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Shi J, Ning M, Xie L, Zhang R, Liu R, Yang X, Chen L. Performance of the ratio of posterior complex length to depth measured by ultrasound as a predictor of difficult spinal anesthesia for elective cesarean delivery: a prospective cohort study. J Anesth 2024:10.1007/s00540-024-03394-6. [PMID: 39164406 DOI: 10.1007/s00540-024-03394-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 08/11/2024] [Indexed: 08/22/2024]
Abstract
PURPOSE Ultrasound view of the interlaminar structure is likely to be associated with difficult spinal anesthesia (DSA), and a poor ultrasound view which cannot show the anterior and posterior complex predicts a difficult spinal technique. As our target site is the posterior complex, this study aimed to assess whether the ratio of posterior complex length to depth measured by ultrasound can predict DSA in cesarean delivery. METHODS Four anesthesiologists with 1-2 years of experience located and marked the puncture interspace using a traditional surface landmark. Subsequently, the ultrasound examiner located and measured the marked interspace via an oblique parasagittal ultrasound scan. The anesthesiologists, who were blinded to the ultrasound results, performed spinal anesthesia using a 25-gauge Whitacre spinal needle. The total number of attempts, including skin punctures and needle passes, was recorded and the DSA was defined as 10 unsuccessful attempts. A multivariable logistic regression analysis was used to determine the independent predictors, and receiver operating characteristic curves were constructed to evaluate the performance of the ratio of posterior complex length to depth for predicting DSA. RESULTS A total of 397 cesarean delivery parturients with successfully measured posterior complex were included in the analysis. DSA occurred in 64 parturients (16.1%). Reduced length [odds ratio (OR) = 0.010, 95% confidence interval (CI), 0.002-0.062, P < 0.001] and increased depth [OR = 6.127, 95% CI, 2.671-14.056, P < 0.001] of the posterior complex were independently predictive of DSA compared with body mass index, abdominal circumference, and palpable surface landmarks. The ratio of posterior complex length to depth for predicting DSA had an area under the curve of 0.86 (95% CI, 0.82-0.90). The optimal cutoff was 0.23, with a sensitivity of 86% (95% CI, 74-93%) and specificity of 72% (95% CI, 67-77%). CONCLUSION The ratio of posterior complex length to depth measured by ultrasound demonstrated a considerable accuracy in predicting DSA for inexperienced anesthesiologists. A higher ratio at ultrasound is an indication to evaluate the optimal puncture body position and interspace in the clinic practice. CLINICAL TRIAL REGISTRATION ChiCTR2200065171 https://www.chictr.org.cn/showproj.html?proj=180855.
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Affiliation(s)
- Jingfa Shi
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, China
- Department of Anesthesiology, Anhui Maternal and Child Health Care Hospital, Maternal and Child Health Care Hospital of Anhui Medical University, Hefei, China
| | - Meng Ning
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, China
| | - Lei Xie
- Department of Anesthesiology, Anhui Maternal and Child Health Care Hospital, Maternal and Child Health Care Hospital of Anhui Medical University, Hefei, China
| | - Rong Zhang
- Department of Anesthesiology, Anhui Maternal and Child Health Care Hospital, Maternal and Child Health Care Hospital of Anhui Medical University, Hefei, China
| | - Rongrong Liu
- Department of Anesthesiology, Anhui Maternal and Child Health Care Hospital, Maternal and Child Health Care Hospital of Anhui Medical University, Hefei, China
| | - Xiuli Yang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, China.
| | - Lijian Chen
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, China.
