Real-time ultrasound-guided spinal anesthesia using the SonixGPS ultrasound guidance system: a feasibility study

Abstract Background: Ultrasound imaging skills are valuable for enhancing the safety of different puncture techniques supported with the fact that the developments in imaging quality have significantly improved our understanding of spinal sonoanatomy. Today, ultrasound imaging has been used to assist or guide central neuroaxial blocks, however, the data about the use of real time guided ultrasound neuroaxial blocks are scanty. The study aimed to identify the value of using the real time ultrasound guidance in applying spinal anaesthesia when compared with the conventional landmark guided approach, regarding the efficiency of the anesthetic technique and incidence of associated common complications. Methods: This randomized controlled trial included 178 patients scheduled for elective Knee orthopedic surgeries under spinal anesthesia in El Kasr Al-Aini Hospital, Cairo University were enrolled in the study. Patients were randomly assigned into conventional group in which 89 patients received landmark guided paramedian spinal anesthesia and ultrasound group in which 89 patients received real time ultrasound guided paramedian spinal anesthesia. Results: The mean numbers of puncture attempts, levels and needle redirections between the conventional group and ultrasound group were 1.61±0.83 vs. 1.12±0.36 (p=0.013), 1.15±0.36 vs. 1.06±0.25 (p=0.018) and 2.68±2.75 vs. 1.94±1.93 (p=0.021) respectively. Ultrasound guided group of patients showed significant lower incidence of bloody puncture and paraesthesia after engaging the needle through the dura. Conclusion: Real time ultrasound guiding improved the ease of introducing spinal anesthesia, reduced the number of puncture attempts, number of puncture levels, number of needle redirections, and incidence of complications.

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Landmark Versus Ultrasound-Guided Subclavian Central Venous Catheterization with a Combined Short and Long Axis Approach in an Intensive Care Setting

Macedonian Medical Review ◽

10.1515/mmr-2017-0009 ◽

2017 ◽

Vol 71 (1) ◽

pp. 44-49

Author(s):

Darko Sazdov ◽

Marija Jovanovski Srceva ◽

Zorka Nikolova Todorova

Keyword(s):

Intensive Care ◽

Real Time ◽

Complication Rate ◽

Ultrasound Guidance ◽

Central Venous Catheterization ◽

Short Axis ◽

Ultrasound Guided ◽

Central Venous ◽

Venous Catheterization ◽

Out Of Plane

Abstract Introduction. Central venous catheterization of the subclavian vein can be achieved with a landmark and an ultrasound-guided method. Using ultrasound the vein can be catheterized with a long axis in plane or a short axis out of plane approach and a combined approach. The aim of the study was to compare the success, average number of attempts and mechanical complication rate between the landmark and the combined ultrasound-guided method. Methods. A total of 162 adult patients from the Intensive Care Unit at Clinical Hospital Acibadem-Sistina, Skopje were included in this prospective study. Patients randomized in the examined group (n=71) were catheterized with real-time ultrasound guidance with a combined short axis out of plane and long axis in plane method. Patients randomized in the control group (n=91) were catheterized with the landmark method. Subclavian vein was catheterized in both groups. Overall success, success on first attempt, number of attempts and complications at the moment of catheterization were the main outcome measures. Results. Catheterization using the landmark method was successful in 94.5% of patients, 65.9% of which during the first attempt. Cannulation using real-time ultrasound guidance was successful in all patients with a first pas success of 83.1%. The complication rate in the ultrasound group was 2.82% and 16.5% in the landmark group (p=0.004404). Conclusion. Real-time ultrasound guidance with a combined short axis out of plane and long axis in plane approach improves success, decreases number of attempts, and reduces mechanical complications rate.

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