A Rule Based on Body Weight for Predicting the Optimum Depth of Spinal Needle Insertion for Lumbar Puncture in Children

2005 ◽  
Vol 12 (Supplement 1) ◽  
pp. 105-106 ◽  
Author(s):  
D. M. Stocker
Keyword(s):  
Body Weight ◽  
Lumbar Puncture ◽  
Needle Insertion ◽  
Spinal Needle ◽  
Rule Based ◽  
Optimum Depth

Computed tomography-guided transforaminal lumbar puncture using local anesthesia and a straight 22-gauge spinal needle for intrathecal nusinersen in adults: Findings in 77 procedures

2021 ◽  
pp. 159101992110328
Author(s):  
Mougnyan Cox ◽  
Kofi-Buaku Atsina ◽  
Preethi Ramchand ◽  
Jonathan Ji ◽  
Neda Sedora-Roman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Spinal Muscular Atrophy ◽  
Lumbar Puncture ◽  
Local Anesthesia ◽  
Muscular Atrophy ◽  
Intrathecal Administration ◽  
Spinal Needle ◽  
Technical Success ◽  
Computed Tomography Guidance ◽  
Blood Patch

Background Intrathecal nusinersen is the first Food and Drug Administration-approved treatment for spinal muscular atrophy. Reliable intrathecal access is critical for initial and maintenance therapy; however, this can be challenging in older patients with spinal muscular atrophy many of whom have had prior lumbar instrumentation and osseous fusion. Transforaminal lumbar punctures have emerged as a technique for intrathecal access that avoids the hazards of cervical punctures. We describe our technique for transforaminal lumbar punctures under computed tomography guidance using local anesthesia and a straight 22-gauge needle. Methods Following local institutional review board approval, medical records of all patients undergoing computed tomography-guided transforaminal lumbar puncture for intrathecal nusinersen injection were obtained and analyzed. The rate of technical success and immediate complications were recorded. Any delayed complications noted in a 3-day follow-up phone call and future office visit were also recorded. Data collation and analysis were performed using Excel. Results A total of 77 transforaminal lumbar punctures were performed with intrathecal administration of nusinersen, for a 100% technical success rate. Local anesthesia was used in 76 cases, with conscious sedation used in one case. General anesthesia was not used in any case. There were no major complications. One patient had a postdural puncture headache that resolved completely after a transforaminal epidural blood patch performed 4 days later. Conclusions Intrathecal administration of nusinersen is critical for treatment of patients with spinal muscular atrophy. Our described technique allows for reliable access to the intrathecal space using local anesthesia and a straight 22-gauge spinal needle under computed tomography guidance, and is easily reproducible.

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

Penetration detection with intention recognition for cooperatively controlled robotic needle insertion

2022 ◽  
pp. 014233122110693
Author(s):  
Yiyun Wang ◽  
Hongbing Li
Keyword(s):  
Lumbar Puncture ◽  
Needle Insertion ◽  
Robot System ◽  
Position Information ◽  
Tissue Properties ◽  
Intention Recognition ◽  
Loss Of Resistance ◽  
Recognition Ability ◽  
Robot Cooperation ◽  
Penetration Detection

In lumbar puncture surgeries, force and position information throughout the insertion procedure is vital for needle tip localization, because it reflects different tissue properties. Especially in pediatric cases, the changes are always insignificant for surgeons to sense the crucial feeling of loss of resistance. In this study, a robot system is developed to tackle the major clinical difficulties. Four different control algorithms with intention recognition ability are applied on a novel lumbar puncture robot system for better human–robot cooperation. Specific penetration detection based on force and position derivatives captures the feeling of loss of resistance, which is deemed crucial for needle tip location. Kinematic and actuation modeling provides a clear description of the hardware setup. The control algorithm experiment compares the human–robot cooperation performance of proposed algorithms. The experiment also dictates the clear role of designed penetration detection criteria in capturing the penetration, improving the success rate, and ensuring operational safety.

Role of Local Anesthesia During Lumbar Puncture in Neonates

PEDIATRICS ◽  
1993 ◽  
Vol 91 (2) ◽  
pp. 379-382 ◽  
Author(s):  
Joaquim M.B. Pinheiro ◽  
Sue Furdon ◽  
Luis F. Ochoa
Keyword(s):  
Success Rate ◽  
Lumbar Puncture ◽  
Local Anesthesia ◽  
Needle Insertion ◽  
Control Group ◽  
Anatomical Landmarks ◽  
Control Groups ◽  
Lidocaine Injection ◽  
Level Of Training ◽  
Physiologic Responses

