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.

Position for Lumbar Punctures

PEDIATRICS ◽  
1992 ◽  
Vol 89 (5) ◽  
pp. 976-976
Author(s):  
JOAQUIM M.B. PINHEIRO
Keyword(s):  
Clinical Trial ◽  
Head And Neck ◽  
Lumbar Puncture ◽  
Local Anesthesia ◽  
Controlled Clinical Trial ◽  
Lateral Neck ◽  
Physiologic Responses ◽  
Fetal Position

To the Editor.— In "A Controlled Clinical Trial of Local Anesthesia for Lumbar Punctures in Newborns"1 Porter et al reported on their attempt to decrease lumbar puncture-induced physiologic instability by using lidocaine. While the cardiorespiratory measures of physiologic instability were not affected by local anesthesia, they were influenced significantly and adversely by the preparatory procedure (ie, being held flexed in the fetal position). As pointed out by the authors, the position chosen for the procedure, which included knees to chest plus flexion of head and neck has been shown to induce more adverse physiologic responses than either the sitting or the modified lateral (neck not flexed) position.2,3

scholarly journals Effect of iRoot BP Plus Pulpotomy for Immediate Repair in Children with Young Permanent Teeth Crown Fracture

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Jiaying Song
Keyword(s):  
Success Rate ◽  
Clinical Effect ◽  
Permanent Teeth ◽  
Control Group ◽  
Observation Group ◽  
Control Groups ◽  
Before And After ◽  
Random Number Table ◽  
The Difference ◽  
And Control

Objective: To explore the clinical effect of iRoot BP Plus pulpotomy for immediate repair in children with young permanent teeth crown fracture. Methods: From September 2017 to October 2018, 80 children (80 affected teeth) with young permanent teeth crown fracture who treated in the hospital were selected as the research objects. Random number table method was used to divide them into observation and control groups with each group of forty patients (40 affected teeth). The children in the control group were treated with calcium hydroxide resin, while the observation group were treated with iRoot BP Plus for immediate repair. The surgical success rate was compared between the two groups, and the pulp vitality before and after treatment were compared. Results: At 3 months and 6 months after surgery, the success rate of children in the observation group was higher than that in the control group, and the difference was statistically significant (P<0.05). The percentage of children with negative pulp activity in the observation group was higher than that in the control group, and the difference was statistically significant (P<0.05). Conclusion: Immediate repair with iRoot BP Plus pulpotomy in children with young permanent teeth crown fracture has significant clinical effect.

A Controlled Clinical Trial of Local Anesthesia for Lumbar Punctures in Newborns

PEDIATRICS ◽  
1991 ◽  
Vol 88 (4) ◽  
pp. 663-669 ◽  
Author(s):  
Fran L. Porter ◽  
J. Philip Miller ◽  
F. Sessions Cole ◽  
Richard E. Marshall
Keyword(s):  
Carbon Dioxide ◽  
Clinical Trial ◽  
Heart Rate ◽  
Lumbar Puncture ◽  
Local Anesthesia ◽  
Subcutaneous Administration ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Transcutaneous Oxygen ◽  
Experimental Group

To evaluate the efficacy of subcutaneous administration of lidocaine for reducing physiologic instability in acutely ill newborns during clinically required procedures, 81 neonates who required lumbar punctures within the first month of life were stratified by birth weight and respiratory support and randomly assigned to an experimental or a control group. The experimental group received an injection of 0.1 mL/kg of 1% lidocaine prior to the lumbar puncture. The control group received a nonanesthetized lumbar puncture without placebo. Changes in heart rate, respiratory rate, transcutaneous oxygen and carbon dioxide tensions, and heart rate variability from baseline, preparatory (positioning/handling), lumbar puncture, and recovery periods were measured. The administration of lidocaine did not minimize physiologic instability in response to the lumbar puncture nor was it associated with any detectable adverse effects other than prolonging the duration of the lumbar puncture. Although significant physiologic changes were observed in response to preparatory procedures, few additional changes beyond those occurred in response to lumbar punctures in either the experimental or control group. It is concluded that local anesthesia failed to influence manifestations of physiologic instability during neonatal lumbar punctures and that preparatory procedures were more destabilizing than either the administration of lidocaine or the lumbar puncture itself. The results suggest that the management of newborns requires emphasis on minimizing the destabilizing effects of required and frequent handling procedures.