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Grabert J, Klebach C, Osberghaus I, Jakobs P, Kim SC, Strizek B, Coburn M, Hilbert T. [Spinal needle broken in situ during elective cesarean section]. DIE ANAESTHESIOLOGIE 2024; 73:36-39. [PMID: 37947804 PMCID: PMC10791703 DOI: 10.1007/s00101-023-01358-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/01/2023] [Accepted: 10/13/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Josefin Grabert
- Klinik und Poliklinik für Anästhesiologie, und Operative Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Christian Klebach
- Klinik und Poliklinik für Anästhesiologie, und Operative Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Isabelle Osberghaus
- Klinik und Poliklinik für Anästhesiologie, und Operative Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Patrick Jakobs
- Klinik und Poliklinik für Anästhesiologie, und Operative Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Se-Chan Kim
- Zentrum für Anästhesie, Perioperative Medizin und Schmerztherapie, Orthopädische Klinik Markgröningen, Markgröningen, Deutschland
| | - Brigitte Strizek
- Zentrum für Geburtshilfe und Frauenheilkunde, Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Mark Coburn
- Klinik und Poliklinik für Anästhesiologie, und Operative Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Tobias Hilbert
- Klinik und Poliklinik für Anästhesiologie, und Operative Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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Alsharif TH, Gronfula AG, Turkistani S, Alshmlany AM, Sharourou Z, Aboueleneein H, Alhamied F. A Systemic Review of Spinal Needles Broken During Neuraxial Anesthesia. Cureus 2023; 15:e40241. [PMID: 37440808 PMCID: PMC10334221 DOI: 10.7759/cureus.40241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 07/15/2023] Open
Abstract
Needle breakage during spinal anesthesia occurs infrequently and represents a serious complication with potentially adverse effects. The objective of this systemic review was to look at the incidence, risk factors, and preventative measures for broken spinal needles. A search of the literature on PubMed, Web of Science, and Embase databases and a manual web search was performed, with no filters and up to April 2023 from inception. Out of the 43 potential studies, 23 were included. The search terms for the full article reading were broken needle, spinal anesthesia, humans, and post-operative, and the exclusion criteria were systematic reviews, conference presentations, and non-full articles. A review of the 23 studies (24 cases) suggests an association between specific risk factors such as obesity and needle size and breaks. Identifying the risks and complications of needle breaks could help physicians modify their practice and inform their patients of any increased risks applicable to them.
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Affiliation(s)
| | - Amin G Gronfula
- Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, IRL
| | | | | | | | | | - Fawaz Alhamied
- Neurology, King Fahad Armed Forces Hospital, Jeddah, SAU
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Hayasaka T, Kawano K, Onodera Y, Suzuki H, Nakane M, Kanoto M, Kawamae K. Comparison of accuracy between augmented reality/mixed reality techniques and conventional techniques for epidural anesthesia using a practice phantom model kit. BMC Anesthesiol 2023; 23:171. [PMID: 37210521 DOI: 10.1186/s12871-023-02133-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/10/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND This study used an epidural anesthesia practice kit (model) to evaluate the accuracy of epidural anesthesia using standard techniques (blind) and augmented/mixed reality technology and whether visualization using augmented/mixed reality technology would facilitate epidural anesthesia. METHODS This study was conducted at the Yamagata University Hospital (Yamagata, Japan) between February and June 2022. Thirty medical students with no experience in epidural anesthesia were randomly divided into augmented reality (-), augmented reality (+), and semi-augmented reality groups, with 10 students in each group. Epidural anesthesia was performed using the paramedian approach with an epidural anesthesia practice kit. The augmented reality (-) group performed epidural anesthesia without HoloLens2Ⓡ and the augmented reality (+) group with HoloLens2Ⓡ. The semi-augmented reality group performed epidural anesthesia without HoloLens2Ⓡ after 30 s of image construction of the spine using HoloLens2Ⓡ. The epidural space puncture point distance between the ideal insertion needle and participant's insertion needle was compared. RESULTS Four medical students in the augmented reality (-), zero in the augmented reality (+), and one in the semi-augmented reality groups failed to insert the needle into the epidural space. The epidural space puncture point distance for the augmented reality (-), augmented reality (+), and semi-augmented reality groups were 8.7 (5.7-14.3) mm, 3.5 (1.8-8.0) mm (P = 0.017), and 4.9 (3.2-5.9) mm (P = 0.027), respectively; a significant difference was observed between the two groups. CONCLUSIONS Augmented/mixed reality technology has the potential to contribute significantly to the improvement of epidural anesthesia techniques.
