ABSTRACT
Background@#Epidural block placement in pediatric patients is technically challenging for anesthesiologists. The use of ultrasound (US) for the placement of an epidural catheter has shown promise. We compared landmark-guided and US-guided lumbar or lower thoracic epidural needle placement in pediatric patients. @*Methods@#This prospective, randomized, comparative trial involved children aged 1–6 years who underwent abdominal and thoracic surgeries. Forty-five children were randomly divided into two groups using a computer-generated random number table, and group allocation was performed by the sealed opaque method into either landmark-guided (group LT) or real-time ultrasound-guided (group UT) epidural placement. The primary outcome was a comparison of the procedure time (excluding US probe preparation). Secondary outcomes were the number of attempts (re-insertion of the needle), bone contacts, needle redirection, skin-to-epidural distance using the US in both groups, success rate, and complications. @*Results@#The median (interquartile range [IQR]) time to reach epidural space was 105.5 (297.0) seconds in group LT and 143.0 (150) seconds in group UT; P = 0.407). While the first attempt success rate was higher in the UT group (87.0% in UT vs. 40.9% in LT; P = 0.004), the number of bone contacts, needle redirections, and procedure-related complications were significantly lower. @*Conclusions@#The use of US significantly reduced needle redirection, number of attempts, bone contact, and complications. There was no statistically significant difference in the time to access the epidural space between the US and landmark technique groups.
ABSTRACT
Amyloidosis cutis dyschromica [ACD] is a rare form of cutaneous amyloidosis, characterized by generalized, asymptomatic hyperpigmentation intermingled with several hypopigmented spots without papulation, atrophy and telangiectasia. Its onset usually begins before puberty. We hereby describe two female siblings of ACD belonging to tribal groups with no systemic involvement. This condition should be considered as a separate entity and need to be differentiated from other variants of primary cutaneous amyloidosis.
ABSTRACT
No abstract available.
Subject(s)
Bronchoscopy , Pneumothorax , Subcutaneous Emphysema , TracheostomyABSTRACT
To objectively assess intranasal diamorphine as an analgesic adjuvant for change of dressings in burn patients. Eleven patients were recruited at a regional burns centre for this pilot study. Intranasal diamorphine at a weight-calculated dose was administered through an atomizer and patient vital signs and APVU scores were documented pre and post administration. A post-procedural satisfaction questionnaire was also completed by all patients. Eleven patients [8 males and 3 females] were recruited for this pilot project. Mean age was 34 years [19-57 years] and mean burn total body surface area [TBSA] was 8.9% [4-17%]. Procedure duration was a mean of 53.0 minutes [30-72 minutes]. Six of the patients had a past history of opiate use. The data of our small-scale study shows that it has good analgesic efficacy, rapid-onset, safety and high degree of patient satisfaction without the need for intravenous access. There were no side-effects and all patients expressed satisfaction with the analgesia given. Intranasal diamorphine provides effective analgesia for moderate to severe procedural pain and can be a safe analgesic adjuvant for change of dressings in burn patients