scholarly journals EVALUATION OF PREDICTORS FOR DIFFICULT LUMBAR NEUROAXIAL BLOCK BY USING ULTRASONOGRAPHY

2021 ◽  
Vol 9 (07) ◽  
pp. 970-978
Author(s):  
Maria Julia Gutierrez Gomez
Keyword(s):  
Elective Surgery ◽  
Medical Center ◽  
Spinous Process ◽  
Technical Difficulty ◽  
Posterior Longitudinal Ligament ◽  
Anesthetic Technique ◽  
Anatomical Landmarks ◽  
Neuraxial Block ◽  
Block Based ◽  
The One

Introduction: The neuraxial block, whether spinal or epidural, is commonly used as an anesthetic technique for the performance of surgeries or the treatment of chronic pain. In studies carried out, described by authors such as Kallidaikurichi et al and Grau et al, it has been shown that even experienced anesthesiologists are able to find the adequate intervertebral space in only 29% of patients who undergo this type of anesthetic procedure. Objectives: To determine the association of ultrasonographic parameters with the technical difficulty of lumbar neuraxial block, in patients undergoing elective surgery. Take ultrasound measurements that include the distance between the skin and the spinous process of L1, L2, L3, L4 and L5. To determine whether the presence of the yellow ligament and / or the posterior longitudinal ligament could be visualized by ultrasound. Assess whether there was concordance between the level determined by the palpation technique of anatomical landmarks and the ultrasound examination. Classify the level of difficulty of the neuraxial block based on the number of punctures, as well as the number of redirections of the needle during blocking. Method: This study included 45 electronic records of patients who underwent elective surgery at the Naval Medical Center in a period from May 2019 to May 2020 and whose anesthesia technique included Lumbar Neuroaxial Block and who also underwent a ultrasonographic tracking for the collection of anatomical data. Results: The results obtained in the analysis of these were not significant for the general objective of our study, however they helped us to conclude that the space referred by anesthesiologists and the one actually approached agrees only in 68.9%. Conclusions: Performing ultrasonography prior to performing BNA can improve its performance.

scholarly journals Effect of preservation of the C-6 spinous process and its paraspinal muscular attachment on the prevention of postoperative axial neck pain in C3–6 laminoplasty

2015 ◽  
Vol 22 (3) ◽  
pp. 221-229 ◽  
Author(s):  
Eiji Mori ◽  
Takayoshi Ueta ◽  
Takeshi Maeda ◽  
Itaru Yugué ◽  
Osamu Kawano ◽  
...  
Keyword(s):  
Neck Pain ◽  
Spinous Process ◽  
Posterior Longitudinal Ligament ◽  
Paraspinal Muscle ◽  
Vas Scores ◽  
The Mean ◽  
Axial Neck Pain ◽  
Process Length ◽  
Preservation Technique

OBJECT Axial neck pain after C3–6 laminoplasty has been reported to be significantly lesser than that after C3–7 laminoplasty because of the preservation of the C-7 spinous process and the attachment of nuchal muscles such as the trapezius and rhomboideus minor, which are connected to the scapula. The C-6 spinous process is the second longest spinous process after that of C-7, and it serves as an attachment point for these muscles. The effect of preserving the C-6 spinous process and its muscular attachment, in addition to preservation of the C-7 spinous process, on the prevention of axial neck pain is not well understood. The purpose of the current study was to clarify whether preservation of the paraspinal muscles of the C-6 spinous process reduces postoperative axial neck pain compared to that after using nonpreservation techniques. METHODS The authors studied 60 patients who underwent C3–6 double-door laminoplasty for the treatment of cervical spondylotic myelopathy or cervical ossification of the posterior longitudinal ligament; the minimum follow-up period was 1 year. Twenty-five patients underwent a C-6 paraspinal muscle preservation technique, and 35 underwent a C-6 nonpreservation technique. A visual analog scale (VAS) and VAS grading (Grades I–IV) were used to assess axial neck pain 1–3 months after surgery and at the final follow-up examination. Axial neck pain was classified as being 1 of 5 types, and its location was divided into 5 areas. The potential correlation between the C-6/C-7 spinous process length ratio and axial neck pain was examined. RESULTS The mean VAS scores (± SD) for axial neck pain were comparable between the C6-preservation group and the C6-nonpreservation group in both the early and late postoperative stages (4.1 ± 3.1 vs 4.0 ± 3.2 and 3.8 ± 2.9 vs 3.6 ± 3.0, respectively). The distribution of VAS grades was comparable in the 2 groups in both postoperative stages. Stiffness was the most prevalent complaint in both groups (64.0% and 54.5%, respectively), and the suprascapular region was the most common site in both groups (60.0% and 57.1%, respectively). The types and locations of axial neck pain were also similar between the groups. The C-6/C-7 spinous process length ratios were similar in the groups, and they did not correlate with axial neck pain. The reductions of range of motion and changes in sagittal alignment after surgery were also similar. CONCLUSIONS The C-6 paraspinal muscle preservation technique was not superior to the C6-nonpreservation technique for preventing postoperative axial neck pain.

