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Zhang Q, Piao S, Chen H, Wu J, Nakamura K. A Linear Piezoelectric Actuator Using "A-Shaped" Structure. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:1382-1391. [PMID: 35073260 DOI: 10.1109/tuffc.2022.3145366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A new design of linear piezoelectric actuator using "A-shaped" structure was proposed, designed, fabricated, and tested. By fusion design of the piezoelectric transducer and the mechanical structure, the proposed actuator only uses the first bending vibration of the center piezoelectric transducer to work. Frequency degeneration is no longer needed, which enables the actuator to adjust its structural parameters according to the application conditions. When applying an alternating voltage at resonance frequency, the center piezoelectric transducer will be stimulated in the first bending vibration. The vibration energy transmitted to the two driving arms generates alternating tilting movements with a phase difference of 180° between the two driving feet, which enables the actuator to push the linear guide when a vertical preload is applied. Under the preload of 120 N, the actuator gained a maximum thrust force of 9.8 N and a maximum output power of 0.62 W with a self-weight of 0.061 kg. The maximum output thrust density and the maximum output power density were 160.6 N/kg and 10.2 W/kg, respectively.
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Hagag U, El Nahas A. Ultrasound-guided retrobulbar nerve block in donkey cadavers. Vet Anaesth Analg 2022; 49:197-202. [DOI: 10.1016/j.vaa.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 01/09/2022] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
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Sadler A, McHardy PG, McLeod G, Wilkinson T. Response to: Safe and Sound (a letter regarding "Ultrasound detection of iatrogenic injury during peribulbar eye block: a cadaveric study"). Reg Anesth Pain Med 2020; 46:556. [PMID: 32948660 DOI: 10.1136/rapm-2020-102030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Amy Sadler
- Department of Anaesthesia, Ninewells Hospital, Dundee, UK
| | - Paul G McHardy
- Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Graeme McLeod
- Department of Anaesthesia, Ninewells Hospital, Dundee, UK.,School of Medicine, University of Dundee, Dundee, Dundee, UK
| | - Tracey Wilkinson
- Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK
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Sadler A, McLeod G, McHardy PG, Wilkinson T. Ultrasound detection of iatrogenic injury during peribulbar eye block: a cadaveric study. Reg Anesth Pain Med 2020; 45:740-743. [DOI: 10.1136/rapm-2020-101433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/14/2020] [Accepted: 04/18/2020] [Indexed: 11/04/2022]
Abstract
BackgroundOphthalmic eye blocks, such as retrobulbar, peribulbar and sub-Tenon’s, are traditionally conducted “blind”. Complications are rare but potentially devastating. Life-threatening complications include brain stem anesthesia and local anesthetic toxicity, whereas sight-threatening complications include globe perforation, optic nerve damage and ocular muscle damage. Ultrasound permits a view of orbital structures and can be used to guide needle placement. The ultrasound appearances of unintended local anesthetic injection into vital orbital structures have not been documented. This study aimed to record the ultrasound appearances of unintended injection locations.MethodsThe spherical shape of the eyeballs of three soft-fix Thiel embalmed human cadavers were restored using glycerol. Iatrogenic injury in peribulbar block was then simulated through injection of printers’ ink mixed with Thiel embalming fluid. Ultrasound was used to guide the needles and the tips were redirected to lie within the globe, lateral rectus and optic nerve. Ultrasound images were recorded during injection. The orbital cavities were then dissected via a superior approach to record the location and extent of injectate spread.ResultsReal-time globe rupture, ocular muscle injection and optic nerve injection were visible using ultrasound. Characteristic appearances were identified in each case. Dissection confirmed needle and injection placement.ConclusionsThe ultrasound appearance of block complications is important to document and should be an integral part of regional anesthesia training. This study is the first to provide such images for ophthalmic nerve blocks. It offers ophthalmic anesthetists and ophthalmologists the potential to diagnose severe complications rapidly and accurately with a potential impact on patient safety.
