Despite the dynamic visualization of cervical structures with USG, interscalene block may result in pneumothorax. An unusual higher pleural dome due to the hyperinflated lung (smoking) probably facilitated the accidental pleural puncture.
Summary: Mandim BLS, Alves RR, Almeida R, Pontes JPJ, Arantes LJ, Morais FP -Pneumothorax Post Brachial Plexus Block Guided by Ultrasound: a Case Report. Background and objectives:Brachial plexus block is used for upper limbs anesthesia. The use of ultrasound-guided (USG) technique for blockade has become popular in recent years, facilitating its execution by providing real-time images of the plexus and surrounding structures while minimizing complications. The purpose of this report is to describe a case of pneumothorax following ultrasound-guided interscalene block.
A consulta pré-operatória para anestesia pediátrica tem importância vital no processo de avaliação da condição clínica do paciente e visa definir os riscos e elegibilidade da anestesia e cirurgia, com informações essenciais para a tomada de decisões a partir de anamnese e exame físico. Estes visam complementar o planejamento da anestesia, bem como a necessidade de medicação pré-anestésica e preparo não farmacológico. É uma responsabilidade intransferível do anestesiologista e a partir dessa avaliação é possível definir o estado físico da criança, os riscos anestésico e cirúrgico, necessidade de solicitação de exames complementares, tratamento ou preparo especial, favorecendo o planejamento perioperatório, baseado no uso apropriado dos recursos hospitalares e programação das atividades cirúrgicas de acordo com as características clínicas do paciente. ABSTRACTThe pre-operative consultation for Pediatric Anesthesia has vital importance in assessment of patient's preoperative clinical condition and seeks to define risks and eligibility of anesthesia and surgery, with essential information to decision-making, regarding to anamnesis and physical examination, which aim to complement anesthesia planning, as well as the need for pharmacologic and non-pharmacological preoperative preparation. The responsibility of the anesthesiologist is non-transferable, and from this evaluation, it is possible to define the physical state of the child, anesthetic and surgical risks and the need to request preoperatively complementary examination, treatment or special preparation, favoring the perioperative planning, based on the appropriate use of hospital resources and programming surgical activities according to the clinical characteristics of the patient.A consulta pré-operatória tem importância vital no processo de avaliação da condição clínica do paciente e visa definir os riscos e elegibilidade da anestesia e cirurgia. As informações obtidas são necessárias para tomada de decisões a partir da anamnese, exame físico e exames complementares. Essa é uma responsabilidade intransferível do anestesiologista, apesar de profissionais de outras especialidades médicas poderem fornecer informações adicionais importantes durante esse processo. 1 A partir dessa avaliação, é possível definir o estado físico da criança, os riscos anestésico e cirúrgico, necessidade de solicitação de exames, tratamento ou prepa-
Total venous anesthesia (AVT) has shown a great advance in the last two decades in both adults and children, after the development of anesthetics with pharmacokinetic and pharmacodynamic properties that allow its use in continuous infusion. Despite the rapid evolution of AVT and target controlled anesthesia for maintenance of general anesthesia in adults, its practice in the pediatric population was initially limited. The advantages of AVT are rapid recovery time, significant reduction of nausea and vomiting, decreased incidence of postoperative delirium, and reduced environmental pollution. Studies have shown that this technique can be used with relative safety in the pediatric population, however, the devices available for continuous infusion and pharmacokinetic models suitable for the pediatric population are still incipient. The development of hardware and software suitable for all age groups, respecting the pharmacokinetic and pharmacodynamic particularities of each of them, still requires more studies.
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