The utility of ultrasonography in anesthesia management in 3 cases of caudal regression syndrome.

Caudal regression syndrome is an extremely rare clinical entity. It is a challenge to anesthesiologist due to its multisystem involvement. Regional anesthesia literature on caudal regression syndrome is scarce. We report three cases where optimal use of ultrasonography aided in providing satisfactory peri-operative pain relief. Furthermore, a cogent and a logical review of the decision-making processes for the regional blockade in children with caudal regression syndrome are presented.

Regional anesthesia in the coronavirus disease (COVID-19) pandemic: Clinical guidelines by AORA, India.

Anesthesiologists are amongst the front line warriors in this COVID-19 pandemic. We need to change our preferences and practices to reduce the spread to healthcare workers and patients in the hospital. General anesthesia involves aerosol-generating procedures while ventilating and intubating the patients. Regional anesthesia maintains respiratory functions, circumvents airway instrumentation and helps to limit viral transmission. This makes a strong case to patronize regional anaesthesia practises whenever possible. Due to various limitations of diagnostic tests available, all patients can be treated as COVID-19 positive and necessary precautions are suggested to limit the transmission. The importance of a practise advisory is to clear the mist around the dos and don'ts to ensure clarity of thoughts leading to improved safety of both patient and health care professional. We propose clinical guidelines for regional anaesthesia practices in COVID-19 positive patient posted for surgery. Furthermore, current recommendations on confirming the COVID-19 negative status is referred. These features are subject to change further with time.

Recent developments in paediatric neuraxial blocks.

Paediatric anaesthesia and paediatric regional anaesthesia are intertwined. Almost all surgeries unless contradicted could be and should be supplemented with a regional block. The main objective of this review is to elaborate on the recent advances of the central neuraxial blocks, such as application of ultrasound guidance and electrical stimulation in the pursuit of safety and an objective end point. This review also takes account of the traditional technique and understand the benefits as well the risk of each as compared with the recent technique. The recent trends in choosing the most appropriate peripheral block for a given surgery thereby sparing the central neuroaxis is considered. A penile block for circumcision or a sciatic block for unilateral foot surgery, rather than caudal epidural would have a better risk benefit equation. Readers will find a special mention on the recent thoughts on continuous epidural analgesia in paediatrics, especially its rise and fall, yet its unique importance. Lastly, the issue of block placements under sedation or general anaesthesia with its implication in this special population is dealt with. We conducted searches in MEDLINE (PubMed) and assessed the relevance of the abstracts of citations identified from literature searches. The search was carried out in English, for last 10 years, with the following key words: Recent advances in paediatric regional anaesthesia; ultrasound guidance for central neuraxial blocks in children; role of electrical stimulation in neuraxial blocks in children; complications in neuraxial block. Full-text articles of potentially relevant abstracts were retrieved for further review.