Ultrasound-Guided Radial Artery Catheterization in a Four-Month-Old Boy
Jun Takeshita, MD, PhD
Osaka Women’s and Children’s Hospital
Ultrasound-guided radial artery catheterization is increasingly used in pediatric patients because it improves procedural accuracy and may enhance first-pass success in infants and small children with small-caliber arteries. Dynamic needle tip positioning (DNTP), a short-axis out-of-plane ultrasound-guided technique, facilitates repeated identification of the true needle tip during needle advancement and enables precise catheter placement.
This video demonstrates ultrasound-guided radial artery catheterization using the DNTP technique in a 4-month-old, 5.5-kg infant with tetralogy of Fallot undergoing a right-sided systemic-to-pulmonary shunt procedure. Because ipsilateral shunt flow may interfere with accurate arterial pressure monitoring, the left radial artery was selected for cannulation. The video illustrates key technical aspects of DNTP, including stepwise needle and probe advancement to maintain visualization of the true needle tip, as well as practical considerations for minimizing complications. It also emphasizes strict aseptic technique, including maximal sterile barrier precautions, a sterile ultrasound probe cover, and sterile ultrasound gel.
The arterial catheter was successfully placed without immediate complications and functioned appropriately throughout the procedure. This video provides a practical demonstration of DNTP and highlights procedural planning and infection prevention strategies for safe and effective pediatric radial artery catheterization.
Ultrasound-Guided Rectus Sheath Block in a Pediatric Patient
Jun Takeshita, MD, PhD
Osaka Women’s and Children’s Hospital
Rectus sheath block (RSB) is a regional anesthesia technique in which a local anesthetic is injected between the posterior aspect of the rectus abdominis muscle and the posterior rectus sheath to block the anterior cutaneous branches of the thoracoabdominal nerves. In pediatric patients, RSB is particularly useful for surgeries performed through umbilical or circumumbilical incisions, such as umbilical hernia repair, laparoscopic surgery with umbilical port placement, pyloromyotomy for hypertrophic pyloric stenosis, and surgery for duodenal atresia, intestinal malrotation, or ovarian cysts. Ultrasound guidance improves the precision and safety of the block by enabling direct visualization of the rectus abdominis muscle, posterior rectus sheath, and underlying peritoneum.
This video demonstrates ultrasound-guided bilateral RSB in a 27-day-old, 3.9-kg neonate undergoing circumumbilical pyloromyotomy for hypertrophic pyloric stenosis. The video highlights the key technical aspects of the procedure, including the identification of the posterior rectus sheath, continuous visualization of the needle tip, appropriate lateral placement of the local anesthetic within the posterior rectus sheath plane, and measures to avoid peritoneal puncture and vascular injury. Particular attention is also given to the conservative dosing of ropivacaine in neonates to minimize the risk of local anesthetic systemic toxicity.
Neuraxial Ultrasound and Combined Spinal-Epidural (CSE) Anesthesia for Cesarean Delivery
Lauren Blake, MD; Fatine Karkri, MD; Brendan Carvalho, MBBCh, FRCA, MDCH, FASA
Stanford University School of Medicine
Neuraxial anesthesia is the gold standard approach for cesarean delivery, offering surgical anesthesia while optimizing maternal and fetal outcomes. This video provides a stepwise demonstration of a combined spinal-epidural (CSE) technique for cesarean delivery. This technique covers patient positioning, identification of the appropriate interspace, sterile preparation, infiltration of local anesthetic, and spinal/epidural needle placement. For single-shot spinal (SSS), a spinal needle is advanced into the subarachnoid space, cerebrospinal fluid return is confirmed with aspiration, and intrathecal medication is administered. For CSE, an epidural needle is advanced into the epidural space using a loss-of-resistance technique, followed by spinal needle insertion through the epidural needle for intrathecal medication administration. This needle-through-needle technique concludes with epidural catheter insertion and securement. Indications and medication dosing for cesarean delivery are discussed for each technique.
Neuraxial Ultrasound and Epidural Blood Patch for Post-dural Puncture Headache
Fatine Karkri, MD; Lauren Blake, MD; Brendan Carvalho, MBBCh, FRCA, MDCH, FASA
Stanford University School of Medicine
This video demonstrates a stepwise technique for performing an autologous epidural blood patch (EBP) to treat post-dural puncture headache (PDPH). The video covers identification of the target interspace, skin cleaning, local anesthesia infiltration, epidural needle placement using loss-of-resistance technique, aseptic collection of autologous blood, controlled injection into the epidural space, and immediate assessment of EBP effect. Indications, contraindications, expected immediate responses, and troubleshooting (including repeat EBP and alternative interventions) are discussed. The technique shown aims to maximize efficacy and enhance safety, and is applicable to PDPH after dural puncture from spinal anesthesia or inadvertent dural puncture during epidural placement.
Spinal Anesthesia for Ambulatory Hip and Knee Arthroplasty Procedures
Bruna Castro de Oliveira, MD
Massachusetts General Hospital
This educational video article details the technique of spinal anesthesia administration for total hip and knee arthroplasty. The presentation details key procedural elements, including anatomical landmarks, midline and paramedian techniques for spinal placement, equipment for spinal anesthesia, patient positioning and preparation, and local anesthetic selection. Spinal anesthesia offers distinct advantages for outpatient arthroplasty, including rapid onset, favorable operative conditions, and facilitation of same-day discharge. The video serves as a practical educational tool that reinforces evidence-based anesthetic practice and supports the continued advancement of safe, efficient care in ambulatory joint replacement surgery.
Neuraxial Ultrasound and Spinal Anesthesia for Cesarean Delivery
Fatine Karkri, MD; Lauren Blake, MD; Brendan Carvalho, MBBCh, FRCA, MDCH, FASA
Stanford University School of Medicine
This video provides a step-by-step demonstration of preprocedural neuraxial ultrasound for lumbar neuraxial procedures. The film shows probe selection and orientation, sonoanatomy landmarks (sagittal and transverse views), measurement of skin-to-posterior complex depth, and skin marking. Indications and evidence for improved procedural accuracy and reduced needle passes are discussed. The technique is applicable to routine obstetric neuraxial procedures and is especially useful in patients with challenging surface landmarks or a history of difficult neuraxial placement.
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