scholarly journals Optimal angle of needle insertion for spinal anesthesia in patients with spondylolisthesis: an ultrasonographic study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Youngwon Kim ◽  
Seokha Yoo ◽  
Sun-Kyung Park ◽  
Hansu Bae ◽  
Young-Jin Lim ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Ultrasound Image ◽  
Image Data ◽  
Needle Insertion ◽  
Oblique View ◽  
Optimal Angle ◽  
Link Type ◽  
Upper Level ◽  
Positive Angle ◽  
Lumbar Spondylolisthesis

Abstract Background Spondylolisthesis is a common degenerative spinal deformity. At the level of spondylolisthesis, the anatomy of the interlaminar space may differ from normal spine, in which case optimal angle of the needle insertion for spinal anesthesia may change. This study compared the optimal angle of needle insertion during spinal anesthesia in patients with and without lumbar spondylolisthesis using ultrasound. Methods We recruited 40 patients, 20 with and 20 without lumbar spondylolisthesis (group S and N, respectively). Ultrasonography was performed in the transverse midline and parasagittal oblique views at the spondylolisthesis level and the adjacent upper level. We measured the probe application angle with the longest interlaminar height of the ligamentum flavum-dura mater complex (LFD), depth from the skin to the LFD, depth from the skin to the anterior complex, and intrathecal space width. A positive angle represented a cephalad angulation. Results The optimal needle insertion angle in the transverse midline view at the spondylolisthesis level was (-) 2.7 ± 3.4° in group S and 0.8 ± 2.5° in group N (P$$<$$ < 0.001). In the parasagittal oblique view, it was (-) 2.7 ± 4.5° in group S and 1.0 ± 3.2° in group N (P = 0.004). There were no between-group differences in the angles at the upper level, with all cephalad angles in both views. Other ultrasound image data were comparable between groups. Conclusion In patients with spondylolisthesis, caudad angulation of the spinal needle can aid successful spinal puncture at spondylolisthesis level, both in the midline and paramedian approaches. Trial registration www.ClinicalTrials.gov (NCT04426916); registered 11 June 2020.

scholarly journals The transverse diameter of right common femoral vein by ultrasound in the supine position for predicting post-spinal hypotension during cesarean delivery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shi-Fa Yao ◽  
Yan-Hong Zhao ◽  
Jing Zheng ◽  
Jie-Yan Qian ◽  
Chen Zhang ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Femoral Vein ◽  
Elective Cesarean Section ◽  
Gravid Uterus ◽  
Transverse Diameter ◽  
Common Femoral Vein ◽  
Link Type ◽  
Spinal Hypotension ◽  
Receiver Operating

Abstract Background Post-spinal anesthesia hypotension during cesarean delivery is caused by decreased systemic vascular resistance due to the blockage of the autonomic nerves, which is further worsened by inferior vena cava (IVC) compression by the gravid uterus. This study aimed to assess whether peak velocity and diameter of the IVC below the xiphoid or right common femoral vein (RCFV) in the inguinal region, as measured on ultrasound, could reflect the degree of IVC compression and further identify parturients at risk of post-spinal hypotension. Methods Fifty-six parturients who underwent elective cesarean section with spinal anesthesia were included in this study; peak velocities and anteroposterior diameters of the IVC and peak velocities and transverse diameters of the RCFV were measured using ultrasound before anesthesia. The primary outcome was the ultrasound measurements of IVC and RCFV acquired before spinal anesthesia and their association with post-spinal hypotension. Hypotension was defined as a drop in systolic arterial pressure by > 20% from the baseline. Multinomial logistic regression analysis was used to identify the association between the measurements of IVC, RCFV, and post-spinal hypotension during cesarean delivery. Receiver operating characteristic curves were used to test the abilities of the identified parameters to predict post-spinal hypotension; the areas under the curve and optimum cut-off values for the predictive parameters were calculated. Results A longer transverse diameter of the RCFV was associated with the occurrence of post-spinal hypotension (odds ratio = 2.022, 95% confidence interval [CI] 1.261–3.243). The area under the receiver operating characteristics curve for the prediction of post-spinal hypotension was 0.759 (95% CI 0.628–0.890, P = 0.001). A transverse diameter of > 12.2 mm of the RCFV could predict post-spinal hypotension during cesarean delivery. Conclusions A longer transverse diameter of RCFV was associated with hypotension and could predict parturients at a major risk of hypotension before anesthesia. Trial registration This study was registered at http://www.chictr.org.cn on 16, May, 2018. No. ChiCTR1800016163.

