scholarly journals Comparison of landmark and real-time ultrasound-guided epidural catheter placement in the pediatric population: a prospective randomized comparative trial

2021 ◽  
Author(s):  
Tanya Mital ◽  
Manoj Kamal ◽  
Mritunjay Kumar ◽  
Rakesh Kumar ◽  
Pradeep Bhatia ◽  
...  
Keyword(s):  
Success Rate ◽  
Real Time ◽  
Epidural Catheter ◽  
Epidural Space ◽  
Pediatric Population ◽  
Comparative Trial ◽  
Epidural Needle ◽  
Ultrasound Guided ◽  
Significant Difference ◽  
The Us

Background: Epidural block placement in pediatric patients is technically challenging for anesthesiologists. The use of ultrasound (US) for the placement of an epidural catheter has shown promise. We compared landmark-guided and US-guided lumbar or lower thoracic epidural needle placement in pediatric patients.Methods: This prospective, randomized, comparative trial involved children aged 1–6 years who underwent abdominal and thoracic surgeries. Forty-five children were randomly divided into two groups using a computer-generated random number table, and group allocation was performed by the sealed opaque method into either landmark-guided (group LT) or real-time ultrasound-guided (group UT) epidural placement. The primary outcome was a comparison of the procedure time (excluding US probe preparation). Secondary outcomes were the number of attempts (re-insertion of the needle), bone contacts, needle redirection, skin-to-epidural distance using the US in both groups, success rate, and complications.Results: The median (interquartile range [IQR]) time to reach epidural space was 105.5 (297.0) seconds in group LT and 143.0 (150) seconds in group UT; P = 0.407). While the first attempt success rate was higher in the UT group (87.0% in UT vs. 40.9% in LT; P = 0.004), the number of bone contacts, needle redirections, and procedure-related complications were significantly lower. Conclusions: The use of US significantly reduced needle redirection, number of attempts, bone contact, and complications. There was no statistically significant difference in the time to access the epidural space between the US and landmark technique groups.

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.

Real-time ultrasound-guided low thoracic epidural catheter placement: technical consideration and fluoroscopic evaluation

2021 ◽  
pp. rapm-2021-102578
Author(s):  
Doo-Hwan Kim ◽  
Jong-Hyuk Lee ◽  
Ji Hoon Sim ◽  
Wonyeong Jeong ◽  
Dokyeong Lee ◽  
...  
Keyword(s):  
Success Rate ◽  
Real Time ◽  
Epidural Catheter ◽  
Epidural Space ◽  
Catheter Placement ◽  
Epidural Catheter Placement ◽  
Thoracic Epidural ◽  
Us Guidance ◽  
Thoracic Epidural Catheter ◽  
First Pass

Background and objectiveThoracic epidural analgesia can significantly reduce acute postoperative pain. However, thoracic epidural catheter placement is challenging. Although real-time ultrasound (US)-guided thoracic epidural catheter placement has been recently introduced, data regarding the accuracy and technical description are limited. Therefore, this prospective observational study aimed to assess the success rate and describe the technical considerations of real-time US-guided low thoracic epidural catheter placement.Methods38 patients in the prone position were prospectively studied. After the target interlaminar space between T9 and T12 was identified, the needle was advanced under real-time US guidance and was stopped just short of the posterior complex. Further advancement of the needle was accomplished without US guidance using loss-of-resistance techniques to normal saline until the epidural space was accessed. Procedure-related variables such as time to mark space, needling time, number of needle passes, number of skin punctures, and the first-pass success rate were measured. The primary outcome was the success rate of real-time US-guided thoracic epidural catheter placement, which was evaluated using fluoroscopy. In addition, the position of the catheter, contrast dispersion, and complications were evaluated.ResultsThis study included 38 patients. The T10–T11 interlaminar space was the most location for epidural access. During the procedure, the mean time for marking the overlying skin for the procedure was 49.5±13.8 s and the median needling time was 49 s. The median number of needle passes was 1.0 (1.0–1.0). All patients underwent one skin puncture for the procedure. The first-pass and second-pass success rates were 76.3% and 18.4%, respectively. Fluoroscopic evaluation revealed that the catheter tips were all positioned in the epidural space and were usually located between T9 and T10 (84.2%). The cranial and caudal contrast dispersion were observed up to 5.4±1.6 and 2.6±1.0 vertebral body levels, respectively. No procedure-related complications occurred.ConclusionReal-time US guidance appears to be a feasible option for facilitating thoracic epidural insertion. Whether or not this technique improves the procedural success and quality compared with landmark-based techniques will require additional study.Trial registration numberNCT03890640.

scholarly journals Pyelonephritis in Pediatric Uropathic Patients: Differences from Community-Acquired Ones and Therapeutic Protocol Considerations. A 10-Year Single-Center Retrospective Study

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 436
Author(s):  
Giovanni Parente ◽  
Tommaso Gargano ◽  
Stefania Pavia ◽  
Chiara Cordola ◽  
Marzia Vastano ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Retrospective Study ◽  
Success Rate ◽  
Pediatric Population ◽  
Gram Negative Bacteria ◽  
Gram Positive ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Significant Difference ◽  
Klebsiella Spp

