scholarly journals Ultrasound Imaging of the Spine for Central Neuraxial Blockade: a Technical Description and Evidence Update

2021 ◽  
Author(s):  
Hari Kalagara ◽  
Harsha Nair ◽  
Sree Kolli ◽  
Gopal Thota ◽  
Vishal Uppal
Keyword(s):  
Ultrasound Imaging ◽  
Spine Surgery ◽  
Postoperative Analgesia ◽  
Spinal Deformity ◽  
Ultrasound Examination ◽  
Technical Difficulty ◽  
Vertebral Level ◽  
Reliable Technique ◽  
Neuraxial Blockade ◽  
Preprocedural Imaging

Abstract Purpose of Review This article describes the anatomy of the spine, relevant ultrasonographic views, and the techniques used to perform the neuraxial blocks using ultrasound imaging. Finally, we review the available evidence for the use of ultrasound imaging to perform neuraxial blocks. Recent Findings Central neuraxial blockade using traditional landmark palpation is a reliable technique to provide surgical anesthesia and postoperative analgesia. However, factors like obesity, spinal deformity, and previous spine surgery can make the procedure challenging. The use of ultrasound imaging has been shown to assist in these scenarios. Summary Preprocedural imaging minimizes the technical difficulty of spinal and epidural placement with fewer needle passes and skin punctures. It helps to accurately identify the midline, vertebral level, interlaminar space, and can predict the depth to the epidural and intrathecal spaces. By providing information about the best angle and direction of approach, in addition to the depth, ultrasound imaging allows planning an ideal trajectory for a successful block. These benefits are most noticeable when expert operators carry out the ultrasound examination and for patients with predicted difficult spinal anatomy. Recent evidence suggests that pre-procedural neuraxial ultrasound imaging may reduce complications such as vascular puncture, headache, and backache. Neuraxial ultrasound imaging should be in the skill set of every anesthesiologist who routinely performs lumbar or thoracic neuraxial blockade. We recommend using preprocedural neuraxial imaging routinely to acquire and maintain the imaging skills to enable success for challenging neuraxial procedures.

scholarly journals Ultrasound Imaging Facilitates Spinal Anesthesia in Adults with Difficult Surface Anatomic Landmarks

2011 ◽  
Vol 115 (1) ◽  
pp. 94-101 ◽  
Author(s):  
Ki Jinn Chin ◽  
Anahi Perlas ◽  
Vincent Chan ◽  
Danielle Brown-Shreves ◽  
Arkadiy Koshkin ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Spinal Anesthesia ◽  
Body Mass ◽  
Ultrasound Imaging ◽  
Technical Difficulty ◽  
Needle Insertion ◽  
Lumbar Spine Surgery ◽  
Distributed Data ◽  
Anatomic Landmarks ◽  
Neuraxial Blockade

Background Poor surface anatomic landmarks are highly predictive of technical difficulty in neuraxial blockade. The authors examined the use of ultrasound imaging to reduce this difficulty. Methods The authors recruited 120 orthopedic patients with one of the following: body mass index more than 35 kg/m² and poorly palpable spinous processes; moderate to severe lumbar scoliosis; or previous lumbar spine surgery. Patients were randomized to receive spinal anesthetic by the conventional surface landmark-guided technique (group LM) or by an ultrasound-guided technique (group US). Patients in group US had a preprocedural ultrasound scan to locate and mark a suitable needle insertion point. The primary outcome was the rate of successful dural puncture on the first needle insertion attempt. Normally distributed data were summarized as mean ± SD and nonnormally distributed data were summarized as median [interquartile range]. Results The first-attempt success rate was twice as high in group US than in group LM (65% vs. 32%; P < 0.001). There was a twofold difference between groups in the number of needle insertion attempts (group US, 1 [1-2] vs. group LM, 2 [1-4]; P < 0.001) and number of needle passes (group US, 6 [1-10] vs. group LM, 13 [5-21]; P = 0.003). More time was required to establish landmarks in group US (6.7 ± 3.1; group LM, 0.6 ± 0.5 min; P < 0.001), but this was partially offset by a shorter spinal anesthesia performance time (group US, 5.0 ± 4.9 vs. group LM, 7.3 ± 7.6 min; P = 0.038). Similar results were seen in subgroup analyses of patients with body mass index more than 35 kg/m and patients with poorly palpable landmarks. Conclusion Preprocedural ultrasound imaging facilitates the performance of spinal anesthesia in the nonobstetric patient population with difficult anatomic landmarks.

