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Agweder A, McLeod G, Zeng Y, Merjavy P, Womack J, Huang Z. Choice of needle and injection rate for fascial plane injection: a randomised controlled study in the soft-embalmed Thiel cadaver. Br J Anaesth 2024; 132:1163-1165. [PMID: 38570299 DOI: 10.1016/j.bja.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 04/05/2024] Open
Affiliation(s)
- Ashraf Agweder
- School of Science and Engineering, University of Dundee, Dundee, UK
| | - Graeme McLeod
- School of Medicine, University of Dundee, Dundee, UK; Department of Anaesthesia, NHS Tayside, Dundee, UK.
| | - Youheng Zeng
- School of Science and Engineering, University of Dundee, Dundee, UK
| | | | - Jonathan Womack
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Zhihong Huang
- School of Science and Engineering, University of Dundee, Dundee, UK; School of Medicine, University of Dundee, Dundee, UK
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McLeod G, Reina MA. Nerve block, nerve damage, and fluid injection pressure: overturning the myth. Br J Anaesth 2024; 132:1022-1026. [PMID: 38182528 DOI: 10.1016/j.bja.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 01/07/2024] Open
Abstract
Histological and micro-ultrasound evidence rebuffs deep-rooted views on the nature of nerve block, nerve damage, and injection pressure monitoring. We propose that the ideal position of the needle tip for nerve block is between the innermost circumneural fascial layer and outer epineurium, with local anaesthetic passing circumferentially through adipose tissue. Thin, circumferential, subepineural expansion that is invisible to the naked eye was identified using micro-ultrasound, and could account for variability of outcomes in clinical practice. Pressure monitoring cannot differentiate between intrafascicular and extrafascicular injection. High injection pressure only indicates intraneural extrafascicular spread, not intrafascicular spread, because it is not possible to inject into the stiff endoneurium in most human nerves.
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Affiliation(s)
- Graeme McLeod
- NHS Tayside, Ninewells Hospital, Dundee, UK; Imaging & Technology, University of Dundee, Dundee, UK; Engineering & Physical Sciences, Heriot-Watt University, Edinburgh, UK.
| | - Miguel A Reina
- CEU San Pablo University Faculty of Medicine, Madrid, Spain; Department of Anesthesiology, Madrid-Montepríncipe University Hospital, Madrid, Spain; University of Florida, College of Medicine, Gainesville, FL, USA
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McLeod G, Sartawi R, Chang C, Mustafa A, Raju P, Lamb C. Craniocaudal spread and clinical translation for combined erector spinae plane block and retrolaminar block in soft embalmed cadavers: a randomised controlled equivalence study. Br J Anaesth 2024; 132:1146-1152. [PMID: 38336519 DOI: 10.1016/j.bja.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/22/2023] [Accepted: 01/12/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Erector spinae plane (ESP) block spread can be unpredictable. We previously improved the spread of ESP injection by addition of retrolaminar (RL) injection. However, it is not clear whether spread at high thoracic levels is similar to spread at midthoracic levels. Our primary objective was to demonstrate that craniocaudal dye spread was equivalent after combined ESP and RL injection using a 19 G Tuohy needle at the third (T3) and sixth (T6) vertebrae in soft embalmed Thiel cadavers. METHODS We randomised 20 combined ESP and RL injections to the T3 and T6 vertebral levels on both sides of 10 prone Thiel cadavers. A 3-8 MHz transducer was placed in the paramedian sagittal plane and a single anaesthetist injected 10 ml dye onto the transverse process, then 10 ml dye onto the laminae of T3 or T6. Cadavers were dissected 24 h later. RESULTS Mean (sd) craniocaudal spread of dye after combined ESP + RL injection at T3 and T6 vertebral levels was equivalent: 8.6 (1.8) vs 8.7 (2.3) levels, respectively; difference (90% confidence interval): -0.1 (-1.4 to 1.6), P=0.904. Dye extended uniformly, cranially and caudally, from the point of injection. A 3D prosection created from a Thiel cadaver confirmed that the dorsal ramus emerges from the costotransverse foramen deep to the intertransverse ligament within the retro-superior costotransverse ligament space. Combined ESP and RL block in six patients before mastectomy achieved extensive anterior, lateral, and posterior chest wall paraesthesia over four to six dermatomes. CONCLUSIONS Combined ESP and RL injections showed equivalent and consistent spread at T3 and T6 injection sites. A pilot study confirmed translation to patients.
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Affiliation(s)
- Graeme McLeod
- NHS Tayside, Division of Imaging and Technology, University of Dundee, Ninewells Hospital, Dundee, UK.
| | - Razan Sartawi
- Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK
| | | | - Ayman Mustafa
- King Faisal Specialist Hospital & Research Center Hospital, Riyadh, Saudi Arabia
| | - Pavan Raju
- NHS Tayside, Ninewells Hospital, Dundee, UK
| | - Clare Lamb
- Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK
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MacLeod CS, O’Neill HL, Shaalan R, Nagy J, Flett MM, Guthrie GJ, McLeod G, Suttie SA. Predicting necrotising soft tissue infections in people who inject drugs: poor performance of the Laboratory Risk Indicator for Necrotising Fasciitis score and development of a novel clinical predictive nomogram in a retrospective cohort with internal validation. Int J Surg 2023; 109:1561-1572. [PMID: 37042577 PMCID: PMC10389200 DOI: 10.1097/js9.0000000000000367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/13/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION Necrotising soft tissue infections (NSTI) can threaten life and limb. Early identification and urgent surgical debridement are key for improved outcomes. NSTI can be insidious. Scoring systems, like the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC), exist to aid diagnosis. People who inject drugs (PWID) are high risk for NSTI. This study aimed to assess the utility of the LRINEC in PWID with lower limb infections and develop a predictive nomogram. METHODS A retrospective database of all hospital admissions due to limb-related complications secondary to injecting drug use between December 2011 and December 2020 was compiled through discharge codes and a prospectively maintained Vascular Surgery database. All lower limb infections were extracted from this database, dichotomised by NSTI and non-NSTI with the LRINEC applied. Specialty management times were evaluated. Statistical analyses involved: chi-square; Analysis of "variance"; Kaplan-Meier, and receiver operating characteristic curves. Nomograms were developed to facilitate diagnosis and predict survival. RESULTS There were 557 admissions for 378 patients, with 124 (22.3%; 111 patients) NSTI. Time from admission to: theatre and computed tomography imaging respectively varied significantly between specialties ( P =0.001). Surgical specialties were faster than medical ( P =0.001). Vascular surgery received the most admissions and had the quickest time to theatre. During follow-up there were 79 (20.9%) deaths: 27 (24.3%) NSTI and 52 (19.5%) non-NSTI. LRINEC ≥6 had a positive predictive value of 33.3% and sensitivity of 74% for NSTI. LRINEC <6 had a negative predictive value of 90.7% and specificity of 63.2% for non-NSTI. Area under the curve was 0.697 (95% CI: 0.615-0.778). Nomogram models found age, C-reactive protein, and non-linear albumin to be significant predictors of NSTI, with age, white cell count, sodium, creatinine, C-reactive protein, and albumin being significant in predicting survival on discharge. CONCLUSION There was reduced performance of the LRINEC in this PWID cohort. Diagnosis may be enhanced through use of this predictive nomogram.
