scholarly journals Ultrasonography for lumbar neuraxial block

2020 ◽  
Vol 15 (4) ◽  
pp. 397-408
Author(s):  
Seokha Yoo ◽  
Youngwon Kim ◽  
Sun-Kyung Park ◽  
Sang-Hwan Ji ◽  
Jin-Tae Kim
Keyword(s):  
Lumbar Spine ◽  
The Elderly ◽  
Needle Insertion ◽  
Current Evidence ◽  
Obese Patients ◽  
Ultrasound Guided ◽  
Insertion Point ◽  
Neuraxial Block ◽  
Intervertebral Level ◽  
Difficult Cases

Ultrasonography can be useful to perform a lumbar neuraxial block. It aids in understanding the anatomy of the lumbar spine before the procedure. Pre-procedural ultrasound imaging provides information about the accurate intervertebral level for puncture, optimal needle insertion point, and depth of needle advancement for a successful neuraxial block. The key ultrasonographic views for lumbar neuraxial block include the transverse midline interlaminar and parasagittal oblique views. Ultrasonography can facilitate lumbar neuraxial block in difficult cases, such as the elderly, obese patients, and patients with anatomical abnormality of the lumbar spine. This review elucidates the basics of spinal ultrasonography for lumbar neuraxial block and the current evidence regarding ultrasound-guided neuraxial block in adults.

scholarly journals The Use of Ultrasonography for the Guidance of Epidural Analgesia in Obstetric Anesthesia

2014 ◽  
Vol 8 (1) ◽  
pp. 44-51 ◽  
Author(s):  
Sanja Kupesic Plavsic ◽  
Hana Teissler ◽  
Claudia Lozano
Keyword(s):  
Lumbar Spine ◽  
Epidural Analgesia ◽  
Clinical Utility ◽  
Obstet Gynecol ◽  
Ultrasound Guidance ◽  
Obstetric Anesthesia ◽  
Review Article ◽  
Current Evidence ◽  
Clinical Approach ◽  
Ultrasound Guided

ABSTRACT This review article describes the development of the use of ultrasound guidance for neuraxial blocks in obstetric anesthesia. Current evidence of the clinical utility and application, basic lumbar spine sonoanatomy and practical clinical approach of the ultrasound-guided technique for neuraxial blocks are presented and discussed. Suggested curriculum is intended to prepare anesthesiology residents for application of ultrasound guidance in epidural analgesia and obstetric anesthesia. How to cite this article Teissler H, Lozano C, Kupesic Plavsic S. The Use of Ultrasonography for the Guidance of Epidural Analgesia in Obstetric Anesthesia. Donald School J Ultrasound Obstet Gynecol 2014;8(1):44-51.

scholarly journals Pre-Procedural Lumbar Neuraxial Ultrasound—A Systematic Review of Randomized Controlled Trials and Meta-Analysis

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 479
Author(s):  
Tatiana Sidiropoulou ◽  
Kalliopi Christodoulaki ◽  
Charalampos Siristatidis
Keyword(s):  
Systematic Review ◽  
Lumbar Spine ◽  
Randomized Controlled Trials ◽  
Success Rate ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Technical Failure ◽  
Obese Patients ◽  
Randomized Controlled ◽  
Meta Analyses

A pre-procedural ultrasound of the lumbar spine is frequently used to facilitate neuraxial procedures. The aim of this review is to examine the evidence sustaining the utilization of pre-procedural neuraxial ultrasound compared to conventional methods. We perform a systematic review of randomized controlled trials with meta-analyses. We search the electronic databases Medline, Cochrane Central, Science Direct and Scopus up to 1 June 2019. We include trials comparing a pre-procedural lumbar spine ultrasound to a non-ultrasound-assisted method. The primary endpoints are technical failure rate, first-attempt success rate, number of needle redirections and procedure time. We retrieve 32 trials (3439 patients) comparing pre-procedural lumbar ultrasounds to palpations for neuraxial procedures in various clinical settings. Pre-procedural ultrasounds decrease the overall risk of technical failure (Risk Ratio (RR) 0.69 (99% CI, 0.43 to 1.10), p = 0.04) but not in obese and difficult spinal patients (RR 0.53, p = 0.06) and increase the first-attempt success rate (RR 1.5 (99% CI, 1.22 to 1.86), p < 0.0001, NNT = 5). In difficult spines and obese patients, the RR is 1.84 (99% CI, 1.44 to 2.3; p < 0.0001, NNT = 3). The number of needle redirections is lower with pre-procedural ultrasounds (SMD = −0.55 (99% CI, −0.81 to −0.29), p < 0.0001), as is the case in difficult spines and obese patients (SMD = −0.85 (99% CI, −1.08 to −0.61), p < 0.0001). No differences are observed in procedural times. Ιn conclusion, a pre-procedural ultrasound provides significant benefit in terms of technical failure, number of needle redirections and first attempt-success rate. Τhe effect of pre-procedural ultrasound scanning of the lumbar spine is more significant in a subgroup analysis of difficult spines and obese patients.

