Incidence of dural sac puncture during neuraxial anesthesia in cats: an observational, retrospective study

2021 ◽  
pp. 1098612X2110212
Author(s):  
Vincenzo Rondelli ◽  
Pablo E Otero ◽  
Francesca Romano ◽  
Natali Verdier ◽  
Regula Bettschart-Wolfensberger ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Medical Records ◽  
Dural Puncture ◽  
Demographic Data ◽  
Intrathecal Injection ◽  
Epidural Injection ◽  
Neuraxial Anesthesia ◽  
Tuohy Needle ◽  
Epidural Needle ◽  
Dural Sac

Objectives The aim of this study was to determine the occurrence of dural puncture, indicated by cerebrospinal fluid (CSF) outflow, in cats receiving neuraxial anesthesia through a lumbosacral injection guided by a pop sensation method. Methods This was an observational, retrospective study. Cats that were scheduled for lumbosacral neuraxial anesthesia were included. Medical records were analyzed to investigate: (1) demographic data; (2) neuraxial anesthesia performed (epidural/spinal); (3) type of needle used, including gauge and length; (4) presence of CSF (yes/no) and/or blood (yes/no) in the hub of the needle; and (5) flicking of the tail during needle advancement (yes/no). Results A total of 94 medical records were analyzed. A 22 G 50 mm Tuohy needle was used in all cats scheduled for an epidural injection (n = 60), whereas a 22 G 40 mm Quincke needle was used in all cats scheduled for an intrathecal injection (n = 34). CSF outflow was detected in 55/60 (91.7%) cats in which a Tuohy needle was used, and 34/34 (100%) of the cats in which a Quincke needle was used ( P = 0.15). Flicking of the tail was detected in 41/60 (68.3%) and in 24/34 (70.6%) injections with Tuohy and Quincke needles, respectively ( P >0.99). Traces of blood, but not active blood outflow, were detected via staining of the first drops of CSF in 2/34 cats in which Quincke needles were used and in none of the cats in which Tuohy needles were used ( P = 0.12). Conclusions and relevance This study shows that the lumbosacral approach for neuraxial anesthesia in cats may result in a dural sac puncture when 22 G Quincke or Tuohy needles are used. The pop sensation method should be deemed effective in predicting intrathecal but not epidural needle placement.

Spinal meningocele due to iatrogenic dural puncture during epidural analgesia for childbirth: 5-year history of headache with a spinal etiology

2009 ◽  
Vol 11 (6) ◽  
pp. 764-767 ◽  
Author(s):  
Besnik Nurboja ◽  
Kia Rezajooi ◽  
Mary C. Newton ◽  
Adrian T. H. Casey
Keyword(s):  
Chronic Headache ◽  
Dural Puncture ◽  
Epidural Injection ◽  
Complete Removal ◽  
Operative Removal ◽  
Dural Sac ◽  
First Case ◽  
Csf Leakage ◽  
History Of ◽  
Spinal Hypotension

Patients undergoing epidural injection for labor pains occasionally sustain iatrogenic inadvertent puncture of the dura with or without damage to the underlying neurological structures. This may be associated with CSF leakage, headache, neurological deficit, and infection. Rarely, the headache persists for years. To the authors' knowledge, chronic headache due to acquired spinal meningocele featuring as a duplicated dural sac, as a sequela of traumatic inadvertent dural puncture, has not been previously reported. The authors report a case of a 20-year-old woman with persistent headaches following an epidural injection. Five years later, the persistent headache was found to be due to a large acquired spinal meningocele. The operative removal of the meningocele led to resolution of headaches. This report highlights the importance of considering a spinal condition as a culprit for chronic headache and postulates a mechanism for the formation of the acquired spinal meningocele appearing as a duplicated dural sac. The authors recommend early MR imaging of the spine for any persisting headache that has a history of attempted spinal access. If an acquired spinal meningocele collection is found, exploration with a view to complete removal of the sac should be considered. To the authors' knowledge, this is the first case report depicting a rare, treatable cause of chronic spinal hypotension resulting in headaches.

