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Introduction: Although the subclavian vein offers significant advantages over other approaches for ultrasound-guided central venous access, it is not the first choice in the pediatric population, mainly due to its proximity to the pleura and the subclavian artery. Objective: To assess the sonoanatomical characteristics of the subclavian vein and adjacent structures using the supraclavicular approach in a pediatric population. Materials and methods: Observational, intraoperative, cross-sectional study, between June 2021 and March 2022. The population consisted of ASA I, II and III children taken to non-emergent surgical procedures under general anesthesia. Images were acquired with the patients under general anesthesia, using a high-frequency linear probe to identify the subclavian vein and measure the anatomical landmarks. Results: A total of 67 children were recruited; mean age was 6 years (IQR: 2-12 years), with male sex predominance (61%). Median weight was 22 kg (IQR: 12.2-34 Kg) and median height was 115 cm (IQR: 88-142 cm). Measurements in relation to the vessel showed a mean distance from the skin of 0.70 cm (SD: 0.18 cm), while mean distance from the skin to the pleura was 1.31 cm (SD: 0.28 cm). Mean vein diameter was 0.49 cm (IQR: 0.40-0.63 cm). The mean hypothetical approach angle to the vessel was 22.09 degrees (SD: 4.37 degrees), while the approach angle to the pleura was 39 degrees (SD: 5.31 degrees). No concurrent visualization of the vein and artery was documented in any of the recorded sonoanatomy windows. The tests pointed to an average difference of 0.61 cm in vessel depth in relation to the pleura, and the angle of approach to the vessel was 16.91 degrees smaller when compared with the angle of approach to the pleura (p < 0.001). Conclusions: Using this technique, the supraclavicular approach to the subclavian vein in children is safe and feasible, with an average skin-to-vessel distance of 0.70 cm, minimizing the risk of pleural puncture. Additional studies are required to optimize this technique in the pediatric population. [ABSTRACT FROM AUTHOR]

Introduction: Spinal anesthesia requires palpation of surfaces in order to identify the intervertebral spaces in the lumbar spine. In elderly individuals, the procedure is more challenging due to age-related degenerative changes in the spine. Objective: To determine which technique between ultrasound (US) guidance or the use of anatomical landmarks to guide spinal anesthesia ensures a higher success rate in elderly patients. Methods: Prospective observational cohort study in patients with an indication to receive subarachnoid anesthesia, regardless of the type of surgical intervention, carried out at Hospital Universitario del Valle and Fundación Hospital San José Buga. Data were collected over a 12-month period at the time of making the puncture. The treating anesthetists were free to choose between US guidance or the use of anatomical landmarks. Results: Overall, 80 patients were assessed, including men and women over 65 years of age (mean 78.50±9.04). The number of punctures as well as needle redirections were significantly lower in the US-guided group. Additionally, in the group in which anatomical landmarks were used to guide the puncture, the marked site did not coincide with the actual puncture site confirmed with US in 37.5% of cases (p<0.001). This could result in inadequate block or complications associated with intradural puncture. Conclusions: US-guided neuroaxial anesthesia in elderly individuals could facilitate success on the first attempt. [ABSTRACT FROM AUTHOR]

Complications in airway management remain a common cause of anesthesia-associated mortality. When a patient is considered with anticipated difficult airway, the management depends on several variables, however, at present, the standard of management continues to be the patient awake approach. In scenarios of acute upper airway obstruction, the only way to guarantee adequate ventilation is to obtain a translaryngeal or transtracheal access, for which, it is necessary to use local anesthesia and grade I / II sedation, avoiding loss of spontaneous ventilation. For this purpose, we propose ultrasound-guided superior laryngeal nerve block, in order to standardize an ultrasound landmark that is reproduceable, with a high success rate, which allows limiting complications related to regional anatomic techniques and thus facilitating the securing of the airway in these patients. [ABSTRACT FROM AUTHOR]

The ultrasound-guided intercostal nerves (cutaneous branches) block in the mid-axillary line at the level of the 8th rib (modified BRILMA) is an analgesic technique described back in 2015. Four patients undergoing open gastrectomy (who are not candidates for epidural analgesia) are discussed. The patients underwent the above-mentioned bilateral block, with the administration of 15 mL of levobupivacaine 0.5% into the fascial plane, between the serratus anterior muscle and the external intercostal muscle, with the aim of blocking the intercostal nerves T6 to 11. Postoperative pain control was adequate, with low levels of opioids used. There were no complications associated with the technique. [ABSTRACT FROM AUTHOR]