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. 

Perioperative outcomes for patients on chronic buprenorphine undergoing spine surgery: A case series

2021 ◽  
Vol 17 (7) ◽  
pp. 171-177
Author(s):  
Ashley L. Sharp, MD ◽  
Stephanie Gilbert, MD ◽  
Danielle N. Perez, MD ◽  
Kerstin Kolodzie, MD, PhD, MAS ◽  
Matthias Behrends, MD
Keyword(s):  
Pain Management ◽  
Outcome Measures ◽  
Spine Surgery ◽  
Elective Surgery ◽  
Medical Center ◽  
Academic Medical Center ◽  
Case Series ◽  
Perioperative Outcomes ◽  
Perioperative Pain ◽  
Perioperative Pain Management

Objective: Pain management following spine surgery can be challenging as patients routinely suffer from chronic pain and opioid tolerance. The increasing popularity of buprenorphine use for pain management in this population may further complicate perioperative pain management due to the limited efficacy of other opioids in the presence of buprenorphine. This study describes perioperative management and outcomes in patients on chronic buprenorphine who underwent elective inpatient spine surgery.Design: The authors performed a retrospective chart review of all patients 18 years of age taking chronic buprenorphine for any indication who had elective inpatient spine surgery at a single institution. Perioperative pain management data were analyzed for all patients who underwent spine surgery and were maintained on buprenorphine during their hospital stay.Setting: The study was performed at a single tertiary academic medical center. Main outcome measures: The primary outcome measures were post-operative pain scores and analgesic medication requirements.Results: Twelve patients on buprenorphine underwent inpatient spine surgery. Acceptable pain control was achieved in all cases. Management included preoperative dose limitation of buprenorphine when indicated and the extensive use of multimodal analgesia.Conclusion: The question whether patients presenting for painful, elective surgery should continue using buprenorphine perioperatively is an area of controversy, and the present manuscript provides more evidence for the concept of therapy continuation with buprenorphine.

scholarly journals Obtenção de Consentimento Informado para Anestesia em Cirurgia Eletiva num Hospital Terciário: Práticas e Contexto Ético-Legal

2019 ◽  
Vol 32 (1) ◽  
pp. 53
Author(s):  
Luís Guilherme Casimiro ◽  
Sara Marisa Pereira ◽  
Sofia Cardoso Pires ◽  
Joana Mourão
Keyword(s):  
Informed Consent ◽  
Elective Surgery ◽  
University Hospital ◽  
Anesthetic Technique ◽  
Patient Relationship ◽  
Active Process ◽  
Legal Principles ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Written Informed Consent

