This report describes a rare case of ventrally exophytic pontine glioma describing operative and neuroanesthesia management. The combination of intraoperative neuromonitoring was used. It constituted: Brain stem evoked responses/potentials, Motor EP: recording from cranial nerve supplied muscle, and Sensory EP: Medial/tibial. Excision of the tumor was done with intra-operative magnatic resonance imaging (iMRI), which is considered a new modality.

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This report describes an unusual case of obstruction of a reinforced endotracheal tube during posterior Fossa exploration to excise glioma tumor. An 11-year-old male child, scheduled for excision of a glioma in the prone position. The trachea was intubated using a 5.0-mm nylon reinforced latex endotracheal tube (TT). The anesthesiologist ventilated his lungs with a mixture of isoflurane 1.0 MAC in oxygen (35%) and medical air. It was observed that his peak airway pressure was 21 cm H2O at the beginning of anaesthesia, increased to 26 cm H2O over three hours. After that and over 30 min, the peak reached 35 cm H2O, while the end-tidal CO2 pressure was 45 mmHg then gradually increased to 100 mmHg. The anesthesiologists suspected partial obstruction of the tracheal tube (TT). However, the anesthesiologists could not pass a suction catheter through the TT. The anesthesiologist could not advance a suction catheter beyond 8 cm. Re-intubation of the trachea with a 5.5 mm PVC TT relieved the airway obstruction. The termination of surgery allowed to take a chest x­ray which revealed unimpressive marginal pneumothorax which was drained but did not relieved the difficulties. The recording of tissue oxygen saturation and end tidal CO2 were consistent with gradual subtotal obstruction which allowed oxygenation, and delivering inhalational agent but retention of carbon dioxide. In this report we described an unusual incidence of tracheal tube obstruction complicated by presence of small pneumothorax which was successfully treated.

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Aims: To report the use of transesophageal Doppler (TED), a minimally invasive cardiac output (COP) monitor, before, during and after reperfusion and study its effect on anesthetic management during living donor liver transplantation (LDLT). Setting and Design: A prospective observational study. Methods: A total of 25 consecutive recipients with a MELD score between 15 and 20 were enrolled. Data were recorded at baseline (TB); anhepatic phase (TA); and post-reperfusion - 1, 5, 10 and 30 minutes. Fluid therapy was guided by corrected flow time (FTc) of the TED. Packed red blood cells (RBCs) were only given when hematocrit was less than 25%. Rotational thromboelastometry (ROTEM) and standard laboratory tests were used to guide component blood products requirements. Results: Post-reperfusion, the COP, Cardiac Index (CI) and stroke volume (SV) increased significantly at all points of measurements; this was associated with a significant decrease in systemic vascular resistance (SVR) ( P <.05). Immediately post-reperfusion, for 5 minutes, mean arterial blood pressure (ABP) dropped significantly (P<.05), and 14 out of the 25 patients required boluses of epinephrine (10 μg) to restore the mean ABP; 3 of the 14 patients required norepinephrine infusion till the end of surgery. Central venous pressure (CVP) and urine output (UOP) at all measures were maintained adequately with FTc-guided fluid replacement. Eight out of the 25 patients required no blood transfusion, and 4 of the 8 patients required no catecholamine support. Conclusion: TED as a sole monitor for COP was able to present significant and reliable changes in the cardiovascular status of the recipients during reperfusion, which could help to guide fluid- and drug-supportive therapy in this population of patients. This preliminary study needs to be applied on a larger scale.

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Background and Aim: Neuraxial adjuvants augment the action of local anesthetics. The aim is to determine the qualitative and quantitative aspects of epidural block of ropivacaine 0.75% versus ropivacaine 0.75% with clonidine for elective cesarean section . Settings and Design: A randomized double-blind study was conducted among 51 healthy parturients, scheduled for elective cesarean section, at Gian Sagar Medical College and Hospital, Banur, Punjab, India. Materials and Methods: Epidural block was administered with 20 ml of ropivacaine 0.75% (group R) and ropivacaine 0.75% and clonidine 75 μg (group RC) and anesthetic level was achieved minimum until T6-T7 dermatome. Onset time of analgesia, sensory and motor block levels, maternal heart rate and blood pressure, neonatal Apgar scores, postoperative analgesic dose and adverse events were recorded. Results: Fifty one patients were enrolled in this study and were subjected to statistical analysis. Groups were comparable with regard to demographic data, neonatal Apgar scores and incidences of side effects except for the higher incidence of dry mouth in patients of RC group. Onset of analgesia was much shorter in RC group along with prolonged duration of analgesia. The incidence of bradycardia and hypotension was more in RC group as compared to R group which was statistically significant. The dose requirement for postoperative pain relief was significantly lesser in RC group. Conclusions: The addition of 75 μg clonidine to isobaric epidural ropivacaine results in longer, complete and effective analgesia with similar block properties and helped to reduce the effective dose of ropivacaine when compared with plain ropivacaine for cesarean delivery.

