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Supplemental video on subparaneural upper trunk block

Video Author: Hongye Zhang
Published on: 05.20.2022
Associated with: Anesthesia & Analgesia. 134(6):1308-1317, June 2022

The subparaneural upper trunk block is performed in the supraclavicular fossa, at the site where the upper trunk has trifurcated into anterior and posterior divisions and the suprascapular nerve. Local anesthetic is injected inside the paraneural sheath between either anterior and posterior divisions or posterior division and the suprascapular nerve.

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Inactivation of prefrontal cortex attenuates behavioral arousal induced by bilateral electrical stimulation of basal forebrain in sevoflurane-anesthetized rat.

Creator: Chris W. Fields & Jon G. Dean

Duration: 6:30

The video in left panel shows behavioral arousal after bilateral electrical stimulation of basal forebrain (200 Hz, 30 s ON, 30 s OFF, 60 – 100 µA) in a female Sprague Dawley rat (session 1). Note that the behavioral arousal after electrical stimulation occurred under continuous sevoflurane exposure; the rat was breathing 1.7% sevoflurane before, during, and after recovery of the righting reflex. The right panel shows the effect of bilateral electrical stimulation in the same rat (session 2;~1 week later) after inactivation of prefrontal cortex with bilateral infusion of 156 µM tetrodotoxin. The inactivation of prefrontal cortex attenuated the arousal-promoting effects of basal forebrain stimulation. The traces on top of the video show the electroencephalographic activation induced by electrical stimulation. The lightning bolt in the upper right-hand corner indicates when the electrical stimuli were being delivered.

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Chemogenetic stimulation of basal forebrain cholinergic neurons via local dialysis delivery of Compound 21 in sevoflurane-anesthetized female ChAT-Cre rat produced behavioral arousal.

Creator: Jon Dean & Chris W. Fields

Duration: 2:35

Chemogenetic stimulation of basal forebrain cholinergic neurons, via local dialysis delivery of 0.5 mM Compound 21, in sevoflurane-anesthetized female ChAT-Cre rat produced behavioral arousal. Note that the rat is continuously inhaling sevoflurane before, during, and after recovery of the righting reflex. The traces on top of the video show the electroencephalographic activation induced by Compound 21.

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Supplemental video on subparaneural upper trunk block

Creator: Hongye Zhang

Duration: 00:43

The subparaneural upper trunk block is performed in the supraclavicular fossa, at the site where the upper trunk has trifurcated into anterior and posterior divisions and the suprascapular nerve. Local anesthetic is injected inside the paraneural sheath between either anterior and posterior divisions or posterior division and the suprascapular nerve.

Play Video |

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Renal sinus cyst.

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Renal artery air embolism upon unclamping at the end of cardiopulmonary bypass.

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Renal artery air embolism and simultaneous transcranial Doppler upon unclamping at the end of cardiopulmonary bypass. A total of 3590 high-intensity transient signals occurred during the procedure.

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Transesophageal probe position to obtain a transgastric view of the left kidney using Vimedix Simulator from CAE Healthcare

Creator: A. Y. Denault

Duration: 0:31

Transesophageal probe position to obtain a transgastric view of the left kidney using Vimedix Simulator from CAE Healthcare. Color Doppler image of the left kidney. The initial pulsed wave Doppler of renal vein flow was continuous but then became pulsatile from an elevated right atrial pressure. Following the administration of 75 ug of epoprostenol by inhalation and 60 ug of intravenous nitroglycerine, the venous Doppler velocity became normal. (With permission of Beaubien-Souligny et al.20)

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Transgastric Abdominal Ultrasonography View #9

Creator: A. Y. Denault

Duration: 1:31

Transgastric abdominal ultrasonography view of the pancreas using a longitudinal view. Note the position of the splenic vein under the pancreas.

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Inactivation of prefrontal cortex attenuates behavioral arousal induced by bilateral electrical stimulation of basal forebrain in sevoflurane-anesthetized rat.

