Users Online: 127 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  
Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Contacts | Login 


RSACP wishes to inform that it shall be discontinuing the dispatch of print copy of JOACP to it's Life members. The print copy of JOACP will be posted only to those life members who send us a written confirmation for continuation of print copy.
Kindly email your affirmation for print copies to dranjugrewal@gmail.com preferably by 30th June 2019.

 

 
Table of Contents
LETTER TO EDITOR
Year : 2018  |  Volume : 34  |  Issue : 2  |  Page : 282-283

Ultrasonography can unfold many Mysteries!


Department of Anesthesia, Christian Medical College, Vellore, Tamil Nadu, India

Date of Web Publication16-Jul-2018

Correspondence Address:
Ekta Rai
Department of Anesthesia, Christian Medical College, Vellore, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joacp.JOACP_355_17

Rights and Permissions

How to cite this article:
Rai E. Ultrasonography can unfold many Mysteries!. J Anaesthesiol Clin Pharmacol 2018;34:282-3

How to cite this URL:
Rai E. Ultrasonography can unfold many Mysteries!. J Anaesthesiol Clin Pharmacol [serial online] 2018 [cited 2019 Nov 22];34:282-3. Available from: http://www.joacp.org/text.asp?2018/34/2/282/236682



Madam,

A 7-year-old, 20 kg boy who was diagnosed with undescended testis and seizure disorders was posted for second stage laproscopic orchidopexy. The child was on T. Sodium valproate and T. clobazam for the focal seizure disorder. His last seizure episode was 6 months ago. He had no other known comorbidity. Preoperatively, the child was active and playful. Vital signs were normal.

Local examination revealed absence of testes on both sides of the scrotum. There was no swelling palpable in groin, perineum, or medial side of thigh. There was a subcoronal penile hypospadias with no chordee, dorsal hooded prepuce, and grooved glans.

He had undergone laparoscopic first stage orchidopexy bilaterally previously. Anesthesia record was not available, and the parents were unable to give history of regional block and any complication related to anesthesia during pervious anesthestics, except that the child came back to the ward postoperatively and was doing well in the ward. Investigations were within normal limits. Ultrasonography (USG) of the abdomen revealed both the testis in the inguinal region.

On the day of the surgery, antiepileptic medications were continued with sips of water and the child was kept comfortable. He accepted inhalational induction, hence, no premedication was offered.

Child was induced with N2O:O2; sevoflurane and IV was established. LMA# 2.5 was secured. Child was positioned in left lateral position and caudal block was planned by landmark technique under strict aseptic conditions. Landmark technique is a routine practice in our hospital.

Once the give was felt with 23-G hypodermic needle, aspiration was performed to rule out blood and cerebrospinal fluid (CSF). On aspiration, clear fluid (1 ml of watery fluid with good flow) was aspirated. The fluid was not oily as CSF. Procedure was abandoned and USG [Figure 1] scan was performed by anesthetist which showed epidural cyst. Surgeons were informed and the surgery continued. Analgesia was managed with fentanyl 3 mcg/kg, morphine 0.1 mg/kg, and paracetamol 20 mg/kg intra -operatively. MRI [Figure 2] and [Figure 3] was done postoperatively under anesthesia on the same day.
Figure 1: Focussed USG of caudal space highlighting the cyst marked with red arrow

Click here to view
Figure 2: Stir-transverse showing the cyst with same density as urine in bladder

Click here to view
Figure 3: MRI highlighting the spinal cyst with same contrast as urine in bladder

Click here to view


MRI showed S2–S4 shows an intraspinal cyst measuring 30 × 9 mm fillingthespinalcanal. Conusendsat L1 level. The child was followed up by the neurologist thereafter. Since most of these cysts are asymptomatic and incidentally found. Usually, they do not require treatment, but when accompanied with neurological symptoms, treatments such as decompressive laminectomy, lumboperitoneal shunting, or percutaneous drainage of cysts are necessary. We suggest that USG scanning should be performed prior to blocks routinely, if available.[1] Ultrasound helps in identifying the incidental abnormalities,[2] anatomical variations [3] such as the dura sac termination,[4] occult spinal dysraphism, etc.

The centrineuraxial blocks are performed under anesthesia in children, hence, is a high-risk procedure. It is desirable to scan the spinal spaces for high risk patients [5] and high-risk procedures for spinal abnormalities prior to blocks.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mirjalili SA, Taghavi K, Frawley G, Craw S. Should we abandon landmark-based technique for caudal anesthesia in neonates and infants? Paediatr Anaesth 2015;25:511–6.  Back to cited text no. 1
    
2.
Kang MS, Lim YJ, Lee SC. Sacral meningeal cyst detected during caudal epidural block. J Korean Pain Soc 1999;12:258–62.  Back to cited text no. 2
    
3.
Aggarwal A, Kaur H, Batra YK, Aggarwal AK, Rajeev S, Sahni D. Anatomic consideration of caudal epidural space: A cadaver study. Clin Anat 2009;22:730–7.  Back to cited text no. 3
    
4.
Joo J, Kim J, Lee J. The prevalence of anatomical variations that can cause inadvertent dural puncture when performing caudal block in Koreans: A study using magnetic resonance imaging. Anaesthesia. 2010;65:23–6.  Back to cited text no. 4
    
5.
Koo BN, Hong JY, Song HT, Kim JM, Kil HK. Ultrasonography reveals a high prevalence of lower spinal dysraphism in children with urogenital anomalies. Acta Anaesthesiol Scand 2012;56:624-8.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
   References
   Article Figures

 Article Access Statistics
    Viewed560    
    Printed16    
    Emailed0    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal