OpenAnesthesia is dedicated to promoting evidenced based medicine in anesthesiology, critical care, and pain management.

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

Direct download: 7.m4v
Category:general -- posted at: 12:00pm PDT

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

Direct download: 201908OB.m4v
Category:general -- posted at: 11:25am PDT

Pediatric One-lung ventilation with Debnath Chatterjee

Direct download: 201908Peds.m4v
Category:general -- posted at: 11:15am PDT

Perioperative management of sickle cell disease

Direct download: 201908Haberkern.m4a
Category:general -- posted at: 1:47pm PDT

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

Direct download: 6.m4v
Category:general -- posted at: 12:00pm PDT

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

Direct download: 201908Wu.m4a
Category:general -- posted at: 12:00pm PDT

Intracardiac Mass

Direct download: 201908TEE.m4v
Category:general -- posted at: 5:15am PDT

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.
Direct download: 201908Block.m4v
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Latex allergy: Fruits; Anaphylaxis: Epinephrine Treatment; Latex Allergy: Treatment

Direct download: 5.m4v
Category:general -- posted at: 12:00pm PDT

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

Direct download: 201907OB.m4v
Category:general -- posted at: 9:56am PDT

Pediatric ECMO with Faith Ross

Direct download: 201907Peds.m4v
Category:general -- posted at: 11:27am PDT

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

Direct download: 4.m4v
Category:general -- posted at: 12:00pm PDT

Technology in anesthesiology

Direct download: 201907SPA.m4a
Category:general -- posted at: 7:17am PDT

Hypertrophic Cardiomyopathy

Direct download: 201907TEE.m4v
Category:general -- posted at: 7:05am PDT

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

Direct download: 3.m4v
Category:general -- posted at: 12:00pm PDT

Neuraxial Techniques to Optimize Labor Analgesia with Brendan Carvalho

Direct download: 201906OB.m4v
Category:general -- posted at: 9:56am PDT

Rheumatic Mitral Disease

Direct download: 201906TEE.m4v
Category:general -- posted at: 2:46pm PDT

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

Direct download: 201906PedsGR.m4v
Category:general -- posted at: 12:00pm PDT

Retinopathy of Prematurity with Aditee Ambardekar

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Category:general -- posted at: 11:40am PDT

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

Direct download: 2.m4v
Category:general -- posted at: 12:00pm PDT

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

Direct download: 201906Black.mp3
Category:general -- posted at: 3:46am PDT

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

Direct download: 1.m4v
Category:general -- posted at: 12:00pm PDT

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

Direct download: 201905OB.m4v
Category:general -- posted at: 10:19am PDT

Hemostasis in pediatric cardiac anesthesia

Direct download: 201905SPA.m4a
Category:general -- posted at: 9:10am PDT

Pediatric Cardiomyopathy with Faith Ross

Direct download: 201905Peds.m4v
Category:general -- posted at: 9:21am PDT

Volume Status: Monitoring; CVP Waveform: Components

Direct download: Keys_to_the_Cart__May_1_2019.m4v
Category:general -- posted at: 12:00pm PDT

Carcinoid heart disease

Direct download: 201905TEE.m4v
Category:general -- posted at: 12:00pm PDT

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

Direct download: 201905Everhart.mp3
Category:general -- posted at: 12:00pm PDT

Epidural hematoma; Epidural Abscess; Post Spinal Backache

Direct download: Keys_to_the_Cart__April_15_2019.m4v
Category:general -- posted at: 12:00pm PDT

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

Direct download: 201904OB.m4v
Category:general -- posted at: 9:13am PDT

Mitral valve endocarditis

Direct download: 201904TEE.m4v
Category:general -- posted at: 7:43am PDT

Wake up safe!

Direct download: 2019Tyler.m4a
Category:general -- posted at: 12:08pm PDT

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

Direct download: SOAP201904.mp3
Category:general -- posted at: 11:43am PDT

Opioids, The Opioid Epidemic, and The OB Anesthesiologist

Direct download: SOAP201901.mp3
Category:general -- posted at: 11:41am PDT

Perioperative Hyperglycemia; Glucose Control

Direct download: Keys_to_the_Cart__April_1_2019.m4v
Category:general -- posted at: 12:00pm PDT

Long-Term Cognitive and Functional Impairments after Critical Illness

Direct download: 201904article.mp3
Category:general -- posted at: 5:35am PDT

Fetal Interventions with Debnath Chatterjee

Direct download: 201904peds.m4v
Category:general -- posted at: 11:03am PDT

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

Direct download: 201903OB.m4v
Category:general -- posted at: 2:10pm PDT

Laryngospasm including Laryngeal Closure Reflex, Signs and symptoms and Management

