Background & Objectives: Invasive anesthetic techniques, such as invasive airway access and image guided nerve blocks, are crucial techniques for anesthesiologists. However, in clinical settings, there are limited opportunities to learn these procedures. Thiel's embalming method is a well-known technique that confers cadavers with superior flexibility and natural coloring, suitable for several applications, such as training and research (1). We conducted a training course for invasive anesthetic techniques using Thiel embalmed cadavers and evaluated the effectiveness of this training. Materials & Methods: After obtaining institutional review board approval, the training course for invasive airway access (cricothyrotomy) and image guided nerve blocks (ultrasound guided nerve block, fluoroscopy guided epidural block, CT guided trigeminal nerve block and CT guided splanchnic nerve block) was held three times between 2013 and 2015. A total of seven Thiel embalmed cadavers were used for this training. Participants were asked about how realistic the puncture sensation was using a questionnaire that used the Likert scale (0;completely different from a living patient, 10; completely the same as a living patient). The self-confidence for doing the procedure, pre-and post-training, was asked of participants on a questionnaire using the Likert scale (0; I cannot do it at all, 10; I can do it with certainty). The results are compared using the Wilcoxon-signed rank test. Values, shown are the median and range.(e.g. 5,0-10) Results: A total of 30 participants were trained. Experience in invasive anesthetic techniques before this training was scarce in participants, with the exception of ultrasound-guided nerve blocks (Emergency cricothyrotomy:0,0-20, Ultrasound guided nerve block: performed several times a week,0- several times a day, Fluoroscopy guided epidural block: 0,0-16, CT guided nerve block: 0,0-2, respectively). The realistic puncture sensation of the Thiel embalmed cadaver is good for training every procedure (Invasive airway access: 7,2-10,Ultrasound guided nerve block: 6,2-10, Fluoroscopy guided epidural block: 8,0-10, CT guided nerve block: 7.5,1-10 respectively). The self-confidence for invasive procedures was significantly increased after training. (Invasive airway access: 3,0-8 to 6.5,0-10,Ultrasound guided nerve block: 5,0-9 to 6,0-9, Fluoroscopy guided epidural block: 3,0-5 to 6.5,0-8, CT guided trigeminal nerve block: 0,0 to 3.5,0-9, CT guided splanchnic nerve block: 0,0-5 to 2.5,0-8 respectively)Conclusion: Thiel embalmed cadavers provide a realistic and effective model for the various kinds of training needed for invasive anesthetic techniques. References: 1. Surg Radiol Anat. 2009 Aug;31(7):531–5. Disclosure of Interest: None declared
In Brief We present a case of continuous subarachnoid block for the treatment of refractory cancer pain in the shoulder and upper extremity on the right side of the patient. The catheter tip was placed in the subarachnoid space close to the nerve roots on the right side at the height of C5 corresponding to the painful region. Until the patient died, his pain was controlled with infusions of bupivacaine (30–58.7 mg/d) and morphine (2–19.6 mg/d) for 120 days during which upper extremity function was not disturbed and respiratory function and performance status were improved. This case suggests continuous subarachnoid block at the low cervical level is useful for refractory cancer pain in the shoulder and upper extremity. Published ahead of print April 7, 2010
Stickler syndrome is a connective tissue disease with the pathogenic involvement of procollagen genes. It is characterized by ocular and joint abnormalities, hearing loss, and midfacial hypoplasia. In Stickler syndrome, the Pierre Robin sequence is a possible complication. A 30-year-old female was admitted at 33 weeks of gestation. She had a genetic diagnosis of Stickler syndrome type 1. The parturient was diagnosed with preeclampsia, and a decision was made to terminate the pregnancy via cesarean section. Combined spinal epidural anesthesia was planned. Pediatricians were included in the operating room in case of neonatal resuscitation. The mother's perioperative course was stable. The neonate needed directional positive airway pressure. He was strongly suspected of having Stickler syndrome. For those with Stickler syndrome undergoing cesarean sections, the risk of a difficult airway must be considered for both the parturient and the neonate. Adequate staffing and collaboration among anesthesiologists, obstetricians, and pediatricians are crucial.
Abstract Background: Continuous interscalene block is widely used for pain management in shoulder surgery. However, continuous interscalene block performed using the catheter-through-needle method is reportedly associated with adverse events such as pericatheter leakage of the local anesthetic, phrenic nerve paralysis, and hoarseness. Because we expected that the catheter-over-needle method would reduce these adverse events, we examined cases in which continuous interscalene block was performed using the catheter-over-needle method to determine what adverse events occurred and when. Methods: We retrospectively reviewed the anesthesia and medical records of adult patients who underwent catheter insertion to receive a continuous interscalene block performed using the catheter-over-needle method at our hospital from July 2015 to July 2017. Results: During the surveillance period, 122 adult patients underwent catheter insertion to receive a continuous interscalene block administered using the catheter-over-needle method. No case of pericatheter local anesthetic leakage was observed. Adverse events, such as dyspnea, hoarseness, insufficient anesthetic effect, dizziness, cough reflex during drinking, or ptosis, were observed in 42 patients (34.4%; 95% confidence interval 26–42.7). Most of the adverse events occurred on postoperative day 2. The median time between surgery and the onset of adverse events was 28.5 h. Conclusions: The catheter-over-needle method may prevent the pericatheter leakage of the local anesthetic. However, adverse events occurred in more than one-third of the patients. During continuous interscalene block, patients must be carefully observed for adverse events, especially on postoperative day 2. Trial registration: This study was registered with the UMIN Clinical Trials Registry (UMIN000037673).