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Affiliation(s)
- Caitlin S. MacLeod
- East of Scotland Vascular Network, Department of Vascular Surgery
- School of Medicine, University of Dundee, Dundee, Scotland
| | | | - Ramy Shaalan
- East of Scotland Vascular Network, Department of Vascular Surgery
- Department of General Surgery, Ain Shams University, Cairo, Egypt
| | - John Nagy
- East of Scotland Vascular Network, Department of Vascular Surgery
| | - Murray M. Flett
- East of Scotland Vascular Network, Department of Vascular Surgery
| | | | - Graeme McLeod
- Department of Anaesthetics, Ninewells Hospital
- Department of General Surgery, Ain Shams University, Cairo, Egypt
| | - Stuart A. Suttie
- East of Scotland Vascular Network, Department of Vascular Surgery
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Chuan A, Qian J, Bogdanovych A, Kumar A, McKendrick M, McLeod G. Design and validation of a virtual reality trainer for ultrasound-guided regional anaesthesia. Anaesthesia 2023; 78:739-746. [PMID: 37010989 DOI: 10.1111/anae.16015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 04/04/2023]
Abstract
Virtual reality is a form of high-fidelity simulation that may be used to enhance the quality of medical education. We created a bespoke virtual reality trainer software using high resolution motion capture and ultrasound imagery to teach cognitive-motor needling skills necessary for the performance of ultrasound-guided regional anaesthesia. The primary objective of this study was to determine the construct validity between novice and experienced regional anaesthetists. Secondary objectives were: to create learning curves for needling performance; compare the virtual environment immersion with other high-fidelity virtual reality software; and compare cognitive task loads imposed by the virtual trainer compared with real-life medical procedures. We recruited 21 novice and 15 experienced participants, each of whom performed 40 needling attempts on four different virtual nerve targets. Performance scores for each attempt were calculated based on measured metrics (needle angulation, withdrawals, time taken) and compared between the groups. The degree of virtual reality immersion was measured using the Presence Questionnaire, and cognitive burden was measured using the NASA-Task Load Index. Scores by experienced participants were significantly higher than novices (p = 0.002) and for each nerve target (84% vs. 77%, p = 0.002; 86% vs. 79%, p = 0.003; 87% vs. 81%, p = 0.002; 87% vs. 80%, p = 0.003). Log-log transformed learning curves demonstrated individual variability in performance over time. The virtual reality trainer was rated as being comparably immersive to other high-fidelity virtual reality software in the realism, possibility to act and quality of interface subscales (all p > 0.06) but not in the possibility to examine and self-performance subscales (all p < 0.009). The virtual reality trainer created workloads similar to those reported in real-life procedural medicine (p = 0.53). This study achieved initial validation of our new virtual reality trainer and allows progression to a planned definitive trial that will compare the effectiveness of virtual reality training on real-life regional anaesthesia performance.
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Affiliation(s)
- A Chuan
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
- Department of Anaesthesia, Liverpool Hospital, Sydney, Australia
| | - J Qian
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - A Bogdanovych
- MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Penrith, NSW, Australia
| | - A Kumar
- Department of Anaesthesia, Macquarie University Hospital, Macquarie Park, NSW, Australia
| | - M McKendrick
- School of Social Sciences, Heriot-Watt University, Edinburgh, UK
| | - G McLeod
- School of Medicine, University of Dundee, UK
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McLeod G, McKendrick M, Tafili T, Obregon M, Neary R, Mustafa A, Raju P, Kean D, McKendrick G, McKendrick T. Patterns of Skills Acquisition in Anesthesiologists During Simulated Interscalene Block Training on a Soft Embalmed Thiel Cadaver: Cohort Study. JMIR Med Educ 2022; 8:e32840. [PMID: 35543314 PMCID: PMC9412904 DOI: 10.2196/32840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/19/2022] [Accepted: 04/26/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The demand for regional anesthesia for major surgery has increased considerably, but only a small number of anesthesiologists can provide such care. Simulations may improve clinical performance. However, opportunities to rehearse procedures are limited, and the clinical educational outcomes prescribed by the Royal College of Anesthesiologists training curriculum 2021 are difficult to attain. Educational paradigms, such as mastery learning and dedicated practice, are increasingly being used to teach technical skills to enhance skills acquisition. Moreover, high-fidelity, resilient cadaver simulators are now available: the soft embalmed Thiel cadaver shows physical characteristics and functional alignment similar to those of patients. Tissue elasticity allows tissues to expand and relax, fluid to drain away, and hundreds of repeated injections to be tolerated without causing damage. Learning curves and their intra- and interindividual dynamics have not hitherto been measured on the Thiel cadaver simulator using the mastery learning and dedicated practice educational paradigm coupled with validated, quantitative metrics, such as checklists, eye tracking metrics, and self-rating scores. OBJECTIVE Our primary objective was to measure the learning slopes of the scanning and needling phases of an interscalene block conducted repeatedly on a soft embalmed Thiel cadaver over a 3-hour period of training. METHODS A total of 30 anesthesiologists, with a wide range of experience, conducted up to 60 ultrasound-guided interscalene blocks over 3 hours on the left side of 2 soft embalmed Thiel cadavers. The duration of the scanning and needling phases was defined as the time taken to perform all the steps correctly. The primary outcome was the best-fit linear slope of the log-log transformed time to complete each phase. Our secondary objectives were to measure preprocedural psychometrics, describe deviations from the learning slope, correlate scanning and needling phase data, characterize skills according to clinical grade, measure learning curves using objective eye gaze tracking and subjective self-rating measures, and use cluster analysis to categorize performance irrespective of grade. RESULTS The median (IQR; range) log-log learning slopes were -0.47 (-0.62 to -0.32; -0.96 to 0.30) and -0.23 (-0.34 to -0.19; -0.71 to 0.27) during the scanning and needling phases, respectively. Locally Weighted Scatterplot Smoother curves showed wide variability in within-participant performance. The learning slopes of the scanning and needling phases correlated: ρ=0.55 (0.23-0.76), P<.001, and ρ=-0.72 (-0.46 to -0.87), P<.001, respectively. Eye gaze fixation count and glance count during the scanning and needling phases best reflected block duration. Using clustering techniques, fixation count and glance were used to identify 4 distinct patterns of learning behavior. CONCLUSIONS We quantified learning slopes by log-log transformation of the time taken to complete the scanning and needling phases of interscalene blocks and identified intraindividual and interindividual patterns of variability.
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Affiliation(s)
- Graeme McLeod
- Ninewells Hospital, Dundee, United Kingdom
- University of Dundee, Dundee, United Kingdom
| | - Mel McKendrick
- Optomize Ltd, Glasgow, United Kingdom
- Heriot-Watt University, Edinburgh, United Kingdom
| | | | | | - Ruth Neary
- Raigmore Hospital, Inverness, United Kingdom
| | | | - Pavan Raju
- Ninewells Hospital, Dundee, United Kingdom
| | | | | | - Tuesday McKendrick
- Barts and The London School of Medicine and Dentistry, London, United Kingdom
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Sartawi RY, McLeod G, Guntur Ramkumar P, Lamb C. Randomized trial comparing the spread of retrolaminar block with the combination of erector spinae block and retrolaminar block in soft embalmed Thiel cadavers. Reg Anesth Pain Med 2022; 47:424-425. [DOI: 10.1136/rapm-2022-103474] [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] [Received: 01/07/2022] [Accepted: 03/03/2022] [Indexed: 11/04/2022]
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McLeod G, Kennedy I, Simpson E, Joss J, Goldmann K. A pilot project informing the design of a web-based dynamic nomogram in order to predict survival one year after hip fracture surgery (Preprint). Interact J Med Res 2021; 11:e34096. [PMID: 35238320 PMCID: PMC9008534 DOI: 10.2196/34096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/18/2022] [Accepted: 02/13/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Graeme McLeod
- Department of Anaesthesia, Ninewells Hospital, National Health Service Tayside, Dundee, United Kingdom
- School of Medicine, University of Dundee, Ninewells Hospital, Dundee, United Kingdom
| | - Iain Kennedy
- Department of Anaesthesia, Ninewells Hospital, National Health Service Tayside, Dundee, United Kingdom
| | - Eilidh Simpson
- Crosshouse Hospital, National Health Service Ayrshire and Arran, Kilmarnock, United Kingdom
| | - Judith Joss
- Department of Anaesthesia, Ninewells Hospital, National Health Service Tayside, Dundee, United Kingdom
| | - Katriona Goldmann
- William Harvey Research Institute, Barts and the London School of Medicine & Dentistry, London, United Kingdom
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McLeod G, Demore C, Soenjaya Y, Chandra A. Study of peripheral nerve trauma from subepineural injection of the brachial plexus in pigs. Response to Br J Anaesth 2021; 127: e195-e196. Br J Anaesth 2021; 127:e196-e197. [PMID: 34602280 DOI: 10.1016/j.bja.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/03/2021] [Accepted: 09/05/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Graeme McLeod
- Institute of Academic Anaesthesia, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, UK.