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Affiliation(s)
- Tatsuya Hayasaka
- Department of Anesthesiology, Yamagata University Hospital, 2-2-2 Iidanishi, Yamagata City, Yamagata, 990-9585, Japan.
| | - Kazuharu Kawano
- Department of Medicine, Yamagata University School of Medicine, Yamagata, Japan
| | - Yu Onodera
- Critical Care Center, Yamagata University Hospital, Yamagata, Japan
| | - Hiroto Suzuki
- Critical Care Center, Yamagata University Hospital, Yamagata, Japan
| | - Masaki Nakane
- Department of Emergency and Critical Care Medicine, Yamagata University Hospital, Yamagata, Japan
| | - Masafumi Kanoto
- Department of Radiology, Division of Diagnostic Radiology, Yamagata University Hospital, Yamagata, Japan
| | - Kaneyuki Kawamae
- Department of Anesthesiology, Yamagata University Hospital, 2-2-2 Iidanishi, Yamagata City, Yamagata, 990-9585, Japan
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Lal J, Bansal T, Jain M, Singh AK. M-mode scan line in ultrasound: A useful guide to identify the midline in central neuraxial block. Indian J Anaesth 2023; 67:402-403. [PMID: 37303866 PMCID: PMC10248889 DOI: 10.4103/ija.ija_807_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: 11/22/2022] [Revised: 02/17/2023] [Accepted: 02/26/2023] [Indexed: 06/13/2023] Open
Affiliation(s)
- Jatin Lal
- Department of Anaesthesiology, PGIMS, Rohtak, Haryana, India
| | - Teena Bansal
- Department of Anaesthesiology, PGIMS, Rohtak, Haryana, India
| | - Mamta Jain
- Department of Anaesthesiology, PGIMS, Rohtak, Haryana, India
| | - Anish K. Singh
- Department of Anaesthesiology, PGIMS, Rohtak, Haryana, India
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Muacevic A, Adler JR. Predictors of Failed Spinal Arachnoid Puncture Procedures: An Artificial Neural Network Analysis. Cureus 2022; 14:e32891. [PMID: 36699768 PMCID: PMC9870597 DOI: 10.7759/cureus.32891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 12/25/2022] Open
Abstract
Background Knowing the predicting factors for difficult neuraxial blocks might help better plan the procedure. This study aimed to determine the predictors of failed spinal arachnoid puncture procedures using artificial neural network (ANN) analysis. Methodology With approvals, prospectively collected data from 300 spinal arachnoid punctures in the operation theater of an academic institute having postgraduate anesthesia training were retrospectively evaluated. Fifteen variables from anthropo-demographic, spinal surface anatomy, procedure, and performers' experiences were fed as input for the ANN. A failed spinal arachnoid puncture procedure was defined as the requirement of more than three punctures, with three punctures but more than six passes, or if the performer handed over the procedure to another, considering it difficult after the second puncture. STATCRAFT v.2 software (Predictive Analytics Solutions Pvt. Ltd., Bengaluru, India) was used for ANN model generation. Considering the overfitting tendency of the ANN, Pr(>|z|) < 0.01 in the ANN was considered significant. The area under the receiver operating characteristic (AuROC) curve of the ANN model and its sensitivity and specificity were also assessed. Significant factors with multiple gradings were also evaluated for their statistical significance across the grades or classes using INSTAT software (Graphpad Prism, La Jolla, CA, USA); a two-tailed P-value of <0.05 was considered significant. Results Interspinous process-based spine grade, performers' experience, and positioning difficulty were significant determinants of failed spinal arachnoid puncture procedures in the ANN model. The ANN model had an AuROC of 0.907, specificity of 0.976, and sensitivity of 0.385. The interclass comparison showed that increasing spinal grades and decreasing experiences were associated with increased pass and puncture. Conclusions The ANN model found the determinants of the failed spinal arachnoid puncture procedure well with good AuROC and specificity but poor sensitivity.
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