Pediatric Atlas of Ultrasound- and Nerve Stimulation-Guided Regional Anesthesia PDF
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In 2007, Tsui, with Springer, published the first textbook and atlas devoted entirely to ultrasound-guided regional blockade in adults, entitled Atlas of Ultrasound and Nerve Stimulation – Guided Regional Anesthesia . Since then, many textbooks and atlases with a similar focus have been written, albeit for the adult population only. Despite the extensive progress made in regional anesthesia over the past decades, there still exists no textbook and/or atlas dedicated to both ultrasound- and nerve stimulation-guided regional blockades for the pediatric population.
In preparing this, the first textbook focused on ultrasound and nerve stimulation for pediatric regional anesthesia; we had the privilege of gathering friends and colleagues as contributing authors. Similar to the situation for the adult population, pediatric regional anesthesia has long been regarded as an “art,” and success with these techniques is perceived widely to be the domain of a few skilled pediatric anesthesiologists. Around 30 years ago, the introduction of nerve stimulation technology began to nudge regional anesthesia closer toward a “science.” However, nerve stimulation has its limitations; the technique relies on electrical impulses to elicit a physiological response from nerves, and considerable variation exists among individuals with respect to this phenomenon. Nerve stimulation guidance is also limited by a number of other factors, including the properties of injectates, physiological fluids (e.g., blood), and disease. Nevertheless, it proved to be a useful and objective method to place, with some reliability, the needle tip close to a target nerve. Surprisingly, the introduction of nerve stimulation did not spark a renewed interest in regional anesthesia, although it proved quite a benefit to those of us who were performing nerve blocks on a regular basis. This is particularly true in the case of pediatric patients, who are usually unable to provide feedback since their blocks are administered under heavy sedation and/or general anesthesia.
Ultrasound imaging is one of the most exciting technological advancements to be applied to regional anesthesia. For the first time in over 100 years, we can visualize the nerve which we intend to block. Unlike nerve stimulation, we foresee ultrasound being a catalyst to draw anesthesiologists toward devoting more of their practice to regional anesthesia. We must remember, however, that the images ultrasound provides us are indirect and open to individual interpretation, depending on the user’s experience level, training, and where they received that experience and training. While some practitioners have a natural gift for interpreting ultrasound images, this is not the case with the majority. There is a significant learning curve that goes with mastering ultrasound-guided regional anesthesia. What is more, it has been shown that combining ultrasound and nerve stimulation can improve block success, meaning that two techniques must be learned and mastered to be used to achieve a common goal. This was the main reason for describing and covering the advantages of both technologies in the adult atlas.
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