Raquia guiada con ultrasonido en tiempo real. Estudio prospectivo observacional de un nuevo abordaje
Real-time ultrasound-guided spinal anaesthesia: a prospective observational study of a new approach.
Conroy PH, Luyet C, McCartney CJ, McHardy PG.
Anesthesiol Res Pract. 2013;2013:525818. doi: 10.1155/2013/525818. Epub 2013 Jan 10.
Abstract
Identification of the subarachnoid space has traditionally been achieved by either a blind landmark-guided approach or using prepuncture ultrasound assistance. To assess the feasibility of performing spinal anaesthesia under real-time ultrasound guidance in routine clinical practice we conducted a single center prospective observational study among patients undergoing lower limb orthopaedic surgery. A spinal needle was inserted unassisted within the ultrasound transducer imaging plane using a paramedian approach (i.e., the operator held the transducer in one hand and the spinal needle in the other). The primary outcome measure was the success rate of CSF acquisition under real-time ultrasound guidance with CSF being located in 97 out of 100 consecutive patients within median three needle passes (IQR 1-6). CSF was not acquired in three patients. Subsequent attempts combining landmark palpation and pre-puncture ultrasound scanning resulted in successful spinal anaesthesia in two of these patients with the third patient requiring general anaesthesia. Median time from spinal needle insertion until intrathecal injection completion was 1.2 minutes (IQR 0.83-4.1) demonstrating the feasibility of this technique in routine clinical practice.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3556419/pdf/ARP2013-525818.pdf
Sonoanatomía relevante para los bloqueos neuroaxiales con ultrasonido con abordaje lumbar paramediano
Sonoanatomy relevant for ultrasound-guided central neuraxial blocks via the paramedian approach in the lumbar region.
Karmakar MK, Li X, Kwok WH, Ho AM, Ngan Kee WD.
Br J Radiol. 2012 Jul;85(1015):e262-9. doi: 10.1259/bjr/93508121. Epub 2011 Oct 18.
Abstract
OBJECTIVES:The use of ultrasound to guide peripheral nerve blocks is now a well-established technique in regional anaesthesia. However, despite reports of ultrasound guided epidural access via the paramedian approach, there are limited data on the use of ultrasound for central neuraxial blocks, which may be due to a poor understanding of spinal sonoanatomy. The aim of this study was to define the sonoanatomy of the lumbar spine relevant for central neuraxial blocks via the paramedian approach.METHODS:The sonoanatomy of the lumbar spine relevant for central neuraxial blocks via the paramedian approach was defined using a "water-based spine phantom", young volunteers and anatomical slices rendered from the Visible Human Project data set.RESULTS:The water-based spine phantom was a simple model to study the sonoanatomy of the osseous elements of the lumbar spine. Each osseous element of the lumbar spine, in the spine phantom, produced a "signature pattern" on the paramedian sagittal scans, which was comparable to its sonographic appearance in vivo. In the volunteers, despite the narrow acoustic window, the ultrasound visibility of the neuraxial structures at the L3/L4 and L4/L5 lumbar intervertebral spaces was good, and we were able to delineate the sonoanatomy relevant for ultrasound-guided central neuraxial blocks via the paramedian approach. CONCLUSION:Using a simple water-based spine phantom, volunteer scans and anatomical slices from the Visible Human Project (cadaver) we have described the sonoanatomy relevant for ultrasound-guided central neuraxial blocks via the paramedian approach in the lumbar region.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3474051/pdf/bjr-85-e262.pdf
Anestesia espinal guiado con ultrasonido en un paciente obeso
Ultrasound-guided spinal anesthesia in an obese patient.
Lebbi MA, Trabelsi W, Bousselmi R, Messaoudi A, Labbène I, Ferjani M.
Tunis Med. 2014 Feb;92(2):164-6.
Abstract
We describe the case of 62-year-old man with a body mass index of 53, hypertension, diabetes mellitus and obstructive sleep apnea that was proposed for transurethral resection of prostate under spinal anesthesia. The surface landmark-guided approach was difficult and was abandoned after many unsuccessful attempts. Spinal anesthesia was achieved in one attempt with ultrasound guidance using the midline approach at the identified level. The trajectory was determined from the transducer angle.
http://www.latunisiemedicale.com/article-medicale-tunisie.php?article=2482&Codelang=en
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Real-time ultrasound-guided spinal anaesthesia: a prospective observational study of a new approach.
