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Boselli E, Hopkins P, Lamperti M, Estèbe JP, Fuzier R, Biasucci DG, Disma N, Pittiruti M, Traškaitė V, Macas A, Breschan C, Vailati D, Subert M. European Society of Anaesthesiology and Intensive Care Guidelines on peri-operative use of ultrasound for regional anaesthesia (PERSEUS regional anesthesia): Peripheral nerves blocks and neuraxial anaesthesia. Eur J Anaesthesiol 2021; 38:219-250. [PMID: 33186303 DOI: 10.1097/eja.0000000000001383] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Nowadays, ultrasound-guidance is commonly used in regional anaesthesia (USGRA) and to locate the spinal anatomy in neuraxial analgesia. The aim of this second guideline on the PERi-operative uSE of UltraSound (PERSEUS-RA) is to provide evidence as to which areas of regional anaesthesia the use of ultrasound guidance should be considered a gold standard or beneficial to the patient. The PERSEUS Taskforce members were asked to define relevant outcomes and rank the relative importance of outcomes following the GRADE process. Whenever the literature was not able to provide enough evidence, we decided to use the RAND method with a modified Delphi process. Whenever compared with alternative techniques, the use of USGRA is considered well tolerated and effective for some nerve blocks but there are certain areas, such as truncal blocks, where a lack of robust data precludes useful comparison. The new frontiers for further research are represented by the application of USG during epidural analgesia or spinal anaesthesia as, in these cases, the evidence for the value of the use of ultrasound is limited to the preprocedure identification of the anatomy, providing the operator with a better idea of the depth and angle of the epidural or spinal space. USGRA can be considered an essential part of the curriculum of the anaesthesiologist with a defined training and certification path. Our recommendations will require considerable changes to some training programmes, and it will be necessary for these to be phased in before compliance becomes mandatory.
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Affiliation(s)
- Emmanuel Boselli
- From the Department of Anaesthesiology, Pierre Oudot Hospital, Bourgoin-Jallieu, University Claude Bernard Lyon I, University of Lyon, France (EB), Leeds Institute of Medical Research at St James's School of Medicine, University of Leeds, Leeds, UK (PH), Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates (ML), Department of Anaesthesiology, Intensive Care and Pain Medicine, University hospital of Rennes, Rennes, France (JPE), Department of Anaesthesiology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France (RF), Intensive Care Unit, Department of Emergency, Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy (DGB), Department of Anaesthesiology, IRCCS Istituto Giannina Gaslini, Genova, Italy (ND), Department of Surgery, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy (MP), Department of Anesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania (VT, AM), Department of Anaesthesia, Klinikum Klagenfurt, Austria (CB), Anaesthesia and Intensive Care Unit, Melegnano Hospital (DV) and Department of Surgical and Intensive Care Unit, Sesto San Giovanni Civic Hospital, Milan, Italy (MS)
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Gidaro A, Vailati D, Gemma M, Lugli F, Casella F, Cogliati C, Canelli A, Cremonesi N, Monolo D, Cordio G, Frosi C, Destefanis R, Rossi A, Alemanno MC, Valenza F, Luisoni MD, Elli S, Caldarini A, Lucchini A, Paglia S, Baroni M, Giustivi D. Retrospective survey from vascular access team Lombardy net in COVID-19 era. J Vasc Access 2021; 23:532-537. [PMID: 33618564 DOI: 10.1177/1129729821997252] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Venous Access Devices (VADs) are the most used devices in COVID-19 patients. OBJECTIVE Identify VADs implanted, catheter related thrombosis (CRT), catheter-related bloodstream infection (CRBSI), and accidental remove of VADs in both COVID-19 positive and COVID-19 free patients. Successive analysis was conducted comparing COVID-19 positive patients with COVID-19 free with inverse probability propensity score weights using simple regression to account for these two confounders (peripheral tip as central/peripheral and hospitalization as no/yes). METHODS This multicenter, retrospective cohort study collected data from seven hospitals in Lombardy during the pandemic period from February 21st to May 31st 2020. RESULTS A total of 2206 VADs were evaluated, 1107 (50.2%) of which were inserted in COVID-19 patients. In COVID-19 cohort the first choice was Long Peripheral Cannula in 388 patients (35.1%) followed by Midline Catheter in 385 (34.8%). The number of "central tip" VADs inserted in COVID-free inpatients and COVID-19 positive were similar (307 vs 334). We recorded 42 (1.9%) CRT; 32 (79.2%) were observed in COVID-19 patients. A total of 19 CRBSI were diagnosed; 15 (78.95%) were observed in COVID-19. Accidental removals were the more represented complication with 123 cases, 85 (69.1%) of them were in COVID-19. COVID-19 significantly predicted occurrence of CRT (OR = 2.00(1.85-5.03); p < 0.001), CRSB (OR = 3.82(1.82-8.97); p < 0.001), and Accidental Removal (OR = 2.39(1.80-3.20); p < 0.001) in our propensity score weighted models. CONCLUSIONS CRT, CRBSI, and accidental removal are significantly more frequent in COVID-19 patients. Accidental removals are the principal complication, for this reason, the use of subcutaneously anchored securement is recommended for a shorter period than usual.
