1
|
Huang C, Zhang Y, Diedrich DA, Li J, Luo W, Zhao X, Guo Y, Luo Y, Zhang T, Wang X, Huang W, Xiao Y. A horizontal and perpendicular interlaminar approach for intrathecal nusinersen injection in patients with spinal muscular atrophy and scoliosis: an observational study. Orphanet J Rare Dis 2024; 19:268. [PMID: 39010073 PMCID: PMC11250962 DOI: 10.1186/s13023-024-03278-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 07/03/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Lumbar puncture is challenging for patients with scoliosis. Previous ultrasound-assisted techniques for lumbar puncture used the angle of the probe as the needle trajectory; however, reproducing the angle is difficult and increases the number of needle manipulations. In response, we developed a technique that eliminated both the craniocaudal and lateromedial angulation of the needle trajectory to overall improve this technique. We assessed the feasibility and safety of this method in patients with scoliosis and identify factors related to difficult lumbar puncture. METHODS Patients with spinal muscular atrophy and scoliosis who were referred to the anesthesia department for intrathecal nusinersen administrations were included. With a novel approach that utilized patient position and geometry, lumbar puncture was performed under ultrasound guidance. Success rates, performance times and adverse events were recorded. Clinical-demographic and spinal radiographic data pertaining to difficult procedures were analyzed. RESULTS Success was achieved in all 260 (100%) lumbar punctures for 44 patients, with first pass and first attempt success rates of 70% (183/260) and 87% (226/260), respectively. Adverse events were infrequent and benign. Higher BMI, greater skin dural sac depth and smaller interlaminar size might be associated with greater difficulty in lumbar puncture. CONCLUSIONS The novel ultrasound-assisted horizontal and perpendicular interlaminar needle trajectory approach is an effective and safe method for lumbar puncture in patients with spinal deformities. This method can be reliably performed at the bedside and avoids other more typical and complex imaging such as computed tomography guided procedure.
Collapse
Affiliation(s)
- Chanyan Huang
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yuanjia Zhang
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Daniel A Diedrich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jiawen Li
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wei Luo
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xu Zhao
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yuting Guo
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Yijun Luo
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Tao Zhang
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xuan Wang
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wenqi Huang
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Ying Xiao
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| |
Collapse
|
2
|
Abrahams E, Robinson M, Pak A. Caudal regression syndrome and interventional pain techniques. INTERVENTIONAL PAIN MEDICINE 2023; 2:100173. [PMID: 39239600 PMCID: PMC11372973 DOI: 10.1016/j.inpm.2022.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/29/2022] [Accepted: 12/06/2022] [Indexed: 09/07/2024]
Affiliation(s)
- Eldhose Abrahams
- Department of Anesthesiology, Oklahoma University Health Sciences Center, Oklahoma City, OK, United States
| | - Michael Robinson
- Department of Anesthesiology, Oklahoma University Health Sciences Center, Oklahoma City, OK, United States
| | - Aimee Pak
- Department of Anesthesiology, Oklahoma University Health Sciences Center, Oklahoma City, OK, United States
| |
Collapse
|
3
|
Santhosh SA, Bhoi D, Thangavel K, Soni L. Ultrasound-assisted transverse process line as a guide for performing lumbar neuraxial block. Saudi J Anaesth 2023; 17:133-135. [PMID: 37032682 PMCID: PMC10077786 DOI: 10.4103/sja.sja_462_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Swathy A. Santhosh
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Debesh Bhoi
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Kathiravan Thangavel
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Lipika Soni
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
4
|
Lin D, Yu L, Chen J, Ye H, Wu Y, Yao Y. Fluoxetine for reducing postoperative cognitive dysfunction in elderly patients after total knee replacement: study protocol for a single-centre, double-blind, randomised, parallel-group, superiority, placebo-controlled trial. BMJ Open 2022; 12:e057000. [PMID: 35768113 PMCID: PMC9240897 DOI: 10.1136/bmjopen-2021-057000] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Postoperative cognitive dysfunction (POCD) is a common complication following major surgical procedures. The underlying pathophysiology is poorly understood, but the role of neuroinflammation is strongly implicated. Given the antineuroinflammatory and neuroprotective effects of fluoxetine, we hypothesise that fluoxetine may reduce the cumulative incidence of POCD in elderly patients undergoing total knee arthroplasty (TKA). METHODS AND ANALYSIS This is a prospective, randomised, double-blind, parallel-group, placebo-controlled, superiority trial. Five hundred elderly patients undergoing unilateral TKA will be randomly assigned to the fluoxetine and placebo groups. The fluoxetine group will receive fluoxetine 20 mg daily 8 weeks preoperatively, and the placebo group will receive placebo capsules daily 8 weeks preoperatively. The primary outcome is the cumulative incidence of POCD at 1 month postoperatively. The secondary outcomes include the occurrence of delirium, the area under the curve of the Numeric Rating Scale pain scores over time, and sleep disturbance. Data on all the results, risk factors and adverse events will also be collected and analysed. ETHICS AND DISSEMINATION The Fujian Provincial Hospital Ethics Board has approved the protocol for this trial (identifier number: K2021-01-009). All participants will be required to provide written informed consent before any protocol-specific procedures. TRIAL REGISTRATION NUMBER ChiCTR2100050424.