Real-time Ultrasound-Guided Lumbar Epidural with Transverse Interlaminar View: Evaluation of an In-Plane Technique

Pain Medicine ◽  
2019 ◽  
Vol 20 (9) ◽  
pp. 1750-1755 ◽  
Author(s):  
Hesham Elsharkawy ◽  
Wael Saasouh ◽  
Rovnat Babazade ◽  
Loran Mounir Soliman ◽  
Jean-Louis Horn ◽  
...  
Keyword(s):  
Success Rate ◽  
Real Time ◽  
Epidural Anesthesia ◽  
Needle Insertion ◽  
Adult Patients ◽  
Epidural Needle ◽  
Anatomical Landmarks ◽  
Care Hospital ◽  
Open Prostatectomy ◽  
Ultrasound Guided

Abstract Objective The anatomical landmarks method is currently the most widely used technique for epidural needle insertion and is faced with multiple difficulties in certain patient populations. Real-time ultrasound guidance has been recently used to aid in epidural needle insertion, with promising results. Our aim was to test the feasibility, success rate, and satisfaction associated with a novel real-time ultrasound-guided lumbar epidural needle insertion in the transverse interlaminar view. Design Prospective descriptive trial on a novel approach. Setting Operating room and preoperative holding area at a tertiary care hospital. Subjects Adult patients presenting for elective open prostatectomy and planned for surgical epidural anesthesia. Methods Consented adult patients aged 30–80 years scheduled for open prostatectomy under epidural anesthesia were enrolled. Exclusion criteria included allergy to local anesthetics, infection at the needle insertion site, coagulopathy, and patient refusal. A curvilinear low-frequency (2–5 MHz) ultrasound probe and echogenic 17-G Tuohy needles were used by one of three attending anesthesiologists. Feasibility of epidural insertion was defined as a 90% success rate within 10 minutes. Results Twenty-two patients were enrolled into the trial, 14 (63.6%) of whom found the process to be satisfactory or very satisfactory. The median time to perform the block was around 4.5 minutes, with an estimated success rate of 95%. No complications related to the epidural block were observed over the 48 hours after the procedure. Conclusions We demonstrate the feasibility of a novel real-time ultrasound-guided epidural with transverse interlaminar view.

Use of Remifentanil Associated with Lidocaine for Feticides in Late Terminations of Pregnancy: A Randomized Clinical Trial

2021 ◽  
pp. 1-7
Author(s):  
Romy Rayssiguier ◽  
Florent Fuchs ◽  
Eve Mousty ◽  
Estelle Morau ◽  
Tarik Hlioua ◽  
...  
Keyword(s):  
Side Effects ◽  
Success Rate ◽  
Harmful Effect ◽  
Phase Iii ◽  
Secondary Outcome ◽  
Control Group ◽  
Lidocaine Injection ◽  
Maternal Tolerance ◽  
Remifentanil Group ◽  
Maternal Side

<b><i>Introduction:</i></b> In France, performance of a termination of pregnancy is legally possible without any gestational age limit. After 22 weeks of gestation, a feticide is ethically performed using usually sufentanil and lidocaine. The aim of this study was to compare the use of remifentanil, a fast-acting morphine-derivating product, instead of sufentanil. <b><i>Methods:</i></b> This 2-center randomized, controlled, single-blinded phase-III treatment trial had 2 parallel arms: an experimental group using remifentanil with lidocaine versus a control group receiving sufentanil associated with lidocaine. This trial took place over a 40-month period. The primary outcome was time to fetal asystole after lidocaine injection. The secondary outcome measures were the procedure’s success rate, the rate of serious maternal side effects, and the presence of cellular or tissue modifications. <b><i>Results:</i></b> The study included 66 women, randomized into 2 groups of similar size and characteristics. Time to fetal asystole did not differ significantly between the groups, with a delay of 4 min (Q1−Q3, 2–11) in the sufentanil group and 4 min (Q1−Q3, 1–10) in the remifentanil group (<i>p</i> = 0.84). Similarly, the success rate of the procedure did not differ significantly. Fetal asystole was procured in &#x3c;2 min and persisted &#x3e;1 min for 16 (25.8%) women in our total population: 7 (22.5%) in the sufentanil group and 9 (29.0%) in the remifentanil group, <i>p</i> = 0.77. No severe maternal side effects were observed. Among the 49 fetopathological examinations performed, the few tissue and cell modifications observed did not cause any interpretation difficulties in either group. <b><i>Discussion/Conclusion:</i></b> Use of remifentanil instead of sufentanil for feticide procedure did not improve time to fetal asystole. No harmful effect was observed for either maternal tolerance or interpretation of the histologic slides.