Creator: Chris W. Fields & Jon G. Dean

Duration: 6:30

The video in left panel shows behavioral arousal after bilateral electrical stimulation of basal forebrain (200 Hz, 30 s ON, 30 s OFF, 60 – 100 µA) in a female Sprague Dawley rat (session 1). Note that the behavioral arousal after electrical stimulation occurred under continuous sevoflurane exposure; the rat was breathing 1.7% sevoflurane before, during, and after recovery of the righting reflex. The right panel shows the effect of bilateral electrical stimulation in the same rat (session 2;~1 week later) after inactivation of prefrontal cortex with bilateral infusion of 156 µM tetrodotoxin. The inactivation of prefrontal cortex attenuated the arousal-promoting effects of basal forebrain stimulation. The traces on top of the video show the electroencephalographic activation induced by electrical stimulation. The lightning bolt in the upper right-hand corner indicates when the electrical stimuli were being delivered.

Play Video |

Supplemental video on subparaneural upper trunk block

Creator: Hongye Zhang

Duration: 00:43

The subparaneural upper trunk block is performed in the supraclavicular fossa, at the site where the upper trunk has trifurcated into anterior and posterior divisions and the suprascapular nerve. Local anesthetic is injected inside the paraneural sheath between either anterior and posterior divisions or posterior division and the suprascapular nerve.

Play Video |

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Duration: 3:07

Video summary covering three featured articles in the June 2022 issue of Anesthesia & Analgesia.

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Creator:

Duration: 2:00

EV- NTA analysis

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Creator: Lovell, Mark

Duration: 2:46

This video provides an overview of the anatomical and functional features of a novel pediatric airway model using a combination of additive manufacturing and casting techniqiues

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Mild amount of peritoneal fluid in unstable patients.

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Transgastric abdominal ultrasonography images of the stomach at various transducer angles show a full stomach.

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Transgastric Abdominal Ultrasonography View #5

Creator: A. Y. Denault

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Animated description on the technique to obtain right portal Doppler interrogation using the Vimedix Simulator from CAE Healthcare. With permission of Denault et al. for the international study on the clinical significance of portalhypertension after cardiac surgery (NCT03656263).

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Portal Venous Air from Mesenteric Ischemia

Creator: A. Y. Denault

Duration: 0:01

Hemodynamic instability in an 85-year-old patient after removal of an intra-aortic pump 2 days after cardiac surgery associated with normal cerebral oximetry values but elevated lactate. Upon examination of the liver, air was present in the portal vein. (With permission of Denault et al.59)

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Creator: A. Y. Denault

Duration: 0:01

Transgastric abdominal ultrasonography images of the stomach at various transducer angles showing a normal stomach.

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Doppler spectrum recording showing single high-intensity transient signals (HITS). HITS within the Doppler spectrum are indicated by the yellow vertical lines with higher power than the flowing blood. B. HITS cluster (>10 HITS per 3-5 cardiac cycles)

Creator: Syed M. Imaduddin, SM

Duration: 00:15

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Duration: 00:13

Video showing one method of securing an endotracheal tube with tape.

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Laryngeal mask airway and cough simulation

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Duration: 0:06

Video depicting a cough simulation with no leak of black light fluorescent Glo Germ™ around the laryngeal mask airway

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Creator: Marta Kelava

Duration: 0:39

SAP block can be performed in supine or lateral position. Using a 12-15 MHz linear ultrasound probe, scanning starts from the midclavicular line just below the clavicle. The ribs are counted with caudal and lateral probe movement until the 4th and 5th ribs are identified in the midaxillary line. The in-plane needle approach and injection is usually performed in an anteroposterior or craniocaudal direction in the midaxillary line at the level of the 4-5th ribs with LA deposition above (superficial SAP) or below (deep SAP) the serratus anterior muscle

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Creator: Marta Kelava

Duration: 0:41

The PIF block is performed under ultrasound guidance, with either cranio-caudal or latero-medial needle advancement. The latter has been proposed to avoid inadvertent puncture of the perforating branch of the internal thoracic artery or the anterior perforating veins joining the internal thoracic vein, with the goal to deposit LA between the pectoralis major and intercostal muscles. The craniocaudal in-plane needle approach and injection is usually performed 1 cm lateral to the sternum at the midsternal level with LA deposition between the pectoralis major and intercostal muscles.