Collapse
Affiliation(s)
- Daoyi Lin
- Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Lulu Yu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Jiaxin Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Hong Ye
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Yushan Wu
- Aanesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Yusheng Yao
- Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| |
Collapse
|
5
|
Nair A, Diwan S. Failed epidural but an inadvertent paravertebral block in a patient with severe scoliosis. Saudi J Anaesth 2022; 16:521-523. [PMID: 36337391 PMCID: PMC9630673 DOI: 10.4103/sja.sja_285_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022] Open
|
6
|
Kirby GA, Guo W, Mitchell JD, Ma H. Using Lumbar X-Ray to Facilitate Modified Taylor's Approach of Spinal Anesthesia in an Elderly Patient With Scoliosis. Cureus 2021; 13:e12556. [PMID: 33564547 PMCID: PMC7863049 DOI: 10.7759/cureus.12556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In geriatric patients scheduled for hip or knee surgery, neuraxial anesthesia is a safe and effective anesthesia method and may be a better option than general anesthesia. Unfortunately, establishing neuraxial anesthesia is not always easy in this group of patients. Anatomical abnormalities, such as spinal stenosis, scoliosis, and narrowed interspaces, contribute to the difficulties that anesthesiologists face while performing these procedures. The classic Taylor’s approach targets the widest interspace, L5-S1, as the needle insertion site and accordingly has an increased success rate in difficult neuraxial anesthesia. As this technique historically relies solely on palpation, it might be difficult in patients with less prominent or distorted anatomic landmarks. Ultrasonography or fluoroscopy guidance may help to better target the epidural or subarachnoid space, but both have limitations due to equipment availability or provider expertise. The modified Taylor’s approach we propose in this case report is based on preoperative lumbar x-ray interpretation when point-of-care image guidance cannot be performed. By measuring on the patient’s preoperative lumbar x-ray, we successfully performed a modified Taylor's approach of spinal anesthesia on an elderly patient with severe scoliosis. She underwent open reduction and internal fixation (ORIF) of the left femur with satisfactory pain control and no complications.
Collapse
Affiliation(s)
- Gregory A Kirby
- Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Wenjuan Guo
- Anesthesiology, Peking Union Medical College Hospital, Beijing, CHN
| | - John D Mitchell
- Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Haobo Ma
- Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| |
Collapse
|
7
|
Iwayama H, Wakao N, Kurahashi H, Kubota N, Hattori A, Kumagai T, Okumura A. Administration of nusinersen via paramedian approach for spinal muscular atrophy. Brain Dev 2021; 43:121-126. [PMID: 32773161 DOI: 10.1016/j.braindev.2020.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/07/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the success rate, procedure time, and adverse events of intrathecal administration of nusinersen via the paramedian approach in adolescents and adults with spinal muscular atrophy (SMA) associated with scoliosis. METHODS Seven patients with genetically confirmed SMA (age, 12-40 years) were included. Intrathecal administration of nusinersen was performed via paramedian approach using fluoroscopy after determination of the largest interlaminal foramen among L2-L3, L3-L4, or L4-L5 by three-dimensional computed tomography. We measured the times for preparation, positioning, and puncture, and the total time of stay. Adverse effects of intrathecal administration were noted. RESULTS Intrathecal administration via paramedian approach was successful for all 38 opportunities. The median total time of stay was 44.0 min (interquartile range, 37.3-50.0 min). The total time of stay was significantly longer in patients with SMA type 1 than in those with SMA type 2, but was not different according to the severity of scoliosis. Adverse effects included oxygen supplementation, headache, and back pain. Sedation was correlated with oxygen supplementation and headache. CONCLUSIONS Intrathecal administration of nusinersen via the paramedian approach had the advantages of a high success rate and short procedure time with fewer adverse events in SMA patients associated with scoliosis.