scholarly journals Effect of Preoperative Intravitreal Bevacizumab on the Surgical Outcome of Neovascular Glaucoma at Different Stages

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Junki Kwon ◽  
Kyung Rim Sung
Keyword(s):  
Success Rate ◽  
Surgical Outcome ◽  
Intravitreal Bevacizumab ◽  
Neovascular Glaucoma ◽  
Control Group ◽  
Ahmed Glaucoma Valve ◽  
Control Groups ◽  
And Control ◽  
Positive Effect

Purpose. To evaluate the effect of preoperative intravitreal bevacizumab (IVB) injection on the surgical outcome of Ahmed glaucoma valve (AGV) implantation according to the angle status in neovascular glaucoma (NVG) eyes. Materials and Methods. This retrospective study included 70 NVG patients who underwent AGV implantation and were followed up for at least 12 months. An IVB injection before AGV implantation was administered to 45 eyes (IVB group), while it was not administered to 25 eyes (control group). Subgroup analyses were done at different stages in terms of the extent of peripheral anterior synechiae (PAS). Results. Mean follow-up period after AGV implantation was 27 ± 15 months. The IVB group showed higher prevalence of the eyes with less than 50% of PAS than that of the control group (78% versus 44%). The overall success rate 1 year postoperatively was 80% and 64% for the IVB and control groups, respectively (P=0.142). When PAS extent was less than 50%, preoperative IVB had a marginally positive effect on surgical outcome (HR = 0.39, P=0.064, per 1-time IVB injection). Conclusions. Preoperative IVB may enhance the success rate of AGV implantation in NVG eyes, before PAS has extensively formed. Further prospective randomized studies controlling the extent of PAS are warranted.

Virtual Reality Simulator for the Training of Lumbar Punctures

2009 ◽  
Vol 48 (05) ◽  
pp. 493-501 ◽  
Author(s):  
F. Hummel ◽  
C. Gerloff ◽  
H. Handels ◽  
M. Färber
Keyword(s):  
Virtual Reality ◽  
Medical Students ◽  
Lumbar Puncture ◽  
Degrees Of Freedom ◽  
Training Session ◽  
Needle Insertion ◽  
Control Group ◽  
Lumbar Region ◽  
Real Patient ◽  
Strongly Agree

Summary Objectives: Lumbar puncture (LP) is performed by inserting a needle into the spinal canal to extract cerebrospinal fluid for diagnostic purposes. A virtual reality (VR) lumbar puncture simulator based on real patient data has been developed and evaluated. Methods: A haptic device with six degrees of freedom is used to steer the virtual needle and to generate feedback forces that resist needle insertion and rotation. An extended haptic volume-rendering approach is applied to calculate forces. This approach combines information from segmented data and original CT data which contributes density information in unsegmented image structures. The system has been evaluated in a pilot study with medical students. Participants of two groups, a training and a control group, completed different first training protocols. User performance has been recorded during a second training session to measure the training effect. Furthermore user acceptance has been evaluated in a questionnaire using a 6-point Likert scale with eight items. Results: Forty-two medical students in two groups evaluated the system. Trained users performed better than less trained users (an average of 39% successfully completed virtual LPs compared to 30%). Findings of the questionnaire show that the simulator is very well accepted. E.g. the users agree that training with such a simulator is useful (Likert grade of 1.5 ± 0.7 with 1 = “strongly agree” and 6 = “strongly disagree”). Conclusions: Results show that the VR LP simulator gives a realistic haptic and visual impression of the needle insertion and enables new insights into the anatomy of the lumbar region. It offers a new way for increasing skills of students and young residents before applying an LP in patients.