| | - Christine Demore
- Sunnybrook Research Institute, Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | | | - Anu Chandra
- School of Medicine, University of Dundee, Ninewells Hospital, Dundee, UK
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Sartawi RY, McLeod G, Mustafa A, Lamb C. Randomized trial comparing the spread of erector spinae block with the combination of erector spinae block and retrolaminar block in soft embalmed Thiel cadavers. Reg Anesth Pain Med 2021; 46:1061-1066. [PMID: 34544754 DOI: 10.1136/rapm-2021-102887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/26/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Erector spinae plane (ESP) and retrolaminar (RL) blocks show unreliable spread. We hypothesize that the combination of ESP and RL blocks provides more extensive and reliable spread of dye than single ESP blocks. Our primary objective was to compare the spread of dye to the paravertebral spaces after the combination block and ESP block in Thiel embalmed cadavers. Spread, the primary end point, was defined as the number of paravertebral spaces colored with dye per injection. MATERIALS AND METHODS A single anesthetist performed ultrasound-guided ESP (20 mL) and combination of ESP and RL (10 mL each) blocks at the third thoracic vertebra of eight soft embalmed Thiel cadavers. Tissue displacement was visualized on an adjacent strain elastography image. Cadavers were dissected 24 hours later and anatomical structures were inspected for the presence of dye. FINDINGS Dye was visualized in more paravertebral spaces with the combination block (median 3 (IQR 3-5 (range 0-8)) vs 1.5 (IQR 0.25-2.75 (range 0-3) and difference (1.5 (0-4), p=0.04). Six out of seven (86%) combined erector spinae and RL blocks spread to at least three paravertebral spaces compared with two out of eight (25%) ESP blocks (RR 3.4, 95% CI 1.0 to 11.8; p=0.04). Contralateral spread occurred in three combination blocks and in one ESP block (OR 9.0, 95% CI 4.0 to 21.1; p<0.001). CONCLUSIONS In conclusion, the combination of ESP and RL blocks was more extensive and reliable than ESP block alone.
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Affiliation(s)
- Razan Yousef Sartawi
- Center for Anatomy and Human Identification (CAHID), University of Dundee, Dundee, UK
| | - Graeme McLeod
- Department of Anaesthesia, Ninewells Hospital, Dundee, UK.,Institute of Academic Anaesthesia, University of Dundee, Dundee, UK
| | - Ayman Mustafa
- Department of Anaesthesia, Ninewells Hospital, Dundee, UK
| | - Clare Lamb
- Center for Anatomy and Human Identification (CAHID), University of Dundee, Dundee, UK
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Cowie A, Sadler A, Columb M, McLeod G. Distribution of in-line fluid injection pressure measurements during 40 MHz microultrasound targeted nerve injection in anaesthetised pigs. Br J Anaesth 2021. [DOI: 10.1016/j.bja.2021.06.011] [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: 11/30/2022] Open
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12
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El-Boghdadly K, Wolmarans M, Stengel AD, Albrecht E, Chin KJ, Elsharkawy H, Kopp S, Mariano ER, Xu JL, Adhikary S, Altıparmak B, Barrington MJ, Bloc S, Blanco R, Boretsky K, Børglum J, Breebaart M, Burckett-St Laurent D, Capdevila X, Carvalho B, Chuan A, Coppens S, Costache I, Dam M, Egeler C, Fajardo M, Gadsden J, Gautier PE, Grant SA, Hadzic A, Hebbard P, Hernandez N, Hogg R, Holtz M, Johnson RL, Karmakar MK, Kessler P, Kwofie K, Lobo C, Ludwin D, MacFarlane A, McDonnell J, McLeod G, Merjavy P, Moran E, O'Donnell BD, Parras T, Pawa A, Perlas A, Rojas Gomez MF, Sala-Blanch X, Saporito A, Sinha SK, Soffin EM, Thottungal A, Tsui BCH, Tulgar S, Turbitt L, Uppal V, van Geffen GJ, Volk T, Elkassabany NM. Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of abdominal wall, paraspinal, and chest wall blocks. Reg Anesth Pain Med 2021; 46:571-580. [PMID: 34145070 DOI: 10.1136/rapm-2020-102451] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is heterogeneity in the names and anatomical descriptions of regional anesthetic techniques. This may have adverse consequences on education, research, and implementation into clinical practice. We aimed to produce standardized nomenclature for abdominal wall, paraspinal, and chest wall regional anesthetic techniques. METHODS We conducted an international consensus study involving experts using a three-round Delphi method to produce a list of names and corresponding descriptions of anatomical targets. After long-list formulation by a Steering Committee, the first and second rounds involved anonymous electronic voting and commenting, with the third round involving a virtual round table discussion aiming to achieve consensus on items that had yet to achieve it. Novel names were presented where required for anatomical clarity and harmonization. Strong consensus was defined as ≥75% agreement and weak consensus as 50% to 74% agreement. RESULTS Sixty expert Collaborators participated in this study. After three rounds and clarification, harmonization, and introduction of novel nomenclature, strong consensus was achieved for the names of 16 block names and weak consensus for four names. For anatomical descriptions, strong consensus was achieved for 19 blocks and weak consensus was achieved for one approach. Several areas requiring further research were identified. CONCLUSIONS Harmonization and standardization of nomenclature may improve education, research, and ultimately patient care. We present the first international consensus on nomenclature and anatomical descriptions of blocks of the abdominal wall, chest wall, and paraspinal blocks. We recommend using the consensus results in academic and clinical practice.