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Background. Pneumonia is the most common nosocomial infection in intensive care units. Most of ICU­acquired pneumonias occur during mechanical ventilation; about half of them develop in the first four days after intubation. Ventilator-associated pneumonia (VAP) can be a lethal complication as it carries a mortality that may approach 50%. Methods. Continuous subglottic suction was utilized in seventeen post cardiac surgery patients with established VAP as part of the management protocol. These patients were compared with a group of 12 patients who did not have continuous subglottic suction part of their management. Results. Institution of continuous subglottic suction in patients with established ventilator associated pneumonia is of value in reducing the number of ventilator dependent days. It also decreases the likelihood of further deterioration in the pulmonary function and reduces the need for antimicrobial agents. Conclusion. Continuous subglottic suction is beneficial in case of established VAP. It prevents further soilage of the airways, speeds up convalescence and shortens the ICU stay. Ideally, it should be instituted early on in case of prolonged mechanical ventilation as one of the effective measures for the prevention of this kind of pneumonia.

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Conjoined twins have been viewed with fascination since antiquity. There are numerous reports in the literature documenting anesthetic management strategies for the separation of conjoined twins. There are also reports in the literature detailing anesthetic approaches for surgical procedures not involving separation. This is the first report of the anesthetic management of a set of omphalagous presenting for palliative repair of omphalocele in Nigeria.

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Background and Aims: Keeping in consideration the merits of total intravenous anesthesia (TIVA), a genuine attempt was made to find the ideal drug combinations which can be used in general anesthesia. This study was conducted to evaluate and compare two drug combinations of TIVA using propofol-ketamine and propofol-fentanyl and to study the induction, maintenance and recovery characteristics following anesthesia with these techniques. Settings and Design: A case control study was conducted, which included 100 patients, in the department of Anaesthesiology and Intensive care, Government Medical College and Hospital, Patiala. Patients and Methods: A hundred patients between the ages of 20 and 50 years of either gender were divided into two groups of 50 each, and they underwent elective surgery of approximately 1 h duration. Group I received propofol-ketamine while group II received propofol-fentanyl for induction and maintenance of anesthesia. All the results were tabulated and analyzed statistically with student's unpaired t-test and chi-square test. Results : Propofol-fentanyl combination produced a significantly greater fall in pulse rate (PR; 9.28% versus 0.23%) and in both systolic (7.94% versus 0.12%) and diastolic blood pressures (BP; 8.10% versus 0.35%) as compared to propofol-ketamine during induction of anesthesia. Propofol-ketamine combination produced stable hemodynamics during maintenance phase while on the other hand propofol-fentanyl was associated with a slight increase in both PR and BP. During recovery, ventilation score was better in group I while movement and wakefulness score was better in group II. Mean time to protrusion of tongue and lifting of head was shorter in group I. Conclusions : Both propofol-ketamine and propofol-fentanyl combinations produce rapid, pleasant and safe anesthesia with only a few untoward side effects and only minor hemodynamic effects.

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The provision of mechanical ventilation for the support of infants and children with respiratory failure or insufficiency is one of the most common techniques that are performed in the Pediatric Intensive Care Unit (PICU). Despite its widespread application in the PICUs of the 21st century, before the 1930s, respiratory failure was uniformly fatal due to the lack of equipment and techniques for airway management and ventilatory support. The operating rooms of the 1950s and 1960s provided the arena for the development of the manual skills and the refinement of the equipment needed for airway management, which subsequently led to the more widespread use of endotracheal intubation thereby ushering in the era of positive pressure ventilation. Although there seems to be an ever increasing complexity in the techniques of mechanical ventilation, its successful use in the PICU should be guided by the basic principles of gas exchange and the physiology of respiratory function. With an understanding of these key concepts and the use of basic concepts of mechanical ventilation, this technique can be successfully applied in both the PICU and the operating room. This article reviews the basic physiology of gas exchange, principles of pulmonary physiology, and the concepts of mechanical ventilation to provide an overview of the knowledge required for the provision of conventional mechanical ventilation in various clinical arenas.