Direct download: Keys_to_the_Cart__March_15_2019.m4v
Category:general -- posted at: 12:00pm PDT

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

Direct download: Keys_to_the_Cart__March_1_2019.m4v
Category:general -- posted at: 12:00pm PDT

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

Direct download: 201903Article.mp3
Category:general -- posted at: 7:11am PDT

Anesthesia medication safety

Direct download: 201902Grigg.m4a
Category:general -- posted at: 5:01am PDT

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

Direct download: Keys_to_the_Cart__February_15_2019.m4v
Category:general -- posted at: 12:00pm PDT

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

Direct download: 201902OB.m4v
Category:general -- posted at: 8:37am PDT

Flail mitral leaflet and repair

Direct download: 201902TEE.m4v
Category:general -- posted at: 4:41am PDT

Anterior Mediastinal Mass with Aditee Ambardekar

Direct download: 201902Peds.m4v
Category:general -- posted at: 2:02pm PDT

ERAS for Cesarean Delivery

Direct download: 201903.m4v
Category:general -- posted at: 12:00pm PDT

Emergency Department Airway Management Responsibilities in the United States

Direct download: 201902_Sappenfield.mp3
Category:general -- posted at: 6:06am PDT

ACLS in Pregnancy

Direct download: 201902.m4v
Category:general -- posted at: 12:00pm PDT

Marijuana in Pregnancy: Sorting through Hazy Evidence with Torri Metz

Direct download: 201901OB.m4v
Category:general -- posted at: 7:58am PDT

Ascending aortic aneurysm

Direct download: 201901TEE.m4v
Category:general -- posted at: 7:09am PDT

Pulmonary Hypertension with Faith Ross

Direct download: 201901Peds.m4v
Category:general -- posted at: 12:55pm PDT

Out of Operating Room Anesthesiology

Direct download: 201901Oscar.m4a
Category:general -- posted at: 11:01am PDT

ACLS in Pregnancy

Direct download: 201901.m4v
Category:general -- posted at: 12:00pm PDT

Persistent Left Superior Vena Cava (PLSVC)

Direct download: 201812TEE.m4v
Category:general -- posted at: 5:20am PDT

Predatory Open-Access Publishing in Anesthesiology

Direct download: 201901article.m4a
Category:general -- posted at: 12:00pm PDT

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

Direct download: 201812OB.m4v
Category:general -- posted at: 7:48am PDT

Mitochondrial disease and anesthesia

Direct download: 201812Morgan.m4a
Category:general -- posted at: 12:00pm PDT

Non-Pharmacology and the Art of Induction with Sam Rodriguez

Direct download: 201812Peds.m4v
Category:general -- posted at: 5:44am PDT

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

Direct download: 201811OB.m4v
Category:general -- posted at: 5:02pm PDT

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

Direct download: 201812Kleiman.mp3
Category:general -- posted at: 9:21am PDT

Pediatric Regional Anesthesia Network (PRAN)

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Category:general -- posted at: 3:47am PDT

Massive thromboembolism

Direct download: 201811TEE.m4v
Category:general -- posted at: 10:11am PDT

Burnout and wellness

Direct download: 201810Expert.mp3
Category:general -- posted at: 3:47am PDT

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

Direct download: 201811Ward.mp3
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Surgical Fires: Prevention and Management with Debnath Chatterjee

Direct download: 201811peds.m4v
Category:general -- posted at: 6:30am PDT

Postpartum Sterilization with Feyce M. Peralta

Direct download: OB201810.m4v
Category:general -- posted at: 5:33am PDT

ACC/AHA Guidelines for Perioperative Cardiovascular Evaluation

Direct download: Keys_to_the_Cart__October_15_2018.m4v
Category:general -- posted at: 12:00pm PDT

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

Direct download: Keys_to_the_Cart__October_8_2018.m4v
Category:general -- posted at: 12:00pm PDT

Aortic endocarditis

Direct download: 201810TEE.m4v
Category:general -- posted at: 10:04am PDT

Craniosynostosis

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Category:general -- posted at: 1:40pm PDT

Craniosynostosis with Aditee Ambardekar

Direct download: Pediatric_Anesthesia_Podcast_of_the_Month_-_October_2018.m4v
Category:general -- posted at: 12:00pm PDT

FFP Indications; Rx: Antithrombin 3 deficiency; FFP Citrate Toxicity Dx/Rx

Direct download: Keys_to_the_Cart__October_1_2018.m4v
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Harmful or Physiologic: Diagnosing Fibrinolysis Shutdown in a Trauma Cohort With Rotational Thromboelastometry