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Affiliation(s)
- Kariem El-Boghdadly
- Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human & Applied Physiological Sciences, King's College London, London, UK
| | - Morné Wolmarans
- Anaesthesiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK
| | - Angela D Stengel
- American Society of Regional Anesthesia and Pain Medicine, Pittsburgh, Pennsylvania, USA
| | - Eric Albrecht
- Department of Anaesthesia, University of Lausanne, Lausanne, Switzerland
| | - Ki Jinn Chin
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Hesham Elsharkawy
- Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA.,Case Western Reserve University, Cleveland, Ohio, USA
| | - Sandra Kopp
- Anesthesiology, Mayo Clinic Graduate School for Biomedical Sciences, Rochester, Minnesota, USA
| | - Edward R Mariano
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jeff L Xu
- Anesthesiology, Westchester Medical Center, Valhalla, New York, USA.,New York Medical College, Valhalla, New York, USA
| | - Sanjib Adhikary
- Anesthesiology and Perioperative Medicine, Penn State, University Park, Pennsylvania, USA
| | | | | | - Sébastien Bloc
- Anesthesiology Department, Ambroise Pare Hospital Group, Neuilly-sur-Seine, Île-de-France, France.,Clinical Research Department, Ambroise Pare Hospital Group, Neuilly-sur-Seine, Île-de-France, France
| | - Rafael Blanco
- Anaesthesia and Intensive Care, King's College Hospital Dubai, Abu Dhabi, UAE
| | - Karen Boretsky
- Anesthesiology, Critical Care and Pain Medicine, Harvard University, Cambridge, Massachusetts, USA
| | - Jens Børglum
- Department of Anesthesiology, Zealand University Hospital Roskilde, Roskilde, Sjaelland, Denmark
| | | | | | - Xavier Capdevila
- Anesthesiology and Critical Care department, Hôpital Lapeyronie, Montpellier, Languedoc-Roussillon, France
| | | | - Alwin Chuan
- University of New South Wales Faculty of Medicine, Putney, New South Wales, Australia
| | | | - Ioana Costache
- Anesthesia, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Mette Dam
- Anaesthesiology, Zealand University Hospital Koge, Koge, Sjælland, Denmark
| | | | - Mario Fajardo
- Anesthesiology, Hospital Universitario de Mostoles, Mostoles, Madrid, Spain
| | - Jeff Gadsden
- Duke University Medical Center, Durham, North Carolina, USA
| | | | - Stuart Alan Grant
- Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Admir Hadzic
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium.,NYSORA, New York, New York, USA
| | - Peter Hebbard
- Department of Anesthesia Northeast Health Wangaratta, Ultrasound Education Group, The University of Melbourne Rural Health Academic Centre - Wangaratta, Wangaratta, Victoria, Australia
| | - Nadia Hernandez
- Anesthesiology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Rosemary Hogg
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | | | - Rebecca L Johnson
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Manoj Kumar Karmakar
- Department of Anesthesia and Intensice Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Paul Kessler
- Anesthesiology, Intensive Care and Pain Medicine, Universitätsklinikum Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Kwesi Kwofie
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Clara Lobo
- Anestesiologia, Hospital das Forças Armadas Polo do Porto, Porto, Portugal
| | | | - Alan MacFarlane
- Department of Cardiology, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Graeme McLeod
- Department of Anaesthesia, Ninewells Hospital, Dundee, UK.,Instittute of Academic Anaesthesia, University of Dundee, Dundee, UK
| | | | - Eml Moran
- Letterkenny University Hospital, Letterkenny, Donegal, Ireland
| | - Brian D O'Donnell
- Department of Anesthesia and Intensive Care Medicine, Cork University Hospital, Cork, Ireland
| | | | - Amit Pawa
- Department of Anaesthesia, St Thomas' Hospital, London, UK.,Regional Anaesthesia - UK, London, UK
| | - Anahi Perlas
- Anesthesia and Pain Management, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Xavier Sala-Blanch
- Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain.,Human Anatomy and Embryology, University of Barcelona Faculty of Medicine, Barcelona, Spain
| | - Andrea Saporito
- Anesthesia, Ospedale Regionale di Bellinzona e Valli Bellinzona, Bellinzona, Switzerland
| | - Sanjay Kumar Sinha
- Anesthesiology, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | - Ellen M Soffin
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | | | - Ban C H Tsui
- Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, USA
| | - Serkan Tulgar
- Anesthesiology and reanimatiom, Maltepe Universitesi Tip Fakultesi, Maltepe, Turkey
| | - Lloyd Turbitt
- Royal Victoria Hospital Laboratory and Mortuary Services, Belfast, UK
| | - Vishal Uppal
- Anesthesia, Dalhousie University - Faculty of Health Professions, Halifax, Nova Scotia, Canada
| | - Geert J van Geffen
- Anesthesiology, Radboud University Nijmegen, Nijmegen, Gelderland, The Netherlands
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany.,Saarland University, Saarbrucken, Saarland, Germany
| | - Nabil M Elkassabany
- Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA .,University of Pennsylvania, Philadelphia, Pennsylvania, USA
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13
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Chandra A, Soenjaya Y, Yan J, Felts P, McLeod G, Demore C. Real-time visualisation of peripheral nerve trauma during subepineural injection in pig brachial plexus using micro-ultrasound. Br J Anaesth 2021; 127:153-163. [PMID: 34006377 DOI: 10.1016/j.bja.2021.03.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Nerve damage is consistently demonstrated after subepineural injection in animal studies, but not after purposeful injection in patients participating in clinical studies. There is a need to better visualise nerves in order to understand the structural changes that occur during subepineural injection. METHODS We scanned the brachial plexuses of three anaesthetised pigs using micro-ultrasound imaging (55-22 MHz probe), inserted 21 gauge block needles into the radial, median, and axillary nerves, and injected two 0.5 ml boluses of saline into nerves at a rate of 12 ml min-1. Our objectives were to measure the area and diameter of nerves and fascicles, and to describe changes in nerve anatomy, comparing our findings with histology. RESULTS Images were acquired at 42 sites across 18 nerves in three pigs and compared dimensions (geometric ratio; 95% confidence interval; P value). As expected, the nerve cross-sectional area was greater in the proximal brachial plexus compared with the mid-plexus (2.10; 1.07-4.11; P<0.001) and the distal plexus (2.64; 1.42-4.87; P<0.001). Nerve area expanded after 0.5 ml injection (2.13; 1.48-3.08; P<0.001). Using microultrasound, subepineural injection was characterised by nerve and fascicle rotation, uniform, or localised swelling and epineural rupture. Micro-ultrasound revealed a unique pattern suggestive of subperineural injection after a median nerve injection, and good face validity with histology. Histology showed epineural trauma and inflammation to the perineurium. CONCLUSION We accurately identified fascicles and real-time structural changes to peripheral nerves using micro-ultrasound. This is the first study to visualise in vivo and in real-time the motion of nerves and fascicles in response to anaesthetic needle insertion and fluid injection.
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Affiliation(s)
- Anu Chandra
- School of Medicine, University of Dundee, Ninewells Hospital, Dundee, UK
| | | | - Judy Yan
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Paul Felts
- Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK
| | - Graeme McLeod
- Institute of Academic Anaesthesia, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, UK.
| | - Christine Demore
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Medical BioPhysics, University of Toronto, Toronto, Canada
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14
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McLeod G, Zihang S, Sadler A, Chandra A, Qiao P, Huang Z, Demore C. Validation of the soft-embalmed Thiel cadaver as a high-fidelity simulator of pressure during targeted nerve injection. Reg Anesth Pain Med 2021; 46:540-548. [PMID: 33906953 DOI: 10.1136/rapm-2020-102132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/24/2021] [Accepted: 03/30/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Although administration of regional anesthesia nerve blocks has increased during the COVID-19 pandemic, training opportunities in regional anesthesia have reduced. Simulation training may enhance skills, but simulators must be accurate enough for trainees to engage in a realistic way-for example, detection of excessive injection pressure. The soft-embalmed Thiel cadaver is a life-like, durable simulator that is used for dedicated practice and mastery learning training in regional anesthesia. We hypothesized that injection opening pressure in perineural tissue, at epineurium and in subepineurium were similar to opening pressures measured in experimental animals, fresh frozen cadavers, glycol soft-fix cadavers and patients. METHODS We systematically reviewed historical data, then conducted three validation studies delivering a 0.5 mL hydrolocation bolus of embalming fluid and recording injection pressure. First, we delivered the bolus at 12 mL/min at epimysium, perineural tissue, epineurium and in subepineurium at 48 peripheral nerve sites on three cadavers. Second, we delivered the bolus at using three infusion rates: 1 mL/min, 6 mL/min and 12 mL/min on epineurium at 70 peripheral nerve sites on five cadavers. Third, we repeated three injections (12 mL/min) at 24 epineural sites over the median and sciatic nerves of three cadavers. RESULTS Mean (95%) injection pressure was greater at epineurium compared with subepineurium (geometric ratio 1.2 (95% CI: 0.9 to 1.6)), p=0.04, and perineural tissue (geometric ratio 5.1 (95% CI: 3.7 to 7.0)), p<0.0001. Mean (95%) injection pressure was greater at 12 mL/min compared with 1 mL/min (geometric ratio 1.6 (95% CI: 1.2 to 2.1), p=0.005). Pressure measurements were similar in study 3 (p>0.05 for all comparisons). DISCUSSION We conclude that the soft-embalmed Thiel cadaver is a realistic simulator of injection opening pressure.