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Affiliation(s)
- Antonio Gidaro
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Davide Vailati
- Intensive Care Unit ASST Melegnano Martesana, Milan, Italy
| | - Marco Gemma
- Intensive Care Unit Fatebenefratelli Hospital, Milan, Italy
| | - Francesca Lugli
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Francesco Casella
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Chiara Cogliati
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | | | | | | | | | - Chiara Frosi
- UOC S.I.T.R.A. ASST OVEST MILANESE, Milan, Italy
| | | | - Anna Rossi
- Foundation Don Carlo Gnocchi Onlus, Milan, Italy
| | - Maria Chiara Alemanno
- Department of Oncology and Hemato-Oncology Fondazione IRCCS-Istituto Nazionale dei Tumor, Milan, Italy
| | - Franco Valenza
- Department of Oncology and Hemato-Oncology Fondazione IRCCS-Istituto Nazionale dei Tumor, Milan, Italy
| | - Mara Dina Luisoni
- Department of Oncology and Hemato-Oncology Fondazione IRCCS-Istituto Nazionale dei Tumor, Milan, Italy
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Vailati D, Montrucchio G, Cerotto V, Capozzoli G, Gori F, Petrini F, Brazzi L. Choice and management of vascular access in the context of COVID-19 outbreak in Italy: Recommendations from clinical practice. J Vasc Access 2020; 23:18-23. [PMID: 33198573 DOI: 10.1177/1129729820968415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
On April 2020, during the outburst of the COVID-19 pandemic in Italy, the SIAARTI ("Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva") Research Group on Vascular Access has formulated some essential recommendations for the optimization of the selection, insertion, and maintenance of the vascular access devices, with the aim of guarantee the operator safety, ensure the effectiveness of the maneuvers, and reduce the risk of complications. Here we describe the key elements of clinical management of vascular access in patients affected by COVID-19.
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Affiliation(s)
- Davide Vailati
- Anesthesia and Intensive Care Unit, Melegnano Hospital, Milano, Italy
| | - Giorgia Montrucchio
- Anesthesia, Intensive Care and Emergency, 'Città della Salute e della Scienza' Hospital, Torino, Italy
| | - Vittorio Cerotto
- Anesthesia and Intensive Care Unit, Città di Castello Hospital, Perugia, Italy
| | | | - Fabio Gori
- Anesthesia and Intensive Care 1, 'Azienda Ospedaliera di Perugia', Perugia, Italy
| | - Flavia Petrini
- Anesthesia and Intensive Care, Chieti Hospital, Chieti, Italy.,Department of Medical Oral and Biotechnological Sciences, University of Chieti Pescara, Italy
| | - Luca Brazzi
- Anesthesia, Intensive Care and Emergency, 'Città della Salute e della Scienza' Hospital, Torino, Italy.,Department of Surgical Sciences, University of Turin, Torino, Italy
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Vailati D, Montrucchio G, Cerotto V, Capozzoli G, Gori F, Petrini F, Brazzi L. Choice and management of vascular access in the context of COVID-19 outbreak in Italy: Recommendations from clinical practice. J Vasc Access 2020. [PMID: 33198573 DOI: 10.1177/1129729820968415.] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
On April 2020, during the outburst of the COVID-19 pandemic in Italy, the SIAARTI ("Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva") Research Group on Vascular Access has formulated some essential recommendations for the optimization of the selection, insertion, and maintenance of the vascular access devices, with the aim of guarantee the operator safety, ensure the effectiveness of the maneuvers, and reduce the risk of complications. Here we describe the key elements of clinical management of vascular access in patients affected by COVID-19.
