COMPARATIVE STUDY OF PRE-PROCEDURE AND REAL TIME ULTRASOUNDGUIDED EPIDURALANAESTHESIA IN OBESE PATIENT.

2021 ◽  
pp. 62-64
Author(s):  
Ravi Anand ◽  
Preeti Kumari ◽  
Sanjeev Kumar ◽  
Siddharth Singh ◽  
Ganesh Kumar Ram
Keyword(s):  
Body Mass Index ◽  
Real Time ◽  
Epidural Catheter ◽  
Median Number ◽  
Catheter Placement ◽  
P Value ◽  
Obese Patients ◽  
Epidural Catheter Placement ◽  
Midline Approach ◽  
Number Of Passes

Background And Aims: Epidural anaesthesia is widely performed using a landmark-guided midline approach. The indistinct or distorted landmark is associated with obesity, previous spinal surgeries, deformities, or degenerative changes due to ageing. In the present study, we compared the efcacy of real-time ultrasound (RUS)-guided paramedian approach, and pre-procedure ultrasound (PUS) landmark-guided paramedian approach in obese patients. Methods: Sixty patients with body mass index (BMI) >30 kg/m2 were included in the study. The participants were randomly assigned to two groups : PUS and RUS group . The primary end point was to attain a successful placement of epidural catheter. Variables like the number of attempts, the number of passes, the time taken for identifying epidural space(s), and time taken for successful epidural catheter placement(s) were secondary end points and were recorded in both the groups. Results: The median number of attempts were 4 (IQR 2-4) and 2 (IQR 1-2), respectively, in the PUS and RUS group (P-value < 0.001). The median number of passes, the median time for identifying space, and the time for successful epidural catheter placement was statistically signicantly less in the RUS group, than the PUS group. Conclusion:The time taken for the identication of the space, the number of attempts, number of passes, and the time taken for successful epidural catheter placement was more in the PUS group as compared to the RUS group.

scholarly journals ADMINISTRATION OF SALINE INJECTION IN EPIDURAL SPACE AVOIDS INTRAVASCULAR CATHETER INSERTION IN PATIENTS UNDERGOING CAESARIAN SECTION: A RANDOMIZE CONTROLLED TRIAL

2016 ◽  
Vol 21 (4) ◽  
pp. 257
Author(s):  
Muhammad Azam ◽  
Naila Akthar ◽  
Tanvir Akhtar Butt
Keyword(s):  
Heart Rate ◽  
Cesarean Section ◽  
Epidural Catheter ◽  
Epidural Space ◽  
Catheter Placement ◽  
P Value ◽  
Intravascular Catheter ◽  
Epidural Catheter Placement ◽  
Significant Difference ◽  
Group A

AbstractObjective:The objective of this study was to determine if injecting 10 ml saline in epidural space before epidural catheter placement in pregnant women undergoing cesarean section can decrease the frequency of inadvertent intravascular catheter placement.Study Design:Randomize Controlled Trail.Place and Duration of Study:Department of Anaesthesia at Gynaecology and Obstetrics operation theater, Jinnah Hospital, Lahore affiliated with College of Physician and Surgeon Pakistan from April 2008 to March 2009.Methodology:Sixty pregnant patients (ASA I and II) randomly allocated in Group A and B equally for elec-tive cesarean section were selected. In each patient epidural space was identified with LOR technique using air in sitting position. In Group A (dry group), no saline was injected while in Group B (saline gro-up), 10 ml saline was injected before epidural catheter placement. Using 16 G Toughy needle, catheter was inserted up to 4 cm in the epidural space. To find out inadvertent intravascular catheter placement, epidural catheter was aspirated to exclude blood. After negative aspiration, test dose of 3ml injection xylocain 2% (with adrenaline 1:200,000) was administrated and patient were monitored one minute for increase in heart rate (> 20% of baseline), tinnitus and perioral numbness.Results:In both group data collected was analyzed in SPSS version 11 and Chi-square test was applied. P value of 0.05 or less was taken significant. Percentage of positive inadvertent intravascular catheterization in term of bloody aspirate (20 and 13.3%) was not signi-ficantly different between two groups (P value = 0.488). Increase in heart rate, tinnitus and perioral numbness was not observed in any patient.Conclusion:There was no significant difference in accidental intravascular catheterization if 10 ml saline is injected through needle before catheter insertion.Key word:Epidural catheter, accidental intravascular catheterization, anaesthesia.

