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The Use of Caudal/Epidural Catheter as the Primary Anesthetic with Dexmedetomidine Secondary to High Risk of Post-Operative Apnea in Premature Infants

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Open Journal of Anesthesiology 2016年第4期6卷 63-66页

作者： Joel Waring Alyssa Lowenwirt miriam flaum Eduard Logvinskiy Dennis E. Feierman Department of Anesthesiology Maimonides Medical Center Brooklyn NY USA

Life threatening post-operative apnea is a known complication of general anesthesia in premature infants. Neuraxial anesthesia has been associated with reduced risk of post-operative apnea. We report two cases, presenting for bilateral inguinal hernia repair, where we used a caudal/epidural catheter for the neuraxial block combined with dexmedetomidine for sedation in preterm infants at high risk for postoperative respiratory complications. Dexmedetomidine assisted in providing both favorable surgical conditions via its well proven sedative effects without respiratory comprised and decreased the discomfort and stress to the child during placement of the epidural catheter and the neuraxial anesthesia provided excellent analgesia and surgical conditions.

关键词： Prematurity Apnea Post-Operative Complication

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A Simple Technique to Improve Standard Nasotracheal Intubation

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Open Journal of Anesthesiology 2017年第9期7卷 328-330页

作者： Don Pang miriam flaum Paul Vastola Piyush Gupta Evan Salant Dennis Feierman Department of Anesthesiology Maimonides Medical Center Brooklyn NY USA Department of Otolaryngology Maimonides Medical Center Brooklyn NY USA

NTI is included in the ASA difficult airway algorithm. However, even with the assistance of a Magill forceps, it might be difficult to place the endotracheal (ET) tube in the trachea because of the angle at which the tube approaches the glottis opening and the inability to bend the tube secondary to the ET-tubes compliance. By placing a soft suction catheter thru the ET-tube, and placing the suction catheter into the trachea first and sliding the tube over the catheter this problem can be avoided. In addition, grabbing the suction catheter rather than the ET-tube, also prevents the rupturing of the ET-tube balloon by the Magill forceps.

关键词： Nasotracheal Intubation Difficult Airway Pediatrics

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A Case Series of 12 Patients Receiving Bilateral Transverse Abdominis Plane Blocks after Cesarean Section

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Open Journal of Anesthesiology 2017年第12期7卷 407-414页

作者： Dennis Feierman Aden Bronstein miriam flaum Marc Dany Mohit Garg Piyush Gupta Kalpana Tyagaraj Department of Anesthesiology Maimonides Medical Center Brooklyn NY USA

Transverse abdominis Plane blocks (TAP) provide effective postoperative analgesia following surgical incisions of the lower and middle abdominal wall, including those associated with cesarean section. This study investigated the efficacy of liposomal bupivacaine diluted with 0.25% bupivacaine administered in bilateral TAP blocks for post-operative analgesia after Ce-sarean section preformed under neuraxial anesthesia. The patients who received the TAP blocks with liposomal bupivacaine had noticeably low pain scores of 1.0 ± 1.4, 1.4 ± 2.1, 1.7 ± 1.9, 1.9 ± 3.3 and 1.9 ± 2.3 at 6, 12, 24, 48 and 72 hours respectively. Only 3 patients used oxycodone (5 mg)/acetaminophen (325 mg) postoperative. One patient took two tables of oxycodone (5 mg)/acetamino-phen (325 mg) after 24 hours, a second patient used oxycodone (5 mg)/aceta-minophen (325 mg) after 72 hours and the third patient was transferred to the intensive care unit (ICU) since she developed postpartum cardiac complications, and was give oxycodone (5 mg)/acetaminophen (325 mg) despite having a 0 pain score. These results suggest that patients treated bilateral TAP blocks with a mixture of liposomal and regular bupivacaine will have low pain scores, high patient satisfaction and reduce the use of postoperative narcotics.

关键词： Liposomal Bupivacaine Exparel TAP Block Cesarean-Section

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