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Affiliation(s)
- Davide Vailati
- Anesthesia and Intensive Care Unit, Melegnano Hospital, Milano, Italy
| | - Giorgia Montrucchio
- Anesthesia, Intensive Care and Emergency, 'Città della Salute e della Scienza' Hospital, Torino, Italy
| | - Vittorio Cerotto
- Anesthesia and Intensive Care Unit, Città di Castello Hospital, Perugia, Italy
| | | | - Fabio Gori
- Anesthesia and Intensive Care 1, 'Azienda Ospedaliera di Perugia', Perugia, Italy
| | - Flavia Petrini
- Anesthesia and Intensive Care, Chieti Hospital, Chieti, Italy.,Department of Medical Oral and Biotechnological Sciences, University of Chieti Pescara, Italy
| | - Luca Brazzi
- Anesthesia, Intensive Care and Emergency, 'Città della Salute e della Scienza' Hospital, Torino, Italy.,Department of Surgical Sciences, University of Turin, Torino, Italy
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5
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Vailati D, Fusco T, Canelli A, Chiariello C, Zerla P. Axillary vein thrombosis in COVID positive patient with midline and continuous positive airway pressure Helmet. J Vasc Access 2020. [PMID: 32669027 DOI: 10.1177/1129729820943424.] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We describe the case of a coronavirus disease patient with midline who, during ventilation with continuous positive airway pressure helmet with underarm fastening straps, presented thrombosis of the axillary vein in the armpit. The tip of the midline ended in the armpit. The thrombosis has been resolved with anticoagulant therapy with low molecular weight heparin of 100 IU/kg bid without giving pulmonary embolism. In an emergency context like this, the need to resort to ventilation strategies even in departments generally not accustomed to the use of these devices and to the management of this type of patients, the need to use and adapt the available material (e.g. being unable to renounce to use underarm fastening straps) obliges us to consider the use of alternative strategies also in the field of vascular access. After this case, we began to consider techniques that allow us to prevent the catheter from ending in the armpit, with benefit. It is essential to continue to observe this patient.
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Affiliation(s)
- Davide Vailati
- Department of Anesthesia and Intensive Care Unit, Melegnano Hospital-ASST Melegnano e della Martesana, Milan, Italy.,Vascular Access Team, ASST Melegnano e della Martesana, Milan, Italy
| | - Tiziana Fusco
- Department of Anesthesia and Intensive Care Unit, Melegnano Hospital-ASST Melegnano e della Martesana, Milan, Italy.,Vascular Access Team, ASST Melegnano e della Martesana, Milan, Italy
| | - Antonio Canelli
- Vascular Access Team, ASST Melegnano e della Martesana, Milan, Italy
| | | | - Pietro Zerla
- Vascular Access Team, ASST Melegnano e della Martesana, Milan, Italy
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Vailati D, Fusco T, Canelli A, Chiariello C, Zerla P. Axillary vein thrombosis in COVID positive patient with midline and continuous positive airway pressure Helmet. J Vasc Access 2020; 22:997-999. [PMID: 32669027 DOI: 10.1177/1129729820943424] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
We describe the case of a coronavirus disease patient with midline who, during ventilation with continuous positive airway pressure helmet with underarm fastening straps, presented thrombosis of the axillary vein in the armpit. The tip of the midline ended in the armpit. The thrombosis has been resolved with anticoagulant therapy with low molecular weight heparin of 100 IU/kg bid without giving pulmonary embolism. In an emergency context like this, the need to resort to ventilation strategies even in departments generally not accustomed to the use of these devices and to the management of this type of patients, the need to use and adapt the available material (e.g. being unable to renounce to use underarm fastening straps) obliges us to consider the use of alternative strategies also in the field of vascular access. After this case, we began to consider techniques that allow us to prevent the catheter from ending in the armpit, with benefit. It is essential to continue to observe this patient.