Collapse
Affiliation(s)
- Hideyuki Iwayama
- Department of Pediatrics, Aichi Medical University, Aichi, Japan.
| | - Norimitsu Wakao
- Department of Orthopedics, Aichi Medical University, Aichi, Japan
| | - Hirokazu Kurahashi
- Department of Pediatrics, Aichi Medical University, Aichi, Japan; Department of Pediatric Neurology, Aichi Prefectural Colony Central Hospital, Aichi, Japan
| | - Norika Kubota
- Department of Pediatrics, Matsue Medical Center, Shimane, Japan
| | - Ayako Hattori
- Department of Pediatrics and Neonatology, Nagoya City University, Aichi, Japan
| | - Toshiyuki Kumagai
- Department of Pediatric Neurology, Aichi Prefectural Colony Central Hospital, Aichi, Japan; Kuma Home Medical Care Clinic, Aichi, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Aichi, Japan
| |
Collapse
|
8
|
Yoo S, Kim Y, Park SK, Ji SH, Kim JT. Ultrasonography for lumbar neuraxial block. Anesth Pain Med (Seoul) 2020; 15:397-408. [PMID: 33329842 PMCID: PMC7724125 DOI: 10.17085/apm.20065] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/20/2020] [Indexed: 12/14/2022] Open
Abstract
Ultrasonography can be useful to perform a lumbar neuraxial block. It aids in understanding the anatomy of the lumbar spine before the procedure. Pre-procedural ultrasound imaging provides information about the accurate intervertebral level for puncture, optimal needle insertion point, and depth of needle advancement for a successful neuraxial block. The key ultrasonographic views for lumbar neuraxial block include the transverse midline interlaminar and parasagittal oblique views. Ultrasonography can facilitate lumbar neuraxial block in difficult cases, such as the elderly, obese patients, and patients with anatomical abnormality of the lumbar spine. This review elucidates the basics of spinal ultrasonography for lumbar neuraxial block and the current evidence regarding ultrasound-guided neuraxial block in adults.
Collapse
Affiliation(s)
- Seokha Yoo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Youngwon Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sun-Kyung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hwan Ji
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
9
|
Walsh E, Zhang Y, Madden H, Lehrich J, Leffert L. Pragmatic approach to neuraxial anesthesia in obstetric patients with disorders of the vertebral column, spinal cord and neuromuscular system. Reg Anesth Pain Med 2020; 46:258-267. [PMID: 33115718 DOI: 10.1136/rapm-2020-101792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/21/2020] [Accepted: 08/22/2020] [Indexed: 11/04/2022]
Abstract
Neuraxial anesthesia provides optimal labor analgesia and cesarean delivery anesthesia. Obstetric patients with disorders of the vertebral column, spinal cord and neuromuscular system present unique challenges to the anesthesiologist. Potential concerns include mechanical interference, patient injury and the need for imaging. Unfortunately, the existing literature regarding neuraxial anesthesia in these patients is largely limited to case series and rare retrospective studies. The lack of practice guidance may lead to unwarranted fear of patient harm and subsequent avoidance of neuraxial anesthesia for cesarean delivery or neuraxial analgesia for labor, with additional risks of exposure to general anesthesia. In this narrative review, we use available evidence to recommend a framework when considering neuraxial anesthesia for an obstetrical patient with neuraxial pathology.