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PECS I&II blocks

Creator: Marta Kelava

Duration: 1:16

A 12-15 MHz linear ultrasound probe is placed at a midclavicular line below the clavicle. The probe is moved inferolaterally to the level of the 3rd rib. With a slight medial tilt, the three layers of muscles are identified: pectoralis major, pectoralis minor and serratus anterior. When performing both blocks simultaneously, single puncture site can be used to preserve near-field imaging with deposition of the LA between the layers of the serratus anterior and pectoralis minor (PECS II), followed by needle withdrawal and injection between the pectoralis minor and pectoralis major (PECS I)

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Xhosa patients information video on spinal anesthesia for cesarean section

Creator: Barry Smit, Craig Kilroe, Dale Hunt, Dr Jessica Purcell-Jones, Dr Rowan Duys.

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The video follows the journey of a Xhosa women having spinal anesthesia for her cesarean section. The procedure and its risks and benefits are described in a Xhosa narrative. Additionally, the patient described her personal experience for part of the video.

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Prebypass Mid Esophageal TEE views of a Bullet In the Aortic Root

Creator: Lee Goeddel

Duration: 0:14

In prebypass imaging the midesophageal 5 chamber view with color Doppler demonstrated a bullet in the aortic root and absence of aortic valve regurgitation. With simultaneous orthogonal imaging the bullet was localized to the non-coronary sinus of Valsalva within the aortic valve. An eccentric mitral regurgitation jet was found in the anterior leaflet of the mitral valve in the midesophageal long axis view. RCC= Right coronary cusp of the aortic valve. LCC= Left coronary cusp of the aortic valve. NCC= Non-coronary cusp of the aortic valve.

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Post Bypass Mid Esophageal TEE views after Bullet Removal and Mitral Valve Repair

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Duration: 0:08

Post-bypass images of the ME 4C view showed no gross abnormality. The midesophageal long axis view demonstrated trace central mitral regurgitation after repair, no residual aortic regurgitation, and an intact aortic root. A2= Middle scallop of the anterior leaflet of the mitral valve. P2= Middle scallop of the posterior leaflet of the mitral valve. AV= Aortic Valve.

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IPACK block performed for Total Knee Arthroplasty

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Creator: L. Rovira

Duration: 00:32

This video show our usual technique of tracheal intubation using a combined technique involving the use of a Glidescope and using a flexible guide (in this case a disposable fiberscope) to pass the tube through the vocal cords. The video contains in synch outer and inner (Glidescope camera) view.

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January 2019 A&A Video Summary

Creator: Jeanette Esau

Duration: 2:00

Video summary of featured articles in Anesthesia & Analgesia for January 2019.

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Rapid Central Vein Assessment and brachiocephalic vein visualization

Creator: Paolo Beccaria

Duration: 0:15

The video represents RaCeVA method, RaCeVA is the acronyms for Rapid Central Vein Assessment. It is the ultrasound method to identify the adequate site and side to central venous access placement.

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Video 1: RV strain measurement using the Epiq7 System (Philips, Andover, MA, USA)

Creator: Massimiliano Meineri, MD

Duration: 1:16

A ME long axis view and a ME four chamber view are selected and analyzed using the Cardiac Motion Quantification (CMQ) analysis software package. First the aortic valve closure is identified and aortic valve closure time set. The ME four chamber is then selected and the LV long axis strain model is applied to the RV to allow correct labeling of septal segments. Tracking is qualitatively assessed and manually adjusted to capture the myocardium. The RV is divided into seven segments and the global strain is measured at – 29.8% with regional peak variability with all segments within limits of normal. RV Septum is de-selected to obtain RV free wall strain that is measured at -31.4%.

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Video 2: RV strain measurement using the Vivid E9 System (GE, Chicago, IL, USA)

Creator: Massimiliano Meineri, MD

Duration: 1:15

The ME four chamber view is analyzed using the Automated Function Imaging (AFI) software package. The LV long axis strain model is applied to the RV to allow correct labeling of septal segments. Tracking quality is automatically assessed for each segment (green: good or red: poor). Parametric display provides measurements for each of the six RV and global strain. The latter is normal at – 22.3% with regional peak variability with basal segments below normal limits. RV myocardial region of interest is redefined and the septum de-selected to obtain RV free wall strain that is measured at approximately -22%

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Absent PV on 2D TEE

Creator: Dr Neelam Aggarwal

Duration: 00:24

A thin rim of valve tissue is seen at pulmonic annulus in modified ME RV inflow-outflow view (sector angle at 800) and modified ME aortic valve long-axis view (sector angle at 1150)

