Vrushali C Ponde

• MD
• Consultant Anaesthesiologist at Children Anaesthesia Services Mumbai India

Anesthesiologists are amongst the front line warriors in this COVID-19 pandemic. We need to change our preferences and practices to reduce the spread to healthcare workers and patients in the hospital. General anesthesia involves aerosol-generating procedures while ventilating and intubating the patients. Regional anesthesia maintains respiratory f...

Background and Aims Regional anesthesia plays a crucial role in perioperative medicine, influencing both immediate and long-term outcomes. However, there is a lack of data regarding the utilization and practices of plexus and peripheral nerve blocks. We attempted to investigate the practices of plexus and peripheral nerve blocks using a validated q...

Introduction: Achieving appropriate levels of premedication and parental separation is needed for smooth induction of anesthesia and prevention of perioperative complications. Both melatonin and midazolam are used for the premedication in children, but we do not have consensus on which premedication is superior among them. Evidence acquisition:...

We sought to examine the incidence of severe postoperative pain in patients with cerebral palsy (CP) in the first 48 hr after surgery performed under combined regional and general anesthesia and its association with patient and surgical factors. In a historical cohort study, we reviewed the electronic records of 452 patients with spastic CP who und...

KEY POINTS � Understanding the difference in anatomy, physiology and pharmacology between adults and children is essential when performing paediatric regional anaesthesia (PRA). � PRA techniques help ensure optimal analgesia, early ambulation and earlier discharge from hospital. � PRA can be performed safely under general anaesthesia or deep sedati...

A 3‐year‐old boy presented with episodes of uneasiness and transient loss of consciousness. Atrial tachyarrhythmias with rapid ventricular rate was diagnosed and initially unsuccessfully treated with oral antiarrhythmic drugs. Subsequent Holter monitoring revealed ventricular arrhythmias. Despite pharmacologic treatment, he needed numerous cardiove...

Background and Aims: The most effective approach for infraclavicular brachial plexus block in adults is to target the posterior cord, usually situated posterior to axillary artery. However, we do not know if this can be extrapolated in children. Our primary objective was to compare the clinical success rate of ultrasound guided infraclavicular brac...

Background and aims: The most effective approach for infraclavicular brachial plexus block in adults is to target the posterior cord, usually situated posterior to axillary artery. However, we do not know if this can be extrapolated in children. Our primary objective was to compare the clinical success rate of ultrasound guided infraclavicular bra...

Abstract Background Caudal epidural analgesia is the most common regional anesthetic performed in infants. Dural puncture, the most common serious complication, is inversely proportional to age. Measuring the distance from the sacrococcygeal membrane to the dural sac may prevent dural puncture. This study measures the sacrococcygeal membrane to dur...

Video-assisted thoracoscopic surgery (VATS) is a frequently performed procedure in children which requires an efficient technique for lung isolation. Unavailability of appropriate size double-lumen tubes (DLT) for children and fiber optic scopes inspired us to create our own technique for lung isolation. This retrospective case series aims to descr...

Objectives: Traditionally caudal epidurals are performed by landmark guided approach using the loss of resistance technique. Improvisations to increase the success rate can be attained by implementing modalities namely the neuro-stimulation and ultrasound but there is paucity of literature comparing these three approaches. Here we compare the thre...

"Illustrated Manual of Ultrasound Guided Regional Anesthesia for Children and Adults 3rd Edition by Dr. Vrushali C Ponde" translated in Japanese

Caudal epidural block is one of the most commonly administered blocks in paediatric population. Continuous caudal technique offers several advantages like its ability to cater to long duration surgeries, higher thoracic procedures and to deliver extended, titratable post-operative pain relief. Current advances in this technique like use of fluorosc...

“Team AORA” has come a long way in learning, teaching and researching and innovating regional anaesthesia. From hands on workshops to full fledge post-doctoral fellowships of a year's duration looks like a joyous journey done together. As I write this, the enthusiasm towards honing skills in regional anaesthesia, RA, is palpable. Even in the most t...