scholarly journals Efficacy and Safety of Prophylactic Intrathecal Normal Saline for Prevention of Post Dural Puncture Headache among Women Undergoing Cesarean Section under Spinal Anesthesia: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Semagn Abate ◽  
Siraj Ahmed ◽  
Getachew Mergia Anbese
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Normal Saline ◽  
Dural Puncture ◽  
Controlled Trial ◽  
Intrathecal Injection ◽  
Repeated Measurements ◽  
Epidural Needle ◽  
Post Dural Puncture Headache ◽  
Resource Limited

Abstract Background: Post-Dural Puncture Headache is the commonest complication of spinal anesthesia. Body of evidence revealed that Conservative management failed to show significant benefit and epidural needle and catheter techniques didn’t provide conclusive evidence. On the other hand, intrathecal injection of normal saline is a simple technique and cost-effective in a resource-limited setup but it is not well examined on its effectiveness and safety profiles.Methods and materials: After Obtaining Ethical clearance from IRB, 152 mothers scheduled for cesarean section under spinal anesthesia were allocated randomly into two groups. Data analysis was done with SPSS version 22. Descriptive statistics were run to see the overall distribution of the study subjects. Unpaired student’s T-test for continuous symmetric data and Mann-Whitney U test for non-normally distributed data were used. Categorical data were analyzed with Chi-square and fisher’s exact test where appropriate. A generalized estimating equation model was used to investigate the interaction of repeated measurements of NRS pain scores of PDPH. Result: The overall incidence of PDPH was 29.6% while the proportion of patients who experienced PDPH was the highest among patients with control as compared to intervention( 36.8% vs 22%) respectively. The GEE model revealed that the NRS pain score was 0.7, 0.4, and 0.2 unit higher at 12, 24, and 48 respectively in control as compared to the interventionConclusion: prophylactic intrathecal normal saline could be an option in a resource-limited setup where the appropriate spinal needle is not accessible and management of moderate and severe PDPH is not feasibleRegistration: The protocol was registered prospectively in Clinical Trials.gov (NCT04393766).

scholarly journals White-Eyed Orbital Blowout Fracture: A Retrospective Study of 22 Patients

2021 ◽  
Vol 64 (12) ◽  
pp. 896-900
Author(s):  
Gyo Han Bae ◽  
Geun Woo Park ◽  
Tai Jung Park ◽  
Woong Jae Noh ◽  
Tae Young Jung
Keyword(s):  
Retrospective Study ◽  
Medical Records ◽  
Demographic Data ◽  
Operation Time ◽  
Graft Material ◽  
Successful Result ◽  
Blowout Fracture ◽  
Ocular Symptoms ◽  
Study Population ◽  
Early Reconstruction

Background and Objectives The study reports on the clinical experience of repairing white-eyed orbital blow out fracture through a retrospective study of various incidences of white-eyed orbital blow out fracture that resulted in different treatment methods and outcomes.Subjects and Method A retrospective study was performed on 22 patients with white-eyed blowout fracture who underwent operation between March 2009 and June 2019 at our clinic. Patients were divided into 2 groups by age: 6 to 12 and 13 to 18. A review of medical records included demographic data, cause of injury, preoperative symptoms, trauma to operation time and surgical outcomes including improvement of postoperative ocular symptoms and complications.Results The study population included 20 males and 2 female patients ranging from 6 to 18 years (mean, 14.2 years) of age. Fifteen of 21 patients with diplopia or limitation of eyeball movement showed a complete improvement of symptoms after surgery and 6 (28.5%) had remaining symptoms. One patient had no ocular symptom, but had oculocardiac reflex including nausea and vomiting. Two cases were re-operated due to adhesion of graft material. There was one sinus infection related to the implant.Conclusion This study shows that early reconstruction and release of incarcerated muscle within 5 days after trauma for white-eyed blowout fracture gives successful result that does not accompany major complications. All of the 22 patients who were operated for white-eyed blowout fractures had successful results.