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Affiliation(s)
- Davide Vailati
- Department of Anesthesia and Intensive Care Unit, Melegnano Hospital—ASST Melegnano e della Martesana, Milan, Italy
- Vascular Access Team, ASST Melegnano e della Martesana, Milan, Italy
| | - Tiziana Fusco
- Department of Anesthesia and Intensive Care Unit, Melegnano Hospital—ASST Melegnano e della Martesana, Milan, Italy
- Vascular Access Team, ASST Melegnano e della Martesana, Milan, Italy
| | - Antonio Canelli
- Vascular Access Team, ASST Melegnano e della Martesana, Milan, Italy
| | | | - Pietro Zerla
- Vascular Access Team, ASST Melegnano e della Martesana, Milan, Italy
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Montrucchio G, Cerotto V, Vailati D, Capozzoli G, Gori F, Brazzi L. Skin microbiome and placement of vascular access: A solved problem? J Infect Prev 2019; 20:301-302. [PMID: 31762793 DOI: 10.1177/1757177419863850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Giorgia Montrucchio
- Department of Anaesthesia, Intensive Care and Emergency, 'Città della Salute e della Scienza' Hospital, Turin, Italy
| | - Vittorio Cerotto
- Anaesthesia, Intensive Care and Pain Care, Città di Castello Hospital, Italy
| | - Davide Vailati
- Anaesthesia and Intensive Care, Melegnano Hospital, Milan, Italy
| | | | - Fabio Gori
- Anaesthesia and Intensive Care 1, 'Azienda Ospedaliera di Perugia', Perugia, Italy
| | - Luca Brazzi
- Department of Anaesthesia, Intensive Care and Emergency, 'Città della Salute e della Scienza' Hospital, Turin, Italy.,Department of Surgical Sciences, University of Turin, Turin, Italy
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Prada F, Del Bene M, Mauri G, Lamperti M, Vailati D, Richetta C, Saini M, Santuari D, Kalani MYS, DiMeco F. Dynamic assessment of venous anatomy and function in neurosurgery with real-time intraoperative multimodal ultrasound: technical note. Neurosurg Focus 2019; 45:E6. [PMID: 29961376 DOI: 10.3171/2018.4.focus18101] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The relevance of the cerebral venous system is often underestimated during neurosurgical procedures. Damage to this draining system can have catastrophic implications for the patient. Surgical decision-making and planning must consider each component of the venous compartment, from the medullary draining vein to the dural sinuses and extracranial veins. Intraoperative ultrasound (ioUS) permits the real-time study of venous compartments using different modalities, thus allowing complete characterization of their anatomical and functional features. The B-mode (brightness mode) offers a high-resolution anatomical representation of veins and their relationships with lesions. Doppler modalities (color, power, spectral) allow the study of blood flow and identification of vessels to distinguish their functional characteristics. Contrast-enhanced US allows one to perform real-time angiosonography showing both the functional and the anatomical aspects of vessels. In this technical report, the authors demonstrate the different applications of multimodal ioUS in neurosurgery for identifying the anatomical and functional characteristics of the venous compartment. They discuss the general principles and technical nuances of ioUS and analyze their potential implications for the study of various venous districts during neurosurgical procedures.
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Affiliation(s)
- Francesco Prada
- 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.,2Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, Virginia
| | - Massimiliano Del Bene
- 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.,Departments of3Experimental Oncology and
| | - Giovanni Mauri
- 4Radiology, European Institute of Oncology, Milan, Italy
| | - Massimo Lamperti
- 5Anesthesiology Unit, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Davide Vailati
- 6Anesthesiology Unit, Ospedale di Circolo di Melegnano, Presidio di Vizzolo Predabissi, Milan, Italy
| | - Carla Richetta
- 7Department of Neurosurgery, Sourasky Medical Center, Tel Aviv, Israel
| | - Marco Saini
- 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Davide Santuari
- 8Department of Vascular Surgery, Ospedale S. Carlo, Milan, Italy; and
| | - M Yashar S Kalani
- 2Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, Virginia
| | - Francesco DiMeco
- 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.,9Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, Maryland
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9
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Prada F, Santuari D, Legnani F, Del Bene M, Mattei L, Lodigiani L, Caputi L, Boffano C, Vailati D. Cerebral Venous Return and high altitude cerebral edema (HACE): hypothesis and study protocol. Veins and Lymphatics 2013. [DOI: 10.4081/cerebvenreturn.2013.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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10
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Cordella R, Acerbi F, Broggi M, Vailati D, Nazzi V, Schiariti M, Tringali G, Ferroli P, Franzini A, Broggi G. Intraoperative neurophysiological monitoring of the cortico-spinal tract in image-guided mini-invasive neurosurgery. Clin Neurophysiol 2013; 124:1244-54. [DOI: 10.1016/j.clinph.2012.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 11/13/2012] [Accepted: 11/14/2012] [Indexed: 10/27/2022]
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Lamperti M, Subert M, Vailati D, Sommariva A. What else regarding central vascular access placement. Minerva Anestesiol 2013; 79:452. [PMID: 23254168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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12
