The learning curve for novices developing regional anaesthesia skills, such as real-time ultrasound-guided needle manipulation, may be affected by innate visuospatial ability, as this influences spatial cognition and motor coordination. We conducted a multinational randomised controlled trial to test if novices with low visuospatial ability would perform better at an ultrasound-guided needling task with deliberate practice training than with discovery learning. Visuospatial ability was evaluated using the mental rotations test-A. We recruited 140 medical students and randomly allocated them into low-ability control (discovery learning), low-ability intervention (received deliberate practice), high-ability control, and high-ability intervention groups. Primary outcome was the time taken to complete the needling task, and there was no significant difference between groups: median (IQR [range]) low-ability control 125 s (69-237 [43-600 s]); low-ability intervention 163 s (116-276 [44-600 s]); highability control 130 s (80-210 [41-384 s]); and high-ability intervention 177 s (113-285 [43-547 s]), p = 0.06. No difference was found using the global rating scale: mean (95%CI) low-ability control 53% (95%CI 46-60%); lowability intervention 61% (95%CI 53-68%); high-ability control 63% (95%CI 56-70%); and high-ability intervention 66% (95%CI 60-72%), p = 0.05. For overall procedure pass/fail, the low-ability control group pass rate of 42% (14/ 33) was significantly less than the other three groups: low-ability intervention 69% (25/36); high-ability control 68% (25/37); and high-ability intervention 85% (29/34) p = 0.003. Further research is required to determine the role of visuospatial ability screening in training for ultrasound-guided needle skills.

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Background Methemoglobinemia is a rare, yet life-threatening disorder that occurs due to an accumulation of methemoglobin in the blood. The clinical presentation often includes dyspnea, cyanosis, and hypoxemia that shows little improvement with the administration of supplemental oxygen. Ester anesthetics, including benzocaine ,are among the most notorious agents for causing this condition in children. The United States (US) Food and Drug Administration (FDA) warns against the administration of benzocaine to those younger than two years old and urges manufacturers to add a statement regarding the development of methemoglobinemia to the packaging of any products containing this ingredient. Case Presentation The objective of this article is to summarize the unique constellation of signs and symptoms observed in a seven-year-old child subsequently diagnosed with benzocaine-induced methemoglobinemia. Additionally, we emphasize the value of utilizing pharmacists as part of an interdisciplinary team when caring for pediatric patients. Conclusion Providers should recognize that methemoglobinemia may occur in toddlers and children outside of the FDA’s specific age warning window and must keep a broad differential for patients presenting with respiratory distress.