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Congratulations to all responsible for this Epic Milestone in Regional Anesthesiology and Acute Pain Medicine. x.com/emarianomd/sta…

Teaching cardiac anatomy to undergraduates using transthoracic echocardiography.#POCUS

All stakeholders need but-in re anaesthetic technique. Patient education important. If a surgeon is not comfortable operating with ‘awake’ patient, then that is a significant barrier. Anaesthetist has to accept a more demanding intraoperative course if LA technique used.

No question pain scores are embedded as vital sign. If patient asked often enough, the answer triggers a pharmacological treatment, often an opioid, when it may not have been required.

Results may be consistent:’posterior spread of dye and limited spread to paravertebral space. This sentence consistent with figure4, but not figure3. Overall limited spread not consistent with clinical reports.

I don’t think this adage is relevant. I think is related to reverse (equally irrelevant) saying: ‘Those who can’t do, teach’. An effective clinical teacher requires time (a precious commodity in the OR) and attributes including mastery of their environment and subject content.

We do the same: sterile transducer cover for every ultrasound-guided procedure including single shot blocks, vascular access.

Most of injectate spread appears to be posteriorly into fascia of deep and intermediate intrinsic muscles of back, and less spread anteriorly to paravertebral space

Suggested infusion regimen: ropivacaine 0.2% 15-20 mL q4h. I run 1 mL/h, just to keep catheter patent.

Problem with many of the RA studies, lack of unambiguous description of technique. ‘Adductor canal’ block studies are one example

Darcy Price was an outstanding clinician and teacher held in high esteem internationally. His service to Regional Anaesthesia and community was exceptional. I enjoyed his unique sense of humour and benefited from his knowledge and expertise in our field. I will really miss Darcy.

Thrilled to part of the excellent Regional Anaesthesia workshop at the Anatomy Department, University of Adelaide. Excellent team, facilities, program and evening debrief!

Patient for total hip replacement. Focussed cardiac ultrasound in anaesthetic room. How would this influence anaesthetic technique? What other cardiac information would you require? # POCUS

Peak velocity across aortic valve was 1.5m/sec.

Severe LV dysfunction/cardiomyopathy, mitral valve annular calcification (moderate mitral regurgitation, not shown). EF estimated 20%. No coronary artery disease on angiography. Spinal (arterial line), no sedation. Ambulating day of surgery. No blocks or infiltration.

Trainee requests Direct Observation of Procedural Skills assessment of brachial plexus block. Can use questions (from ncbi.nlm.nih.gov/pubmed/24749931) to provide block-specific content.

Perivalvular aortic and mitral valvular regurgitation following TAVI. Normal left and right ventricular size and function. Calcific Posterior MV leaflet. #POCUS

Preoperative echocardiography reported a 'severely abnormal LV mass'. #POCUS in anaesthetic room demonstrated a mass sufficiently distal to the left ventricular outflow tract and aortic valve to reassure anaesthetist that spinal anaesthesia would be safe.

Agree, in my practice for rapid surgical anesthesia require perineural spread around 4 nerves, fascia prevent spread, need to identify barriers during injection.

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