Pyelonephritis (PN) represents an important cause of morbidity in the pediatric population, especially in uropathic patients. The aim of the study is to demonstrate differences between PNs of uropathic patients and PNs acquired in community in terms of uropathogens involved and antibiotic sensitivity; moreover, to identify a proper empiric therapeutic strategy. A retrospective study was conducted on antibiograms on urine cultures from PNs in vesicoureteral reflux (VUR) patients admitted to pediatric surgery department and from PNs in not VUR patients admitted to Pediatric Emergency Unit between 2010 and 2020. We recorded 58 PNs in 33 patients affected by VUR and 112 PNs in the not VUR group. The mean age of not VUR patients at the PN episode was 1.3 ± 2.6 years (range: 20 days of life–3 years), and almost all the urine cultures, 111 (99.1%), isolated Gram-negative bacteria and rarely, 1 (0.9%), Gram-positive bacteria. The Gram-negative uropathogens isolated were Escherichia coli (97%), Proteus mirabilis (2%), and Klebsiella spp. (1%). The only Gram-positive bacteria isolated was an Enterococcus faecalis. As regards the antibiograms, 96% of not VUR PNs responded to beta-lactams, 99% to aminoglycosides, and 80% to sulfonamides. For the VUR group, mean age was 3.0 years ± 3.0 years (range: 9 days of life–11 years) and mean number of episodes per patient was 2.0 ± 1.0 (range: 1–5); 83% of PNs were by Gram-negatives bacteria vs. 17% by Gram-positive: the most important Gram-negative bacteria were Pseudomonas aeruginosa (44%), Escherichia coli (27%), and Klebsiella spp. (12%), while Enterococcus spp. determined 90% of Gram-positive UTIs. Regimen ampicillin/ceftazidime (success rate: 72.0%) was compared to ampicillin/amikacin (success rate of 83.0%): no statistically significant difference was found (p = 0.09). The pathogens of PNs in uropathic patients are different from those of community-acquired PNs, and clinicians should be aware of their peculiar antibiotic susceptibility. An empiric therapy based on the association ampicillin + ceftazidime is therefore suggested.

scholarly journals Real-time ultrasound-guided vs. anatomical landmark-guided paramedian epidural anesthesia in overweight parturients undergoing analgesic labor: a randomized controlled trial

2021 ◽  
Keyword(s):  
Success Rate ◽  
Real Time ◽  
Epidural Anesthesia ◽  
Anatomical Landmark ◽  
Ultrasound Guided ◽  
Intervertebral Space ◽  
Puncture Site ◽  
Change Rate ◽  
Procedure Duration ◽  
Total Procedure

We evaluated whether real-time ultrasound-guided epidural block is more suitable for overweight parturients undergoing analgesic labor than traditional palpation positioning. Sixty overweight at-term pregnant women (body mass index ≥30 kg/m2) with singleton pregnancy, prepared for vaginal delivery with epidural analgesia, were randomly allocated into two groups. The parturients in the anatomical landmark catheterization group received paramedian epidural anesthesia using the anatomical landmark-guided technique, while real-time ultrasound-guided positioning was performed in the ultrasound-guided-catheterization group. Total procedure duration, time to identify the puncture site and perform the puncture, first attempt success rate, number of attempts, number of needle-redirections, intervertebral-space-change rate, satisfaction score, and complications were compared between the groups. Procedure duration and time to identify the puncture site were significantly shorter in the anatomical landmark catheterization group (440.1 ± 97.2 s vs. 521.9 ± 68.4 s, p < 0.001 and 24.9 ± 13.6 s vs. 112.2 ± 15.6 s, p < 0.001, respectively). There was no significant difference in the time to perform the puncture (385.3 ± 89.7 s vs. 365.1 ± 73.0 s, p = 0.341). The first attempt success rate was lower while the number of attempts and number of needle-redirections were higher in the anatomical landmark catheterization group (p < 0.05). The intervertebral-space-change rate was similar across the groups. Satisfaction was significantly lower in the ultrasound-guided catheterization group (p = 0.009). Complication occurrence, e.g., catheterization difficulty or bleeding during catheterization, dural puncture, and lower-back pain, was similar across the groups. Real-time ultrasound-guided paramedian epidural anesthesia improved the first attempt success rate and reduced the number of attempts and number of needle-redirections in overweight parturients undergoing analgesic labor. However, the longer total procedure duration and time to identify the puncture site might dissatisfy parturients.

scholarly journals Application of Intelligent Ultrasound in Real-Time Monitoring of Postoperative Analgesic Nerve Block

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Zhengwei Li ◽  
Ling Zhao ◽  
Wutao Wang ◽  
Ling Zheng
Keyword(s):  
Brachial Plexus ◽  
Success Rate ◽  
Real Time ◽  
Nerve Block ◽  
Postoperative Analgesia ◽  
Nerve Stimulator ◽  
Ultrasound Guided ◽  
Intelligent Monitoring ◽  
Average Success Rate ◽  
Plexus Block

