viernes, 29 de junio de 2018

Bloqueos neuroaxiales con ultrasonido / Ultrasound guided central neuraxial block

Junio 29, 2018. No. 3126
Sonoanatomía relevante para los bloqueos neuroaxiales centrales guiados por ecografía a través del abordaje paramediano en la región lumbar.
Sonoanatomy relevant for ultrasound-guided central neuraxial blocks via the paramedian approach in the lumbar region.
Br J Radiol. 2012 Jul;85(1015):e262-9. doi: 10.1259/bjr/93508121. Epub 2011 Oct 18.
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 centralneuraxial 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.
Ultrasonido para bloqueos neuroaxiales
Ultrasound for Central Neuraxial Blockade
Kyle R. Kirkham, Ki Jinn Chin
Curr Anesthesiol Rep (2013) 3:242-249
Abstract The evidence base supporting the role of ultrasound to assist the performance of neuraxial anesthesia has become increasingly strong over the last decade. In both the lumbar and thoracic spine, ultrasound has been shown to optimize technical performance, improve patient outcomes, and potentially reduce harm. Specifically, ultrasound aids in identification of intervertebral levels, estimation of depth to epidural and intrathecal spaces, and localization of important landmarks including the midline and interlaminar space. These characteristics can facilitate both planning and performance of neuraxial blockade by reducing the required number of needle insertions and redirections, minimizing the risk of traumatic needle placements, and improving block effectiveness after epidural placement. This report details the evidence supporting each of these outcomes and also discusses the current understanding of both learning and teaching the skill of neuraxial ultrasonography. Keywords Ultrasound Epidural anesthesia Spinal anesthesia
Guía con ultrasonido para bloqueos neuroaxiales
Ultrasound guided central neuraxial block
Samina Ismail
Anaesth Pain & Intensive Care 2015;19(3):361-365
Central neuraxial blocks (CNB) are the preferred blocks in the practice of regional anesthesia. Palpation of the anatomical landmarks is used for the identification of the space, which is not always the best method when CNB is performed in overweight patients or patients having atypical spines like scoliosis. Ultrasound (US) has recently been utilized to facilitate CNB. However, CNB US can be difficult, because the structures need to be visualized by US are surrounded by bones, which do not allow ultrasound rays to pass through. Therefore in order to allow deeper penetration, the ultrasound probe used for CNB is a curved probe of low frequency of 2-5 mHz, as it allows deeper penetration at the expense of image resolution. There are two scanning planes; transverse and longitudinal which supplements each other. US for CNB helps in determining the intercristal line, exact intervertebral level, midline, ideal point of insertion, distance to ligamentum flavum and needle trajectory. US for CNB has improved patient safety by decreasing the number of attempts, chances of dural puncture and damage to conus medullaris. It has also improved patient satisfaction and has proved to be an ideal learning tool for the trainees. Key words: Regional Anesthesia; Spinal Injections; Spinal Puncture; Anesthesia, Spinal; Anesthesia, Epidural; Anesthesia, Conduction; Ultrasonography Citation: Ismail S. Ultrasound Guided Central Neuraxial Block.
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