Lumbar Spine Surgery in the Elderly

Spine ◽  
1994 ◽  
Vol 19 (13) ◽  
pp. 1431-1435 ◽  
Author(s):  
Bo Jönsson ◽  
Björn Strömqvist
Keyword(s):  
Lumbar Spine ◽  
Spine Surgery ◽  
The Elderly ◽  
Lumbar Spine Surgery ◽  
Surgery In The Elderly

Natural product-based nanomedicine: Recent advances and issues for the treatment of Alzheimer's disease

2021 ◽  
Vol 20 ◽  
Author(s):  
Choy Ker Woon ◽  
Wong Kah Hui ◽  
Razif Abas ◽  
Muhammad Huzaimi Haron ◽  
Srijit Das ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Natural Products ◽  
Medicinal Plants ◽  
Drug Transport ◽  
The Elderly ◽  
Current Evidence ◽  
Alternative Approach ◽  
Progressive Neurodegeneration ◽  
The Brain

: Alzheimer's disease (AD) affects the elderly and is characterized by progressive neurodegeneration caused by different pathologies. The most significant challenges in treating AD include the inability of medications to reach the brain because of its poor solubility, low bioavailability, and the presence of the blood-brain barrier (BBB). Additionally, current evidence suggests the disruption of BBB plays an important role in the pathogenesis of AD. One of the critical challenges in treating AD is the ineffective treatments and its severe adverse effects. Nanotechnology offers an alternative approach to facilitate the treatment of AD by overcoming the challenges in drug transport across the BBB. Various nanoparticles (NP) loaded with natural products were reported to aid in drug delivery for the treatment of AD. The nano- sized entities of NP are great platforms for incorporating active materials from natural products into formulations that can be delivered effectively to the intended action site without compromising the material’s bioactivity. The review highlights the applications of medicinal plants, their derived components, and various nanomedicine-based approaches for the treatment of AD. The combination of medicinal plants and nanotechnology may lead to new theragnostic solutions for the treatment of AD in the future.

scholarly journals Humeral Head Replacement and Reverse Shoulder Arthroplasty for the Treatment of Proximal Humerus Fracturesm

2017 ◽  
Vol 11 (1) ◽  
pp. 1108-1114 ◽  
Author(s):  
Aaron Andrew Frombach ◽  
Kendra Brett ◽  
Peter Lapner
Keyword(s):  
Shoulder Arthroplasty ◽  
New Technology ◽  
Reverse Shoulder Arthroplasty ◽  
Standard Of Care ◽  
The Elderly ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Current Evidence ◽  
Complication Rates ◽  
Surgical Fixation

Acute proximal humeral fractures in the elderly are generally treated non-operatively if alignment is acceptable and in stable fracture patterns. When operative treatment is indicated, surgical fixation is often difficult or impossible to obtain. Hemiarthroplasty has long been the standard of care. However, with its reliance on tuberosity healing, functional outcomes and patient satisfaction are often poor. Reverse shoulder arthroplasty has emerged as a new technology for treating proximal humeral fractures but the indications for its use remain uncertain. While not conclusive, the evidence suggests that reverse shoulder arthroplasty yields more consistent results, with improved forward elevation and higher functional outcome scores. The primary advantages of hemiarthroplasty are improved shoulder rotation and shorter operative time. Complication rates do not vary significantly between the two options. Although higher quality trials are needed to further define the role of reverse shoulder arthroplasty, current evidence suggests that this is a reasonable option for surgeons who are highly familiar with its use.