Validation of a bioabsorbable device that seals perforations after Tuohy needle dural puncture in an ovine model

2021 ◽  
pp. rapm-2020-102225
Author(s):  
Carles García-Vitoria ◽  
Mireia García -Roselló ◽  
Miguel A Reina ◽  
Jose De Andres ◽  
Álvaro Jesús Gutiérrez-Bautista ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Epidural Space ◽  
Dural Puncture ◽  
Tuohy Needle ◽  
Epidural Needle ◽  
Cerebrospinal Fluid Leakage ◽  
Study Group ◽  
Manufacturing Defects ◽  
Fluid Leakage ◽  
Sealing Device

BackgroundWe designed a device to close accidental dural puncture via the offending puncturing epidural needle directly after diagnosis of the puncture and before removing the needle. The aim of this study was to quantify this device’s ability to seal cerebrospinal fluid leakage.MethodsForty-six anesthetized adult sheep were studied in a single-blind randomized controlled fashion in two equal groups.An intentional dural puncture was performed with an 18-gage Tuohy needle on all the sheep between L6 and S1 levels. Contrast medium was injected through the needle. Twenty-three animals receive treatment with the sealing device. Two minutes after device placement, or dural puncture in the control group, a CT scan was performed on the animals to estimate contrast material leakage. A region of interest (ROI) was defined as the region that enclosed the subarachnoid space, epidural space, and neuroforaminal canal (the vertebral body above and half of its equivalent height in sacrum below the puncture site). In this region, the total contrast volume and the volumes in the epidural space (EPIDURAL) were measured. The primary outcome measure was the EPIDURAL/ROI ratio to ascertain the proportion of intrathecally injected fluid that passed into the epidural space in both groups. The secondary outcomes were the total amount of contrast in the ROI and the EPIDURAL.ResultsThe device was deployed successfully in all but two instances, where it suffered from manufacturing defects.Leakage was less in the study group (1.0 vs 1.4 mL, p=0.008). The median EPIDURAL/ROI ratio was likewise less in the study group (29 vs 46; p=0.013; 95% CI (−27 to –3.5)).ConclusionThis novel dural puncture-sealing device, also envisaged to be used in other comparable iatrogenic leakage scenarios to be identified in the future, was able to reduce the volume of cerebrospinal fluid that leaked into the epidural space after dural puncture. The device is possibly a valuable way of preventing fluid leakage immediately after the recognition of membrane puncture.

scholarly journals The spinal headache in pregnant women

1970 ◽  
Vol 1 (2) ◽  
pp. 4-9
Author(s):  
Krzysztof M Kuczkowski
Keyword(s):  
Pregnant Women ◽  
Subarachnoid Space ◽  
Dural Puncture ◽  
Intrathecal Injection ◽  
Epidural Needle ◽  
Postdural Puncture Headache ◽  
Widespread Application ◽  
Post Dural Puncture Headache ◽  
Prevention And Treatment ◽  
Spinal Epidural

Pregnant women are at particular risk of dural puncture (and the subsequent headache) because of sex, young age, and the widespread application of regional anesthesia. The incidence of epidural needle-induced post-dural puncture headache (PDPH) also known as spinal headache in pregnant women following dural puncture with a large bore needle has been reported to range 76-85%. Although a few measures have been proposed to prevent PDPH Intrathecal injection of saline, insertion of the epidural catheter into the subarachnoid space through the dural hole, none have been shown to work with certainty to date. This article reviews the latest developments aimed at prevention and treatment of this debilitating condition. Key Words: Labor analgesia; epidural, combined spinal epidural; complications, dural puncture, postdural puncture headache (PDPH); prevention.   doi:10.3126/njog.v1i2.1486 N. J. Obstet. Gynaecol Vol. 1, No. 2, p. 4 - 9 Nov-Dem 2006

Percutaneous sclerotherapy for spongiform venous malformations – analysis of patient-evaluated outcome and satisfaction

VASA ◽  
2017 ◽  
Vol 46 (6) ◽  
pp. 477-483
Author(s):  
Robert Karl Clemens ◽  
Frederic Baumann ◽  
Marc Husmann ◽  
Thomas Oleg Meier ◽  
Christoph Thalhammer ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Medical Records ◽  
Venous Malformation ◽  
Primary Treatment ◽  
Venous Malformations ◽  
Treated Area ◽  
Item Questionnaire ◽  
Percutaneous Sclerotherapy ◽  
Multiple Treatments ◽  
Pain Improvement