Intrathecal administration for the treatment of patients with difficult to manage chronic pain represents a therapeutic breakthrough that reduces adverse effects and improves the patient's quality of life. However, the use and refill of infusion pumps entails certain risks. A difficult access to the refill port and the potential for subcutaneous infiltration are rare but potentially fatal complications. The use of ultrasonography as real-time guidance for the localization of the port has been suggested. The case of a patient with a diagnosis of ankylosing spondylitis and chronic pain, with neuroplasticity phenomena in the management of analgesia with opioid intrathecal infusion pump and the need for frequent refill is discussed. An ultrasound-guided static method using coordinates was used for a successful, free of complications refill. The technique described for the refill of intrathecal infusion pumps is a practical and innovative approach which, through adequate training, may reduce the risks and complications during the procedure in patients requiring frequent refills. [ABSTRACT FROM AUTHOR]

Introduction: Neonatal patients presenting with tracheoesophageal fistula represent a challenge to the anesthesiologist due to the multiple difficulties this pathology involves for airway management. Case discussion: Following is a description of a case of a neonate undergoing tracheoesophageal fistula repair using ultrasound-guided orotracheal intubation as an adjunct to selective intubation. Conclusion: Perioperative ultrasound is a promising tool for airway management of the pediatric patient. Further studies to assess the possibility to position the technique as a standard of care are needed. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of chronic shoulder pain is 20%, and treatment involves pharmacological and non-pharmacological means, as well as analgesic interventional procedures. The use of intra-articular injections and ultrasound-guided blocks has increased with favorable results, but there are few comparisons to determine their effective use in patients with chronic pain due to shoulder arthrosis refractory to pharmacological treatment. Objective: To compare the clinical efficacy and safety of 2 interventional techniques in patients with chronic shoulder pain secondary to arthrosis. Methods: Retrospective cohort analytical study to compare the clinical efficacy and safety of 2 interventional techniques in terms of pain relief, improvement time, and adverse effects in patients coming to Instituto Colombiano del Dolor (Colombian Pain Institute) between June 2011 and April 2012, followed during a period of at least 16 weeks. Results: The analysis included 62 patients with chronic shoulder pain secondary to osteoarthritis. Suprascapular nerve blocks were performed in 29 patients, and tricompartmental blockade was used in 33 patients, and both procedures were performed under ultrasound guidance. A statistically significant reduction in pain intensity was found during the 16-week period in both groups (P<0.0001), and there were no complications. Conclusion: Both analgesic techniques provided significant pain reduction over the 16-week period, with a superior clinical trend in favor of the suprascapular nerve block, and they were found to be safe therapeutic options because of the low rate of complications. [ABSTRACT FROM AUTHOR]

Introduction: Pudendal nerve blocks have a wide range of clinical applications for the management of acute post-operative pain in urologic and gynaecologic surgery, in coloproctology, as well as in pain medicine for differential diagnosis, and for the management of pudendal neuropathies. However, despite its benefits, it is infrequently used. Objective: To perform a detailed description of the most recent ultrasound-guided techniques with the aim of encouraging safe and reproducible learning. Materials and methods: We have performed a broad, non-systematic review of the literature through Medline, Embase and Science Direct between 1985 and 2016, to evaluate the most relevant articles, using the following key words: pudendal nerve anatomy; pudendal nerve; pudendal nerve blocks; pudendal nerve ultrasound; pudendal neuralgia; nerve entrapment; chronic pain; Alcock canal and pelvic pain. The search was limited to articles published in Spanish; English and French. Results: Recent descriptions were found of a large number of anatomic variants, which are described in detail and shown in graphic documents in order to facilitate the sonoanatomic correlation of nerve location as a guide for the performance of the pudendal nerve block through the different approaches. Conclusions: The deep and detailed knowledge of the anatomy of the pudendal nerve and its variations is essential for the realization of Regional Anesthesia techniques guided by images. These promising techniques should continue to be evaluated with clinical studies. [ABSTRACT FROM AUTHOR]