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Objective: To examine the validity of central venous oxygen saturation (ScvO ₂ ) as a numerical substitution of mixed venous oxygen saturation (SvO ₂ ) in adult patients undergoing normothermic on pump beating coronary artery bypass grafting (CABG). Materials and Methods: Prospective clinical observational study was done at King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. Thirty four adult patients scheduled for coronary artery surgery were included. Patients were monitored by a pulmonary artery catheter (PAC) as a part of our routine intraoperative monitoring. SvO ₂ and ScvO ₂ were simultaneously measured 15 minutes (T1) and 30 minutes (T2) after induction of anesthesia, 15 and 30 minutes after initiation of cardiopulmonary bypass (T3 and T4), and 15 and 30 minutes after admission to intensive care unit (T5 and T6). Results: ScvO ₂ showed higher reading than SvO ₂ all through our study. Our results showed perfect positive statistically significant correlation between SvO ₂ and ScvO ₂ at all data points. Individual mean of difference (MOD) between both the readings at study time showed MOD of 1.34 and 1.44 at T1 and T2 simultaneously. This MOD was statistically insignificant, but after on pump beating normothermic bypass was initiated; MOD was 5.2 and 4.4 at T3 and T4 with high statistical significance. In ICU, MOD continues to have high statistical significance, MOD was 6.3 at T5 and at T6 it was 4.6. Conclusions: In on pump beating CABG patients; ScvO ₂ and SvO ₂ are not interchangeable numerically. ScvO ₂ is useful in the meaning of trend; our data suggest that ScvO ₂ is equivalent to SvO ₂ , only in the course of clinical decisions as long as absolute values are not required.

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Background. In the adult population, analgesia following lower abdominal surgery and laparoscopic procedures can be provided by a transversus abdominis plane (TAP) block where local anesthetic is placed between the internal oblique and the tranversus abdominis muscles using an injection in the triangle of Petit. We present preliminary experience with the postoperative analgesic efficacy of TAP block in pediatric patients. Patients and Methods. Ten pediatric patients, ranging in age from 10 months to 8 years were reviewed. Using ultrasound guidance, a TAP block was placed on both sides with 0.3 mL/kg of 0.25% bupivacaine with epinephrine 1:200,000 after the completion of the surgical procedure. The surgical procedures included ureteral reimplantation (n=3), colostomy takedown (n=2), pelvic laparoscopy for evaluation of abdominal pain (n=2), laparoscopic appendectomy (n=2), and bilateral inguinal hernia repair (n=1). Results. In 8 of 10 patients, the TAP block was judged to be successful as no postoperative analgesic agents were required for the initial 7-11 postoperative hours. Four patients required no intravenous opioids postoperatively and were treated with oral opioids as outpatients. The other 4 patients required 0.15 ± 0.04 mg/kg of morphine during the first 24 postoperative hours. The TAP block was judged to be unsuccessful in 2 patients who required intravenous opioids during their immediate postoperative course, starting at 2 and 3 hours postoperatively. These two patients required 0.3-0.4 mg/kg of morphine during the first 24 postoperative hours. No adverse effects related to TAP block were identified. Conclusion. Our preliminary experience suggests that TAP block provides effective analgesia following umbilical and lower abdominal surgery in infants and children.

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Background: Postoperative nausea and vomiting (PONV) is a common complication following general anesthesia. Different regimens have been described for the treatment of PONV with few that mention the prevention of it. Therefore, we conducted this study to compare the effect of preloading with either crystalloids or colloids on the incidence of PONV following laparoscopic cholecystectomy (LC), under general anesthesia. Materials and Methods: This study was carried out on 80 patients who underwent LC. The patients were divided into four groups (each 20 patients), to receive preloading of intravenous fluid, as follows: Group 1 received, 10 ml/kg of low-MW tetrastarch in saline (Voluven ^TM ), group 2 received, 10 ml/kg medium-MW pentastarch in saline (Pentaspan ^TM ), group 3, received 10 ml/kg of high-MW heta-starch in saline (Hespan ^TM ), and group 4, received 10 ml/kg Lactated Ringer's, and this was considered as the control group. All patients received the standard anesthetic technique. The incidence of PONV was recorded, two and 24 hours following surgery. The need for antiemetics and/or analgesics was recorded postoperatively. Results: The highest incidence of PONV was in group 3 (75% of the patients) compared to the other three groups. Also the same trend was found with regard to the number of patients who needed antiemetic therapy. It was the highest incidence in group 3 (70%), followed by group 2 (60%), and then group 1(35%), and the least one was in the control group (25%). Conclusion: Intravascular volume deficits may be a factor in PONV and preloading with crystalloids showed a lower incidence of PONV.