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Real-time ultrasound-guided right supraclavicular approach to the central vein

Creator:

Duration: 0:15

Identify the right jugular vein and carotid artery at the level of the thyroid cartilage on the short-axis view. Then, the probe is moved caudally following the internal jugular vein in the center of the monitor. Once the probe has reached the clavicle, it is inclined following the internal jugular vein to identify where it merges with the right subclavian vein and the underlying pleura on the long-axis view. The puncture needle is inserted using the long-axis view and advanced while identifying the needle point in real-time, until it reaches the right brachiocephalic vein.

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Video clip 2. 2D-TEE analysis of the right coronary artery and tricuspid valve

Creator:

Duration: 0:24

First part: The ME view, obtained by slightly withdrawing the probe from the modified ME 5-chamber view in video clip 1, demonstrates two cardiac masses (“proximal” and “distal”), with the RCA penetrating the left side of the distal mass. Second part: Color flow Doppler reveals laminar blood flow in the RCA. Third part: Simultaneous orthogonal planes to the RCA based on the ME aortic valve short axis view. Fourth part: Simultaneous orthogonal planes to the tricuspid valve based on the modified trans-gastric RV inflow-outflow view.

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Creator: i-movie

Duration: 0:24

Prebypass comprehensive TEE showed severely depressed left ventricular function with spontaneous echo contrast (SEC), basal to mid-ventricular inferior and inferolateral wall akinesis, dilated apex with dyskinesis and no evidence of left ventricular thrombus. A prominent false tendon (FT) was visualized at the mid-esophageal long-axis view both before and after thrombus evacuation. AK: akinesis, DK: dyskinesis.

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Creator: J. Kirk Edwards, MD

Duration: 0:07

2D transesophageal echo (TEE) view of the mid-esophageal (ME) color Doppler x-plane of the short axis (SAX) and long axis (LAX). Color Doppler displays moderate to severe eccentric aortic insufficiency (AI) directed away from the noncoronary leaflet.

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How to Perform Focused Cardiovascular Ultrasound

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 23:23

A brief, screen-in-screen review of the techniques required to perform bedside cardiac ultrasound at the parasternal, apical, and subcostal windows.

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Video 1: Normal parasternal long axis

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:08

The right ventricle is under the transducer. There is normal excursion and coaptation of the aortic and mitral valves. The chambers are normal in size. There is brisk excursion of the aortic root, brisk opening of the mitral valve, a normal descent of the base of the MV, and normal thickening of the left ventricular segments.

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Video 2: Significant aortic stenosis seen in the PLAX

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:06

The aortic valve is heavily calcified and does not open well. The degree of stenosis cannot be quantified from this view, but with excursion this limited the assumption should be that the patient has severe stenosis until it is proven otherwise. In addition to aortic valve calcification, the mitral annulus is heavily calcified, there is left ventricular hypertrophy, and the left atrium is enlarged.

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Video 4: Dilated cardiomyopathy seen in the PLAX

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:08

The RVOT, LA, and LV are all dilated and appear proportionally large compared to the aortic annulus and root. Compare the relative sizes with Video 1 (normal PLAX.) There is evidence of decreased LV systolic function, with decreased motion of the aortic root, decreased excursion of the anterior mitral leaflet, decreased mitral annular excursion, and decreased thickening of the left ventricular segments. There is also a left pleural effusion.

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Video 5: Rheumatic mitral disease seen in the PLAX

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:05

Left ventricular and aortic valve function appear normal. There is thickening of the tips of the mitral leaflets, with diastolic bowing seen particularly in the anterior mitral leaflet (the “hockey stick” appearance). The left atrium appears enlarged as well, consistent with elevated left atrial pressure from mitral stenosis.

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Video 6: Systolic anterior motion of the anterior mitral leaflet in the PLAX

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:07

Multiple beats are shown in this clip and the image does not remain still because the patient was severely dyspneic. The patient has significant hypertrophy of the anterioseptal wall of the left ventricle. In multiple cardiac cycles the anterior mitral leaflet can be seen to impinge on the left ventricular outflow tract.

