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Thon JN, Weigand MA, Kranke P, Siegler BH. Efficacy of therapies for post dural puncture headache. Curr Opin Anaesthesiol 2024; 37:219-226. [PMID: 38372283 PMCID: PMC11062605 DOI: 10.1097/aco.0000000000001361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
PURPOSE OF REVIEW Clinical management of postdural puncture headache (PDPH) remains an interdisciplinary challenge with significant impact on both morbidity and quality of life. This review aims to give an overview of the most recent literature on prophylactic and therapeutic measures and to discuss novel findings with regard to currently published consensus practice guideline recommendations. RECENT FINDINGS Although current evidence does not support a recommendation of any specific prophylactic measure, new data is available on the use of intrathecal catheters to prevent PDPH and/or to avoid invasive procedures. In case of disabling or refractory symptoms despite conservative treatments, the epidural blood patch (EBP) remains the therapeutic gold standard and its use should not be delayed in the absence of contraindications. However, recent clinical studies and meta-analyses provide additional findings on the therapeutic use of local anesthetics as potential noninvasive alternatives for early symptom control. SUMMARY There is continuing research focusing on both prophylactic and therapeutic measures offering promising data on potential alternatives to invasive procedures, although there is currently no treatment option that comes close to the effectiveness of an EBP. A better understanding of PDPH pathophysiology is not only necessary to identify new therapeutic targets, but also to recognize patients who benefit most from current treatments, as this might enhance their therapeutic efficacy.
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Affiliation(s)
- Jan N. Thon
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Im Neuenheimer Feld 420, Heidelberg, Germany
| | - Markus A. Weigand
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Im Neuenheimer Feld 420, Heidelberg, Germany
| | - Peter Kranke
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital, Würzburg University Hospital, Würzburg, Bavaria, Germany
| | - Benedikt H. Siegler
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Im Neuenheimer Feld 420, Heidelberg, Germany
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Kim M, Yoon K, Lee S, Shin MS, Kim KG. Development of an Artificial Soft Solid Gel Using Gelatin Material for High-Quality Ultrasound Diagnosis. Diagnostics (Basel) 2024; 14:335. [PMID: 38337851 PMCID: PMC10855452 DOI: 10.3390/diagnostics14030335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/12/2024] [Accepted: 01/21/2024] [Indexed: 02/12/2024] Open
Abstract
For ultrasound diagnosis, a gel is applied to the skin. Ultrasound gel serves to block air exposure and match impedance between the skin and the probe, enhancing imaging efficiency. However, if use of the ultrasound gel exceeds a certain period of time, it may dry out and be exposed to air, causing impedance mismatch and reducing imaging resolution. In such cases, the use of a soft, solid gel proves advantageous, as it can be employed for an extended period without succumbing to the drying phenomenon and can be reused after disinfection. Its soft consistency ensures excellent skin adhesion. Our soft solid gel demonstrated approximately 1.2 times better performance than water, silicone, and traditional ultrasound gels. When comparing the dimensions of grayscale, dead zone, vertical, and horizontal regions, the measurements for the traditional ultrasound gel were 93.79 mm, 45.32 mm, 103.13 mm, 83.86 mm, and 83.86 mm, respectively. In contrast, the proposed soft solid gel exhibited dimensions of 105.64 mm, 34.48 mm, 141.1 mm, and 102.8 mm.
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Affiliation(s)
- Minchan Kim
- Medical Devices R&D Center, Gachon University Gil Medical Center, 21, 774 Beon-gil, Namdong-daero, Namdong-gu, Incheon 21565, Republic of Korea; (M.K.); (K.Y.); (S.L.)
| | - Kicheol Yoon
- Medical Devices R&D Center, Gachon University Gil Medical Center, 21, 774 Beon-gil, Namdong-daero, Namdong-gu, Incheon 21565, Republic of Korea; (M.K.); (K.Y.); (S.L.)
- Premedicine Course, College of Medicine, Gachon University, 38-13, 3 Beon-gil, Dokjom-ro 3, Namdong-gu, Incheon 21565, Republic of Korea
| | - Sangyun Lee
- Medical Devices R&D Center, Gachon University Gil Medical Center, 21, 774 Beon-gil, Namdong-daero, Namdong-gu, Incheon 21565, Republic of Korea; (M.K.); (K.Y.); (S.L.)
- Department of Health and Safety Convergence Sciences & Health and Environmental Convergence Sciences, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774 Beon-gil, Namdong-gu, Incheon 21565, Republic of Korea
| | - Kwang Gi Kim
- Medical Devices R&D Center, Gachon University Gil Medical Center, 21, 774 Beon-gil, Namdong-daero, Namdong-gu, Incheon 21565, Republic of Korea; (M.K.); (K.Y.); (S.L.)
- Department of Biomedical Engineering, College of Health Science, Gachon University, 191 Hambak-moero, Yeonsu-gu, Incheon 21936, Republic of Korea
- Department of Health Sciences and Technology, Gachon Advanced Institute for Health Sciences and Technology (GAIHST), Gachon University, 38-13, 3 Beon-gil, Dokjom-ro, Namdong-gu, Incheon 21565, Republic of Korea
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Tawfik MM, Eldeeb AH. Reply to letter to the editor: Ultrasonography versus palpation for spinal anesthesia in obese parturients undergoing cesarean delivery: a randomized controlled trial. Reg Anesth Pain Med 2023:rapm-2023-104824. [PMID: 37524500 DOI: 10.1136/rapm-2023-104824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 08/02/2023]
Affiliation(s)
- Mohamed Mohamed Tawfik
- Anesthesia and Surgical Critical Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Amany Hazem Eldeeb
- Anesthesia and Surgical Critical Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Aveline C. To the editor regarding 'Ultrasonography versus palpation for spinal anesthesia in obese parturients undergoing cesarean delivery: a randomized controlled trial'. Reg Anesth Pain Med 2023:rapm-2023-104768. [PMID: 37524499 DOI: 10.1136/rapm-2023-104768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 08/02/2023]
Affiliation(s)
- Christophe Aveline
- Anesthesiology and Surgical Intensive Care Unit, Hôpital Privé Sévigné, Cesson Sévigné, France
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