Conroy PH, Luyet C, McCartney CJ, McHardy PG.
Anesthesiol Res Pract. 2013;2013:525818. doi: 10.1155/2013/525818. Epub 2013 Jan 10.
Abstract
Identification of the subarachnoid space has traditionally been achieved by either a blind landmark-guided approach or using prepuncture ultrasound assistance. To assess the feasibility of performing spinal anaesthesia under real-time ultrasound guidance in routine clinical practice we conducted a single center prospective observational study among patients undergoing lower limb orthopaedic surgery. A spinal needle was inserted unassisted within the ultrasound transducer imaging plane using a paramedian approach (i.e., the operator held the transducer in one hand and the spinal needle in the other). The primary outcome measure was the success rate of CSF acquisition under real-time ultrasound guidance with CSF being located in 97 out of 100 consecutive patients within median three needle passes (IQR 1-6). CSF was not acquired in three patients. Subsequent attempts combining landmark palpation and pre-puncture ultrasound scanning resulted in successful spinal anaesthesia in two of these patients with the third patient requiring general anaesthesia. Median time from spinal needle insertion until intrathecal injection completion was 1.2 minutes (IQR 0.83-4.1) demonstrating the feasibility of this technique in routine clinical practice.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3556419/pdf/ARP2013-525818.pdf
Sonoanatomía relevante para los bloqueos neuroaxiales con ultrasonido con abordaje lumbar paramediano
Sonoanatomy relevant for ultrasound-guided central neuraxial blocks via the paramedian approach in the lumbar region.
Karmakar MK, Li X, Kwok WH, Ho AM, Ngan Kee WD.
Br J Radiol. 2012 Jul;85(1015):e262-9. doi: 10.1259/bjr/93508121. Epub 2011 Oct 18.
Abstract
OBJECTIVES:The use of ultrasound to guide peripheral nerve blocks is now a well-established technique in regional anaesthesia. However, despite reports of ultrasound guided epidural access via the paramedian approach, there are limited data on the use of ultrasound for central neuraxial blocks, which may be due to a poor understanding of spinal sonoanatomy. The aim of this study was to define the sonoanatomy of the lumbar spine relevant for central neuraxial blocks via the paramedian approach.METHODS:The sonoanatomy of the lumbar spine relevant for central neuraxial blocks via the paramedian approach was defined using a "water-based spine phantom", young volunteers and anatomical slices rendered from the Visible Human Project data set.RESULTS:The water-based spine phantom was a simple model to study the sonoanatomy of the osseous elements of the lumbar spine. Each osseous element of the lumbar spine, in the spine phantom, produced a "signature pattern" on the paramedian sagittal scans, which was comparable to its sonographic appearance in vivo. In the volunteers, despite the narrow acoustic window, the ultrasound visibility of the neuraxial structures at the L3/L4 and L4/L5 lumbar intervertebral spaces was good, and we were able to delineate the sonoanatomy relevant for ultrasound-guided central neuraxial blocks via the paramedian approach. CONCLUSION:Using a simple water-based spine phantom, volunteer scans and anatomical slices from the Visible Human Project (cadaver) we have described the sonoanatomy relevant for ultrasound-guided central neuraxial blocks via the paramedian approach in the lumbar region.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3474051/pdf/bjr-85-e262.pdf
Anestesia espinal guiado con ultrasonido en un paciente obeso
Ultrasound-guided spinal anesthesia in an obese patient.
Lebbi MA, Trabelsi W, Bousselmi R, Messaoudi A, Labbène I, Ferjani M.
Tunis Med. 2014 Feb;92(2):164-6.
Abstract
We describe the case of 62-year-old man with a body mass index of 53, hypertension, diabetes mellitus and obstructive sleep apnea that was proposed for transurethral resection of prostate under spinal anesthesia. The surface landmark-guided approach was difficult and was abandoned after many unsuccessful attempts. Spinal anesthesia was achieved in one attempt with ultrasound guidance using the midline approach at the identified level. The trajectory was determined from the transducer angle.
http://www.latunisiemedicale.com/article-medicale-tunisie.php?article=2482&Codelang=en
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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