scholarly journals FUNCTIONAL ASSESSMENT OF OLDER OBESE PATIENTS CANDIDATES FOR BARIATRIC SURGERY

2014 ◽  
Vol 51 (1) ◽  
pp. 25-28 ◽  
Author(s):  
Denis PAJECKI ◽  
Marco Aurélio SANTO ◽  
Ana Lumi KANAGI ◽  
Daniel RICCIOPPO ◽  
Roberto de CLEVA ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Bariatric Surgery ◽  
Activities Of Daily Living ◽  
Functional Assessment ◽  
Daily Living ◽  
Functional Decline ◽  
The Elderly ◽  
Obese Patients ◽  
Instrumental Activities

Context Obesity in the elderly is associated with exacerbation of functional decline (dependency), that occurs with aging, because of decreased muscle mass and strength, and increased joint dysfunction. Consequently, there is progressive loss of independence, autonomy, chronic pain and impaired quality of life. The weight loss can bring benefits in all these aspects, especially when accompanied by exercises. Elderly patients with morbid obesity may be submitted to surgical treatment, taking into account that the massive weight loss, eventually caused by bariatric surgery, may exacerbate the loss of muscle mass and nutritional complications that may bring harm to the overall health and quality of life of these patients. The functional assessment of elderly patients, candidates for bariatric surgery and the extent to which surgery can bring benefits to the patients, in the field of functionality, has still to be determined. Objective To describe profile functionality in obese elderly referred to a bariatric surgery program. Methods Patients with age ≥60 and BMI ≥35 underwent comprehensive geriatric assessment that evaluates co morbidities, medication use, ability to perform basic activities of daily living and instrumental activities of daily living, and the “Timedupandgo” test to evaluate mobility, whose cut-off point was ≤10 seconds. Statistical analysis was performed in order to see if there is a positive correlation of dependency with BMI and age (over or under 65 years). Results Forty subjects have completed evaluation. The mean age was 64.1 years (60-72) and 75% were women. They had an average weight of 121.1 kg (72.7-204) and a mean BMI of 47.2 kg/m2 (35.8-68.9). 16 patients (40%) have shown dependency for activities of daily living, 19 (47,5%) for instrumental activities of daily living and 20 patients (50%) had a “Timedupandgo” test over 10 seconds. Statistical analysis (t-Student, Mann-Whitney, Binary Logistic Regression) has shown positive correlation of dependency in activities of daily living for BMI >49 kg/m2, dependency in instrumental activities of daily living for BMI >46,5 kg/m2, and “Timedupandgo” test greater than 10 seconds for BMI >51 kg/m2 (P<0,05). No dependency difference was observed for patients over or under 65 years age. Conclusions Functional decline is observed in almost half of the morbid obese patients over 60 years old. It is related to increasing BMI (BMI >46,5 kg/m2) but not related to age (60 to 65 years or over 65 years). Functional decline should be considered a co-morbidity in the elderly obese patients and should be assessed before bariatric surgery in this population.

scholarly journals Facet joint degeneration adversely affects ultrasound imaging of the lumbar spine

2019 ◽  
Vol 21 (2) ◽  
pp. 131
Author(s):  
Karthikeyan Srinivasan ◽  
Hong Kuan Kok ◽  
Mona Mubarak ◽  
William Torregianni ◽  
Robert Whitty
Keyword(s):  
Lumbar Spine ◽  
Ligamentum Flavum ◽  
Facet Joint ◽  
Posterior Longitudinal Ligament ◽  
Joint Degeneration ◽  
Neuraxial Block ◽  
Interspinous Space ◽  
Facet Joint Degeneration ◽  
Experienced Operator ◽  
Magnetic Resonance Imaging Mri