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Affiliation(s)
- Graeme McLeod
- Department of Anaesthesia, Ninewells Hospital, Dundee, UK .,Institute of Academic Anaesthesia, University of Dundee, Dundee, UK
| | - Shengli Zihang
- Institute of Academic Anaesthesia, University of Dundee, Dundee, UK
| | - Amy Sadler
- Department of Anaesthesia, Ninewells Hospital and Medical School, Dundee, UK
| | - Anu Chandra
- Institute of Academic Anaesthesia, University of Dundee, Dundee, UK
| | - Panpan Qiao
- Department of Bioengineering, University of Dundee, Dundee, UK
| | - Zhihong Huang
- Institute of Academic Anaesthesia, University of Dundee, Dundee, UK
| | - Christine Demore
- Department of BioPhysics, Sunnybrook Research Institute, Toronto, Ontario, Canada
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15
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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16
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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] [What about the content of this article? (0)] [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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Howard C, Saraswat D, McLeod G, Yeung A, Jeong D, Lam J. Canada's Prosthetic Coverage: a Review of Provincial Prosthetic Policy. Can Prosthet Orthot J 2020; 2:33489. [PMID: 37614768 PMCID: PMC10443461 DOI: 10.33137/cpoj.v2i2.33489] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/12/2020] [Indexed: 11/23/2022] Open
Abstract
The Canadian healthcare system serves as an example of equity and federal service to citizens across the world. However, it is not without its challenges. Prosthetic coverage across Canada is highly variable and largely unable to provide equal coverage for Canadian persons living with amputation. Many persons with limb loss are forced to rely upon personal resources, fundraising, or the charity of non-governmental organizations in order to meet this basic healthcare need. This disparity in the Canadian healthcare system is unusual and largely undescribed in the literature. We thus explore the nature of Canadian healthcare prosthetic coverage across Canada, investigating the variability in coverage, presence of prosthetic coverage policies, clarity of policy, eligibility criteria, and interval of prosthetic replacement. Our findings highlight potential areas for improvement within current Canadian healthcare policy.
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Affiliation(s)
- C.W. Howard
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - D.K. Saraswat
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - G McLeod
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - A Yeung
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - D Jeong
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - J Lam
- Faculty of Medicine, McGill University, Montreal, Québec, Canada
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18
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McLeod G, Finch C, Morgan D, Kountouris A, Fortington L. Medically treated cricket injuries in Victoria: a 15 year review of emergency department presentations and hospital admissions. J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.270] [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: 11/25/2022]
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19
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Bowness J, Seeley J, Varsou O, McKinnie A, Zealley I, McLeod G, Grant C. Arterial Anatomy of the Anterior Abdominal Wall: Evidence-Based Safe Sites for Instrumentation Based on Radiological Analysis of 100 Patients. Clin Anat 2019; 33:350-354. [PMID: 31444816 DOI: 10.1002/ca.23463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/19/2019] [Accepted: 08/01/2019] [Indexed: 11/08/2022]
Abstract
Multiple medical interventions require percutaneous instrumentation of the anterior abdominal wall, all of which carry a potential for vascular trauma. We assessed the presence, position, and size of the anterior abdominal wall superior and inferior (deep) epigastric arteries to determine the safest site with respect to vascular anatomy of the rectus sheath. In a review of 100 arterial phase, contrast-enhanced abdominal computed tomography scans, anterior abdominal wall arteries were assessed bilaterally at three axial planes: transpyloric, umbilicus, and anterior superior iliac spine (ASIS). The mean age of patients was 69.2 years (SD ± 15), with 62 male and 38 female. An artery was visible least frequently at the transpyloric plane (5%), compared with the umbilicus (72-79%) and ASIS (93-96%), on the left (χ2 (4) = 207.272; P < 0.001) and right (χ2 (4) = 198.553; P < 0.001), with a moderate strength association (Cramer's V = 0.588 (left) and 0.575 (right)). The arteries were most commonly observed within the rectus abdominis muscle at the level of the umbilicus and ASIS on both sides (62-68%). The inferior epigastric artery was observed to be larger in diameter, start more laterally, and move medially as it travelled superiorly. These data suggest that the safest site to instrument the rectus sheath, with respect to vascular anatomy, is at the transpyloric plane. This information on anatomical variation of the anterior abdominal wall vasculature may be of particular interest to anesthetists performing rectus sheath block and surgeons during laparoscopic port insertion. Clin. Anat. 33:350-354, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- James Bowness
- Institute of Academic Anaesthesia, University of Dundee, Dundee, United Kingdom.,Department of Anaesthesia, Ninewells Hospital, Dundee, United Kingdom
| | - Jonathan Seeley
- Department of Anaesthesia, Ninewells Hospital, Dundee, United Kingdom
| | - Ourania Varsou
- Anatomy Facility, School of Life Sciences, University of Glasgow, United Kingdom
| | - Angela McKinnie
- Department of Radiology, Ninewells Hospital, Dundee, United Kingdom
| | - Ian Zealley
- Department of Radiology, Ninewells Hospital, Dundee, United Kingdom
| | - Graeme McLeod
- Institute of Academic Anaesthesia, University of Dundee, Dundee, United Kingdom.,Department of Anaesthesia, Ninewells Hospital, Dundee, United Kingdom
| | - Calum Grant
- Department of Anaesthesia, Ninewells Hospital, Dundee, United Kingdom
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20
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Taylor A, McKendrick M, Sadler A, Halcrow J, Raju P, Mustafa A, Seeley J, McLeod G. Within-subjects analysis of operator performance with and without needle tip tracking during ultrasound-guided sciatic regional nerve block on the soft embalmed Thiel cadaver. Br J Anaesth 2019. [DOI: 10.1016/j.bja.2018.10.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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21
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Sadler A, McKendrick M, Taylor A, Halcrow J, Raju P, Mustafa A, Seeley J, McLeod G. Construct validation of metrics for translation of regional anaesthesia skills from the soft embalmed cadaver to patients. Br J Anaesth 2019. [DOI: 10.1016/j.bja.2018.10.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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22
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McLeod G, O’Conner S, Morgan D, Finch C, Fortington L. Injuries in organised community level cricket, how much do we know? A systematic review. J Sci Med Sport 2018. [DOI: 10.1016/j.jsams.2018.09.209] [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: 11/28/2022]
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23
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Chandra A, Yan J, Soenjaya Y, Demore C, McLeod G. Visualising peripheral nerve trauma real time using micro-ultrasound during regional anaesthesia. Br J Anaesth 2018. [DOI: 10.1016/j.bja.2018.05.039] [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: 11/30/2022] Open
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24
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Chandra A, Yan J, Soenjaya Y, Demore C, Columb M, McLeod G. Identifying the needle-tip position during regional anaesthesia with needle-tip pressure at different flow rates. Br J Anaesth 2018. [DOI: 10.1016/j.bja.2018.05.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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25
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Taylor A, McLeod G. Preparing to Pass the FRCA . C. Whymark. Br J Anaesth 2017. [DOI: 10.1093/bja/aew394] [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: 11/14/2022] Open
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26
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Chandra A, Eisma R, Felts P, Munirama S, Corner GA, Demore CEM, McLeod G. The feasibility of micro-ultrasound as a tool to image peripheral nerves. Anaesthesia 2016; 72:190-196. [DOI: 10.1111/anae.13708] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2016] [Indexed: 01/14/2023]
Affiliation(s)
- A. Chandra
- Institute for Medical Science and Technology; University of Dundee; Dundee UK
