scholarly journals Double Assurance of Epidural Space Detection Using Fiberoptics-Based Needle Design and Autofluorescence Technologies for Epidural Blockade in Painless Labor

Sensors ◽  
2018 ◽  
Vol 18 (11) ◽  
pp. 3592
Author(s):  
Cihun-Siyong Gong ◽  
Huang-Chang Lee ◽  
Yin Chang ◽  
Chien-Kun Ting ◽  
Po-Hsun Tu
Keyword(s):  
Fluorescence Spectroscopy ◽  
Epidural Space ◽  
Ex Vivo ◽  
In Vivo Study ◽  
Epidural Needle ◽  
Needle Puncture ◽  
Double Peak ◽  
Interspinous Ligament ◽  
Auto Fluorescence

Purpose: Technology of reflectance spectroscopy incorporated with auto-fluorescence spectroscopy were employed to increase the safety of epidural placement in regional anesthesia which is generally used for surgery, epidural anesthesia, post-operative pain control and painless childbirth. Method: Ex vivo study of auto-fluorescence spectroscopy was performed for the para-vertebral tissues contained fat, interspinous ligament, supraspinous ligament and ligamentumflavum by multimode microplate reader at wavelength 405 nm for the purpose of tissue differentiation. A specially designed optic-fiber-embedded needle was employed to incorporate with both reflectance and autofluorescence spectroscopies in order to probe the epidural space as double assurance demands. In vivo study was carried out in a Chinese native swine weighted about 30 kg under intubated general anesthesia with ventilation support. The reflective (405 nm) and autofluorescence signals (λ and λ*) were recorded at 5 different sites by an oscilloscope during the needle puncture procedure from skin to epidural space in the back of the swine. Results: Study of either autofluorescence spectroscopy for tissue samples or ex vivo needle puncture in porcine trunk tissues indicates that ligmentumflavum has at least 10-fold higher fluorescence intensity than the other tissues. In the in vivo study, ligamentumflavum shows a double-peak character for both reflectance and autofluorescence signals. The epidural space is located right after the drop from the double-peak. Both peaks of reflectance and fluorescence are coincident which ensures that the epidural space is correctly detected. Conclusions: The fiber-optical technologies of double-assurance demands for tissue discrimination during epidural needle puncture can not only provide an objective visual information in a real-time fashion but also it can help the operator to achieve much higher success rate in this anesthesia procedure.

Fiber-needle Swept-source Optical Coherence Tomography System for the Identification of the Epidural Space in Piglets

2015 ◽  
Vol 122 (3) ◽  
pp. 585-594 ◽  
Author(s):  
Wen-Chuan Kuo ◽  
Meng-Chun Kao ◽  
Kuang-Yi Chang ◽  
Wei-Nung Teng ◽  
Mei-Yung Tsou ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Epidural Space ◽  
Ex Vivo ◽  
Optical Probe ◽  
Epidural Needle ◽  
Optical Coherence ◽  
Fiber Probe ◽  
Swept Source ◽  
Signal Intensities

Abstract Background: Epidural needle insertion is traditionally a blind technique whose success depends on the experience of the operator. The authors describe a novel method using a fiber-needle–based swept-source optical coherence tomography (SSOCT) to identify epidural space. Methods: An optical fiber probe was placed into a hollow 18-gauge Tuohy needle. It was then inserted by an experienced anesthesiologist to continuously construct a series of two-dimensional SSOCT images by mechanically rotating the optical probe. To quantify this observation, both the average SSOCT signal intensities and their diagnostic potentials were assessed. The insertions were performed three times into both the lumbar and thoracic regions of five pigs using a paramedian approach. Results: A side-looking SSOCT is constructed to create a visual image of the underlying structures. The image criteria for the identification of the epidural space from the outside region were generated by the analysis of a training set (n = 100) of ex vivo data. The SSOCT image criteria for in vivo epidural space identification are high sensitivity (0.867 to 0.965) and high specificity (0.838 to 0.935). The mean value of the average signal intensities exhibits statistically significant differences (P < 0.01) and a high discriminatory capacity (area under curve = 0.88) between the epidural space and the outside tissues. Conclusions: This is the first study to introduce a SSOCT fiber probe embedded in a standard epidural needle. The authors anticipate that this technique will reduce the occurrence of failed epidural blocks and other complications such as dural punctures.

scholarly journals Reliability and Safety of Contra-Lateral Oblique View for Interlaminar Epidural Needle Placement

2018 ◽  
Vol 1 (21;1) ◽  
pp. E65-E73
Author(s):  
Richard Derby
Keyword(s):  
Epidural Space ◽  
Ligamentum Flavum ◽  
Case Series ◽  
Senior Author ◽  
Epidural Block ◽  
Observer Agreement ◽  
Epidural Needle ◽  
Oblique View ◽  
Fluoroscopic Imaging