Aim: Ultrasound of neuraxis can be used to identify the best possible inter-spinous space to perform neuraxial block. The aim of this study was to assess the anatomical correlation between neuraxial ultrasound and magnetic resonance imaging (MRI).Material and method: Twenty-one patients who underwent MRI of the lumbar spine had ultrasound of lumbar neuraxis performed by an experienced operator. Each lumbar interspinous space was graded on ultrasound as good [posteriorcomplex (ligamentum flavum and duramater) and anterior complex (posterior longitudinal ligament) visible], intermediate (either anterior complex or posterior complex visible) or poor (both anterior complex and posterior complex not visible) in both the transverse median (TM) and paramedian sagittal oblique (PSO) plane. Pre-determined MRI parameters were measured by a radiologist blinded to sonographic findings at each inter-spinal level.Results: Seventy-eight lumbar interspinous spaces were evaluated. There was a significant association (p<0.004) between the facet joint degeneration on MRI and the poor ultrasound view in the transverse median (TM) group. The odds of obtaining a poor view in TM plane was 7 times higher (95% CI 1.7-28.9, p=0.007) in the presence of facet joint degeneration. None of the other variables had a significant association with a poor neuraxial view in the TM plane. Poor views in the parasagittal oblique (PSO) plane did not correlate with any of the variables measured on MRI.Conclusion: Facet joint degeneration is a major contributing factor to poor neuraxial ultrasound views in the TM plane. 

scholarly journals Unimed Recife's experience in treating 1,039 patients with Covid-19

2021 ◽  
Author(s):  
Marcelo Moraes Valença ◽  
Martha Maria Romeiro Figueiroa F. Fonseca ◽  
Cátia Arcuri Branco ◽  
Alex Maurício Garcia Santos ◽  
Antonio Oliveira ◽  
...  
Keyword(s):  
Health Management ◽  
Demographic Data ◽  
The Elderly ◽  
Obese Patients ◽  
Mechanical Ventilator ◽  
Average Hospital Stay ◽  
Average Hospital ◽  
Management Platform ◽  
Pathophysiological Process ◽  
Number Of Patients

ObjectiveTo describe the features related to patients with Covid-19 admitted to Unimed Recife hospitals, Recife, Brazil, evaluating demographic data, lethality, use of a mechanical ventilator, presence of associated diseases, the need to use the ICU, among other aspects related to the prognosis of these patients.MethodData were collected from the DRG Brazil health management platform, including the period from March 16, 2020, when the first patient with Covid-19 was admitted to the Hospital da Unimed III, until January 31, 2021. All patients admitted to one of the three hospitals of Unimed Recife - Hospital Unimed Recife I, Hospital Unimed Recife III, and Hospital Geral Unimed Recife – were included in the study. In the same period, we evaluated the number of patients with Covid-19 or suspected Covid-19 who were seen in the emergency room at Hospital Unimed Recife III.ResultsOne hundred twenty-six thousand five hundred fifty-three patients were seen in the Emergency Unit of Hospital Unimed Recife III in the period between March 26, 2020, and January 31, 2021; of those 126,553 patients seen in the emergency 39,340 (31.09%) patients were diagnosed with having Covid-19 or suspected of Covid-19. In the 10-month period, 1,039 patients with Covid-19 were hospitalized, 61% with hypertension, 31.1% with SARS, 30.0% with diabetes, and 9.9% were obese. The average hospital stay was 11.2 days. 342/1,039 (32.9%) patients were admitted to the ICU, and 57.9% of them had mechanical ventilation. The overall lethality was 13.76% (143 deaths/1,039 inpatients). An increase in lethality by Covid-19 was associated with increased age. Lethality in the first period of the Covid-19 pandemic was significantly higher when compared to the last 5 months of the pandemic(17.6% versus 9.7%). Obesity significantly increased lethality in patients with Covid-19 [120 deaths/1,016 non-obese patients (11.8%) versus 23 deaths/103 obese patients (22.3%), OR 2.15 (1.30 - 3.50), p = 0.005)].ConclusionWe conclude that Covid-19 is a disease with a poor prognosis, especially in the elderly and obese patients. In the second 5-month period of the Covid-19 pandemic, we noticed a significant reduction in lethality by Covid-19 in hospitalized patients. Covid-19 is a new disease and the mechanism by which the viruses multiply or how the pathophysiological process occurs in the infected organism are still barely understood.

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