Elsevier

Current Anaesthesia & Critical Care

Volume 19, Issues 5–6, October–December 2008, Pages 302-308
Current Anaesthesia & Critical Care

Paediatric Anaesthesia
Applications of ultrasound in paediatric anaesthesia

https://doi.org/10.1016/j.cacc.2008.09.004Get rights and content

Summary

Ultrasound (US) scanning during the placement of major regional nerve blocks or intravascular catheters allows a non-invasive real-time image display of tissue planes, neurovascular structures and needles. Advances in scanner technology have allowed anaesthetists to accurately target needle placement, which enhances the success and safety of these procedures. This review will summarise the use of US for regional blockade and vascular cannulation in paediatric anaesthetic practice.

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.

References (40)

  • G. Schuepfer et al.

    Generating a learning curve for pediatric caudal epidural blocks: an empirical evaluation of technical skills in novice and experienced anesthetists

    Reg Anesth Pain Med

    (2000 Jul–Aug)
  • P.D. Craven et al.

    Regional (spinal, epidural, caudal) versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in early infancy

    Cochrane Database Syst Rev

    (2003)
  • E. Giaufré et al.

    Epidemiology and morbidity of regional anesthesia in children: a one-year prospective survey of the French-language society of pediatric anesthesiologists

    Anesth Analg

    (1996 Nov)
  • Y. Auroy et al.

    Serious complications related to regional anesthesia: results of a prospective survey in France

    Anesthesiology

    (1997 Sep)
  • Q.A. Fisher et al.

    Detection of intravascular injection of regional anaesthetics in children

    Can J Anaesth

    (1997 Jun)
  • R.C. Cork et al.

    Ultrasonic localization of the lumbar epidural space

    Anesthesiology

    (1980 Jun)
  • H.B. Abramowitz et al.

    Use of Doppler for difficult axillary block

    Anesthesiology

    (1981 Nov)
  • C. Ecoffey

    Pediatric regional anesthesia – update

    Curr Opin Anaesthesiol

    (2007 Jun)
  • B. Dalens

    Some current controversies in paediatric regional anaesthesia

    Curr Opin Anaesthesiol

    (2006 Jun)
  • P. Marhofer et al.

    Pilot study of neuraxial imaging by ultrasound in infants and children

    Paediatr Anaesth

    (2005 Aug)
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