Direct download: 201810Roman.mp3
Category:general -- posted at: 12:00pm PDT

Type and Screen; Blood: Crossmatch; Refusal of Blood Transfusion

Direct download: Keys_to_the_Cart__September_24_2018.m4v
Category:general -- posted at: 5:16am PDT

Pediatric Regional Anesthesia

Direct download: 201809Rosenberg.m4a
Category:general -- posted at: 5:58am PDT

Maternal Comorbidities Combined with Physiologic Changes of Pregnancy Requiring ICU Admission with Jennifer Hofer

Direct download: OB201809.m4v
Category:general -- posted at: 9:13am PDT

Introduction to Congenital Heart Disease, Part 3 (Single​ Ventricle Physiology) with Faith Ross

Direct download: Pediatric_Anesthesia_Podcast_of_the_Month_-_September_2018.m4v
Category:general -- posted at: 7:14am PDT

Hypertrophic Cardiomyopathy

Direct download: 201809TEE.m4v
Category:general -- posted at: 1:15pm PDT

Pacemaker Intraoperative Complications; Blood supply to the AV node; Cardiac cycle ECG

Direct download: 201831.m4v
Category:general -- posted at: 12:00pm PDT

A Simulation Study to Evaluate Improvements in Anesthesia Work Environment Contamination After Implementation of an Infection Prevention Bundle

Direct download: 201809Porteous.mp3
Category:general -- posted at: 2:30pm PDT

Pacemaker Nomenclature; Pacer Lead Placement: ECG Morphology; Pacemaker: Intraoperative Complications

Direct download: 201830.m4v
Category:general -- posted at: 12:00pm PDT

Succinylcholine: Termination of Blockade; Phase II Depolarizing Blockade

Direct download: 201829.m4v
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Anesthetic neurotoxicity

Direct download: 201808Flick.m4a
Category:general -- posted at: 4:24am PDT

Update on Button Battery Ingestion Guidelines with Debnath Chatterjee

Direct download: 201808Peds.m4v
Category:general -- posted at: 1:15pm PDT

Viscoelastic Testing for Obstetric Hemorrhage with Daniel Katz

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Category:general -- posted at: 1:13pm PDT

Amiodarone: Hemodynamic Effect; Amiodarone: Side effects; Amiodarone: Toxicity

Direct download: 201828.m4v
Category:general -- posted at: 12:00pm PDT

Obesity: Airway Evaluation; Morbid Obesity: Rapid Desaturation

Direct download: 201827.m4v
Category:general -- posted at: 12:00pm PDT

Atrial Septal Defect, Part 2

Direct download: 201808TEE.m4v
Category:general -- posted at: 12:00pm PDT

Morbid Obesity: Drug Dosing; Obesity Succinylcholine Dosing; Obesity: Airway Evaluation

Direct download: 201826.m4v
Category:general -- posted at: 12:00pm PDT

The Perioperative Care of the Transgender Patient

Direct download: 201808Luis.mp3
Category:general -- posted at: 12:00pm PDT

Becker’s Muscular Dystrophy: Rhabdomyolysis; Succinylcholine: Normal Potassium Release

Direct download: 201825.m4v
Category:general -- posted at: 12:00pm PDT

Epidural Fever with Elizabeth Lange

Direct download: 201807OB.m4v
Category:general -- posted at: 5:48am PDT

Atrial Septal Defect, Part 1

Direct download: 201807TEE.m4v
Category:general -- posted at: 12:51pm PDT

The Anesthesia Perioperative “Call for Help”—Experience at a Quaternary Pediatric Medical Center: Analysis of 67,564 Anesthesia Encounters

Direct download: 201807Bistra.mp3
Category:general -- posted at: 7:38am PDT

Introduction to Congenital Heart Disease, Part 2 with Faith Ross

Direct download: 201807-desktop.m4v
Category:general -- posted at: 7:21am PDT

Treatment for vasodilatory shock; Critical care

Direct download: 2018Khanna.mp3
Category:general -- posted at: 12:00pm PDT

Pediatric Difficult AIrway

Direct download: OA-SPA_July_2018_Ask_the_Expert_Fiadjoe.mp3
Category:general -- posted at: 12:00pm PDT

Left Ventricle

Direct download: Keys_to_the_Cart__June_18_2018.m4v
Category:general -- posted at: 12:00pm PDT

Maternal Sepsis with Melissa Bauer

Direct download: OB66.m4v
Category:general -- posted at: 10:59am PDT