| | - R. Eisma
- Centre for Anatomy and Human Identification; University of Dundee; Dundee UK
| | - P. Felts
- Centre for Anatomy and Human Identification; University of Dundee; Dundee UK
| | - S. Munirama
- Department of Anaesthesia; Manchester Royal Infirmary; Manchester UK
| | - G. A. Corner
- School of Engineering, Physics and Mathematics; University of Dundee; Dundee UK
| | - C. E. M. Demore
- Institute for Medical Science and Technology; University of Dundee; Dundee UK
- Sunnybrook Research Institute; Toronto Ontario Canada
| | - G. McLeod
- Department of Anaesthesia; Ninewells Hospital; Dundee UK
- Institute for Academic Anaesthesia; University of Dundee; Dundee UK
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Rae J, McLeod G. Clinical Anesthesia Fundamentals. Br J Anaesth 2015. [DOI: 10.1093/bja/aev382] [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: 11/13/2022] Open
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28
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Joy J, McLeod G, Lee N, Munirama S, Corner G, Eisma R, Cochran S. Quantitative assessment of Thiel soft-embalmed human cadavers using shear wave elastography. Ann Anat 2015; 202:52-6. [DOI: 10.1016/j.aanat.2015.06.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/08/2015] [Accepted: 06/30/2015] [Indexed: 10/23/2022]
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29
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Munirama S, McLeod G. A systematic review and meta-analysis of ultrasound versus electrical stimulation for peripheral nerve location and blockade. Anaesthesia 2015; 70:1084-91. [DOI: 10.1111/anae.13098] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2015] [Indexed: 11/28/2022]
Affiliation(s)
- S. Munirama
- Department of Anaesthetics; Manchester Royal Infirmary; Manchester UK
| | - G. McLeod
- Department of Anaesthetics; Ninewells Hospital; Dundee UK
- Institute of Academic Anaesthesia; University of Dundee Medical School; Dundee UK
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30
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31
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Munirama S, Joy J, Columb M, Habershaw R, Eisma R, Corner G, Cochran S, McLeod G. A randomised, single-blind technical study comparing the ultrasonic visibility of smooth-surfaced and textured needles in a soft embalmed cadaver model. Anaesthesia 2014; 70:537-42. [DOI: 10.1111/anae.12925] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2014] [Indexed: 11/28/2022]
Affiliation(s)
- S. Munirama
- Institute of Academic Anaesthesia; University of Dundee; Dundee UK
| | - J. Joy
- Institute for Medical Science and Technology; University of Dundee; Dundee UK
| | - M. Columb
- Departments of Anaesthesia & Intensive Care Medicine; Wythenshawe Hospital; Manchester UK
| | - R. Habershaw
- Institute for Medical Science and Technology; University of Dundee; Dundee UK
| | - R. Eisma
- Centre for Anatomy and Human Identification; University of Dundee; Dundee UK
| | | | - S. Cochran
- Institute for Medical Science and Technology; University of Dundee; Dundee UK
| | - G. McLeod
- Institute of Academic Anaesthesia; University of Dundee; Dundee UK
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32
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Munirama S, Joy J, Eisma R, Corner G, Cochran S, McLeod G. Images in anesthesiology: shear wave elastography: novel technology for ultrasound-guided regional anesthesia. Anesthesiology 2013; 119:698. [PMID: 24137685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Shilpa Munirama
- Department of Anaesthesia and Institute of Academic Anaesthesia, Ninewells Hospital & Medical School, Dundee, Scotland, UK.
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Guo S, Schwab A, McLeod G, Corner G, Cochran S, Eisma R, Soames R. Echogenic regional anaesthesia needles: a comparison study in Thiel cadavers. Ultrasound Med Biol 2012; 38:702-707. [PMID: 22390992 DOI: 10.1016/j.ultrasmedbio.2012.01.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 11/22/2011] [Accepted: 01/01/2012] [Indexed: 05/31/2023]
Abstract
Ultrasound guidance is now the standard procedure for regional nerve block in anesthesiology. However, ultrasonic visualisation of needle manipulation and guidance within tissues remains a problem. Two new echogenic needles (Pajunk and Braun) have been introduced to anesthesiology clinical practice but evaluation has been restricted to preserved animal tissue. In this study, the visibility of both echogenic needles was compared with a standard nonechogenic needle in a Thiel cadaver model. A total of 144 intramuscular injections were made in the upper arm in-plane and out-of-plane to the ultrasound beam at four angles (30°, 45°, 60° and 75°). The visibility of the needle was assessed by two independent, blinded observers using a 5-point Likert ordinal scale. Weighted κ for interobserver agreement was 0.77 (95% confidence interval [CI]: 0.68-0.86). The Pajunk echogenic needle was more visible than the Braun standard needle in-plane (p = 0.04), and the Braun standard and Braun echogenic needles out-of-plane (p = 0.02). Independent predictors of visibility using logistic regression were needle (p < 0.001) and plane of insertion (p = 0.08), receiver operator characteristic (ROC) area under the curve 0.90. In conclusion, the Pajunk echogenic needle offers the best visibility for ultrasound-guided regional anesthesia.
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Affiliation(s)
- Shuo Guo
- Institute for Medical Science and Technology, University of Dundee, Dundee, Scotland, UK
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34
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Dias M, Newton D, McLeod G, Belch JJ, Khan F. Vasoactive properties of calcitonin gene-related peptide in human skin. INT ANGIOL 2011; 30:424-428. [PMID: 21804480] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM Calcitonin gene-related peptide (CGRP) is a potential mediator of neurogenic inflammation in eczema, psoriasis and rosacea, and also contributes to vasodilatation and oedema in complex regional pain disorder. We investigated the feasibility of administering CGRP and its antagonist CGRP8-37 by iontophoresis in human skin to characterise their vasoactive profiles. METHODS Two doses of each peptide were administered by iontophoresis (5 and 10 min duration at 0.1 mA) to the forearm skin of 6 healthy young men. Skin blood flow responses over 25 min were assessed using laser Doppler imaging. RESULTS Iontophoresis of CGRP caused a gradual change in blood flow, with no significant difference in response between each dose. The peak change in flow had a coefficient of variation of 21% to 36%, while the variability of the total cumulative response was much greater. Iontophoresis of CGRP8-37 for 5 min caused only a small, transient increase in skin blood flow, while 10 min iontophoresis resulted in a significant increase in blood flow. CONCLUSION CGRP and CGRP8-37 can be administered by iontophoresis to human skin. Further experiments are needed to determine the optimum duration of iontophoresis and period of measurement.
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Affiliation(s)
- M Dias
- Department of Anesthesia, University of Dundee, Dundee, UK.
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McLeod G. An Introductory Curriculum for Ultrasound-guided Regional Anesthesia: A Learner’s Guide. Br J Anaesth 2010. [DOI: 10.1093/bja/aeq209] [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: 11/13/2022] Open
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McLeod G, Eisma R, Schwab A, Corner G, Soames R, Cochran S. An evaluation of Thiel-embalmed cadavers for ultrasound-based regional anaesthesia training and research. Ultrasound 2010. [DOI: 10.1258/ult.2010.010016] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Working hours of UK trainee doctors have recently been reduced to 48 hours per week, reducing exposure to clinical cases. As such, there is widespread acceptance that trainees need to train in environments other than the ward or operating theatre in order to gain practical skills. Formalin-fixed cadavers demonstrate gross muscle and nerve anatomy but needle insertion under ultrasound guidance is poor. In contrast, a new development in medical simulation is the use of Thiel-embalmed cadavers, developed by Professor Thiel of the University of Graz, Austria, using a novel preservation technique that retains full flexibility of the limbs. Thiel cadavers have been used to successfully simulate laparoscopic surgery, neurosurgery and oral surgery. This paper investigates, for the first time, the application of ultrasound-based regional anaesthesia to the Thiel cadaver by tracing the course of peripheral nerves, injecting local anaesthetic around nerves, and reproducing inadvertent intraneural injection by injecting preservative directly into the nerve. The Thiel cadaver provides good conditions for anaesthetists to simulate regional anaesthetic block techniques using ultrasound.
