Rostral spread 2-3 levels and approximately 5 levels caudally

- Ultrasound identification/differentiation of the target transverse process and its transition to its adjacent rib can ensure injection at the correct site

- Transverse process appears as blunt and flat while the rib is seen as round on ultrasound with pleura clearly seen in close proximity

- Constant visualization of the needle along its entire length until its contact to the transverse process may decrease the likelihood of a pneumothorax

- Consider use of weight-appropriate dose of local anesthetic to decrease the likelihood of LAST

Block Anesthesiologist:  Gloria Shih Cheng, M.D.

Synopsis:  Jose Enrique Lagueras Garcia, M.D.

Production: Sandy Thammasithiboon, M.D. / ST Film

References:

1. Altiparmak B, et al. 2019. Comparison of the effects of modified pectoral nerve block and erector spinae plane block on postoperative opioid consumption and pain scores of patients after radical mastectomy surgery: a prospective, randomized, control trial. J Clin Anesth. 54:61-65.
2. Altinpulluk EY, et al. 2019. Bilateral postoperative ultrasound-guided erector spinae plane block in open abdominal hysterectomy: a case series and cadaveric investigation. Rom J Anaesth Intensive Care. 26(1): 83-88.
3. Ahiskalioglu, et al. 2018. Erector spinae plane block for bilateral lumbar transverse process fracture in emergency department: a new indication. Am J Emerg Med. 36(10)1927.
4. Ciftci B, et al. 2019. Ultrasound-guided single shot preemptive erector spinae plane block for postoperative pain management.J Cardiothorac Vasc Anesth. 33(4): 1175-1176.
5. Elkoundi A, et al. 2019. Erector spinae plane block for pediatric hip surgery-a case report. Korean J Anesthesiol. 72(1):68-71.
6. Ince I, et al. 2018. Erector spinae plane block catheter insertion under ultrasound guidance for thoracic surgery: case series of three patients. Eurasian J Med. 50(3)204-205.
7. Jadon A, et al. 2018. Flouroscopic-guided erector spinae plane block: a feasible option. Indian J Anaesth. 62(10):806-808.
8. Jones MR, et al. 2019. Confirmation of erector spinae plane block analgesia for 3 distinct scenarios: a case report. A A Pract. 12(5): 141-144.
9. Luis-Navarro JC, et al. 2018. Erector spinae plane block in abdominal surgery: case series. Indian J Anaesth. 62(7): 549-554.
10. Kumar, A, et al. 2018. The use of liposomal bupivacaine in erector spinae plane block to minimize opioid consumption for breast surgery: a case report. A A Pract. 10(9)239-241.
11. Nath S, et al. 2018. USG-guided continuous erector spinae block as a primary mode of perioperative analgesia in open posterolateral thoracotomy: a report of two cases. Saudi J Anaesth. 12(3): 471-474.
12. Petsas D, et al. 2018. Erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy. J Pain Res. 11: 1983-1990.
13. Tulgar S, et al. 2019. Ultrasound-guided erector spinae plane block: indications, complications, and effects on acute and chronic pain based on a single-center experience. Cureu 11(1): e3815.

Latex allergy: Fruits; Anaphylaxis: Epinephrine Treatment; Latex Allergy: Treatment

Beyond the Binary: Caring for Sexual and Gender Minority Patients on the Birth Unit

Pediatric ECMO with Faith Ross

Sugammadex (Bridion®), Pharmacology. Warnings and precautions, and Reintubation considerations after use

Technology in anesthesiology

Hypertrophic Cardiomyopathy

Hypothalamus; Pituitary gland; Hypothalamic-pituitary-target organ axes Sheehan’s syndrome Management

Neuraxial Techniques to Optimize Labor Analgesia with Brendan Carvalho

Rheumatic Mitral Disease

The Pediatric Transgender Patient: Foundations and Perioperative Considerations with Remigio Roque

Retinopathy of Prematurity with Aditee Ambardekar

Post-Operative Urinary Retention (POUR); Control of micturition; Management of POUR

Drug Calculation Errors in Anesthesiology Residents and Faculty: An Analysis of Contributing Factors

Local anesthetics: Mechanism of action, Onset, potency, duration, Nerve fibers; Local Anesthetic Systemic Toxicity (LAST)

None Born Positive: Elimination of Maternal to Child Transmission of HIV

Hemostasis in pediatric cardiac anesthesia

Pediatric Cardiomyopathy with Faith Ross

Volume Status: Monitoring; CVP Waveform: Components

Carcinoid heart disease

Nighttime Extubation Does Not Increase Risk of Reintubation, Length of Stay, or Mortality: Experience of a Large, Urban, Teaching Hospital

Epidural hematoma; Epidural Abscess; Post Spinal Backache

Shared Decision Making on Labor​ and Delivery with May Pian-Smith​

Mitral valve endocarditis

Wake up safe!

Value of OB Anesthesia–Current Needs, Future Directions, Controversies

Opioids, The Opioid Epidemic, and The OB Anesthesiologist

Perioperative Hyperglycemia; Glucose Control

Long-Term Cognitive and Functional Impairments after Critical Illness

Fetal Interventions with Debnath Chatterjee

The NPMS Hemorrhage Bundle: Enhancing the Management of Maternal Hemorrhage with Michaela Farer

Laryngospasm including Laryngeal Closure Reflex, Signs and symptoms and Management

Placenta accreta (Definition and Risk factors); Anesthetic management of cesarean delivery of placenta accreta

Challenging the Traditional Definition of a Difficult Intubation: What Is Difficult?

Anesthesia medication safety

Non-obstetric surgery in pregnant women; Timing of non-obstetric surgery; Perioperative fetal monitoring

Vasopressor Use in Obstetrics: Past, Present, and Future with Nicole Higgins

Flail mitral leaflet and repair

Anterior Mediastinal Mass with Aditee Ambardekar

ERAS for Cesarean Delivery

Emergency Department Airway Management Responsibilities in the United States

ACLS in Pregnancy

Marijuana in Pregnancy: Sorting through Hazy Evidence with Torri Metz

Ascending aortic aneurysm

Pulmonary Hypertension with Faith Ross

Out of Operating Room Anesthesiology

ACLS in Pregnancy

Persistent Left Superior Vena Cava (PLSVC)

Predatory Open-Access Publishing in Anesthesiology

Trial of Labor after Cesarean Delivery: Which patients? Which hospitals?

Mitochondrial disease and anesthesia

Non-Pharmacology and the Art of Induction with Sam Rodriguez

Decision Making in Anesthesiology: An Introduction to Behavioral Economics with Daniel Katz

World Health Organization Surgical Safety Checklist: Compliance and Associated Surgical Outcomes in Uganda’s Referral Hospitals

Pediatric Regional Anesthesia Network (PRAN)

Massive thromboembolism

Burnout and wellness

Evaluating Patient-Centered Outcomes in Clinical Trials of Procedural Sedation, Part 2 Safety: Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research Recommendations

Surgical Fires: Prevention and Management with Debnath Chatterjee

Postpartum Sterilization with Feyce M. Peralta

ACC/AHA Guidelines for Perioperative Cardiovascular Evaluation

Citrate Toxicity Dx/Rx; Transfusion Mortality: Causes; Delayed Transfusion Reaction

Aortic endocarditis