scholarly journals Comparison of the effects of sagittal versus transvers 25-gauge quincke needle insertion on post-dural puncture headache development

2020 ◽  
Vol 7 (7) ◽  
pp. 554-559
Author(s):  
Mehmet Tercan ◽  
Tuğba Bingöl Tanrıverdi ◽  
Gülçin Patmano ◽  
Ahmet Atlas ◽  
Ahmet Kaya ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Dura Mater ◽  
Dural Puncture ◽  
Multivariate Logistic Regression Analysis ◽  
Needle Insertion ◽  
Spinal Needle ◽  
Post Dural Puncture Headache ◽  
Spinal Puncture ◽  
American Society

Objective: Post-dural puncture headache (PDPH) is one of the most important complications after spinal anesthesia. This study aimed to investigate the effect of the sagittal or transverse application of 25-gauge Quincke spinal needle on PDPH development in patients undergoing cesarean section. Material and Methods: A total of 295 patients with a planned cesarean section between the ages of 18-40 years with an American Society of Anesthesiologists score of 1 or 2 were included in the study. For the spinal intervention, 25-gauge Quincke spinal needle was used in all patients. Patients were included in one of two groups according to the spinal needle cutting direction of the dura mater fibers as sagittal (parallel to dura mater fibers, Group S; n=145) or transverse group (perpendicular to dura mater fibers, Group T; n=150). Results: PDPH developed in 27 (9.2%) patients. Patients in Group T had significant higher ratio of PDPH compared to patients in Group S (16% vs. 2.1%, p<0.001). Additionally, patients with PDPH had a significantly higher frequency of ≥2 spinal puncture attempts compared to patients without PDPH (22.2% vs. 4.5%, p=0.003). Multivariate logistic regression analysis demonstrated that transverse needle direction (OR: 11.40, 95% CI: 2.73-34.71; p<0.001) and ≥2 spinal puncture attempts (OR: 9.73, 95% CI: 3.13-41.55; p<0.001) and were independent predictors for PDPH development. Conclusion: Transverse insertion of the 25-gauge Quincke needle into spinal cord fibers and repeated interventions are independently associated with the development of PDPH in cesarean section patients undergoing spinal anesthesia

The Optimal Angle of Needle Insertion for Caudal Block in Adults

2008 ◽  
Vol 54 (3) ◽  
pp. 295 ◽  
Author(s):  
Ho Dong Rhee ◽  
Duck Mi Yoon ◽  
Eun Young Park ◽  
Hyung Seok Lee ◽  
Kyung Bong Yoon ◽  
...  
Keyword(s):  
Needle Insertion ◽  
Caudal Block ◽  
Optimal Angle

Evidence That Intravenous Vasopressors Can Affect Rostral Spread of Spinal Anesthesia in Pregnancy

2004 ◽  
Vol 101 (1) ◽  
pp. 28-33 ◽  
Author(s):  
David W. Cooper ◽  
Leo Jeyaraj ◽  
Ryan Hynd ◽  
Rebekah Thompson ◽  
Tim Meek ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Epidural Space ◽  
Systolic Arterial Pressure ◽  
Light Touch ◽  
Double Blind ◽  
Touch Sensation ◽  
Upper Level ◽  
Combined Spinal Epidural Anesthesia ◽  
In Pregnancy

