Probable Venous Air Embolism During Caudal Anesthesia in a Child

Epidural and subarachnoid blockade in children

“…The loss of resistance technique with saline or air is currently the most popular. Loss of resistance to air techniques have resulted in venous air emboli from the epidural veins and on occasion acute cardiorespiratory deterioration consistent with a large venous air embolism [74,75]. This potential danger is worsened if there is a right to left shunt which results in a systemic air embolus and 50% of 5-year-old children have a probe patent foramen ovale.…”

Retrospective versus contemporaneous nausea scores

“…These might include patient personality and pre-operative expectations, the actual degree of postoperative nausea and vomiting (PONV) experienced and learned beliefs about 'normal' PONV from seeing how other patients fare. and vomiting may be reduced by the use of metoclopramide [4]. We believe the adoption of such a technique would have led to a far more favourable outcome in the general anaesthesia group with a considerable reduction in morbidity.…”

Loss of resistance to normal saline is preferred to identify the epidural space: a survey of Canadian pediatric anesthesiologists

“…Two case reports describe suspected VAE with the use of LORA in pediatric patients which resulted in hemodynamic instability. 7,22 The volume of air required to produce right ventricular dysfunction in humans is unknown, although the lowest volume required in dogs is 0.5 mL·kg -1 ·min -1 . 23 A probe patent foramen ovale exists in 50% of children up to five years of age which can open intermittently during crying and therefore risk embolization of air into the systemic circulation.…”