Abstract. Background: Congenital venous malformations are frequently treated with sclerotherapy. Primary treatment goal is to control the often size-related symptoms. Functional impairment and aesthetical aspects as well as satisfaction have rarely been evaluated. Patients and methods: Medical records of patients who underwent sclerotherapy of spongiform venous malformations were reviewed and included in this retrospective study. The outcome of sclerotherapy as self-reported by patients was assessed in a 21 item questionnaire. Results: Questionnaires were sent to 166 patients with a total of 327 procedures. Seventy-seven patients (48 %) with a total of 159 procedures (50 %) responded to the survey. Fifty-seven percent of patients were male. The age ranged from 1 to 38.1 years with a median age of 16.4 years. The lower extremities were the most common treated area. Limitations caused by the venous malformation improved in the majority of patients (e.g. pain improvement 87 %, improvement of swelling 83 %) but also worsening of symptoms occurred in a minority of cases. Seventy-seven per cent would undergo sclerotherapy again. Conclusions: Sclerotherapy for treatment of venous malformations results in significant reduction of symptoms. Multiple treatments are often needed, but patients are willing to undergo them.

Post-Operative Dysphagia in Anterior Cervical Discectomy and Fusion

2021 ◽  
pp. 000348942110155
Author(s):  
Leonard Haller ◽  
Khush Mehul Kharidia ◽  
Caitlin Bertelsen ◽  
Jeffrey Wang ◽  
Karla O’Dell
Keyword(s):  
Risk Factors ◽  
Medical Records ◽  
Assessment Tool ◽  
Demographic Data ◽  
Anterior Cervical Discectomy ◽  
Cervical Discectomy ◽  
Long Term Follow Up

Objective: We sought to identify risk factors associated with long-term dysphagia, characterize changes in dysphagia over time, and evaluate the incidence of otolaryngology referrals for patients with long-term dysphagia following anterior cervical discectomy with fusion (ACDF). Methods: About 56 patients who underwent ACDF between May 2017 to February 2019 were included in the study. All patients were assessed for dysphagia using the Eating Assessment Tool (EAT-10) survey preoperatively and late postoperatively (≥1 year). Additionally, 28 patients were assessed for dysphagia early postoperatively (2 weeks—3 months). Demographic data, medical comorbidities, intraoperative details, and post-operative otolaryngology referral rates were collected from electronic medical records. Results: Of the 56 patients enrolled, 21 patients (38%) had EAT-10 scores of 3 or more at long-term follow-up. None of the demographics, comorbidities, or surgical factors assessed were associated with long-term dysphagia. Patients who reported no long-term dysphagia had a mean EAT-10 score of 6.9 early postoperatively, while patients with long-term symptoms had a mean score of 18.1 ( P = .006). Of the 21 patients who reported persistent dysphagia symptoms, 3 (14%) received dysphagia testing or otolaryngology referrals post-operatively. Conclusion: Dysphagia is a notable side effect of ACDF surgery, but there are no significant demographics, comorbidities, or surgical risk factors that predict long-term dysphagia. Early postoperative characterization of dysphagia using the EAT-10 questionnaire can help predict long-term symptoms. There is inadequate screening and otolaryngology follow-up for patients with post-ACDF dysphagia.

scholarly journals Characteristics of patients with osteonecrosis of the jaw with oral versus intravenous bisphosphonate treatment

2021 ◽  
Vol 43 (1) ◽  
Author(s):  
Seung-Hun Lee ◽  
So-Young Choi ◽  
Min-Su Bae ◽  
Tae-Geon Kwon
Keyword(s):  
Retrospective Study ◽  
Clinical Characteristics ◽  
Demographic Data ◽  
Osteonecrosis Of The Jaw ◽  
Group Differences ◽  
Bisphosphonate Treatment ◽  
Administration Route ◽  
Lesion Number ◽  
Different Characteristics ◽  
Intravenous Bisphosphonate