Introduction: Brachial plexus block as an anesthetic technique for upper limb surgery has some advantages over general anesthesia. The technique is widely used in our practice, with high effectiveness and adequate safety profile. However, the relationship between block failure and failure-determining factors has not been measured. Objectives: To identify and quantify brachial plexus block failure-associated factors for upper limb surgery as an initial observation aimed at developing prevention-oriented risk profiles and strategies. Materials and methods: An analytical observational study was conducted by collecting data from electronic medical records of upper limb surgery using brachial plexus block from the San Ignacio University Hospital between 2011 to 2012. Block failures were identified using standardized clinical criteria, measuring potentially associated factors. Dichotomous comparisons were made and uni- and multivariate logistic regression analysis was performed to identify potential statistically significant variables, based on failed cases and successful controls. Results: None of the proposed factors was independently associated with failure of brachial plexus block. A qualitative description of failed cases presented confounding factors associated with local practices and the failure characteristics did not show a clinically plausible trend. Conclusions: There were no factors determined by patient, anesthetic procedure, surgical procedure and operator that could be independently associated with brachial plexus block failure. The suggestion is to fine-tune the definition of failures, not just in the research environment, but in the current clinical practice; to improve the anesthesia records to rise the numbers and the quality of data bases for a quantitative determination of the risk of peripheral regional anesthesia failure and design prevention strategies focused on risk groups. [ABSTRACT FROM AUTHOR]

Introduction: The axillary block of the brachial plexus is widely used as an anaesthesia and analgesia technique in upper limb surgery, specifically for hand, wrist and forearm procedures. The use of nerve stimulation and ultrasound guidance has increased the rate of success with this block. Objective: This article presents a non-systematic review of the most recent literature on axillary block of the brachial plexus using ultrasound and peripheral nerve stimulation. Methods and materials: A search for a non-systematic review was conducted in the Cochrane, Pubmed/Medline, Embase and OVID databases. Conclusion: The axillary block of the brachial plexus is an anaesthetic and analgesic technique for upper limb surgery that has a high percentage of success, with a low degree of difficulty for the procedure. [ABSTRACT FROM AUTHOR]

Ultrasonography performed by non-radiologist specialists is a tool that contributes to the diagnosis and monitoring of neurocritical patients. It is a non-invasive, low-cost, accurate and fast method that helps improve safety and timeliness in settings where prompt decision-making is imperative, such as in the operating room, critical care units or the emergency room. The objective is to conduct a narrative review, presenting ultrasound applications focused on the central nervous system that may be useful in neuroanesthesia and neurocritical care. A search was performed of related terms on databases in the medical literature. Relevant papers where selected and reviewed to perform a non-systematic review focusing on the visualization of the midline and lateral ventricles, the measurement of the optic nerve sheath as a surrogate marker of intracranial hypertension, and the use of colour Doppler for visualizing the middle cerebral artery. It is expected that the use of ultrasound examination of the central nervous system will continue to evolve given its advantages, good correlation with studies considered as the gold standard, and the growing availability of the device. Advancements in this field are expected to improve timeliness and provide objective guidance for decision-making. We recognize the importance of developing skills in the use of this method of exploration in those services where it is required. [ABSTRACT FROM AUTHOR]

Ultrasonography as a diagnostic and therapeutic tool has greatly impacted the anesthesiologist's routine in multiple practical applications. However, only recently there have been some reports published in the literature on the use of ultrasonography for the management of the airway in the surgical and ICU patients. Being a portable, easy to use, non-invasive tool that does not require any ionizing energy, ultrasonography becomes highly attractive when the anesthesiologist faces practical issues in a difficult airway. The purpose of this review was precisely to show the potential uses of ultrasonography for difficult airway management, from the literature perspective. There is enough trials-based evidence so far to recommend the use of ultrasonography for the following situations: identification of anatomical airway structures, static detection of a failed or esophageal intubation, dynamic airway measurements, and size determination of endotracheal tubes; identification of predictors of a difficult airway in patients with challenging necks, and trans-tracheal techniques to secure the airway. Nevertheless, further studies with strong methodological quality are required to show the potential of ultrasonography to impact the difficult airway management and the morbidity and mortality associated with this condition. [ABSTRACT FROM AUTHOR]