Predictive model for major complications 2 years after corrective spine surgery for adult spinal deformity

2018 ◽  
Vol 28 (1) ◽  
pp. 180-187 ◽  
Author(s):  
Mitsuru Yagi ◽  
Naobumi Hosogane ◽  
Nobuyuki Fujita ◽  
Eijiro Okada ◽  
Osahiko Tsuji ◽  
...  
Keyword(s):  
Predictive Model ◽  
Spine Surgery ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Major Complications

Neuraxial Blockade in Patients with Preexisting Spinal Stenosis, Lumbar Disk Disease, or Prior Spine Surgery

2010 ◽  
Vol 111 (6) ◽  
pp. 1511-1519 ◽  
Author(s):  
James R. Hebl ◽  
Terese T. Horlocker ◽  
Sandra L. Kopp ◽  
Darrell R. Schroeder
Keyword(s):  
Spinal Stenosis ◽  
Spine Surgery ◽  
Neuraxial Blockade ◽  
Lumbar Disk ◽  
Lumbar Disk Disease

Abstract P154: Ultrasound Imaging for Serial Measurements of Venous Diameters in Rats

Hypertension ◽  
2015 ◽  
Vol 66 (suppl_1) ◽  
Author(s):  
Teresa Krieger-Burke ◽  
Bridget M Seitz ◽  
Gregory D Fink ◽  
Stephanie W Watts
Keyword(s):  
Blood Pressure ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Real Time ◽  
Ultrasound Imaging ◽  
Imaging System ◽  
Sprague Dawley ◽  
Reliable Technique ◽  
Venous Capacitance ◽  
Anesthetized Rats

The purpose of our study was to investigate serial ultrasound imaging in rats as a means to quantify the diameters of splanchnic veins in real time and the effect of drugs on venous capacitance. A 21 MHz probe ( Vevo 2100 imaging system,Visual Sonics Inc.) was used to collect images containing the portal vein (PV) and the superior mesenteric vein (SMV) in anesthetized male Sprague-Dawley rats maintained at 37°C. Stable landmarks were established and we were able to repeatedly locate specific cross-sections of PV and SMV. When controlled for respiratory and cardiac cycles during measurements, respective diameters of these vessels remained within 0.75±0.15% and 0.2±0.10% of baseline (PV: 2.02±0.15 mm; SMV: 1.67±0.05 mm) when located and measured every 5 minutes over 45 minutes (n=3 rats). PV and SMV remained within 1.0±0.6% and 0.38±0.9% from baseline, respectively, when measured on separate days over 10 weeks in a preliminary study using 2 rats. The consistency of raw vessel measurements allowed these vessels to serve as their own control during subchronic pharmacologic interventions. In a second study, the vasodilator sodium nitroprusside (2 mg/kg, i.v. bolus) was administered to anesthetized rats (n=3) following collection of baseline vessel measurements. PV and SMV diameters increased 37.23±2.4% and 29.77±8.8% from baseline by 30 minutes post drug administration while mean arterial pressure decreased 10.32±1.7 mmHg. Conversely, the administration of the venoconstrictor sarafotoxin (S6C) (5 ng/kg, i.v. bolus) to other anesthetized rats (n=3) decreased PV and SMV diameters 22.10±2.4% and 9.44±1.6% from baseline within 5 minutes, associated with an increase in mean arterial pressure of 12.85±3.2 mmHg. Together these results support serial ultrasound imaging as a reliable technique to accurately measure acute and subchronic changes in the diameter of splanchnic veins concurrent with blood pressure changes in intact rats. The ability to follow rat abdominal vein diameters in real time will assist in determining the role of the venous circulation in blood pressure regulation.

Does corrective spine surgery improve the standing balance in patients with adult spinal deformity?

2018 ◽  
Vol 18 (1) ◽  
pp. 36-43 ◽  
Author(s):  
Mitsuru Yagi ◽  
Hideaki Ohne ◽  
Shinjiro Kaneko ◽  
Masafumi Machida ◽  
Yoshiyuki Yato ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Standing Balance

scholarly journals Diagnostic Tactics in the Absence of Ultrasound Images of the Gallbladder

2019 ◽  
pp. 24-28
Author(s):  
A. N. Chukanov ◽  
I. V. Tikhonenko
Keyword(s):  
Gall Bladder ◽  
Amniotic Fluid ◽  
Ultrasound Imaging ◽  
Congenital Malformations ◽  
Ultrasound Examination ◽  
Diagnostic Procedures ◽  
Normative Values ◽  
Ultrasound Images ◽  
Gamma Glutamyl Transpeptidase ◽  
Fluid Test

Objective: determine the optimal checklist of diagnostic procedures, whose application will make it possible to effectively identify and differentiate malformations of the biliary system of the fetus accompanied by the absence of ultrasound imaging of the gallbladder. Material . The fetuses in single-fetal pregnancy in the period of gestation of 16-37 weeks were examined. Results. The study has determined the optimal checklist of the diagnostic procedures, including dynamic sonography, biochemical amniotic fluid test, magnetic resonance imaging, which should be carried out in the absence of ultrasound imaging of the gallbladder during the screening ultrasound examination of pregnant women aimed at the identification of the congenital malformations of the fetus. The cases and conditions of the biochemical amniotic fluid testing have been identified. The standards of the percentile values of the total alkaline phosphatase and gamma-glutamyl transpeptidase concentrations in amniotic fluid have been developed. Conclusion. If the gall bladder of the fetus cannot be visualized by ultrasound, isolated agenesis of the gall bladder, atresia of the biliary tract, cystic fibrosis, aneuploidy, multiple congenital malformations should be suspected. In view of the extremely unfavorable prognosis in case of biliary atresia, the verification ultrasound examination should be repeated dynamically several times over the next week, and if the gallbladder is not detected, then for the differential diagnosis it is necessary to use additional methods such as MRI and biochemical amniotic fluid test in order to determine changes in their concentration of digestive enzymes in comparison with the normative values determined by the authors.

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