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Affiliation(s)
| | - Roos Eisma
- Centre for Anatomy and Human Identification, University of Dundee
| | - Andreas Schwab
- Centre for Anatomy and Human Identification, University of Dundee
| | | | - Roger Soames
- Centre for Anatomy and Human Identification, University of Dundee
| | - Sandy Cochran
- Institute for Medical Science and Technology, University of Dundee, UK
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Jariwala A, Evans A, McLeod G. Not all stubbed toes are innocuous--A case report of rare malignant eccrine spiradenoma (spiradenocarcinoma) of the toe. Foot Ankle Surg 2010; 16:e32-3. [PMID: 20483125 DOI: 10.1016/j.fas.2009.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Revised: 05/22/2009] [Accepted: 05/30/2009] [Indexed: 02/04/2023]
Abstract
Malignant eccrine spiradenoma (MES) is a rare adnexal tumour derived from cutaneous sweat glands. We describe a case of MES arising on the tip of the right middle toe. The lesion had been managed as a non-specific chronic ulcer for 4 years. The lesion was treated by elective amputation. We wish to emphasise through this case report the importance of keeping this rare but potentially lethal tumour in mind when managing chronic non-healing ulcers in extremities.
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Affiliation(s)
- A Jariwala
- Department of Orthopaedics and Trauma Surgery, TORT Centre, Ninewells Hospital, Dundee DD1 9SY, Scotland, United Kingdom.
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McLeod G, Munishankar B, MacGregor H, Murphy D. Maternal haemodynamics at elective caesarean section: a randomised comparison of oxytocin 5-unit bolus and placebo infusion with oxytocin 5-unit bolus and 30-unit infusion. Int J Obstet Anesth 2010; 19:155-60. [DOI: 10.1016/j.ijoa.2009.08.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 08/05/2009] [Accepted: 08/24/2009] [Indexed: 11/25/2022]
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McLeod G. Ultrasound Guidance for Nerve Blocks: Principles and Practical Implementation. Br J Anaesth 2009. [DOI: 10.1093/bja/aep057] [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: 11/13/2022] Open
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Murphy DJ, MacGregor H, Munishankar B, McLeod G. A randomised controlled trial of oxytocin 5IU and placebo infusion versus oxytocin 5IU and 30IU infusion for the control of blood loss at elective caesarean section—Pilot study. ISRCTN 40302163. Eur J Obstet Gynecol Reprod Biol 2009; 142:30-3. [DOI: 10.1016/j.ejogrb.2008.09.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 07/31/2008] [Accepted: 09/03/2008] [Indexed: 11/25/2022]
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Jariwala A, Haines S, McLeod G. “Locked” posterior dislocation of the shoulder with communition of the lesser tuberosity: a stabilisation technique. Eur J Orthop Surg Traumatol 2008. [DOI: 10.1007/s00590-008-0318-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
PURPOSE To determine whether flexion contracture continues to improve up to 5 years after total knee arthroplasty (TKA). METHODS Records of 200 women and 123 men (mean age, 72 years) with osteoarthritis and preoperative flexion contracture were reviewed. 155 (48%) involved the left knee and 168 (52%) the right knee. Patients were assessed clinically before TKA and one and 5 years later, by a single researcher using a goniometer to measure flexion contracture, range of movement, maximum flexion, and the Knee Society Score. In all patients the same prosthesis design was used. The surgical technique was standard and involved a medial parapatellar approach with bone resection. RESULTS All variables improved significantly from pre-TKA to one-year post-TKA and from one-year post-TKA to 5-year post-TKA; respectively the mean flexion contracture decreased from 11 to 3 to 2 degrees; the mean knee range of movement increased from 90 to 103 to 107 degrees; the mean maximum flexion increased from 101 to 106 to 109 degrees; and the mean Knee Society Scores increased from 39 to 87 to 90. CONCLUSION Functional outcome and flexion contracture may continue to improve up to 5 years after TKA.
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Affiliation(s)
- K Cheng
- Department of Orthopaedic and Musculoskeletal Trauma, Perth Royal Infirmary, Taymount Terrace, Perth, Perthshire, United Kingdom.
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Andrew M, Jarvis T, Howard B, McLeod G, Robinson S, Standen R, Toohey D, Williams A. The Environmental Stewardship System (ESS): a generic system for assuring rural environmental performance. ACTA ACUST UNITED AC 2007. [DOI: 10.1071/ea06025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The Environmental Stewardship System (ESS) is proposed as a generic assurance system for demonstrating environmental performance. It incorporates Environmental Management Systems (EMS) and is matched to natural resources management (NRM) and catchment targets. ESS is a framework for aligning and clarifying environmental objectives and targets across scales. It operates at the catchment and farm levels, interdependently, focusing on the main industries, mainstream farming methods and whole-farm business management. For farmers, it provides a staged pathway of increasing levels of performance and audit process that they can progress along, up to full ISO 14001. It is a modular system that is expandable to suit the particular operational needs of land managers, industries and catchment agencies. ESS is an inclusive framework for integrating various industry farm management improvement schemes and other management requirements. It is an auditable system to provide recognition to land managers who deliver environmental stewardship. The ESS was developed from the findings of the Murray–Darling Basin Commission’s Watermark Environmental Stewardship Project. By addressing the four major deficiencies in current arrangements for NRM delivery (the Stewardship Standard is poorly defined at the Murray–Darling Basin and at the local scales; reporting of outcomes is poorly aligned across scales; and auditing arrangements are not integrated) ESS has the potential to significantly improve the delivery of NRM within Australia, when the drivers for uptake are strong enough. In particular, it would reinforce and elaborate the Australian regional NRM delivery model at the subregional scale. The ESS provides a national framework for assured agricultural production and rural land management. It is in the public domain for others to draw from or adopt.
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Shephard MDS, Allen GG, Barratt LJ, Barbara JAJ, Paizis K, McLeod G, Brown M, Vanajek A. Albuminuria in a remote South Australian Aboriginal community: results of a community-based screening program for renal disease. Rural Remote Health 2003; 3:156. [PMID: 15877493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION The poverty, poor environmental living conditions and poor health standards experienced by Aboriginal Australians in some communities in rural and remote Australia have been described recently as 'fourth world'. For more than a century Aboriginal people have suffered the effects of dispossession of their land; destruction of their traditional culture and values; and exposure to infectious diseases, alcohol and the Western diet that is high in fat and sugar. Collectively these factors have contributed to the prevalence of chronic disease that afflicts Aboriginal people. In particular, renal disease has emerged during the last decade as a major contemporary health problem for Aboriginal Australians. According to the latest age- and sex-adjusted figures, Aboriginal people now have approximately nine-fold the risk of non-Aboriginal Australians of developing end-stage renal disease. In parts of Australia's Northern Territory, where Aboriginal people represent over 20% of the Territory's population, the rates of end-stage renal disease have been described as 'epidemic', reaching 2700 per million in the Tiwi Islands. In response to a request from the Umoona Tjutagku Health Service in mid 1997, the Renal Unit at Flinders Medical Centre, Adelaide, South Australia, formed a partnership with the health service to conduct a renal-disease screening program for adult members of the Umoona Community at Coober Pedy, a town 850 kilometres north of Adelaide. The partnership was later expanded to include screening for children (conducted by the Renal Unit at the Women's and Children's Hospital, Adelaide, South Australia). The community named the program 'The Umoona Kidney Project'. The Umoona community had recently experienced the dislocation of a number of its older people who suffered from advanced renal disease and were undergoing dialysis in a variety of centres in South Australia and the Northern Territory. As a result, the community had suffered social trauma. Consistent with the community's overall holistic approach to healthcare, the community wanted the renal program to provide a focus for community awareness of and knowledge about chronic disease, as well as to complement existing health programs. OBJECTIVES The study objectives were to identify the prevalence of risk factors for renal disease, notably albuminuria, in adults from a remote Aboriginal community, and to examine the association of albuminuria with other risk factors; to empower Aboriginal health workers to self-manage a sustainable, community-controlled renal health program; and to assess the reliability and cultural acceptability of point-of-care technology for detecting renal disease. METHOD The study was a three-year cross-sectional voluntary adult screening program (The Umoona Kidney Project). The study was performed as a partnership between the Flinders Medical Centre Renal Unit and the Umoona Tjutagku Health Service, and it involved nephrologists, medical scientists, Aboriginal health workers and clinical nurses. SETTING Umoona Tjutagku Health Service, 850 km north of Adelaide. PARTICIPANTS 158 adult members of the Umoona community: 58 males (37%; mean age = 43.8 years, range 23-78) and 100 females (63%; mean age = 39.6 years, range 18-72). MAIN OUTCOME MEASURES First morning urine albumin : creatinine ratio measured by the Bayer DCA 2000 point-of-care analyser machine (Bayer Australia, Melbourne, Australia); lying and standing blood pressure; random blood glucose; body mass index; urinalysis. RESULTS The study found that of screened adults, 29/149 (19%, 95% C.I. 13%-27%) had persistent microalbuminuria and 13/149 (9%, 95% C.I. 4%-14%) had persistent macroalbuminuria; 62/148 participants (42%, 95% C.I. 34%-50%) had overt hypertension; 35/145 participants (24%, 95% C.I. 17%-32%) had diabetes; 3 participants were newly diagnosed as having non-insulin dependent diabetes; 96/148 participants (65%, 95% C.I. 57%-73%) were either overweight or obese. Strong correlation was observed between the progression of albuminuria and age, all blood pressure categories, blood glucose, body mass index and an increasing number of risk factors. CONCLUSIONS The Umoona Kidney Project identified a significant community burden of previously unknown incipient and established renal disease that required addressing via clinical- and community-based interventions. The DCA 2000 was a reliable instrument for detecting albuminuria on-site in the remote clinical location and was well accepted by Aboriginal health workers and community participants.
