In this video, a bilateral ultrasound-guided rectus sheath nerve block is demonstrated on a 7-year-old male child undergoing umbilical hernia repair. After the induction of general anesthesia, nerve block time-out is conducted. Following this, the periumbilical area is cleansed using chlorhexidine. A high-frequency linear ultrasound probe is then placed in a transverse orientation lateral to the umbilicus to identify the rectus muscle and its posterior rectus sheath. The three lateral abdominal wall muscles—internal oblique, external oblique, and transversus abdominis—are also visualized lateral to the rectus muscle.
Using an in-plane technique, a 22-gauge, 50-millimeter-long Pajunk needle is inserted from lateral to medial direction. The needle is advanced through the subcutaneous tissue and the body of the rectus muscle until it reaches the target plane between the rectus muscle and the posterior rectus sheath. Correct needle placement is confirmed through hydro dissection with normal saline, where proper spread is indicated by separation of the rectus sheath from the muscle or by the rectus muscle lifting up.
Next, 0.2% Ropivacaine, a local anesthetic, is incrementally injected. The procedure is then repeated on the opposite side with total drug volume typically ranging from 0.05 ml/kg to 1.0 ml/kg up to a maximum total volume of 10 to 20 ml. The patient tolerates the procedure well and does not require any opioids intraoperatively or postoperatively in the post-anesthesia care unit.
This video demonstrates an overview of radial arterial cannulation in a pediatric patient using real-time ultrasound (US) guidance. Ultrasound imaging is a useful tool in the armamentarium for guiding arterial line placement, and its use has become commonplace due to increased accessibility and improved technology. Ultrasound imaging facilitates the detection of abnormal anatomy and abnormal findings (e.g. thrombosis). It also allows for real-time guidance for arterial cannulation, which is especially valuable during difficult insertions such as in neonates or small infants, patients with weak or absent pulses or landmarks, and those with multiple prior cannulations. There is evidence of higher success rates with first attempts and decreased complications compared to the traditional landmark and palpation techniques.
This video demonstrates the placement of a central venous catheter (CVC) in the internal jugular vein (IJV) in an infant using real-time ultrasound (US) guidance. Traditionally, the landmark approach has been the technique used to guide CVC placement. Presently, the use of ultrasound (US) for guiding placement has become commonplace due to increased accessibility, improved technology, and evidence of increased first-attempt success rates and decreased complications. Real-time US-guided central venous cannulation is now the recommended technique over the landmark technique by professional organizations. The experienced use of US allows for the detection of abnormal anatomy or findings (e.g. vein thrombosis) and allows for real-time visualization, which is especially helpful during difficult insertions, absence of landmarks, and in challenging patient groups such as in small infants.