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Neurogenically mediated bradycardia that may result in cardiac arrest is a rare but well-recognised complication during anaesthesia. Three cases are described that illustrate certain features. In the first, hidden haemorrhage during laparoscopy under general anaesthesia was revealed during reinsufflation of gas into the peritoneum at the end of the operation. The second case developed asystole when positioned supine with tilt after spinal anaesthesia for caesarean section. This occurred on two occasions separated by ten years. In the third case, asystole developed 95 minutes after a spinal when the patients legs were lowered down from the lithotomy position. All patients were resuscitated with drug treatment and, in the first case, intravenous fluids.

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The number of noninvasive and minimally invasive procedures performed outside of the operating room has grown exponentially over the last several decades. Sedation, analgesia, or both may be needed for many of these interventional or diagnostic procedures. Individualized care is important when determining if a patient requires procedural sedation analgesia (PSA). The patient might need an anti-anxiety drug, pain medicine, immobilization, simple reassurance, or a combination of these interventions. The goals of PSA in four different multidisciplinary practices namely; emergency, dentistry, radiology and gastrointestinal endoscopy are discussed in this review article. Some procedures are painful, others painless. Therefore, goals of PSA vary widely. Sedation management can range from minimal sedation, to the extent of minimal anesthesia. Procedural sedation in emergency department (ED) usually requires combinations of multiple agents to reach desired effects of analgesia plus anxiolysis. However, in dental practice, moderate sedation analgesia (known to the dentists as conscious sedation) is usually what is required. It is usually most effective with the combined use of local anesthesia. The mainstay of success for painless imaging is absolute immobility. Immobility can be achieved by deep sedation or minimal anesthesia. On the other hand, moderate sedation, deep sedation, minimal anesthesia and conventional general anesthesia can be all utilized for management of gastrointestinal endoscopy.

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Background: Postoperative nausea and vomiting (PONV) is one of the complications which hamper the successful implementation of day care surgical procedure in spite of the availability of so many antiemetic drugs and regimens for its prevention. The aim was to compare the prophylactic effects of intravenously (IV) administered ondansetron and palonosetron on PONV prevention in patients undergoing laparoscopic gynecological surgery under general anesthesia. Methods: A prospective double-blind study comprised of 60 ASAI/II female patients between the age group of 25 and 40 years was carried out in the Departments of Anesthesiology and Obstetrics and Gynecology of our institute. Patients were randomly divided into two groups of 30 patients each in a double-blind manner. Group I received 8 mg of inj. ondansetron IV while group II received inj. palonosetron 0.075 mg IV 5 minutes before the induction of anesthesia. The need for rescue antiemetics, episodes of PONV and other side effects were observed for 6 hours in the postanesthesia care unit and thereafter complaints were received on phone after the discharge. At the end of study, results were compiled and statistical data was subjected to statistical analysis using Student two-tailed 't' and c² test and value of P<0.05 was considered significant. Results: The demographical profile of the patients was comparable. Twenty and 13.33% of the patients in group I had nausea and vomiting episodes postoperatively as compared to 6.67% and 3.33%, respectively, in group II which was statistically significant (P<0.05). Twenty percent of the patients in group I experienced significant post-op headache as compared to 6.67% in group II. The mean rescue dose of antiemetic was significantly higher (10.6 mg) in the group I as compared to group II (6.4 mg) (P=0.036). The rest of parameters were comparable and statistically nonsignificant. Conclusions: Palonosetron is a comparatively better drug to prevent the PONV in patients undergoing day care surgical procedures as compared to ondansetron as it has got a prolonged duration of action and favorable side-effects profile.

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Negative pressure pulmonary edema (NPPE) is a dangerous and potentially fatal condition with a multifactorial pathogenesis. Frequently, NPPE is a manifestation of upper airway obstruction, the large negative intrathoracic pressure generated by forced inspiration against an obstructed airway is thought to be the principal mechanism involved. This negative pressure leads to an increase in pulmonary vascular volume and pulmonary capillary transmural pressure, creating a risk of disruption of the alveolar-capillary membrane. The early detection of the signs of this syndrome is vital to the treatment and to patient outcome. The purpose of this review is to highlight the available literature on NPPE, while probing the pathophysiological mechanisms relevant in both the development of this condition and that involved in its resolution.