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Simovich MJ, Miller B, Ezzeldin H, Kirkland BT, McLeod G, Fulmer C, Nathans J, Jacobson SG, Pittler SJ. Four novel mutations in the RPE65 gene in patients with Leber congenital amaurosis. Hum Mutat 2001; 18:164. [PMID: 11462243 DOI: 10.1002/humu.1168] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Leber congenital amaurosis (LCArpar; is a heterogeneous disorder representing the congenital forms of retinitis pigmentosa accounting for about 5% of all retinal dystrophies. The RPE65 gene product is required for regeneration of the visual pigment for phototransduction. Defects in the RPE65 gene have so far been shown to account for approximately 10 % of known cases of LCA. Here we describe four additional novel mutations in the RPE65 gene (c.889delA, c.131G>A, c.1249G>C, c.430T>G) and several novel polymorphisms in a large series of LCA patients. Hum Mutat 18:164, 2001.
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Affiliation(s)
- M J Simovich
- Department of Biochemistry & Molecular Biology, University of South Alabama College of Medicine, Mobile, AL, USA
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Van Donkersgoed J, Jewison G, Bygrove S, Gillis K, Malchow D, McLeod G. Canadian beef quality audit 1998-99. Can Vet J 2001; 42:121-6. [PMID: 11272455 PMCID: PMC1476488] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The second beef quality audit was conducted in Canada in 1998-99 to determine the prevalence of quality defects in slaughtered cattle and to monitor changes since the first audit in 1995. Approximately 0.6% of the number of cattle processed annually in Canada were evaluated. Brands were observed on 49% and tag was observed on 43% of the hides. Both brands and tag had increased from 1995. Seventy percent of the cattle were polled and 5% had full horns; thus, the number of horned cattle had decreased from 1995. Bruises were found on 54% of the carcasses, which was a decrease from 78% in 1995. Sixty-eight percent of the bruises were minor, 28% major, and 4% critical in severity. The distribution of bruises on the carcass was 17% on the chuck, 36% on the rib, 30% on the loin, and 16% on the round. Grubs were observed on 0.008% of the carcasses, and surface injection site lesions were observed on 0.2% of the whole carcasses, a decrease from the 1.3% seen in 1995. Seventy-two percent of the livers were passed for human food and 14% for pet food; 14% were condemned. Approximately 64% of the liver losses were due to abscesses. Five percent of the heads and tongues and 0.3% of the whole carcasses were condemned. The hot carcass weight was highly variable in all cattle, averaging 353 kg (s = 43). The average ribeye area was 90 cm2 (s = 13). Both hot carcass weight and ribeye area had increased from 1995. The average grade fat was 9 mm (s = 5), ranging from 0 mm to 48 mm. Lean meat yield averaged 58.8% (s = 4.6). One percent of the carcasses were devoid of marbling, 17% were Canada A, 49% were Canada AA, 32% were Canada AAA, and 1% were Canada Prime, which was an increase in marbling from 1995. Dark cutters were found in 1% of all carcasses; 1% of steers, 0.5% of heifers, 3% of cows, and 14% of bulls. Three percent of the carcasses were underfinished and 13% were overfinished. The number of overfinished carcasses had increased from 1995. Stages, steers with bullish traits, were infrequently observed in 0.5% of the steers, and 0.2% of the steers and 0.3% of the heifers had poor conformation. Yellow fat was not observed in any steers or heifers, but it was found on 65% of the cow carcasses. Only 0.6% of the heifers had an aged carcass, based on skeletal maturity. Based on August 1998 to July 1999 prices, it was estimated that the Canadian beef industry lost $82.62 per head processed, or $274 million annually, from quality nonconformities, which was an increase from 1995. Additional improvements in management, feeding, handling, genetics, marketing, and grading are needed in the beef industry to reduce quality defects.
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Affiliation(s)
- J Van Donkersgoed
- Canadian Cattlemen's Association, 11 Bruns Road, Lacombe, Alberta T4L 1P1
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McLeod G, Davies H, Munnoch N, Bannister J, MacRae W. Postoperative pain relief using thoracic epidural analgesia: outstanding success and disappointing failures. Anaesthesia 2001; 56:75-81. [PMID: 11167441 DOI: 10.1046/j.1365-2044.2001.01763-7.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.9] [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: 11/20/2022]
Abstract
Six hundred and forty patients received epidural analgesia for postoperative pain relief following major surgery in the 6-year period 1993-1998. Although satisfactory pain relief was achieved in over two-thirds of patients for a median duration of 44 h after surgery, one-fifth of patients (133 individuals) still experienced poor pain relief. Almost one out of three patients (194 individuals) had a problem with their epidural. Eighty-three patients (13%) suffered a technical failure and 84 (13%) patients had their epidurals removed at night time when pain-free because of pressure on beds. Seven patients had their epidural replaced and subsequently experienced excellent pain relief for a median of 77 h. Lack of resources prevented a further 480 patients from receiving the potential benefits of epidural analgesia. These results would suggest that the practical problems of delivering an epidural service far outweigh any differences in drug regimens or modes of delivery of epidural solutions.
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Affiliation(s)
- G McLeod
- Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
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Smith L, Hammond R, Roberts K, Machin D, McLeod G. Determination of the crystal structure of anhydrous sodium dodecyl sulphate using a combination of synchrotron radiation powder diffraction and molecular modelling techniques. J Mol Struct 2000. [DOI: 10.1016/s0022-2860(00)00666-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Davies HT, McLeod G, Bannister J, Macrae WA. Obstacles in organisation of service delivery reduce potential of epidural analgesia. BMJ 1999; 319:1499-500. [PMID: 10582949 PMCID: PMC1117220 DOI: 10.1136/bmj.319.7223.1499b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Burke D, McLeod G. Combined spinal epidural anaesthesia: question of technique. Int J Obstet Anesth 1999; 8:219; author reply 219-20. [PMID: 15321144 DOI: 10.1016/s0959-289x(99)80138-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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