Paediatric AnaesthesiaApplications of ultrasound in paediatric anaesthesia
Section snippets
Principles of ultrasound
US waves are so named as they are transmitted at a frequency greater than that of human acoustic sensory perception. US waves used in medical imaging have a frequency in the low megahertz (MHz) range, the most commonly used probes emitting signals from 2 to 14 MHz. The technique of ultrasonic imaging of tissues has been used in medical practice for over 60 years, one of the earliest descriptions involved the use of ship-building ultrasonic equipment to image abdominal viscera.1 The ability to
Ultrasound for regional anaesthesia
Regional anaesthesia has a vital role in modern day anaesthetic practice, particularly with the increasing use of day surgery facilities in both adult and paediatric patients. Aims to minimise in-patient stay following surgical procedures has led to an increase in the requirement for effective regional anaesthesia and a reduction in systemic opioid administration. A decrease in post-operative pain and reduced opioid requirements has been demonstrated following day surgery procedures with
Ultrasound for vascular access
Central venous catheters (CVC) are routinely inserted in paediatric patients undergoing cardiac surgery. The internal jugular vein (IJV) is the preferred site of cannulation, with alternatives being the subclavian and femoral veins. The traditional landmark approach to the IJV involves inserting the needle at the apex of the sternal and clavicular heads of the sternocleidomastoid muscle and directing it posterior and caudad in the direction of the ipsilateral nipple. If the neck muscles are not
Education
A core working knowledge of paediatric neurovascular anatomy is an integral part of training in US guidance to perform regional blockade or vascular cannulation. At present there are few formal guidelines on education programmes. The most severe neurological complications of regional blocks are rare in paediatric anaesthesia, with a peripheral nerve injury rate of less than 1:1000.36 The rate of neurological complications during central neuraxial block insertion is difficult to quantify. The
Summary
The increasing availability of high resolution portable US equipment, in conjunction with recent published evidence detailing improved success rates and a high safety profile of US guidance for regional blockade and vascular cannulation, is an encouraging development in the field of paediatric anaesthesia over the last decade. After adequate training, it is possible to enhance an already very safe practice, performing more successful regional blocks using lower amounts of LA, and reducing the
Acknowledgements
The authors would like to express their thanks to Dr. Gillian Lauder for her assistance in the preparation of images for this manuscript.
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