Background The authors have previously observed an apparent association between rostral spread of spinal anesthesia and choice of intravenous vasopressor given to maintain maternal systolic arterial pressure during cesarean delivery. This study tested the hypothesis that an intravenous infusion of phenylephrine can reduce rostral spread of spinal anesthesia in pregnancy, compared with ephedrine. Methods The study was randomized and double blind. It compared phenylephrine 100 microg/ml (phenylephrine group, n = 30), and ephedrine 3 mg/ml (ephedrine group, n = 30), given by infusion, to prevent maternal hypotension during combined spinal-epidural anesthesia for cesarean delivery. Two ml intrathecal plain levobupivacaine, 0.5%, combined with 0.4 ml intrathecal fentanyl, 50 microg/ml, and 10 ml epidural saline was given with the patient in the sitting position. The upper level of neural blockade to cold and light touch sensation was recorded at 10 and 20 min postspinal. Epidural space pressure was recorded at 5, 10, 15, and 20 min. Results At 20 min, the upper dermatome blocked to cold sensation was median T3 (interquartile range, T2-T4) for the phenylephrine group, compared with T1 (T1-T2) for the ephedrine group (P = 0.001). At 20 min, the upper dermatome blocked to light touch sensation was median T5 (T4-T8) for the phenylephrine group, compared with T3 (T2-T6) for the ephedrine group (P = 0.009). The mean epidural space pressure in the phenylephrine group was 16 (13-19) mmHg, compared with 16 (13-18) mmHg in the ephedrine group (P = 0.63). Conclusions This study provides evidence that intravenous phenylephrine can decrease rostral spread of spinal anesthesia in pregnancy, compared with intravenous ephedrine. Further work is required to investigate possible mechanisms and to assess its clinical significance.

Toward hemodynamic diagnosis of carotid artery stenosis based on ultrasound image data and computational modeling

2014 ◽  
Vol 52 (11) ◽  
pp. 971-983 ◽  
Author(s):  
Luísa C. Sousa ◽  
Catarina F. Castro ◽  
Carlos C. António ◽  
André Miguel F. Santos ◽  
Rosa Maria dos Santos ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Computational Modeling ◽  
Carotid Artery Stenosis ◽  
Ultrasound Image ◽  
Image Data ◽  
Artery Stenosis

scholarly journals A New Classification Method in Ultrasound Images of Benign and Malignant Thyroid Nodules Based on Transfer Learning and Deep Convolutional Neural Network

Complexity ◽  
2021 ◽  
Vol 2021 ◽  
pp. 1-9 ◽  
Author(s):  
Weibin Chen ◽  
Zhiyang Gu ◽  
Zhimin Liu ◽  
Yaoyao Fu ◽  
Zhipeng Ye ◽  
...  
Keyword(s):  
Neural Network ◽  
Convolutional Neural Network ◽  
Transfer Learning ◽  
Thyroid Nodules ◽  
Ultrasound Image ◽  
Image Data ◽  
Data Sets ◽  
Thyroid Ultrasound ◽  
Joint Training ◽  
Secondary Transfer

Thyroid nodule is a clinical disorder with a high incidence rate, with large number of cases being detected every year globally. Early analysis of a benign or malignant thyroid nodule using ultrasound imaging is of great importance in the diagnosis of thyroid cancer. Although the b-mode ultrasound can be used to find the presence of a nodule in the thyroid, there is no existing method for an accurate and automatic diagnosis of the ultrasound image. In this pursuit, the present study envisaged the development of an ultrasound diagnosis method for the accurate and efficient identification of thyroid nodules, based on transfer learning and deep convolutional neural network. Initially, the Total Variation- (TV-) based self-adaptive image restoration method was adopted to preprocess the thyroid ultrasound image and remove the boarder and marks. With data augmentation as a training set, transfer learning with the trained GoogLeNet convolutional neural network was performed to extract image features. Finally, joint training and secondary transfer learning were performed to improve the classification accuracy, based on the thyroid images from open source data sets and the thyroid images collected from local hospitals. The GoogLeNet model was established for the experiments on thyroid ultrasound image data sets. Compared with the network established with LeNet5, VGG16, GoogLeNet, and GoogLeNet (Improved), the results showed that using GoogLeNet (Improved) model enhanced the accuracy for the nodule classification. The joint training of different data sets and the secondary transfer learning further improved its accuracy. The results of experiments on the medical image data sets of various types of diseased and normal thyroids showed that the accuracy rate of classification and diagnosis of this method was 96.04%, with a significant clinical application value.

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