Abstract Purpose This retrospective study was aimed to evaluate the clinical characteristics and treatment outcomes in patients with osteonecrosis of the jaw who were receiving oral versus intravenous (IV) bisphosphonate (BP). Materials and methods This retrospective study enrolled subjects who had been diagnosed with medication-related osteonecrosis of the jaw (MRONJ) during the period from July 2010 to June 2014. Information regarding the following demographic and clinical characteristics was collected: demographic data, administration route and type of BP, duration of BP medication, primary disease, number of involved sites, location of the lesion, number of surgeries, outcome of treatments, and laboratory test. All the patients were divided into oral and IV BP groups; and the between-group differences were compared. Results Total 278 patients were divided into two groups as per the route of BP administration. The proportion of oral BP-related MRONJ group were more dominant over IV BP group (oral BP, n = 251; IV BP, n = 27). In the IV BP group, the average dosing duration (31.4 months) was significantly shorter than that in the oral BP group (53.1 months) (P < 0.001). The average number of involved sites in the oral BP group (1.21 ± 0.48) was smaller than that in the IV BP group (1.63 ± 0.84) (P < 0.001). The average number of surgeries was higher in the IV BP group (1.65 ± 0.95) as compared to that in the oral BP group (0.98 ± 0.73) (P < 0.001). Outcome after the surgery for MRONJ after IV BP was poor than oral BP group. Conclusion IV administration of BP causes greater inhibition of bone remodeling and could lead more severe inflammation. Therefore, even if the duration of IV administration of BP is shorter than that of oral BP, the extent of the lesion could be more extensive. Therefore, the result suggests that the MRONJ after IV BP for cancer patients needs to be considered as different characteristics to oral BP group for osteoporosis patents.

Changes of Periodontal Tissues Because of Orthodontic Treatment: A Retrospective Study

2021 ◽  
pp. 232020682110034
Author(s):  
Hamad Alzoman ◽  
Khalid Alamoud ◽  
Waad K. Alomran ◽  
Abdullazez Almudhi ◽  
Naif A. Bindayel
Keyword(s):  
Retrospective Study ◽  
Orthodontic Treatment ◽  
Tooth Movement ◽  
Positive Impact ◽  
Demographic Data ◽  
Gingival Recession ◽  
Confounding Factors ◽  
Crown Height ◽  
Periodontal Tissues ◽  
Before And After

Aim: To evaluate the periodontal status before and after orthodontic treatment and to analyze the confounding factors associated with it. Materials and Methods: The present retrospective study analyzed pre- and posttreatment records of a total of 60 patients. Intraoral digital photographs before and after the orthodontic treatment were used to measure the following three periodontal variables: (a) width of the keratinized gingiva, (b) gingival recession, and (c) the status of interdental papilla. The ImageJ 46 software imaging program was used to perform the required measurements. The clinical data were then analyzed in an association with the participants’ demographic data, the type of orthodontic tooth movement, and other confounding factors. The data obtained were manually entered into the statistical package and analyzed using a significance level set at P < .05. Descriptive statistics, paired t-tests, and Pearson’s correlation analysis were used to identify differences among the studied variables. Results: Among the 60 patients, the majority (66.7%) were females. Most cases of the treated malocclusion were Class II, and most patients underwent intrusion and retrusion movements. The width of keratinized gingiva increased for most sites of upper teeth. In contrast, the lower teeth showed a mix of improvement and compromised width of keratinized gingiva. As a measure of gingival recession, the difference of clinical crown height revealed the tendency toward a reduced clinical crown height for most sites. Upper left lateral incisors and canines showed significant values with regard to keratinized gingival width measurements and tooth movements such as extrusion and intrusion movements. Likewise, with regard to the clinical crown height, upper right central incisors showed significant differences when correlated with the interincisal angle, lower incisors to the mandibular plane, and upper incisors to the NA line. The upper lateral incisors also showed significant correlations to certain cephalometric measurements. Conclusions: The orthodontic treatment was found to exert a significantly positive impact on the surrounding periodontium, particularly in the upper canine areas. Likewise, various types of tooth movement were found to positively affect the periodontium.

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