Local anesthesia decreases physiologic responses to pain in neonates but has not been used routinely during lumbar punctures in newborns, as it might obscure anatomical landmarks. However, local anesthesia may decrease newborns' struggling during lumbar puncture, thus facilitating the procedure and increasing its success rate. The success rate of lumbar punctures was compared in neonates allocated prospectively to 0.2 to 0.5 mL of 1% lidocaine anesthesia (n = 48) or a control group (n = 52). Newborns were held in a modified lateral recumbent postion (neck not flexed) and their struggling response to the various steps in the lumbar puncture was scored by the holder. The newborns' struggling motion score increased in response to lidocaine injection, but response to the subsequent spinal needle insertion was significantly decreased. Despite this decreased motion, no differences were noted in the number of attempts per lumbar puncture (1.9 ± 0.2 [SEM] in lidocaine and 2.1 ± 0.2 in control groups), rate of lumbar puncture failure (15% in lidocaine and 19% in control groups), or the number of traumatic lumbar punctures (46% in both groups). The success rate of lumbar puncture was not dependent on level of training of physicians performing the procedure. No acute complications, cerebrospinal fluid contamination, or subsequent meningitis was noted in either group. It is concluded that local anesthesia with lidocaine decreases the degree of struggling but does not alter the success rate of lumbar puncture in neonates. The practice of withholding lidocaine anesthesia from neonates undergoing lumbar punctures cannot be justified by arguing that it makes the procedure more difficult to perform.

No touch technique for spinal needle insertion

2003 ◽  
Vol 12 (4) ◽  
pp. 310 ◽  
Author(s):  
Neeraj Kumar ◽  
Tripiti Sinha ◽  
V.K. Grover
Keyword(s):  
Needle Insertion ◽  
Spinal Needle

scholarly journals Syncopal Attack! - A Rare Complication after Whitacre Spinal Needle Insertion during Spinal Anaesthesia

2021 ◽  
Vol 10 (24) ◽  
pp. 1845-1847
Author(s):  
Sanjot Ninave ◽  
Aditya Rameshbabu Devalla
Keyword(s):  
Caesarean Section ◽  
Spinal Anaesthesia ◽  
Vasovagal Syncope ◽  
Needle Insertion ◽  
Spinal Needle ◽  
Common Mechanism ◽  
Lower Segment ◽  
Young Females ◽  
Lower Segment Caesarean Section ◽  
Sequence Of Events

Fine gauze spinal needles are known to decrease the incidence of postdural puncture headache (PDPH) in patients undergoing spinal anaesthesia. We present a rare case of syncopal attack in a patient posted for caesarean section. A patient undergoing elective surgery with inadequate anxiolysis can have a rare chance of a syncopal attack. Hence, high level of suspicion and management of a vasovagal attack is vital. The most common mechanism of syncope is reflex mediated, which can be ‘neurally’ or ‘vasovagally’, and it characteristically develops in the sitting or upright position but may occur in supine position also.1,2 It is characterized by a rapid onset, brief duration, and with a spontaneous recovery. Anxious and apprehensive patients prior to any surgical or anaesthetic procedure can lead to a vasovagal syncope, especially in young females.3 Medline search did not reveal any case report regarding the vasovagal syncope just after spinal needle insertion in young females undergoing spinal anaesthesia. Spinal anaesthesia is the most common anaesthesia performed for lower segment caesarean section (LSCS). A case of syncopal attack with sequence of events, during the insertion of a 25 G Whitacre spinal needle, in a parturient posted for emergency lower segment caesarean section, is discussed here.

scholarly journals Safety and Success of Lumbar Puncture in Young Infants: A Prospective Observational Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Luca Bedetti ◽  
Licia Lugli ◽  
Lucia Marrozzini ◽  
Alessandro Baraldi ◽  
Federica Leone ◽  
...  
Keyword(s):  
Body Weight ◽  
Adverse Events ◽  
Observational Study ◽  
Lumbar Puncture ◽  
Intraventricular Hemorrhage ◽  
Prospective Observational Study ◽  
Respiratory Support ◽  
Success Rates ◽  
Non Invasive ◽  
Young Infants

Objective: This study aims to evaluate safety and success rates of lumbar puncture (LP) and to identify factors associated with adverse events or failure of LP in infants.Methods: This two-center prospective observational study investigated infants younger than 90 days of age who underwent LP. Need for resuscitation oxygen desaturation (SpO2 &lt; 90%), bradycardia and intraventricular hemorrhage were considered adverse events. LP failed if cerebrospinal spinal fluid was not collected or had traces of blood. Logistic regression analysis was used to evaluate whether corrected gestational age (GA), body weight at LP, position, and any respiratory support during LP affected SpO2 desaturation or failure of LP.Results: Among 204 LPs, 134 were performed in full-term and 70 in pre-term born infants. SpO2 desaturations occurred during 45 (22.4%) LPs. At multivariate analysis, lower GA at LP (p &lt; 0.001), non-invasive respiratory support (p 0.007) and mechanical ventilation (p 0.004) were associated with SpO2 desaturations. Transient, self-resolving bradycardia occurred in 7 (3.4%) infants. Two infants had intraventricular hemorrhage detected within 72 h of LP. No further adverse events were registered. Failure of LP occurred in 38.2% of cases and was not associated with any of the factors evaluated.Conclusions: LP was safe in most infants. Body weight or GA at LP did not affect LP failure. These data are useful to clinicians, providing information on the safety of the procedure.

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