A Quick Guide: Ultrasound Guided Nerve Blocks

Background and aims: Regional anaesthesia techniques are a part of perioperative medicine that affects both perioperative and long-term outcomes. We have a paucity of the data on the usage and practices of plexus and peripheral nerve blocks (PNBs). To the best of our knowledge, this is the first effort to validate a survey for plexus and PNBs. Sub...

1 | INTRODUC TI ON Caudal regression syndrome is a broad term for a rare complex disorder characterized by abnormal development of the lower (caudal) end of the spine. It represents a spectrum ranging from asymptom-atic to mild symptoms to cases with severe, disabling or potentially life-threatening complications. 1 These children may have a wide v...

The benefits of regional anaesthesia and the accompanying concerns of general anaesthesia in newborns make the former a safe and valuable addition. Multiple regional anaesthesia techniques, ranging from the central neuraxial blocks, truncal blocks, and peripheral nerve blocks are available. Empowering us to make the case to case decision to choose...

Although rare, complications can occur in paediatric regional anaesthesia (PRA). An awareness of the various steps where things could go wrong, and the measures taken to rectify them, can go a long way in preventing and treating PRA effectively. Complications due to needle and its trajectory, The needle puncture point Infections, swellings, tendern...

Paediatric anaesthesia and paediatric regional anaesthesia are intertwined. Currently, almost all paediatric patients posted for surgery could and should be given a regional block unless and until contraindicated. This is because the scope, techniques, and their benefits have a wide range and complications are rare. The first report that used regio...

MMI

Rett syndrome is a genetic neurodevelopmental disorder which occurs in females and includes autism, spasticity, hypotonia, microcephaly, scoliosis, stereotyping, abnormal respiratory control and seizures. They are at an increased predisposition for QT interval prolongation and cardiac arrhythmias. An 8-year-old severely intellectually impaired girl...

Background and Aims: Current concerns related to the anaesthetic neurotoxicity have brought a renewed interest in regional anaesthesia. Regional anaesthesia reduces the need for opioids and inhalational anaesthetics. The immaturity of the neonatal and infant nervous system may render them more prone to neurotoxicity. We describe our technique of an...

Learning points Peripheral nerve blockade was used to induce vasodilatation of the peripheral vessels by means of a sympathetic blockade. Furthermore, it also stopped the afferent impulses and inhibited the peripheral vasoconstriction because of a reduction in the pain-induced release of catecholamines, cortisol, and antidiuretic hormone. When comp...

Preoperative medication is used in children (a) to provide sedation and tranquility, (b) to supplement general anesthesia techniques, (c) to decrease airway secretions, and (d) to block unwanted autonomic responses. Sedatives/hypnotics and anxiolytics can be used for the first two, while anti-cholinergics may be useful to accomplish the third and f...

Are we too focused on blocks, to care, for the patient as an individual who needs holistic care? “Work is love made visible” Khalil Gibran We feel very contented, useful and happy when our patients are safe and comfortable in the perioperative period. Learning new techniques and implementing fresh ideas add a lot of meaning and zeal to our daily...

About what is ideally expected from a professional, working as a specialist in pediatric anaesthesia.

Background and aims: The fascia iliaca compartment block (FICB) is commonly administered in children for anterolateral thigh surgery. The actual spread of the local anaesthetic (LA) beneath the fascial layers in children is not known. We hypothesised that in children there could be a possibility of the LA to reach lumbar plexus with the dose we us...

ABSTRACT Paediatric regional anaesthesia today is one of the fastest growing and exciting aspects of paediatric anaesthesia, which requires an ongoing fervour to learn. Application of paediatric regional anaesthesia in neonates, infants, toddlers and children is undertaken to treat perioperative pain without disturbing the physiological milieu with...