Introduction: Informed consent is an active process of the doctor-patient relationship, based on ethical and legal principles. The anesthetic act has inherent risks, which should be subject of specific consent. The aim of this study was to evaluate the degree of implementation of written specific informed consent for anesthesia in the context of elective surgery.Material and Methods: An observational prospective study, at a tertiary university hospital, in 230 patients aged 60 years or older, undergoing elective surgery between May and July 2017. Eligible patients who consented to participate were interviewed clinically on the day before surgery. In the postoperative period, the anesthetic technique and the existence of the written informed consent for the anesthetic and surgical procedures were assessed. Patients who were unable to give informed consent or those admitted in the Intensive Care Unit after surgery were excluded. Results: Written informed consent for the surgical procedure was obtained for 225 (97.8%), while it was obtained in just 96 (41.7%) patients for the anesthetic act. There was a higher prevalence of stroke, anemia, and higher Charlson and physical American Society of Anesthesiologists scores in patients without written informed consent for the anesthetic act.Discussion: We identified a low implementation of written informed consent for anesthesia. This situation may have important implications in the context of disciplinary, civil or criminal liability.Conclusion: Despite its importance, the practice of written informed consent for anesthesia in this institution is not yet implemented on a regular basis.

Shortening Z-osteotomy for the proximal phalanx of the hallux using axial guides

1995 ◽  
Vol 85 (5) ◽  
pp. 249-254 ◽  
Author(s):  
L Hodor ◽  
T Hess
Keyword(s):  
Medical Center ◽  
Proximal Phalanx ◽  
Technical Difficulty ◽  
Autogenous Bone ◽  
Postoperative Results ◽  
Follow Up Studies ◽  
Regional Medical ◽  
Regional Medical Center ◽  
Proximal Screw

The shortening Z-osteotomy of the proximal phalanx of the hallux has been presented as an alternative to the Regnauld enclavement procedure for patients with the appropriate indications. In addition to sharing the same positive characteristics as the Regnauld procedure, the Z-osteotomy has technical and physiologic advantages. The advantages of the Z-osteotomy over the Regnauld include maintenance of the intrinsic attachments at the base of the proximal phalanx, less risk of avascular necrosis, less technical difficulty, and absence of complications associated with an autogenous bone graft. Also, it does not affect the sesamoid apparatus. Research and extended follow-up studies will continue at Lakewood Regional Medical Center. In the last year, one author has completed approximately 13 of these procedures. The postoperative results have been encouraging and successful with one exception. In one case, the increase of the hallux interphalangeal angle was probably caused by excessive tightening of the distal screw compared with the proximal screw.

scholarly journals Multispecialty pulmonary hypertension clinic in the VA

2017 ◽  
Vol 7 (4) ◽  
pp. 758-767 ◽  
Author(s):  
Matthew Jankowich ◽  
Ryan Hebel ◽  
Jennifer Jantz ◽  
Siddique Abbasi ◽  
Gaurav Choudhary
Keyword(s):  
Pulmonary Hypertension ◽  
Odds Ratio ◽  
Medical Center ◽  
Randomized Study ◽  
Right Heart Catheterization ◽  
Morbidity And Mortality ◽  
Heart Catheterization ◽  
One Year ◽  
The One ◽  
Few Data

Pulmonary hypertension (PH) is often associated with cardiopulmonary co-morbidities, especially in older adults. A multispecialty approach to suspected PH is recommended, but there are few data on adherence to guidelines or outcomes in such patients. This was a single-center retrospective study of consecutively evaluated Veteran patients with suspected PH evaluated in a multispecialty PH clinic at a Veterans Affairs Medical Center, evaluating clinical characteristics, workup outcomes, and prognosis. The referral population (n = 125) was older (mean ± SD age = 73.6 ± 9.8 years) with frequent co-morbidities (e.g. COPD 60%) and obesity (mean ± SD BMI = 32.8 ± 8.1 kg/m2). Of 94 patients undergoing right heart catheterization (RHC), 73 (78%) had confirmed PH (mean pulmonary artery pressure ≥ 25 mmHg). PH was associated with higher BMIs (odds ratio [95% CI] for PH per 1 unit increase = 1.10 [1.02–1.19]) and brachial pulse pressures (odds ratio per 1 mmHg increase = 1.07 [1.02–1.13]). Seventy out of 73 were classifiable by WHO PH groupings. Most patients underwent guideline-recommended PH evaluation. Observed one-year mortality was high (17.8%); the one-year hospitalization rate was 34.2%. These results compare favorably to observations from the VA Clinical Assessment, Reporting, and Tracking cohort of Veterans with PH by RHC (19.1% and 60.9% one-year mortality and hospitalization rates, respectively). Multispecialty PH clinic evaluation revealed a high prevalence of co-morbidities in veterans with suspected PH; PH was prevalent in this referral population. PH patients had significant morbidity and mortality but supportive care measures improved following PH evaluation. Further prospective randomized study is needed to determine if a multispecialty clinic approach improves PH morbidity and mortality in veterans.