Lung ultrasound is a monitoring tool that expands globally in different scenarios, it provides a range of ultrasound parameters that represent lung tissue without pathology, and artifacts that will be generated by the presence of pathology will be a great support during the diagnostic exercise for the physician, who should have the opportunity to do an assessment bedside the patient, dynamically, without risk to himself or to the patient. The semiology described for some of the diseases related to the physician involved in perioperative or critical patient management, has been taken from groups of experts who have validated some of these results with standard techniques such as chest radiography or computerized tomography. [ABSTRACT FROM AUTHOR]

Introduction: Performing ultrasound-guided nerve blocks has proven to be safe, but ergonomic considerations are essential. Objective: To describe the influence of operator position, monitor location, and hand position in performing ultrasound-guided nerve blocks. Methods: A non-systematic literature search was conducted in the Medline/Pubmed and Embase databases. Results: Poor ergonomics is a key factor of error when performing nerve blocks under ultrasound guidance. «In-plane» needle insertion increases success. An inappropriate position may be a cause of muscle-skeletal disorders. Based on these results, we propose specific element location and operator position for the performance of certain nerve blocks. Conclusion: Performing ultrasound-guided nerve blocks requires an ergonomic work area allowing for greater comfort and effectiveness, thus reducing the occurrence of muscleskeletal disorders. [ABSTRACT FROM AUTHOR]

Foot innervation, defined as distal to the tibial and fibular malleoli, is provided by five nerves, namely the tibial, peroneal (deep and superficial), sural and saphenous nerves. Blockade of these nerves is referred to as ankle block. The main advantage of using this block in foot surgery over other regional techniques is the absence of motor blockade above the ankle, which allows faster mobility after surgery. The use of ultrasound for this block has been shown to be of higher clinical efficacy when compared to a landmark approach. The purpose of this continuing education article is not only to detail the anatomy and sonoanatomy of the five nerves innervating the foot, but the ultrasound technique as well. The ultrasoundguided ankle block can be used alone as anaesthetic technique or as adjuvant for analgesia in foot surgery. [ABSTRACT FROM AUTHOR]

Introduction: The Modified Wilson Infraclavicular approach (MWIA) was described in our institution for brachial plexus blocks in pediatric patients. However, concordance studies between this approach and ultrasound for the identification of ideal puncture site have not been reported. Objective: To determine the concordance between MWIA and ultrasound for localization of the ideal puncture site. Materials and methods: Descriptive observational study; we included 100 healthy patients between 1 and 16 years of age, with parental consent, over a 5-month period. Continuous variables were described and kappa statistics were used for concordance evaluation. We also conducted a multivariate analysis to confirm the relationship between the measured distances and weight and height. Results: The distance from the skin to the brachial plexus, as well as the distance between the coracoid process and the brachial plexus, and the distance from the coracoid process to the pleura were all smaller in abduction, with no statistically significant difference. Height and weight are independent factors that determine the distance between the coracoid process and the posterior cord, both in adduction and abduction. The concordance of MWIA vs. ultrasound for determining the ideal puncture site was 47% in both positions. Conclusions: Concordance between MWIA and Ultrasound for the determination of the ideal puncture site is low when it comes to anatomic localization; however, this technique must be evaluated in randomized clinical studies in order to determine its efficacy and usefulness. Height and weight are independent factors that determine the distance between the coracoid process and the posterior cord in adduction and abduction. [ABSTRACT FROM AUTHOR]

Introduction: Chronic pain is a highly prevalent condition and its treatment includes multiple measures, including ultrasound-guided analgesic blocks. There are no reports available including different types of blocks in chronic pain patients. Objective: To determine the clinical efficacy and safety of ultrasound-guided interventional management in chronic pain patients that consulted at Instituto Colombiano del Dolor in 2011. Materials and methods: Descriptive follow-up trial of a cohort of 149 chronic pain patients undergoing ultrasound-guided interventional therapy at Instituto Colombiano del Dolor in Medellín city, from May through December 2011. Data were collected prior to the procedure, at day two and then one month later. Pain intensity was measured with the visual analogue scale. Results: 149 patients were analyzed. The most common block was the supra-scapular nerve. The efficacy of the blocks was 79.2% and 38.9% after two days and one month, respectively, with a statistically significant difference between the intensity of the initial pain and pain at follow-up. The incidence of complications was low. There were no differences in the outcomes between the patients with a diagnosis of fibromyalgia and those who had not been receiving any prior pharmacological therapy. Conclusions: Ultrasound-guided interventional pain management is an effective and safe technique. [ABSTRACT FROM AUTHOR]

