Does ultrasound guidance add accuracy to continuous caudal-epidural catheter placements in neonates and infants?

Summary

Background

Caudo-lumbar and caudo-thoracic epidural anesthesia is an established technique that carries a low risk of dural puncture or spinal cord trauma in infants. Traditionally catheter advancement is based on external measurements. However, malpositioning of catheters are known to occur. We hypothesized that caudal-epidural catheters inserted under real-time ultrasound guidance may be more accurate than the accuracy of the measurements traditionally used for their placement.

Methods

We studied 25 patients, aged 2 days to 5 months, posted for abdominal or thoracic surgery, receiving general anesthesia followed by caudo-epidural continuous block. External measurement defined as the distance from the caudal space and the surgically congruent vertebral level was measured in centimeters with the back gently flexed. Subsequently, a caudo-epidural block was performed in the same position. The epidural catheter insertion was followed under real-time ultrasound guidance till the predetermined vertebral level was reached. The actual length placed under real-time ultrasound scan was defined as the actual length. The high-frequency probe was placed longitudinal and paramedian to the spine. The vertebral level was determined by identifying the lumbosacral junction in longitudinal saggital view and counting the vertebrae up from L5. The catheter length at the skin was compared with the length recorded by external measurement.

Results

The actual length placed under real-time ultrasound scan were consistently longer than the external distance between the caudal space and selected vertebral level. The mean values of ultrasound were higher than the mean values of external measurement with a difference of 4.28 cm. Accuracy was not affected by age or affected by the selected vertebral level in the age group we studied.

Conclusions

We conclude that catheters placed under ultrasound guidance are more accurate than the traditional method developed before the advent of ultrasound in young infants.

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A limited evaluation of the association of race and anesthetic medication administration: A single-center experience with appendectomies

Summary

Background

Although it is known that a patient's race may influence their medical care, racial patterns of medication administration in pediatric anesthesia have not been well-studied. The aim of this study was to determine if differences exist between Black and White children with regard to administration of anesthetic and analgesic medications for a single procedure at our institution.

Methods

We conducted a retrospective review of medications administered to patients for emergency appendectomies at a large academic children's hospital from 2010 to 2015. We examined the association between patient race and administration of preoperative midazolam and intraoperative ondansetron, lidocaine, ketorolac, and weight-based doses of fentanyl and morphine.

Results

During the study period, 1680 patients (1329 White, 351 Black) underwent emergency appendectomy. There were no significant racial differences in administration of intraoperative anesthetic medications between Black and White children. In unadjusted analysis, Black children were less likely to receive preoperative midazolam than White children (OR=0.74 [95% CI, 0.58-0.94], P=.012). After adjusting for confounders, there was no evidence of racial differences in administration of preoperative or intraoperative medications.

Conclusions

We did not find a significant difference in preoperative or intraoperative medication administration based on race when we adjusted for age, gender, and attending anesthesiologist practice patterns. We encourage all institutions to monitor their own practice patterns with regard to race.

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Colorectal Cancer Screening in Asia

Abstract

Purpose of Review

Colorectal cancer (CRC) is increasing in Asia, especially in regions with higher levels of economic development. Several Asian countries have launched population CRC screening programs to combat this devastating disease because previous studies have demonstrated that either fecal occult blood test or lower gastrointestinal endoscopy can effectively reduce CRC mortality.

Recent Findings

Screening includes engaging the population, testing, administering a confirmation examination, and treating screening-detected neoplasms; thus, monitoring the whole process using measurable indicators over time is of utmost importance. Only when the quality of every step is secured can the effectiveness of CRC screening be maximized. Screening and verification examination rates remain low in Asian countries, and important infrastructure, including cancer or death registry systems, colonoscopy capacity, and reasonable subsidization for screening, is lacking or insufficient.

Summary

Future research should identify potential local barriers to screening. Good communication and dialog among screening organizers, clinicians, professional societies, and public health workers are indispensible for successful screening programs.

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Pancreatic Sphincter Precutting using a Dual Knife to Relieve Acute Pancreatic Duct Obstruction

A 47-year-old woman diagnosed with chronic pancreatitis was admitted to our hospital. Computed tomography (CT) revealed main pancreatic duct (MPD) dilatation with multiple calcifications (Fig. 1a). Pancreatic extracorporeal shock wave lithotripsy (P-ESWL) was performed for stone disintegration starting from the pancreatic head (Fig. 1c). After P-ESWL, the patient complained of intense abdominal pain. Intramuscular injection of pethidine was repeatedly applied but did not relieve the pain. Repeated CT revealed that the diameter of the MDP had increased from 8.11mm to 17.99mm (Fig.

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The contribution of long non-coding RNAs in Inflammatory Bowel Diseases

Inflammatory Bowel Diseases (IBDs) are multifactorial autoimmune diseases with growing prevalence but the interaction between genetic, environmental and immunologic factors in their development is complex and remains obscure. There is great need to understand their pathogenetic mechanisms and evolve diagnostic and therapeutic tools. Long non-coding RNAs (lncRNAs) are RNA molecules longer than 200 nucleotides that are known to interfere in gene regulation but their roles and functions have not yet been fully understood.

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Pancreatic Sphincter Precutting using a Dual Knife to Relieve Acute Pancreatic Duct Obstruction

A 47-year-old woman diagnosed with chronic pancreatitis was admitted to our hospital. Computed tomography (CT) revealed main pancreatic duct (MPD) dilatation with multiple calcifications (Fig. 1a). Pancreatic extracorporeal shock wave lithotripsy (P-ESWL) was performed for stone disintegration starting from the pancreatic head (Fig. 1c). After P-ESWL, the patient complained of intense abdominal pain. Intramuscular injection of pethidine was repeatedly applied but did not relieve the pain. Repeated CT revealed that the diameter of the MDP had increased from 8.11mm to 17.99mm (Fig.

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The contribution of long non-coding RNAs in Inflammatory Bowel Diseases

Inflammatory Bowel Diseases (IBDs) are multifactorial autoimmune diseases with growing prevalence but the interaction between genetic, environmental and immunologic factors in their development is complex and remains obscure. There is great need to understand their pathogenetic mechanisms and evolve diagnostic and therapeutic tools. Long non-coding RNAs (lncRNAs) are RNA molecules longer than 200 nucleotides that are known to interfere in gene regulation but their roles and functions have not yet been fully understood.

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