**12. Conclusion**

The position of the ultrasound image display is sometimes overlooked. However, we have found it to be a key point for successful and easy completion of ultrasound‐guided proce‐ dures, especially when performed by practitioners with a low level of experience. For this purpose, our iPad system may be effective. In addition, it allows the ultrasound machine to be placed behind the operator, with only the display in front of their face, thus enabling a nerve

**Figure 21.** An ergonomic in‐line arrangement of the image display, direction of needle insertion, and visual axis of the

**Figure 22.** As shown in this representative image, the ultrasound machine is positioned behind the operator, who performs a paravertebral nerve block procedure on a prone patient while observing ultrasound images on an iPad.

block to be performed with overhand movements (**Figure 22**).

operator is crucial for successful and quick completion of ultrasound‐guided procedures.

46 Current Topics in Anesthesiology

Use of regional anesthesia in combination with general anesthesia provides important advan‐ tages for management of oxidative stress as well as control of hemodynamics during surgery. For improving the performance of regional anesthesia, addition of LMWD as an adjuvant to the local anesthetic solution is quite effective. In addition, ultrasound technology is very helpful to make regional anesthesia easier and safer to perform, while it is also valuable for reevaluation of caudal block treatment in adults. Utilization of a caudal block technique along with ultrasound guidance may be effective for adult patients undergoing surgery in the lower abdomen region, especially high‐risk cases, as the technique is simple with minimum hemo‐ dynamic effects. We have also found that placement of ultrasound images in a proper in‐line position by use of an iPad and the VT‐100 image transfer system helps to facilitate accurate and quick needle insertion to the target, especially for novice practitioners. When considering these advantages of regional anesthesia and its advancement with the help of ultrasound technol‐ ogy, it is expected that the combined use of regional and general anesthesia will become more common for anesthetic management in the near future. Even though additional time is needed, regional anesthesia in conjunction with general anesthesia should be considered in all cases
