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

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.

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

Current Anesthesiology Reports ◽

10.1007/s40140-021-00456-3 ◽

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.

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Correlation between the Body Mass Index (BMI) of Pregnant Women and the Development of Hypotension after Spinal Anesthesia for Cesarean Section

Brazilian Journal of Anesthesiology ◽

10.1016/s0034-7094(11)70003-4 ◽

2011 ◽

Vol 61 (1) ◽

pp. 21-30 ◽

Cited By ~ 12

Author(s):

Fernando Souza Nani ◽

Marcelo Luis Abramides Torres

Keyword(s):

Body Mass Index ◽

Cesarean Section ◽

Pregnant Women ◽

Spinal Anesthesia ◽

Body Mass ◽

The Body

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The Influence of Body Mass Index on Sensorimotor Block and Vasopressor Requirement during Spinal Anesthesia for Elective Cesarean Delivery

QJM ◽

10.1093/qjmed/hcaa039.061 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

N M A Elsayed ◽

S S W Rizkallah ◽

R M H Maamoon ◽

S H A Ahmed

Keyword(s):

Body Mass Index ◽

Spinal Anesthesia ◽

Cesarean Delivery ◽

Body Mass ◽

Fixed Dose ◽

Morbidly Obese ◽

Elective Cesarean Delivery ◽

Organ Systems ◽

Block Level ◽

Elective Cesarean

Abstract Background Physiological changes associated with pregnancy are significant enough to have serious anesthetic implications. When these are compounded by obesity, the anesthesiologists may have to deal with a patient with seriously limited physiological reserve. Obese patients often had co-morbidities and pathological changes in different organ systems. Aim The objective of this study is to determine if obesity have a clinical important effect on the vasopressor requirements or the block height following a standard fixed dose of spinal anesthesia during elective cesarean delivery. Methodology In this prospective randomized comparative clinical study, two groups of 33 patients were recruited with widely differing body mass indices to examine the influence of body mass index (BMI) on the responses to a specific dose of spinal bupivacaine. One group includes women with BMI < 32 kg/m2 (group N) and the other group has a BMI of > 40 kg/m2 (group O). Results This study showed that Body Mass Index doesn’t have much influence on sensorimotor block level and vasopressor requirement during spinal anesthesia for elective cesarean delivery &so the dose of spinal bupivacaine should not be reduced in morbidly obese parturients. Conclusion The result of the present study showed that Body Mass Index up to 50 doesn’t have much influence on sensorimotor block level or vasopressor requirement during spinal anesthesia for elective cesarean delivery &so the dose of spinal bupivacaine should not be reduced in morbidly obese parturients.

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Effect of body mass index in patients undergoing resection for gastric cancer: A single-center U.S. experience.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.25 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 25-25

Author(s):

Joyce Wong ◽

Shams Rahman ◽

Nadia Saeed ◽

Hui-Yi Lin ◽

Khaldoun Almhanna ◽

...

Keyword(s):

Gastric Cancer ◽

Body Mass Index ◽

Body Mass ◽

Disease Free Survival ◽

Technical Difficulty ◽

Tumor Location ◽

Normal Weight ◽

Lymph Node Count ◽

Clinicopathologic Factors ◽

The Impact

25 Background: With the rise of obesity in the U.S., the impact of body mass index (BMI) on surgical outcomes and survival in gastric cancer remains undetermined. Methods: An IRB-approved, prospectively-maintained institutional database of patients referred for surgical evaluation of gastric cancer was reviewed. Patients were stratified according to BMI: <18.5 (underweight), 18.5-25 (normal weight), 25.1-30 (overweight), and >30 (obese). Clinicopathologic factors and overall survival (OS) were analyzed using polytomous regression, Pearsons correlation and Kaplan Meier when appropriate. Results: From 1997-2012, 222 patients underwent exploration for gastric adenocarcinoma. Of these, 186 (84%) patients had BMI recorded: 9 (5%) with BMI<18.5, 72 (39%) 18.5-25, 62 (33%) 25.1-30, and 43 (23%) >30. 135 (73%) ultimately underwent resection. Operative factors including American Society of Anesthesiology (ASA) score and blood loss were not significantly associated with BMI. Increased BMI was associated with longer operative time, P=0.02. Pathologic factors including proximal tumor location, perineural invasion (PNI), lymphovascular invasion (LVI), positive surgical margins, and positive lymph nodes (LN+) were all associated with a worse OS. Although increased BMI was associated with a lower total lymph node count, P=0.004, the number of LN+ was not associated with BMI. Tumor location, PNI, LVI, margin status, and final pathologic stage were not significantly associated with BMI. Additionally, the use of neoadjuvant or adjuvant chemotherapy was not associated with BMI. Median OS for the group was 22 months. When stratified by BMI, median OS was improved with increased BMI: 21 months for <18.5, 13 months for 18.5-25, 28 months for 25-30, and 34 months for >30, P=0.02. Similarly, disease free survival (DFS) improved with increasing BMI: 2 months for <18.5, 7 months for 18.5-25, 15 months for 25.1-30, and 15 months for >30, P=0.02. Conclusions: Although BMI may impact the technical difficulty of resection for gastric cancer, increasing BMI is not associated with more aggressive disease. In this experience, increased BMI does not adversely impact OS or DFS.

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