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Shilo-Benjamini Y. A review of ophthalmic local and regional anesthesia in dogs and cats. Vet Anaesth Analg 2019; 46:14-27. [DOI: 10.1016/j.vaa.2018.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 10/19/2018] [Accepted: 10/20/2018] [Indexed: 12/17/2022]
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Impact of Video Technology for Improving Success of Medial Canthus Episcleral Anesthesia in Ophthalmology. Reg Anesth Pain Med 2018; 42:757-759. [PMID: 28961602 DOI: 10.1097/aap.0000000000000658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Efficient learning of regional anesthesia in ophthalmology remains challenging because trainees are afforded limited opportunity to practice ocular anesthesia. The aim of this prospective, randomized, blinded study was to determine whether teaching with video improves regional anesthesia skills of residents in ophthalmology. METHODS From January to October 2016, 32 novice anesthesiology residents were evaluated while performing medial canthus episcleral procedures during a 5-day rotation. Residents were randomly assigned to either receive or not receive a video review of their performance at day 3. The primary outcome was a comparison of akinesia using a 12-point scale before incision assessed by the blinded surgeon. RESULTS A total of 288 blocks were performed by 32 residents and were assessed by 3 surgeons before the intervention (144 blocks) and after the intervention (144 blocks). Residents in the review group improved to a greater degree compared with residents in the no-review group. The median overall akinesia scores for the review and no-review groups were similarly low (6; interquartile range [IQR], 2-11; and 6 [IQR, 2-9], respectively) on day 1 of the rotation, whereas anesthesia performed by residents in the video group provided a better akinesia score (12 [IQR, 10-12] vs 8 [IQR, 6-10]; P < 0.001) on day 5 of the rotation. CONCLUSIONS Video-assisted teaching significantly improves performance of medial canthus episcleral anesthesia performed by novice trainees.
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Reply to Drs Palte and Gayer. Reg Anesth Pain Med 2018; 43:103-104. [DOI: 10.1097/aap.0000000000000713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abu Elyazed MM, Abdelghafar MS, Mogahed MM, Nassif MA. The effect of adding cisatracurium versus hyaluronidase to levobupivacaine and lidocaine mixture in single injection peribulbar block for cataract surgery. EGYPTIAN JOURNAL OF ANAESTHESIA 2017. [DOI: 10.1016/j.egja.2017.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mohamed M. Abu Elyazed
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Egypt
| | | | - Mona Mohamed Mogahed
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Egypt
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Calenda E, Muraine M. Ultrasound comparison of diffusion of local anesthetic solution after a peribulbar and a sub-Tenon's block: a pilot study. Int J Ophthalmol 2016; 9:638-9. [PMID: 27162743 DOI: 10.18240/ijo.2016.04.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 05/04/2015] [Indexed: 11/23/2022] Open
Affiliation(s)
- Emile Calenda
- Department of Anesthesiology, Rouen University Hospital, Institute for Biomedical Research, Rouen 76031, France
| | - Marc Muraine
- Department of Opthalmology, Rouen University Hospital, Institute for Biomedical Research, Rouen 76031, France
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Comparison of Needle Path, Anesthetic Dispersion, and Quality of Anesthesia in Retrobulbar and Peribulbar Blocks. Reg Anesth Pain Med 2016; 41:37-42. [DOI: 10.1097/aap.0000000000000340] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
In the past decade ophthalmic anesthesia has witnessed a major transformation. The sun has set on the landscape of ophthalmic procedures performed under general anesthesia at in-hospital settings. In its place a new dawn has ushered in the panorama of eye surgeries conducted under regional and topical anesthesia at specialty eye care centers. The impact of the burgeoning geriatric population is that an increasing number of elderly patients will present for eye surgery. In order to accommodate increased patient volumes and simultaneously satisfy administrative initiatives directed at economic frugality, administrators will seek assistance from anesthesia providers in adopting measures that enhance operating room efficiency. The performance of eye blocks in a holding suite meets many of these objectives. Unfortunately, most practicing anesthesiologists resist performing ophthalmic regional blocks because they lack formal training. In future, anesthesiologists will need to block eyes and manage common medical conditions because economic pressures will eliminate routine preoperative testing. This review addresses a variety of topical issues in ophthalmic anesthesia with special emphasis on cannula and needle-based blocks and the new-generation antithrombotic agents. In a constantly evolving arena, the sub-Tenon's block has gained popularity while the deep angulated intraconal (retrobulbar) block has been largely superseded by the shallower extraconal (peribulbar) approach. Improvements in surgical technique have also impacted anesthetic practice. For example, phacoemulsification techniques facilitate the conduct of cataract surgery under topical anesthesia, and suture-free vitrectomy ports may cause venous air embolism during air/fluid exchange. Hyaluronidase is a useful adjuvant because it promotes local anesthetic diffusion and hastens block onset time but it is allergenic. Ultrasound-guided eye blocks afford real-time visualization of needle position and local anesthetic spread. An advantage of sonic guidance is that it may eliminate the hazard of globe perforation by identifying abnormal anatomy, such as staphyloma.
