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Oxygenation during difficult airway management

head. The operator stands behind, with the ultrasound screen in front of, the patient (Fig. 3). In our experience, this makes it easier to control the ultrasound probe and facilitates block performance. Sagittal images of the ribs are obtained by placing a linear probe in line with the midaxillary line. Second, a 100-mm needle is introduced in-plane from an inferior to superior direction. The length of the needle enables administration of local anaesthetic across up to three intercostal spaces above the level of insertion. From the two approaches described by Blanco et al, we usually choose the one deep to the serratus anterior muscle, as it seems to provide a good anterior distribution [1] of the block. In addition, many of our patients are thin, so the serratus anterior muscle is not very prominent and the deep plane is more easily identified. The procedure is repeated on the contralateral hemithorax. It usually takes approximately ten minutes to block the two hemithoraces. Patients report good analgesia and are usually discharged the following day without the need for rescue analgesia.