Definitive guide to ultrasound-guided peripheral nerve blocks (PNBs) and interventional analgesia injections.Buy
Guía definitiva de los bloqueos de nervios periféricos (BNP) guiados por ecografía y otras técnicas de analgesia intervencionista.Comprar ahora!
Guia definitivo para bloqueios de nervos periféricos (PNBs) guiados por ultrassom e injeções de analgesia intervencionista.Compre agora!
Given the below case, what would be your next step in managing this patient’s condition, and why would you choose this approach over other interventions?
How would you approach the management of this patient? What alternative techniques or precautions might you suggest to optimize patient outcomes while maintaining safety?
We present the case of a two month old infant weighing 4kg, undergoing inguinal hernia repair. We opted for performing a caudal block and sedating the patient with continuous dexmedetomidine, leaving him with spontaneous breathing and completely opioid free.
On induction the patient received intravenously Atropine 0.1mg, Midazolam 0.3mg, and Propofol 6mg. After successful induction and confirmation of spontaneous breathing dexmedetomidine was started at 1mcg/kg/h, which was reduced to 0.75mcg/kg/h after 10min. A caudal block was performed with 0.25% Levobupivacaine 3ml, and surgical incision followed after 15min. No response to the incision was detected, with the patient maintaining his initial heart rate of 145bpm. Dexmedetomidine was discontinued when skin suturing began, and the patient awoke uneventfully right after surgical dressings were applied. Throughout the procedure the patient remained perfectly still and hemodynamicly stabile, which indirectly excludes any kind of endocrinological response to pain.
Utilizing this way of anesthetic management we avoid potential complications associated with difficult ventilation, intubation, and extubation. Patient was discharged from the hospital the same afternoon.