Cord trauma is a risk with a cervical and thoracic interlaminar epidural approach to the epidural space. Intermittent lateral fluoroscopic imaging to detect needle depth is often cumbersome and may be difficult to interpret. In comparison, the contra-lateral oblique (CLO) fluoroscopic view is efficient and easy to interpret. However, the in vivo reliability and safety of this technique has not been formally investigated. The senior author collected fluoroscopic images on 278 consecutive patients undergoing an interlaminar epidural block at the T1-T2 level performed using a 17 gauge Tuohy needle. Before catheter placement, anterior-posterior (AP) and CLO fluoroscopic images were saved with the needle at the ligamentum flavum and the needle just through the ligamentum flavum. We randomly selected the images of 40 cases that included the paired CLO images (total 80 images) documenting the views at and through the ligamentum flavum. Three interventionalists were asked to review, in a blinded fashion, the randomly selected, paired CLO images and to score each image, recording whether the 17 gauge needle was in or out of the epidural space to determine the accuracy and reliability of this technique. There was a 97.5%, 95%, and 93.8% agreement between each reviewing physician and the senior author resulting in a correlation using the Kappa statistic value of 0.950, 0.875, and 0.874, respectively (P < 0.001). The 3 reviewing physicians disagreed with the senior author’s correct answer in 2.5%, 5%, and 6.2%, respectively, however, the disagreement occurred primarily because of poor image quality. Agreement between the 3 reviewing physicians was 93.8%, 96.3%, and 90%, with a Kappa value of 0.875, 0.924, and 0.799, respectively (P < 0.001). There was 100% technical success in the 278 case series without “wet taps,” provocation of pain during entry, or any other immediate post procedural complication. We conclude the CLO view provides an efficient and reliable method to visualize needle tip depth in relation to the epidural space. The close inter-observer agreement was possible with minimal physician instruction. Key words: Cervical interlaminar, cervical epidural, contra-lateral oblique, fluoroscopic imaging

Assessment of the osteogenic potential of alendronate on isolated adipose-derived stem cells: An ex-vivo and in-vivo study

2015 ◽  
Vol 10 (1) ◽  
pp. 32
Author(s):  
MarwaM Ellithy ◽  
MohamedS Ayoub ◽  
EffatA Abbas ◽  
MohamedA Abd El Hamid ◽  
HouryM Baghdadi ◽  
...  
Keyword(s):  
Stem Cells ◽  
Ex Vivo ◽  
In Vivo Study ◽  
Osteogenic Potential ◽  
Adipose Derived Stem Cells

scholarly journals Influence of extracorporeal membrane oxygenation on the pharmacokinetics of ceftolozane/tazobactam: an ex vivo and in vivo study

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Camille Mané ◽  
Clément Delmas ◽  
Jean Porterie ◽  
Géraldine Jourdan ◽  
Patrick Verwaerde ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Ex Vivo ◽  
In Vivo Study ◽  
Membrane Oxygenation

scholarly journals New device permitting non‐invasive reversal of fetal endoscopic tracheal occlusion: ex‐vivo and in‐vivo study

2020 ◽  
Vol 56 (4) ◽  
pp. 522-531 ◽  
Author(s):  
D. Basurto ◽  
N. Sananès ◽  
E. Verbeken ◽  
D. Sharma ◽  
E. Corno ◽  
...  
Keyword(s):  
Ex Vivo ◽  
In Vivo Study ◽  
Tracheal Occlusion ◽  
New Device ◽  
Non Invasive

scholarly journals Brain Tissue Conductivity Measurements with MR-Electrical Properties Tomography: An In Vivo Study

2020 ◽  
Author(s):  
Stefano Mandija ◽  
Petar I. Petrov ◽  
Jord J. T. Vink ◽  
Sebastian F. W. Neggers ◽  
Cornelis A. T. van den Berg
Keyword(s):  
Electrical Properties ◽  
Healthy Subjects ◽  
Ex Vivo ◽  
Simulated Data ◽  
Ground Truth ◽  
In Vivo Study ◽  
Conductivity Measurements ◽  
Tissue Conductivity ◽  
Before And After