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Background: This study was undertaken to find out the effect of early tracheostomy on weaning from mechanical ventilation. Pulmonary mechanics and arterial blood gases were assessed before and after tracheostomy in patients with severe head injury (Glasgow coma score < 8) requiring prolonged mechanical ventilation. Patients and Methods: The study included 20 mechanically ventilated patients of either sex between 20 and 45 years of age, who had suffered brain injury due to head trauma during admission (Glasgow coma scores of <8). Mean airway pressure, peak airway pressure, plateau pressure, PaO ₂ and PaCO ₂ were measured 24 h before and after tracheostomy. Static and dynamic compliances were calculated. Results: Plateau airway pressures were not affected by tracheostomy, but peak airway pressure was reduced (29.90 ± 3.21 cm H ₂ O before tracheostomy versus 24.30 ± 1.83 cm H ₂ O after tracheostomy, P < 0.001). Dynamic compliance, but not static compliance, was improved by tracheostomy. Tracheostomy did not affect PaCO ₂ , but it improved PaO ₂ (83.09 ± 5.99 mmHg before versus 90.84 ± 5.61 mmHg after, P ≤ 0.001). Conclusions: The work of breathing through a tracheostomy tube may be less than through an endotracheal tube of same internal diameter.

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Background: Low flow anesthesia can lead to reduction of anesthetic gas and vapor consumption. Laryngeal mask airway (LMA) has proved to be an effective and safe airway device. The aim of this study is to assess the feasibility of laryngeal mask airway during controlled ventilation using low fresh gas flow (1.0 L/min) as compared to endotracheal tube (ETT). Patients and Methods : Fifty nine non-smoking adult patients; ASA I or II, being scheduled for elective surgical procedures, with an expected duration of anesthesia 60 minutes or more, were randomly allocated into two groups - Group I (29 patients) had been ventilated using LMA size 4 for females and 5 for males respectively; and Group II (30 patients) were intubated using ETT. After 10 minutes of high fresh gas flow, the flow was reduced to 1 L/min. Patients were monitored for airway leakage, end-tidal CO ₂ (ETCO ₂ ), inspiratory and expiratory isoflurane and nitrous oxide fraction concentrations, and postoperative airway-related complications Results : Two patients in the LMA-group developed initial airway leakage (6.9%) versus no patient in ETT-group. Cough and sore throat were significantly higher in ETT patients. There were no evidences of differences between both groups regarding ETCO ₂ , uptake of gases, nor difficulty in swallowing. Conclusion : The laryngeal mask airway proved to be effective and safe in establishing an airtight seal during controlled ventilation under low fresh gas flow of 1 L/min, inducing less coughing and sore throat during the immediate postoperative period than did the ETT, with continuous measurement and readjustment of the tube cuff pressure.

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Background. Propofol is an intravenous anesthetic that is often used as an adjuvant during monitored anesthesia care, the addition of ketamine to propofol may counteract the cardiorespiratory depression seen with propofol used alone. Ketofol (ketamine/propofol combination) was used for procedural sedation and analgesia. However, evaluation of the effectiveness of different concentrations of Ketofol in procedural operation regarding changes in haemodynamics, emergence phenomena, recovery time, the doses, and adverse effects was not yet studied, so this randomized, double blinded study was designed to compare the quality of analgesia and side effects of intravenous different concentrations of ketofol Patient and Methods. One hundred children of both sex undergoing procedural operation, e.g. esophgoscopy, rectoscopy, bone marrow aspiration and liver biopsy participated in this. Patients received an infusion of a solution containing either combination of propofol: ketamine (1:1) (Group I) or propofol: ketamine (4:1) (Group II). Subsequent infusion rates to a predetermined sedation level using Ramsay Sedation Scale. Heart rate, noninvasive arterial blood pressure (NIBP), oxygen saturation (SpO2), end tidal carbon dioxide (Etco ₂ ) and incidence of any side effects were recorded. Results. There were no significant hemodynamic changes in both groups after induction. However, there was an increase in postoperative nausea, psychomimetic side effects, and delay in discharge times in group I compared to group II. Conclusion. The adjunctive use of smaller dose of ketamine in ketofol combination minimizes the psychomimetic side effects and shortens the time of hospital discharge.