Background and Aims: Current concerns related to the anesthetic neurotoxicity have brought a renewed interest in regional anesthesia. Regional anesthesia reduces the need for opioids and inhalational anesthetics. The immaturity of the neonatal and infant nervous system may render them more prone to neurotoxicity. We describe our technique of anesth...

Contents: Basic principles of ultrasound physics................................................................................1 2. Upper extremity blocks....................................................................................................23 • Cervical plexus block........................................................................

This presentation gives a gist of recent trends in regional anaesthesia. Practical issues faced by the regional anaesthesia enthusiast to practise these modalities are discussed here, This applies more to the Indian work culture.

A comfortable patient is the key for any successful regional technique. This is perhaps because the anesthesiologist gets maximum cooperation from the patient which puts us at natural ease for block procedure. Although not a must, this is welcome scenario. Axillary approach brachial plexus block is best suited for distal forearm and hand cases. The...

A comfortable patient is the key for any successful regional technique. This is perhaps because the anesthesiologist gets maximum cooperation from the patient which puts us at natural ease for block procedure. Although not a must, this is welcome scenario. Axillary approach brachial plexus block is best suited for distal forearm and hand cases. The...

Pediatric regional anesthesia, does it work??? This article was written for Win conclave

"Current status and future challenges for regional anaesthesia practice in India". This topic was a didactic lecture delivered in the European Society of Paediatric Anaesthesiologist meeting held in Belgium on 7th,8th and 9th of september 2018

Regional anaesthesia for neonatal population is a didactic lecture delivered in the annual conference held by the Mauritus Society of anaesthesiology

''Complications in paediatric regional anaesthesia " was delivered as a didactic lecture in the meeting held by Mauritius Anaesthesiologist Association.

Background: Children that have had a meningomyelocele repair often present for hip and bilateral lower limb surgeries. Due to vertebral, epidural, and nerve root abnormalities, placement of epidural catheter is difficult. Aims: We aim to describe the potential role of ultrasound in delineating the most appropriate intervertebral space for centra...

Background: Caudo-lumbar and caudo-thoracic epidural anesthesia is an established technique that carries a low risk of dural puncture or spinal cord trauma in infants. Traditionally catheter advancement is based on external measurements. However, malpositioning of catheters are known to occur. We hypothesized that caudal-epidural catheters inserte...

Syngnathia, bony maxilla-mandibular fusion, is a rare anomaly and usually associated with cleft palate or other systemic anomalies. We herewith describe a method to maintain adequate depth of anaesthesia while managing airway by fibre-optic (FO) intubation

Background and Aims: The cost effectiveness of ultrasound‑guided regional anesthesia is an issue which requires discussion. Based on our experience, we hypothesized that this is an economically viable option. Material and Methods: In this retrospective study, we included 90 patients who underwent upper extremity surgeries in our institute solely un...

Background and Aims: The cost effectiveness of ultrasound‑guided regional anesthesia is an issue which requires discussion. Based on our experience, we hypothesized that this is an economically viable option. Material and Methods: In this retrospective study, we included 90 patients who underwent upper extremity surgeries in our institute solely un...

Pediatric patients with complex multitudinous orthopedic problems undergoing complex, long duration, multiple limb procedures pose a unique challenge to the paediatric anaesthesiologist. The advances in pediatric regional anaesthesia, an ever evolving branch, have led to successful management of such patients throughout the perioperative period. Th...

Background: There is a lack of information about the prevalence of pain among school going Indian children, and therefore, this study was conducted. A cross-sectional population survey was conducted in school children from Grades III to VI. The objective was to determine the prevalence of pain, including chronic pain. The secondary objectives were...

Background The needle tip placed at the level of posterior cord under ultrasound guidance is described as the most effective way to obtain single shot successful block in adults, for forearm and hand surgeries.Objective The aim of this research was to study the spread of dye (depicting the local anesthetic) through catheters placed along the poster...

