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Postoperative analgesia following total knee arthroplasty (TKA) often includes intrathecal opioids, periarticular injection (PAI) of local anesthetic, systemic multimodal analgesia, and/or peripheral nerve blockade. The adductor canal block (ACB) provides analgesia without muscle weakness and magnesium sulphate (MgSOElective TKA patients were randomized to: 1) sham ACB, 2) ropivacaine ACB, or 3) ropivacaine ACB with added MgSOOf 130 patients, 121 were included. Nine were excluded post randomization: four were protocol violations, three did not meet inclusion criteria, and two had severe pain requiring open label blockade. There were no differences in the median [interquartile range] time to first PCA request: sham, 310 min [165-550]; ropivacaine ACB, 298 min [120-776]; and ropivacaine ACB with MgSOWe found no analgesic benefit of a postoperative ACB, with or without added MgSOwww.clinicaltrials.gov (NCT02581683); registered 21 October 2015.RéSUMé: OBJECTIF: L’analgésie postopératoire suivant une arthroplastie totale du genou (ATG) inclut souvent des opioïdes intrathécaux, une injection périarticulaire (IPA) d’anesthésique local, une analgésie multimodale systémique, et/ou des blocs des nerfs périphériques. Le bloc du canal des adducteurs (BCA) permet une analgésie sans faiblesse musculaire et le sulfate de magnésium (MgSO

To describe a novel airway management technique for thoracoscopic repair of a type C tracheoesophageal fistula (TEF) in a neonate.A full-term neonate with a type C TEF presented for thoracoscopic repair. The fistula was at the level of the carina, making its isolation from positive pressure ventilation using traditional techniques difficult. In addition, non-ventilation of the right lung was required. The use of two Fogarty type balloon-tipped embolectomy catheters placed alongside the endotracheal tube successfully achieved the goal of blocking ventilation of the fistula and the right lung. The use of fibreoptic bronchoscopy greatly facilitated placement of the blockers. The patient made an uneventful recovery.Placing two balloon-tipped blockers, one in the TEF and the other in the right mainstem bronchus, is a viable technique for thoracoscopic fistula repair when the fistula is at or very close to the level of the carina.

To describe a patient with probable choledochal sphincter spasm after preoperative morphine, and to suggest a history of cholecystectomy as a predisposing factor.A 60 yr old man for femoral-popliteal artery bypass grafting developed right upper quadrant abdominal pain after preoperative morphine and scopolamine. He had a previous cholecystectomy. His pain was relieved with naloxone.Choledochal sphincter spasm should be part of a differential diagnosis in right upper quadrant pain after sedative doses of morphine, especially if there is a previous cholecystectomy.

To comparein vitro the contamination susceptibility of three needleless and one standard needle injection systems. The Baxter InterLink, St. Paul Medical Key-Lok, Braun SafSite, and Becton Dickinson heparin lock, were compared. Fifty of each were studied. Each system was connected to a culture bottle and injected 30 times over 72 hr. The manufacturers’ directions were followed except for Braun’s, which recommend that a new sterile cap be used after each injection. Instead, the same cap was used after each injection to reflect day-to-day clinical practice. Culture bottles were subsequently analyzed for bacterial growth The contamination rates for the heparin lock, InterLink, Key-Lok, and SafSite were 3/50 (6%), 6/50 (12%), 4/50 (8%), and 36/50 (72%), respectively. All positive cultures grew coagulase-negative staphylococcus species. There was no difference in contamination rates between the InterLink, Key-Lok, and heparin lock designs. The contamination rate of the SafSite was higher (P < 0.001) than the other three systems. The InterLink and Key-Lok systems had a similarly low contamination susceptibility as a standard needle injection system. It was not clear if the high contamination rate found with the SafSite system was due to non-adherence to the manufacturer’s directions for handling.