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We describe a patient with long-standing ankylosing spondylitis who underwent percutaneous nephrolithotomy under spinal anesthesia. At preoperative assessment, it was considered that intubation of the trachea was likely to be difficult. Fiberoptic bronchoscopy was attempted, but without success. As the standard technique for spinal anesthesia failed, a variation of the paramedian approach in the lumbosacral approach, also known as Taylor's approach was successfully attempted. This resulted in adequate sensory and motor blockade for the surgical procedure. The patient did not require airway interventions, but equipment and aids to secure airway were available.

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Central venous catheterization (CVC) is a commonly performed intraoperative procedure. Traditionally, CVC placement is performed blindly using anatomic landmarks as a guide to vessel position. Real-time ultrasound provides the operator the benefit of visualizing the target vein and the surrounding anatomic structures prior to and during the catheter insertion, thereby minimizing complications and increasing speed of placement. A 22-year-old male underwent open reduction and internal fixation of acetabulum fracture in prone position. Excessive continuous bleeding intraoperatively warranted placement of CVC in right internal jugular vein (IJV), which was not possible in prone position without the help of ultrasound. Best view of right IJV was obtained and CVC was placed using real-time ultrasound without complications. Ultrasound-guided CVC placement can be done in atypical patient positions where traditional anatomic landmark technique has no role. Use of ultrasound not only increases the speed of placement but also reduces complications known with the traditional blind technique.

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Background. Prevention and treatment of postoperative pain and postoperative nausea and vomiting (PONV), continue to be a major challenge in the postoperative care. This study was designed to compare the effects of small dose of oral gabapentin versus clonidine as premedication on early postoperative pain and on PONV in patients undergoing elective abdominal surgery under general anesthesia. Methods. In a randomized placebo controlled study, 120 ASA I and II patients scheduled for elective abdominal surgery were randomly assigned to receive either 0.2mg oral clonidine (n=40) or 300mg gabapentin (n=40) or placebo (n=40) 1hr before surgery. They were anesthetized using the same technique. Demographic data, post operative visual analogue scale (VAS), PONV and total morphine consumption by PCA pump were recorded in the recovery room and during first 6 hr after surgery. Results. Two patients in gabapentin compared with 13 patients in clonidine group (p<0.05) and 29 patients in placebo group (p<0.05) had VAS >3 in recovery room. The mean morphine consumptions were 4.75±7.5, 1.95±5.51 and 1.56±1.5mg in placebo, clonidine and gabapentin group with significant differences (P<0.05). These measurements were 18±15.8, 13.1±12.6 and 12.1±12.9 mg respectively during first 6 hr after surgery with significant differences (P<0.05). PONV was not statistically different between the study groups in the recovery room and during first 6 hr after the surgery. Conclusion. This study showed that oral premedication with 300mg gabapentin reduces postoperative pain and total morphine consumption but not PONV during recovery and in the first 6 hr after abdominal surgery.

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Gynecological laparoscopy is a commonly performed procedure. Providing anesthesia for this can present a challenge, particularly in the day surgery population. Poor analgesia, nausea, and vomiting can cause distress to the patient and increased cost for the health system, because of overnight admission. In this review we discuss anesthetic and analgesic techniques for day-case gynecological laparoscopy. The principles include multimodal analgesia, the use of the oral route wherever possible, and the contribution of the surgeon.

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Ultrasound has added a feather in the cap of the anesthesiologists as real-time nerve localization and drug deposition around the nerve structure under real-time guidance is now a reality, as the saying "seeing is believing" has been proven true with the advent of ultrasound in anesthesia. Pediatric patients are a unique group regarding their anatomical and physiological features in comparison with adults; regional blocks in adults with the anatomical landmark and surface marking are almost uniform across the adult population. The landmark technique in pediatric patients is not reliable in all patients due to the variability in the age and size; the advent of ultrasound in assisting nerve localization has changed the way regional blocks are achieved in children and the range of blocks performed on adults can now be performed on pediatric patients; with advances in the technology and dexterity of ultrasound equipment, the chances of success of blocks has increased with a smaller dose of the local anesthetic in comparison to the traditional methods. Anesthesiologists are now able to perform blocks with more accuracy and avoid complications like intravascular injection and injury to the pleura and peritoneum during routine practice with the assistance of high-frequency transducers and top of the range portable ultrasound machines; catheters can be inserted to provide a continuous analgesia in the postoperative period. This review article describes the common peripheral blocks in pediatric patients; the readers are encouraged to gain experience by attending workshops, hands-on practice under supervision, and conduct random controlled trials pertaining to ultrasound-guided blocks in the pediatric age group. The recent literature is encouraging and further research is promising; a wide range of blocks being described in detail by many prominent experts from all over the world.

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