CONTENTS Foreword-----------------------------------------------------------------VII Preface------------------------------------------------------------------- VIII Acknowledgement ------------------------------------------------------ IX 1. Basic Principles of Ultrasound Physics -------------------------- 1 2. Upper Extremity Blocks--------------...

Background and objectivesArthrogryposis multiplex congenital is hallmarked with immobile joints and muscle fibrosis. The main objective of this study was to compare the success rate of ultrasound‐guided sciatic and femoral nerve blocks with nerve stimulations in children diagnosed with distal arthrogryposis multiplex congenita. Method Sixty childre...

Neonatal upper limb ischemia due to accidental arterial damage remains a major concern, which can lead to devastating complications if untreated. The primary objective of this case report is to emphasize the role of continuous infraclavicular brachial plexus block, the issues related with block performance in an ischemic hand, and the importance of...

Paediatric anaesthesia and paediatric regional anaesthesia are intertwined. Almost all surgeries unless contradicted could be and should be supplemented with a regional block. The main objective of this review is to elaborate on the recent advances of the central neuraxial blocks, such as application of ultrasound guidance and electrical stimulatio...

The aim of the study was to derive a clinically useful formula for paravertebral block for thoracic, lumbar (L1) and cervical level (C6) as per the ultrasound-guided measurements in neonates, infants and children up to 5 years of age. Observational study. Seventy-five patients from 2 days to 60 months were included. Paravertebral transverse ultraso...

Placement of sciatic catheters with ultrasound and stimulating catheters is known. Literature regarding catheter placements with only ultrasound is limited. We aimed to investigate the feasibility of performing continuous sciatic nerve block exclusively with ultrasound guidance and minimal equipment. Forty ASA 1 and 2 patients aged 8 months-10 year...

The primary objective of this study was to assess the success rate of ultrasound-guided sciatic needle placement regardless of the motor stimulation in infants and toddlers. Forty-five consecutive patients aged 7 months-2 years, scheduled for foot surgery, were included in this prospective, descriptive and blinded study. After induction of general...

The classical response to nerve stimulation may be altered in cases of radial club hand. Ultrasound guidance may prove to be a useful tool in such situations. In this study, we compared the success rate of ultrasound-guided infraclavicular brachial plexus block with nerve stimulation for children undergoing radial club hand repair. Fifty children,...

The infraclavicular approach to the brachial plexus provides suitable anesthesia and also lends itself well to stabilizing and securing a catheter for a continuous infusion. We describe an approach for continuous infusions using an infraclavicular approach in children. Twenty-five patients aged 8 mo to 3 yr, weighing 7-14 kg, scheduled for forearm...

Radial club hand is a congenital deformity in which the radius is absent, the metacarpophylangeal and interphalayngeal joints are fused and muscles arising from the radius are absent. This can alter the motor response to peripheral nerve stimulation. The classical motor response to median nerve stimulation (contractions of the fingers) cannot be el...

There are several issues that influence the anaesthetic care of children with cerebral palsy such as seizures , spasticity, and sensitivity to pain medications, scoliosis, mental retardation, inability to communicate, respiratory infections, variable patterns of breathing, excessive drooling and other associated medical conditions. A series of 62 c...

Introduction: This study was undertaken to evaluate the quality of anesthesia provided by sciatic nerve & fascia iliaca compartment nerve blocks in pediatric patients undergoing lower limb surgery. Patients and methods: 75 paediatric patients in the age group of 8 - 24 months, of both sex belonging to ASA status 1&2, weighing 7 -15kg , posted for l...

We report the use of continuous regional block with light general anaesthesia in epidermolysis bullosa simplex. A 4-year-old girl suffering from florid epidermolysis bullosa simplex was scheduled for external fixator (JESS) for manus valgus deformity of the left forearm. Haemoglobin was 7.6 g.dl(-1) and blood chemistry was normal. She had no histor...