Collapse
Affiliation(s)
- Elisa Walsh
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yi Zhang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hannah Madden
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James Lehrich
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lisa Leffert
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
10
|
Ballarapu GK, Nallam SR, Samantaray A, Kumar VAK, Reddy AP. Thoracolumbar curve and Cobb angle in determining spread of spinal anesthesia in Scoliosis. An observational prospective pilot study. Indian J Anaesth 2020; 64:594-598. [PMID: 32792735 PMCID: PMC7413347 DOI: 10.4103/ija.ija_914_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/12/2020] [Accepted: 05/09/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Disparity in spread of spinal anesthesia is a known complication in scoliosis patients. Our primary aim was to compare this disparity based on Cobb Angle and thorocolumbar spine curvature. Secondary aim was to calculate the appropriate lateral angulation of the spinal needle from midline for successful lumbar puncture. Materials and Methods All poliomyelitis patients with scoliosis posted for lower limb orthopedic contracture release surgeries were enrolled into Group A (Cobb Angle <50°), Group B (Cobb Angle >50°), and on thoracolumbar curve into Group R (Right), Group L (Left). Group A, B, R, and L were studied for bilateral spread of spinal anaesthesia. Lateral angle of the spinal needle from midline was noted with Goniometer in groups A and B. Statistical analysis was done using unpaired t test and Chi-square test. Results Failures in subarachnoid block (SAB) (unilateral anaesthesia/inadequate/patchy block) was significant in Group B (P = 0.033). Segmental disparity in bilateral spread of spinal anaesthesia was significant in Group R with P value of 0.042. Approximate lateral angle for needle in Group A was (4.1 ± 2.45) and in Group B was (9.14 ± 2.45). Conclusions The study showed that there was a strong correlation between right-sided thoracolumbar curve and the spread of spinal anesthesia.
Collapse
Affiliation(s)
- Girija K Ballarapu
- Department of Anaesthesia, Balaji Institute of Surgery Research and Rehabilitation Hospital, Tirupati, India
| | - Srinivasa R Nallam
- Department of Anaesthesia and Critical Care, Government Medical College, Kadapa, India
| | - Aloka Samantaray
- Department of Anaesthesia, Sri Venkateshwara Institute of Medical Sciences, Tirupati, India
| | - V A Kiran Kumar
- Department of Neurosurgery, Narayana Medical College Hospital, Chintareddy Palem, Nellore, India
| | - Aditya P Reddy
- Department of Anaesthesia, Dr Pinnamaneni Siddhardha Medical College, Chinoutpally, Krishna, Andhra Pradesh, India
| |
Collapse
|
11
|
Park SK, Bae J, Yoo S, Kim WH, Lim YJ, Bahk JH, Kim JT. Ultrasound-Assisted Versus Landmark-Guided Spinal Anesthesia in Patients With Abnormal Spinal Anatomy. Anesth Analg 2020; 130:787-795. [DOI: 10.1213/ane.0000000000004600] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
12
|
Bisherwal S, Puhal S, Saini R, Rani A. Anaesthetic management and challenges involved in goldenhar's syndrome; A series of two cases. BALI JOURNAL OF ANESTHESIOLOGY 2020. [DOI: 10.4103/bjoa.bjoa_32_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
13
|
Paliwal B, Sharma RS, Bhatia P, Kamal M. Fluoroscopic guided epidural anaesthesia: A rescuing skill in difficult anaesthetic management. Indian J Anaesth 2019; 63:679-680. [PMID: 31462820 PMCID: PMC6691642 DOI: 10.4103/ija.ija_268_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Bharat Paliwal
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ravi S Sharma
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pradeep Bhatia
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Manoj Kamal
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| |
Collapse
|
14
|
Katz R, McCaul CL. Anaesthetic management for caesarean section of a parturient with a known difficult airway and closed spinal dysraphism. Int J Obstet Anesth 2018; 38:137-142. [PMID: 30415798 DOI: 10.1016/j.ijoa.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/15/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
Abstract
Many anaesthetists consider patients with existing neurological deficits, untreated spinal pathology or those having undergone major spinal intervention to be precluded from undergoing neuraxial anaesthesia. While this is partly rooted in fears of litigation there is also a lack of consensus of the best practice in the anaesthetic management of these patients. We present our management of a parturient who attended our institution, having a number of anaesthetic complexities including a known difficult airway, spinal fusion and persistent spinal cord tethering. She successfully underwent delivery under neuraxial blockade for the delivery of her fourth child. We believe that by undergoing a thorough multidisciplinary clinical evaluation, including the extensive use of neuroimaging and ultrasound, it may be possible to plan and perform safe neuraxial anaesthesia.
