Ultrasound-guided continuous sciatic nerve blocks in two children with venous malformations in the lower limb.

CAN J ANESTH 54: 11 www.cja-jca.org November, 2007 to two attempts. After the final spray, the mean visual analogue scores for pain, anxiety and coughing were 7.8 ± 1.3, 6.5 ± 1.7 and 5.2 ± 1.5, respectively (where 0 was described as awful and 10 as enjoyable). All subjects reported the airway spray of lidocaine to have been acceptable; two found it enjoyable. The time from start to final spray of lidocaine using the FOBMADgic® unit ranged from 21 to 28 min. The median dose of lidocaine was 2.5 mg·kg–1 (range 2.1–2.8 mg·kg–1). No patient experienced any local anesthetic side-effect and fibreoptic intubation was successfully completed on the first attempt in all patients. During the procedure, patient reaction scores (no reaction = 1, slight grimacing = 2, strong grimacing = 3, verbal objection = 4, defensive movement of the head, hands or feet = 5)5 were 1.9 ± 0.6 with nasotracheal intubation and 1.6 ± 0.7 with orotracheal intubation, respectively. According to this preliminary experience, we consider that using a combination of FOB and MADgic® atomizer for airway topical anesthesia has several advantages. First, it can provide excellent topical anesthesia of the airway. Second, this technique is well tolerated by the awake sedated patient. Third, it is non-invasive and therefore has minimal risk of airway damage. Fourth, there is no restriction on the patients’ head and neck position. However, it must be pointed out that a limitation of this technique is its inability to anesthetize the nasal mucosa. To reduce airway damage caused by repeated manipulation, the FOB-MADgic® unit should not be inserted through the nasal cavity, because it has an external diameter of about 6–8 mm.