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Lamperti M, Subert M, Cortellazzi P, Vailati D, Caldiroli D. In Response. Anesth Analg 2012. [DOI: 10.1213/ane.0b013e31826bb408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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Lamperti M, Subert M, Cortellazzi P, Vailati D, Borrelli P, Montomoli C, D'Onofrio G, Caldiroli D. Is a neutral head position safer than 45-degree neck rotation during ultrasound-guided internal jugular vein cannulation? Results of a randomized controlled clinical trial. Anesth Analg 2012; 114:777-84. [PMID: 22253269 DOI: 10.1213/ane.0b013e3182459917] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The optimal degree of neck rotation during internal jugular vein (IJV) cannulation remains undetermined because previous studies suggested using sonography, but without puncturing the vein. We assessed whether a neutral position (NP) of the head (0 degrees) during ultrasound-guided cannulation of the IJV was safer than rotating the neck to 45 degrees head turned. The effect of these 2 positions during ultrasound-guided cannulation on major complications was the primary outcome. Overall complications, venous access time, and perception of difficulty during the procedure were also evaluated. METHODS A prospective, randomized, controlled, nonblinded study was conducted in a tertiary neurosurgical hospital. Patients undergoing major elective neurosurgical procedures requiring a central venous line were randomly allocated to 2 groups; ultrasound-guided cannulation of the IJV was then performed using an out-of-plane orientation. RESULTS One thousand four hundred twenty-four patients were evaluated, but 92 were excluded; 670 were allocated to the head turned group and 662 to the NP group. Cannulation was 100% successful. Demographic data were similar in the 2 groups except for IJV positions. There were only 10 major complications: 6 in the 0-degree NP group and 4 in the 45-degree head turned group. The frequency of these complications was not different between the 2 groups. The overall complication rate was 13%, and was higher in women, in patients with ASA physical status ≥II, and in patients with a smaller diameter vein, or when the vein was located deeper and lateral or in the anterolateral position. An increased venous access time was associated with an increased rate of overall complications. The perception of difficulty performing the procedure with the head placed in the 2 positions was not statistically different in either group. CONCLUSION A head NP was as safe as a 45-degree neck rotation during ultrasound-guided IJV cannulation with regard to both major and minor complications, and venous access time was similar. Ultrasound guidance helps determine optimal head rotation for IJV cannulation.
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Affiliation(s)
- Massimo Lamperti
- Department of Neuroanesthesia, Neurological Institute Besta, Via Celoria, 11 20136 Milan, Italy.
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Lamperti M, Caldiroli D, Cortellazzi P, Vailati D, Pedicelli A, Tosi F, Piastra M, Pietrini D. Safety and efficacy of ultrasound assistance during internal jugular vein cannulation in neurosurgical infants. Intensive Care Med 2008; 34:2100-5. [PMID: 18618096 DOI: 10.1007/s00134-008-1210-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 05/30/2008] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Ultrasound guidance (USG) for internal jugular cannulation is the best solution in difficult settings where paediatric patients are involved. This is an outcome study on efficacy and complications of the USG for the internal jugular vein (IJV) cannulation in neurosurgical infants as well as an ultrasound study of anatomical findings of the IJVs in infants. DESIGN AND SETTINGS A prospective study conducted in two Academic Neurosurgical hospitals. PARTICIPANTS In 191 babies (body weight <15 kg), anatomical findings were studied. We performed CVC echo guided placement in 135/191 infants (weighting <10 kg). RESULTS After a brief training period, both institutions adopted a common protocol and USG device. We obtained successful cannulation in all patients. Carotid puncture (1.5%) was the only main complication registered and minor complications were poor. Time required for cannulation was 12.5 +/- 5.7 min. Anatomical findings (in 191 patients) were IJV laterality in 34.6% cases, IJV antero-lateral in 59.7% and anterior in 5.7%. A linear relation was found between weight and internal jugular vein diameter even if R(2) = 0.43 and the model cannot be used to predict the exact size of the vein. In 62/135 babies weighting <10 kg, anatomical measurements were done in supine and Trendelemburg position. Trendelemburg position increases significantly (P < 0.001) IJV diameter, but not IJV depth. CONCLUSIONS We considered ultrasound guidance as the first choice in infants because it can enhance IJV cannulation success, safety, and allows one to measure relationships and diameter of the IJV and optimise the central line positioning.
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Affiliation(s)
- M Lamperti
- Department of Neuroanaesthesiology, National Neurological Institute C. Besta, Milan, Italy.
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Severgnini A, Iorno V, Moschini V, Bisicchia MC, Vailati D. The role of the pain therapist in the approach to chronic headache. Neurol Sci 2003; 24 Suppl 2:S115-7. [PMID: 12811607 DOI: 10.1007/s100720300056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Chronic daily headache (CDH) represents, for the anesthesiologists, a big match in the management of a pain which is simultaneously central and periferic, of a pain wich is psychical and disabiliting. This is a pain conducting the patient to overuse analgesic medicaments even making worse "allodynia" and the organic integrity. That's why a multidisciplinary approach to this kind of chronic benign pathology permits to improve prognosis and quality of life.
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Affiliation(s)
- A Severgnini
- Pain Therapy Unit, Anesthesia and Reanimation Service, Istituti Clinici di Perfezionamento, 7 Via C. Salutati, I-20146 Milan, Italy
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