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Video 7: Both pleural and pericardial effusions seen in the PLAX

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:05

The descending thoracic aorta is outside the pericardium, and a pericardial effusion will be seen extending between the heart and the aorta in this view while a pleural effusion will be seen deep and lateral to the aorta.

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Video 9: Parasternal short axis (PSAX) with akinesis of the inferior segment

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:06

The thinning of this segment suggests a scar consistent with previous myocardial infarction.

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Video 10: Parasternal short axis (PSAX) showing a pericardial effusion

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:07

A pericardial effusion around the heart, hyperdynamic left ventricular systolic function, and decreased LV filling in diastole.

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Video 11: Parasternal short axis (PSAX) in a patient with septic shock.

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:07

Septic shock, decreased left ventricular (LV) afterload, and increased cardiac output. The LV is full in diastole and empty in systole, consistent with the patient’s low-afterload state.

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Video 12: Parasternal short axis (PSAX) showing RV pressure overload

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:08

The interventricular septum (IVS) is normally convex with respect to the left left ventricle throughout the cardiac cycle. In this case the IVS is flat in both systole and diastole, suggesting that the right and left ventricular pressures are similar (near systemic pulmonary artery pressures.)

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Video 13: Normal apical four chamber (A4).

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:08

The apex of the left ventricle is directly under the ultrasound transducer. All four chambers can be visualized. There is normal global and regional biventricular systolic function, normal excursion and coaptation of the mitral and tricuspid valves, and normal chamber sizes.

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Video 14: Apical four chamber showing ischemia in the LAD territory

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:11

A large portion of the myocardium at the LV apex is not thickening. There is decreased global LV systolic function and left atrial enlargement as well.

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Video 15: Apical four chamber showing prolapse

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:09

Prolapse of both anterior and posterior mitral leaflets with left atrial enlargement.

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Video 16: Apical 4 chamber showing an abnormal mitral valve opening in a patient with rheumatic heart disease

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:09

Abnormal mitral valve opening in a patient with rheumatic heart disease. The tips of the mitral leaflets are thickened. The left atrium appears qualitatively enlarged compared with the size of the left ventricle.

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Video 17: Apical four chamber showing an enlarged right ventricle with decreased RV systolic function

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:09

Enlarged right ventricle with decreased RV systolic function in a patient with a history of chronic severe pulmonary hypertension.

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Video 18: Apical four chamber zoomed in on the tricuspid valve

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:11

Apical four chamber zoomed in on the tricuspid valve. This valve does not coapt well in systole, suggesting the presence of significant tricuspid regurgitation.

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Video 20: Subcostal four chamber with right ventricular dilation and hypertrophy

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:10

Subcostal four chamber with right ventricular dilation and hypertrophy. The free wall of the RV appears as thick as the left ventricle. The RV appears larger than the LV, suggesting significant enlargement.

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Video 21: Subcostal four chamber in a patient with pericardial effusion and tamponade.

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:11

Subcostal four chamber in a patient with pericardial effusion and tamponade. The effusion is seen as a large echolucent space around the heart. The right atrium appears collapsed in ventricular systole and the right ventricle appears compressed in ventricular diastole. These findings are both consistent with tamponade physiology.

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Video 22: Normal subcostal IVC view (SC IVC)

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:19

The liver is at the top of the screen, with the thin-walled IVC seen entering the right atrium. There is more than 50% collapse of the IVC when the patient sniffs.

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Video 23: Subcostal IVC in a patient with cardiac tamponade

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:10

Subcostal IVC in a patient with cardiac tamponade. The IVC appears dilated and does not collapse as the patient sniffs.

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Video 24: Subcostal IVC in a patient with hypovolemia

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:14

Subcostal IVC in a patient with hypovolemia. The IVC is small and collapses completely as the patient breathes.

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Creator: Jeanette Esau

Duration: 2:01

Video summary of featured articles in Anesthesia & Analgesia for October 2015.

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Creator: Jeanette Esau

Duration: 1:55

Video summary of featured articles in Anesthesia & Analgesia for April 2015.

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Creator: Edward C. Nemergut, MD

Duration: 5:38

Video summary of featured articles in Anesthesia & Analgesia for July 2013.

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Creator: Edward C. Nemergut, MD

Duration: 6:09

Video summary of featured articles in Anesthesia & Analgesia for June 2013.

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