A LOW-POWER PARAMETERIZED HARDWARE DESIGN FOR THE ONE-DIMENSIONAL DISCRETE FOURIER TRANSFORM OF VARIABLE LENGTHS

2002 ◽  
Vol 11 (04) ◽  
pp. 405-426 ◽  
Author(s):  
JIUN-IN GUO ◽  
CHIEN-CHANG LIN ◽  
CHIH-DA CHIEN
Keyword(s):  
Fourier Transform ◽  
Low Power ◽  
Discrete Fourier Transform ◽  
Hardware Design ◽  
Ip Core ◽  
Distributed Arithmetic ◽  
One Dimensional ◽  
System Requirements ◽  
Block Based ◽  
The One

This paper presents a new low-power parameterized hardware design for the one-dimensional (1D) discrete Fourier transform (DFT) of variable lengths. By combining the cyclic convolution formulation, block-based distributed arithmetic (BDA), and Cooley–Tukey decomposition algorithm together, we have developed a parameterized hardware design for the DFT of variable lengths ranging from 256 to 4096 points and with different modes of performance. The proposed design can perform different lengths of DFT computation through the configuration of parameters, which not only provides the flexibility in computing different length DFT but also facilitates the performance-driven design considerations in terms of power consumption and processing speeds, that is, we can configure the proposed design in different modes of performance by setting different parameters. This feature is beneficial to developing a parameterized DFT soft Intellectual Property (IP) core or hard IP core for meeting the system requirements of different silicon-on-a-chip (SOC) applications as compared with the existing fixed length DFT designs.

scholarly journals Implementation of a Pediatric Pharmacy Education Program at a Community Regional Medical Center

2020 ◽  
Vol 25 (1) ◽  
pp. 25-30
Author(s):  
Chelsea L. Ferguson ◽  
Sarah Ferrell ◽  
Karen Kovey ◽  
Joanna Young ◽  
Sara Trovinger
Keyword(s):  
Health System ◽  
Education Program ◽  
Medical Center ◽  
Surrogate Marker ◽  
Pharmacy Education ◽  
Web Based ◽  
Before And After ◽  
Regional Medical Center ◽  
The One ◽  
Provider Survey

OBJECTIVES This study aimed to implement a web-based pediatric education program designed for pharmacists who participate in neonatal and pediatric order verification at a community-based health system and to evaluate the success through measuring outcomes related to both comfort and competence of pharmacists in pediatric and neonatal pharmacotherapy. METHODS This prospective quality improvement study assessed changes in confidence and competence from before to after education. Eight educational modules were designed to provide education based on the needs of this institution. All pharmacists who participate in neonatal and pediatric order verification were eligible for inclusion throughout the health system. Time in the verification queue for pediatric and neonatal medication orders was compared for before to after education as an objective surrogate marker for comfort and competence. A provider survey was conducted before and after education to assess the providers' perspective of the quality and necessity of pharmacist-provider interactions. RESULTS All confidence scores showed statistical improvement from before to after education (p &lt; 0.001). Before to after education competency scores significantly improved (median 77% [IQR, 69%–85%] to 100% [IQR, 92%–100%]; p &lt; 0.01). The module with the lowest mean score (87%) was module 4 (Antibiotics Part 1), and the one with highest number of retakes (24 retakes from 16 different pharmacists) was module 5 (Antibiotics Part 2). CONCLUSIONS Targeted web-based education effectively improved both confidence and competence among health-system pharmacists to provide pediatric and neonatal care in a community hospital.

Sign in / Sign up

Export Citation Format

Share Document