Introduction: The passive leg raising test allows physicians to determine which patients require treatment with intravenous fluids. Objectives: It is important to be aware of tools that help us to determine the response to the passive leg raising test, as well as understanding in which clinical situations it can be performed. Materials and methods: Non-systematic review. Medline and PubMed databases were consulted in search of relevant articles. Results: Through echocardiography, pulse pressure and capnography can be determined as a response to leg raising. Conclusions: This article explores the tools that are useful in determining the response to this maneuver, and the clinical conditions in which it is indicated. [ABSTRACT FROM AUTHOR]

Introduction: Central venous catheterization, performed by the anatomical landmark technique, has a mechanical complication rate between 5% and 19%. This technique has been modified and new approaches have been implemented aiming to improve patient safety. With the introduction of ultrasonography in the clinical practice, and recently in central venous catheter insertion, the rate of complications has dropped over time. Objective: To measure the clinical application of the algorithm "Successful ultrasound-guided internal jugular vein cannulation". Methods: A descriptive, prospective, case series study. Patients over 18 years of age were selected, and the informed consent documentation was filled out appropriately. Patients with masses, anatomical abnormalities, insertion site infections and coagulopathy (international normalized ratio ≥ 2.0, platelet count ≤ 50.000) were excluded. Central venous cannulation was performed under ultrasound guidance in accordance with safety recommendations from the Anaesthesia Department of the Fundación Santa Fe de Bogotá University Hospital (HUFSFB). Adjustment and validation of the algorithm was done according to an expert consensus in our department. A descriptive univariate analysis was conducted, and efficacy was determined on the basis of the number of attempts to achieve successful venous cannulation, and the incidence of complications. Results: This series included 38 patients with a mean age of 62 years. In 97.4% of the cases, successful venous cannulation was achieved on the first attempt. Guidewire displacement was observed in one case, requiring a second attempt. The posterior jugular vein wall was punctured in two patients (5.2%), with no associated arterial vascular injury or pneumothorax. Conclusions: This algorithm resulted in a high rate of successful first attempts and the prevention of potential complications, improving operational standards and healthcare quality for the patients. [ABSTRACT FROM AUTHOR]

Introduction: Chronic pain is one of the primary reasons why people seek medical help. It produces functional limitation, affects mood, and impairs job performance. Many times it is difficult to manage and responds poorly to pharmacological therapies, posing a challenge for the multidisciplinary team in charge of treating this disorder. A number of approaches to relieve pain are the subject of growing research, including the application of agents such as botulinum toxin on painful points. Objective: To carry out a non-systematic narrative review of the scientific evidence available on the use of botulinum toxin for the treatment of chronic pain. Materials and methods: A search was conducted in the PUBMED database, including metaanalyses, systematic reviews, Cochrane reviews, clinical trials, narrative reviews and case series, published between 1997 and 2013, in order to carry out a non-systematic narrative review. Results: Overall, 66 articles were considered for an update on the proposed topic. Conclusions: Botulinum toxin has certain properties that might have a beneficial effect on chronic pain. However, there is not sufficient evidence supporting its use in the majority of indications in this group of patients. Additional studies are required to recommend its use. Ultrasound is considered a useful tool to guide its application. [ABSTRACT FROM AUTHOR]