AbstractFirst in vivo brain conductivity reconstructions using Helmholtz MR-Electrical Properties Tomography (MR-EPT) have been published. However, a large variation in the reconstructed conductivity values is reported and these values differ from ex vivo conductivity measurements. Given this lack of agreement, we performed an in vivo study on eight healthy subjects to provide reference in vivo brain conductivity values. MR-EPT reconstructions were performed at 3 T for eight healthy subjects. Mean conductivity and standard deviation values in the white matter, gray matter and cerebrospinal fluid (σWM, σGM, and σCSF) were computed for each subject before and after erosion of regions at tissue boundaries, which are affected by typical MR-EPT reconstruction errors. The obtained values were compared to the reported ex vivo literature values. To benchmark the accuracy of in vivo conductivity reconstructions, the same pipeline was applied to simulated data, which allow knowledge of ground truth conductivity. Provided sufficient boundary erosion, the in vivo σWM and σGM values obtained in this study agree for the first time with literature values measured ex vivo. This could not be verified for the CSF due to its limited spatial extension. Conductivity reconstructions from simulated data verified conductivity reconstructions from in vivo data and demonstrated the importance of discarding voxels at tissue boundaries. The presented σWM and σGM values can therefore be used for comparison in future studies employing different MR-EPT techniques.

751 Prediction of Colonic Neoplasia Through Spectral Marker Analysis from the Endoscopically Normal Rectum: An Ex Vivo and In Vivo Study

2008 ◽  
Vol 134 (4) ◽  
pp. A-109
Author(s):  
Hemant K. Roy ◽  
Vladimir Turzhitsky ◽  
Andrew Gomes ◽  
Michael J. Goldberg ◽  
Jeremy D. Rogers ◽  
...  
Keyword(s):  
Ex Vivo ◽  
In Vivo Study ◽  
Marker Analysis ◽  
Colonic Neoplasia

scholarly journals In vivo study and thermodynamic investigation of two lanthanum complexes, La(dpp)3 and La(XT), for the treatment of bone resorption disorders

2015 ◽  
Vol 6 (11) ◽  
pp. 6439-6447 ◽  
Author(s):  
J. F. Cawthray ◽  
D. M. Weekes ◽  
O. Sivak ◽  
A. L. Creagh ◽  
F. Ibrahim ◽  
...  
Keyword(s):  
Bone Resorption ◽  
Ex Vivo ◽  
In Vivo Study ◽  
Oral Drug ◽  
Thermodynamic Investigation ◽  
Preventative Measure ◽  
Drug Candidates

Lanthanum could act as a preventative measure against bone resorption disorders; two compounds are thoroughly investigated both in vivo and ex vivo as potential oral drug candidates.

scholarly journals Ex vivo and in vivo study of Kowa HA-2 applanation tonometer in the measurement of intraocular pressure in cats

2017 ◽  
Vol 38 (6) ◽  
pp. 3647
Author(s):  
Claudia Lizandra Ricci ◽  
Rogério Giuffrida ◽  
Glaucia Prada Kanashiro ◽  
Hilidia Stephania Rufino Belezzi ◽  
Carolina De Carvalho Bacarin ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Ex Vivo ◽  
Clinical Signs ◽  
In Vivo Study ◽  
Eye Drops ◽  
Significant Difference ◽  
Applanation Tonometer ◽  
Ex Vivo Study ◽  
Healthy Eyes

The objective of this study was to evaluate the use of the Kowa HA-2 applanation tonometer in measuring intraocular pressure (IOP) in cats. Ten healthy eyes were used in an ex vivo study in which the calibration curve for manometry vs. tonometry was determined by artificially raising the IOP in 5 mmHg increments up to 60 mmHg (10-60 mmHg). Both eyes of 10 anesthetized cats were studiedin vivo to compare manometry vs. tonometry. In the ambulatory study, 78 healthy eyes, 7 eyes with glaucoma and 20 eyes with uveitis were evaluated by tonometry, which was performed with topical anesthesia and 1% fluorescein eye drops for the formation of fluorescein semicircles. The correlation coefficient (r²) between the manometer and the Kowa HA-2 tonometer was 0.993 and the linear regression equation was y = 0.0915x + 0.0878 in the ex-vivo study. In the in vivo study, the IOP values (mean±SD, in mmHg) in manometry were 15.6 ± 1.1(14.0 – 17.5) and in tonometry were 15.5 ± 1.2(13.5 – 17.2), with no significant difference (P > 0.05) between manometry and tonometry. In ambulatory study, using the Kowa HA-2 tonometer, the IOP values (mean±SD, in mmHg) were 15.0 ± 1.5 (11.8 – 18.3) for the healthy eyes, 38.4 ± 8.1(29.6 – 53.7) for glaucomatous eyes and 10.4 ± 2.0(5.3 – 12.2) for eyes with uveitis. There was a strong correlation and accuracy between the IOP values with the manometry and the Kowa HA-2 tonometer. In the ambulatorystudy the IOP values obtained with the tonometer were compatible for animals with healthy eyes and with clinical signs of glaucoma and uveitis. We conclude that the Kowa HA-2 tonometer can be used in the measurement of IOP in cats, since it is a practical and accurate method in this species.

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