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Affiliation(s)
- Howard D Palte
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL, USA
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Najman IE, Meirelles R, Ramos LB, Guimarães TCF, do Nascimento P. A randomised controlled trial of periconal eye blockade with or without ultrasound guidance. Anaesthesia 2015; 70:571-6. [DOI: 10.1111/anae.12976] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2014] [Indexed: 11/29/2022]
Affiliation(s)
- I. E. Najman
- Department of Anaesthesiology; Botucatu School of Medicine; UNESP; São Paulo Brazil
- Benjamin Constant Institute for the Blind; Rio de Janeiro Brazil
| | - R. Meirelles
- Benjamin Constant Institute for the Blind; Rio de Janeiro Brazil
| | - L. B. Ramos
- Benjamin Constant Institute for the Blind; Rio de Janeiro Brazil
| | - T. C. F. Guimarães
- Research Department of Organ Transplantations; Secretariat of Health; Rio de Janeiro Brazil
| | - P. do Nascimento
- Department of Anaesthesiology; Botucatu School of Medicine; UNESP; São Paulo Brazil
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Wagatsuma JT, Deschk M, Floriano BP, Ferreira JZ, Fioravanti H, Gasparello IF, Oliva VNLS. Comparison of anesthetic efficacy and adverse effects associated with peribulbar injection of ropivacaine performed with and without ultrasound guidance in dogs. Am J Vet Res 2014; 75:1040-8. [DOI: 10.2460/ajvr.75.12.1040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chemosis Secondary to Anterograde Episcleral (Sub-Tenon) Spread of Local Anesthetic during Retrobulbar Eye Block. Anesthesiology 2014; 121:877. [DOI: 10.1097/aln.0b013e3182a0594b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Supplemental Digital Content is available in the text.
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Bensghir M, Badou N, Houba A, Balkhi H, Haimeur C, Azendour H. Convulsions during cataract surgery under peribulbar anesthesia: a case report. J Med Case Rep 2014; 8:218. [PMID: 24957659 PMCID: PMC4088311 DOI: 10.1186/1752-1947-8-218] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 04/28/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Locoregional anesthesia techniques are increasingly used for cataract surgery. From these techniques, peribulbar anesthesia has been very successful over the retrobulbar anesthesia seen its effectiveness and safety. However, peribulbar anesthesia is not without risk. CASE PRESENTATION A 70-year-old African man was scheduled for cataract surgery and lens implant for his right eye. His medical history included hypertension, diabetes mellitus and gall bladder surgery. There were no personal or family antecedents of allergy, epilepsy or taking food or toxic drug. No abnormalities were detected in his preoperative evaluation. In the operating room, standard monitoring was installed and a peripheral venous catheter 18g was inserted. Peribulbar anesthesia was realized with two injections in primary gaze position. The anesthetic mixture contained lidocaine 2% and bupivacaine 0.5%. The needle used was 25GA, 19mm, ¾ inch. The first injection was performed in his lower temporal peribulbar space with 5mL of mixture; the second injection was performed with 3mL of mixture in his upper nasal peribulbar space. These injections were performed after a negative aspiration test and followed by manual compression of his globe for 5 minutes. Five minutes after peribulbar anesthesia, his blood pressure increased to 209/115mmHg requiring three bolus of nicardipine (3.0mg) to reduce his blood pressure to 134/56mmHg. One minute after, he had generalized tonic-clonic seizures. Tracheal intubation was performed. His capillary blood glucose was 170mg/dL, axillary temperature was 36.5°C, and his serum electrolytes were normal. He recovered spontaneous ventilation 1.5 hours later. A neurological examination noted no deficit. Extubation was performed 15 minutes later without incident. A brain computed tomography and electroencephalogram were unremarkable. He was discharged on the second day and operated on 1 month later under general anesthesia. CONCLUSIONS Various serious complications can occur during locoregional anesthesia techniques in ophthalmic surgery. The mastering and perfecting of these techniques by practitioners and compliance with safety standards in anesthesia are the only way to guarantee the prevention of such complications.
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Affiliation(s)
- Mustapha Bensghir
- Department of Anesthesiology Military Hospital Mohammed V Rabat, University of Mohammed V Souissi, Rabat, Morocco.
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Beylacq L, Laterrade T, Penna M, Chouraqui M, Hein F, Sabia M, Nouette-Gaulain K. Anesthésie locorégionale échoguidée en ophtalmologie. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.pratan.2013.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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