Learning US Assisted Neuraxial Technique during a Pandemic: Case Report

Abstract

mask or equivalent hospital policy at this time). Anaesthesia was induced with propofol, fentanyl and rocuronium and was maintained with sevofurane in a mixture of oxygen and nitrous oxide. The patient’s trachea was intubated orally using a McGrath video-laryngoscope with a size 8 mm (ID) standard tracheal tube. Following intubation, a radial arterial line was sited and the patient placed in the left lateral position. A consultant anaesthetist with extensive experience in the use of ultrasound assisted neuraxial techniques scanned the patient’s back with a curvilinear probe. Using ultrasound, the consultant demonstrated the sacrum and identified the lumbar intervertebral spaces showing narrow gaps and a longitudinally rotated spine. Spinous process shadow on the ultrasound showed that in the left lateral position the midline was significantly superior to the previous decompression scar (Figure 1). Abstract We present the case of an anaesthetic registrar learning ultrasound assisted neuraxial anaesthesia during the COVID-19 pandemic. An 81-year-old patient with significant scoliosis required anaesthesia for a revision hip replacement following periprosthetic fracture. Despite the communication difficulties presented by wearing full personal protective equipment to reduce potential transmission of COVID-19 an experienced consultant anaesthetist was able to demonstrate the relevant lumbar spine sonoanatomy to a year six anaesthetic registrar. The registrar was then able to perform a first pass neuraxial procedure in the left lateral position under general anaesthesia. The anaesthetic had good effect and the patient was comfortable post operatively with minimal opiate requirements. The patient was discharged to his home from hospital 14 days later.