Introduction: Knee osteoarthritis is a common cause for consultation around the world. Many patients with mild symptoms respond to conservative treatment, while others require interventional therapy including peripheral nerve blocks. Objective: To establish the clinical efficacy and safety of interventional management with ultrasound-guided saphenous nerve block in patients with chronic keen pain. Materials and methods: Descriptive, retrospective trial in chronic keen pain patients who underwent ultrasound-guided interventional therapy at the pain clinic in the country, between September 2011 and June 2012, to determine the clinical efficacy and safety of the procedure. Data were obtained from all patients prior to the procedure, and then at two days, one month and three months later. The pain intensity was measured using the visual analog scale. Results: 25 saphenous nerve blocks were performed. 68% of the patients experienced pain relief within two days. 56% and 40% exhibited relief one and three months after the procedure, respectively, with a statistically significant difference (p < 0.0001) between the baseline visual analog scale and the follow-up evaluation. Patients with a history of fibromyalgia, neuropathic characteristics and previous knee surgery exhibited variable analgesic responses to the procedure. Conclusions: Interventionist chronic knee pain management with ultrasound-guided saphenous nerve block was an effective and safe approach for these patients. [ABSTRACT FROM AUTHOR]

Over the entire world, point of care ultrasonography has gained evidence and acceptance between clinicians of multiple specialties. Even when it has multiple uses, there are a lot of barriers for its implementation. With this document, I pretend to incentivate its disseminated use among colombian anesthesiologists. [ABSTRACT FROM AUTHOR]

Introduction: Chronic shoulder pain is one of the most frequent causes of consultation for musculoskeletal pain. Physical and drug therapy usually result in little improvement and surgical intervention commonly fails. Tricompartmental blockade of the shoulder is an option when baseline therapy fails and ultrasonography is a tool that facilitates the approach, improves the efficacy and reduces the complications. Objective: To determine the efficacy and safety of ultrasound-guided tricompartmental blockade of the shoulder in chronic pain patients. Methods and materials: A descriptive, prospective, follow-up study was made of a cohort of 19 patients with chronic shoulder pain receiving ultrasound-guided tricompartmental blockade of the shoulder. Data were collected prior to the procedure with four, eight and sixteen week controls. Pain intensity was measured with the visual analog scale. Results: Average age was 58.89 years, 73.7% were females. All patients referred severe pain prior to the block. The percentage of patients with reduced pain in the four follow-up periods was 78.3%. Conclusions: Chronic shoulder pain considerably affects the quality of life. Tricompartmental blockade of the shoulder is an alternative when drug therapy fails, with good outcomes, although the scientific evidence is very scarce. In our study the ultrasound-guided tricompartmental blockade of the shoulder is an effective and safe technique. [ABSTRACT FROM AUTHOR]

Introduction: The painful shoulder syndrome is one of the most common chronic pain conditions of muscle-skeletal origin. It is frequent to find patients who do not improve with conservative treatment based on medications and physical therapy, or even with surgical management. Ultrasound-guided suprascapular blockade is another option when basic therapy does not work. Objective: To determine the clinical efficacy and safety of interventional management with ultrasound-guided suprascapular nerve block in patients with chronic shoulder pain. Materials and methods: A descriptive, prospective, follow-up study was conducted in a cohort of 46 patients with chronic shoulder pain disorder who received interventional treatment under ultrasound guidance at the Colombian Pain Institute between October 2011 and May 2012, with the objective of determining efficacy and safety of the procedure. Data were gathered before the procedure, and then two days later and one month after the procedure. Pain intensity was measured using the visual analogue scale (VAS). Results: Forty-six blocks were performed. Overall, 78.3% of the patients experienced at least 50% reduction of pain two days later, and 47.8% had pain relief after one month, with a statistically significant difference (p < 0.0001) between the starting VAS median score and the median scores on the second postoperative day and at one month. There were no complications. Conclusions: Ultrasound-guided suprascapular blockade is an effective and safe treatment option in patients with chronic shoulder pain. [ABSTRACT FROM AUTHOR]

Perioperative management of patients with Wolff-Parkinson-White requires a special care by anaesthesiologists. Choosing the most suitable anaesthetic technique is very important. Both general anaesthesia or neuroaxial blockade may result in hemodynamic instability and arrhythmias development. Rectus sheath block is considered as a useful regional technique for umbilical surgery in patients at high-risk of cardiopulmonary complications. [ABSTRACT FROM AUTHOR]

As an extension to the physical exam, point of care ultrasonography is a tool with multiple applications. Widely used for regional anesthesia, there is not enough diffussion among anesthesiologist of the multiple possibilities that echography gives to them. This article was written to help spreading the multiple applications that ultrasound has in anesthesia, critical care and pain management. [ABSTRACT FROM AUTHOR]