In order to monitor the effect of nerve block in postoperative analgesia more accurately, this paper puts forward the application research of ultrasonic real-time intelligent monitoring of nerve block in postoperative analgesia. Ultrasonic real-time intelligent monitoring of nerve block in upper limb surgery, lower limb surgery, and abdominal surgery combined with the nerve stimulator. The experiments show that there are 5 cases of adverse reactions when the nerve stimulator is only used, but no adverse reactions occur when combined with ultrasound-guided block. Continuous subclavian brachial plexus block with the ultrasound-guided nerve stimulator can clearly see the subclavian brachial plexus and its surrounding tissue structure, the direction of needle insertion in the plane, and the diffusion of narcotic drugs. The average success rate of block was up to 95.2%, which was significantly higher than that of nerve stimulator alone, and the success rate of recatheterization after the first failure was also improved. The average postoperative analgesia satisfaction was 85.6%, the average operation time was only 20 min, and the subclavian artery and pleura were avoided effectively. No pneumothorax and other complications occurred. The average success rate of ultrasound-guided subclavicular brachial plexus block in 1-2-year-old children was 97%, which was much higher than the average success rate of nerve stimulator localization with 63%. Ultrasound-guided nerve block not only directly blocks nerves under visual conditions but also helps to observe the structures around nerves and dynamically observe the diffusion of local anesthetics, which can significantly improve the accuracy and success rate of nerve block and reduce the incidence of complications.

Comparison of Bronchoscopy-Guided and Real-Time Ultrasound-Guided Percutaneous Dilatational Tracheostomy: Safety, Complications, and Effectiveness in Critically Ill Patients

2017 ◽  
Vol 34 (3) ◽  
pp. 191-196 ◽  
Author(s):  
Aykut Sarıtaş ◽  
Muhammed M. Kurnaz
Keyword(s):  
Real Time ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Demographic Data ◽  
Percutaneous Dilatational Tracheostomy ◽  
Apache Ii ◽  
Ultrasound Guided ◽  
Dilatational Tracheostomy ◽  
The Us ◽  
The Mean

Objective: To compare the efficacy, safety, and incidence of complications between fiber-optic bronchoscopy-guided percutaneous dilatational tracheostomy (FOB-PDT) and ultrasound-guided percutaneous dilatational tracheostomy (US-PDT) and to determine whether US-PDT is a viable alternative to FOB-PDT. Methods: This randomized prospective study was carried out in 80 patients who were randomly divided into US-PDT and FOB-PDT groups. Demographic data and Acute Physiology and Chronic Health Evaluation II (APACHE II), procedure duration, hemorrhage status, complications, procedure difficulty, displacement of entry location after US, and hemodynamic data were evaluated in both groups. Tracheal incision was performed with real-time US and a transverse probe position in the out-of-plane mode. Results: No significant differences were observed between the 2 groups in terms of demographic data, oral intubation time, APACHE II values, difficulty of the procedure, or the number of needle interventions ( P > .05). The mean hemorrhage ratio of the FOB-PDT group was significantly higher than that of the US-PDT group ( P < .05). The entry location was changed in 6 patients in the US-PDT group following neck examination with US. The mean duration of the procedure for the FOB-PDT group was significantly longer than that for the US-PDT group ( P < .05). Conclusion: Ultrasound-guided percutaneous dilatational tracheostomy is a safe procedure for critically ill patients and has the advantages of a low complication rate, short duration of procedure, being informative with regard to neck anatomy, and facilitating prevention of vascular puncture. Thus, US-PDT can be used as an alternative to FOB-PDT.

scholarly journals Ultrasound Guided Intravenous Access by Nursing versus Resident Staff in a Community Based Teaching Hospital: A “Noninferiority” Trial

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Thomas Carter ◽  
Chris Conrad ◽  
J. Link Wilson ◽  
Godwin Dogbey
Keyword(s):  
Success Rate ◽  
Nursing Staff ◽  
Community Hospital ◽  
Ultrasound Guided ◽  
Community Based ◽  
Intravenous Access ◽  
Didactic Instruction ◽  
Significant Difference ◽  
Hands On

Objectives. Ultrasound (US) guidance is a safe and effective method for peripheral intravenous (IV) catheter placement. However, no studies have directly compared the success rate of emergency medicine (EM) residents and nurses at using this technique especially in community hospital settings. This prospective “noninferiority” study sought to demonstrate that nursing staff are at least as successful as EM residents at placing US guided IVs.Methods. A group of 5 EM residents and 11 nurse volunteers with at least two years’ experience underwent training sessions in hands-on practice and didactic instruction with prospective follow-up. Two failed attempts on a patient using standard approach by an emergency department (ED) nurse were deemed to be “difficult sticks” and randomly assigned to either a nurse or resident, based on the day they presented.Results. A total of 90 attempts, consisting of trials on 90 patients, were recorded with a success rate of 85% and 86% for residents and nurses, respectively. With apvalue of .305, there was no statistically significant difference in the success rate between the residents and nurses.Conclusion. Properly trained nursing staff can be as equally successful as EM residents in placing US guided intravenous lines.

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