Collapse
Affiliation(s)
- R Katz
- Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland.
| | - C L McCaul
- Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland
| |
Collapse
|
15
|
Lee A, Loughrey JP. The role of ultrasonography in obstetric anesthesia. Best Pract Res Clin Anaesthesiol 2017. [DOI: 10.1016/j.bpa.2016.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
16
|
Bauchat JR, McCarthy RJ, Koski TR, Wong CA. Labor Analgesia Consumption and Time to Neuraxial Catheter Placement in Women with a History of Surgical Correction for Scoliosis. Anesth Analg 2015; 121:981-987. [DOI: 10.1213/ane.0000000000000690] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
17
|
CHIN KJ, PERLAS A, CHAN V. The ultrasound-assisted paraspinous approach to lumbar neuraxial blockade: a simplified technique in patients with difficult anatomy. Acta Anaesthesiol Scand 2015; 59:668-73. [PMID: 25736612 DOI: 10.1111/aas.12502] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 01/31/2015] [Indexed: 02/06/2023]
Abstract
Pre-procedural ultrasound imaging of the spine to identify the interspinous and interlaminar space has been shown to facilitate subsequent performance of lumbar neuraxial blockade. However, adequate visualization of the vertebral canal can be challenging for less-experienced operators, and particularly in subjects with difficult anatomy. In this case report, we describe a simplified technique of ultrasound-assisted neuraxial blockade that addresses these limitations and may thus be a useful fallback option. A pre-procedural scan is performed in which the main ultrasonographic landmarks to be identified are the neuraxial midline and the spinous processes, rather than the posterior and anterior complexes of the vertebral canal. Another key difference is the use of a paraspinous (or paramedian) needle approach rather than a midline approach that is advantageous where the interspinous spaces are narrowed by disease or suboptimal patient positioning. The anatomical basis and technical performance of this novel ultrasound-assisted paraspinous approach are presented in detail.
Collapse
Affiliation(s)
- K. J. CHIN
- Department of Anesthesia; Toronto Western Hospital; University of Toronto; Toronto Ontario Canada
| | - A. PERLAS
- Department of Anesthesia; Toronto Western Hospital; University of Toronto; Toronto Ontario Canada
| | - V. CHAN
- Department of Anesthesia; Toronto Western Hospital; University of Toronto; Toronto Ontario Canada
| |
Collapse
|
18
|
Abstract
Ultrasound has permeated the practice of anesthesiology and is becoming an essential tool for the obstetric anesthesiologist in the labor and delivery suite. The most common applications include guidance for neuraxial (epidural and spinal) anesthesia and acute pain nerve blocks, as well as guidance for central and peripheral vascular access. Obstetric anesthesiologists are becoming increasingly familiar with diagnostic applications, including transthoracic echocardiography (TTE) and lung and gastric ultrasound. There is intense interest in developing standard curricula for achieving competency in ultrasound skills during residency training and expanding the role of ultrasound in education and research.
Collapse
Affiliation(s)
- Allison Lee
- Department of Anesthesiology, Columbia University, 630 West 168th St PH5, New York, NY 10032.
| |
Collapse
|
19
|
|
20
|
|
21
|
Bowens C, Dobie K, Devin C, Corey J. Reply from the authors. Br J Anaesth 2014; 112:1126-7. [DOI: 10.1093/bja/aeu176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
22
|
Development of an Ultrasound Phantom for Spinal Injections With 3-Dimensional Printing. Reg Anesth Pain Med 2014; 39:429-33. [DOI: 10.1097/aap.0000000000000136] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|