Conjugated Linoleic Acid Causes a Marked Increase in Liver α-Tocopherol and Liver α-Tocopherol Transfer Protein in C57BL/6 J Mice

2010 ◽  
Vol 80 (1) ◽  
pp. 65-73 ◽  
Author(s):  
Pei-Min Chao ◽  
Wan-Hsuan Chen ◽  
Chun-Huei Liao ◽  
Huey-Mei Shaw
Keyword(s):  
Antioxidant Enzymes ◽  
Linoleic Acid ◽  
Conjugated Linoleic Acid ◽  
Thiobarbituric Acid ◽  
Control Group ◽  
Thiobarbituric Acid Reactive Substances ◽  
Control Groups ◽  
Protein Levels ◽  
Transfer Protein ◽  
And Control

Conjugated linoleic acid (CLA) is a collective term for the positional and geometric isomers of a conjugated diene of linoleic acid (C18:2, n-6). The aims of the present study were to evaluate whether levels of hepatic α-tocopherol, α-tocopherol transfer protein (α-TTP), and antioxidant enzymes in mice were affected by a CLA-supplemented diet. C57BL/6 J mice were divided into the CLA and control groups, which were fed, respectively, a 5 % fat diet with or without 1 g/100 g of CLA (1:1 mixture of cis-9, trans-11 and trans-10, cis-12) for four weeks. α-Tocopherol levels in plasma and liver were significantly higher in the CLA group than in the control group. Liver α-TTP levels were also significantly increased in the CLA group, the α-TTP/β-actin ratio being 2.5-fold higher than that in control mice (p<0.01). Thiobarbituric acid-reactive substances were significantly decreased in the CLA group (p<0.01). There were no significant differences between the two groups in levels of three antioxidant enzymes (superoxide dismutase, glutathione peroxidase, and catalase). The accumulation of liver α-tocopherol seen with the CLA diet can be attributed to the antioxidant potential of CLA and the ability of α-TTP induction. The lack of changes in antioxidant enzyme protein levels and the reduced lipid peroxidation in the liver of CLA mice are due to α-tocopherol accumulation.

Sri Lankan Cleft Lip and Palate Study Model Analysis: Clefts of the Secondary Palate

1993 ◽  
Vol 30 (2) ◽  
pp. 227-230 ◽  
Author(s):  
Andrew Mccance ◽  
David Roberts-Harry ◽  
Martyn Sherriff ◽  
Michael Mars ◽  
William J.B. Houston
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Model Analysis ◽  
Control Group ◽  
Tooth Size ◽  
Sri Lankan ◽  
Control Groups ◽  
Secondary Palate ◽  
Comparable Control ◽  
And Control

The study models of a group of adult Sri Lankan patients with clefts of the secondary palate were investigated. Tooth-size and arch-dimension comparisons were made with a comparable control group. Significant differences were found between the cleft and control groups in tooth sizes, chord lengths, and arch widths. The cleft group dimensions were generally smaller than those of the control group. Overjets were larger in the cleft group.

THE EFFECT OF APPLYING ANIMAL CARTOON PICTURES ON STUDENTS’ ACHIEVEMENT IN WRITING NARRATIVE TEXT

2017 ◽  
Vol 6 (1) ◽  
Author(s):  
Hasanul Arifin Zul And Masitowarni Siregar
Keyword(s):  
T Test ◽  
Narrative Text ◽  
Control Group ◽  
First Year ◽  
Writing Achievement ◽  
Control Groups ◽  
Post Test ◽  
Written Test ◽  
And Control ◽  
Experimental Group

This thesis is focused on the investigation of the effect of applying animal cartoon pictures on students’ achievement in writing narrative text. This study aims to find whether applying animal cartoon pictures significantly affect the students’ writing achievement or not. The data in this study were obtained by administering a written test. The population was the 2015/2016 first year (grade XI) of SMA Swasta Nusantara Lubuk Pakam and 66 students were taken as the sample by using random sampling. The sample was divided into two groups, experimental and control groups. The experimental group was taught by applying animal cartoon pictures while the control group without animal cartoon pictures (x = lecturing). The data were taken the scores from the pre-test and post-test to both experimental and control groups. These data were analyzed by using t-test. The result of computing the t-test obviously showed that t-observed is higher than t-table (5.21 >1,67) with the degree of freedom 64 (df =N-2) at the level significance 0,05 one tail test. It showed that the application of animal cartoon pictures significantly affected the students of SMA Swasta Nusantara Lubuk Pakam achievement in writing narrative text.

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