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.

Avoid suboptimal perioperative analgesia during major surgery by enhancing thoracic epidural catheter placement and hemodynamic performance

2021 ◽  
pp. rapm-2020-102352
Author(s):  
Sarah A Bachman ◽  
Johan Lundberg ◽  
Michael Herrick
Keyword(s):  
Epidural Catheter ◽  
Treatment Strategies ◽  
Preventive Treatment ◽  
Catheter Placement ◽  
Major Surgery ◽  
Perioperative Analgesia ◽  
Neuraxial Blockade ◽  
Epidural Catheter Placement ◽  
Thoracic Epidural ◽  
Catheter Failure

Thoracic epidural analgesia (TEA) is an established gold standard for postoperative pain control especially following laparotomy and thoracotomy. The safety and efficacy of TEA is well known when the attention to patient selection is upheld. Recently, the use of fascial plane blocks (FPBs) has evolved as an alternative to TEA most likely because these blocks avoid problems such as neurological comorbidity, coagulation disorders, epidural catheter failure and hypotension due to sympathetic denervation. However, if an FPB is performed, postoperative monitoring and adjuvant treatments are still necessary. Also, the true efficacy of FPBs is questioned. Thus, should we prioritize less efficient analgesic regimens with FPBs when preventive treatment strategies for epidural catheter failure and hypotension exist for TEA? It is time to promote and underscore the benefits of TEA provided to patients undergoing major open surgical procedures. In our mind, FPBs and landmark-guided techniques should be limited to less extensive surgery and when either neuraxial blockade is contraindicated or resources for optimal epidural catheter placement and maintenance are not available.

scholarly journals Impact of brief prewarming on anesthesia-related core-temperature drop, hemodynamics, microperfusion and postoperative ventilation in cytoreductive surgery of ovarian cancer a randomized trial

2019 ◽  
Author(s):  
Lutz Kaufner ◽  
Phil Niggemann ◽  
Tobias Baum ◽  
Sara Casu ◽  
Jalid Sehouli ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Epidural Catheter ◽  
Core Temperature ◽  
Cytoreductive Surgery ◽  
Patient Flow ◽  
Temperature Drop ◽  
Subcutaneous Fat ◽  
Catheter Placement ◽  
Body Core Temperature ◽  
Epidural Catheter Placement

Abstract Background: General (GA)- and epidural-anesthesia may cause a drop in body-core-temperature (BCTdrop), and hypothermia, which may alter tissue oxygenation (StO2) and microperfusion after cytoreductive surgery for ovarian cancer. Cell metabolism of subcutaneous fat- or skeletal muscle cells, measured in microdialysis, may be affected. We hypothesized that forced-air prewarming during epidural catheter placement and induction of GA maintains normothermia and improves microperfusion. Methods: After ethics approval 47 women scheduled for cytoreductive surgery were prospectively enrolled. Women in the study group were treated with a prewarming of 43°C during epidural catheter placement. BCT (Spot on®, 3M) was measured before (T1), after induction of GA (T2) at 15 min (T3) after start of surgery, and until 2h after ICU admission (TICU2h). Primary endpoint was BCTdrop between T1 and T2. Microperfusion-, hemodynamic- and clinical outcomes were defined as secondary outcomes. Statistical analysis used the Mann-Whitney-U- and non-parametric-longitudinal tests. Results: BCTdrop was 0.35 °C with prewarming and 0.9 °C without prewarming (p< 0.005) and BCT remained higher over the observation period (ΔT4 = 0.9 °C up to ΔT7 = 0.95 °C, p<0.001). No significant differences in hemodynamic parameters, transfusion, arterial lactate and dCO2 were measured. In microdialysis the ethanol ratio was temporarily, but not significantly, reduced after prewarming. Lactate, glucose and glycerol after PW tended to be more constant over the entire period. Postoperatively, six women without prewarming, but none after prewarming were mechanical ventilated (p< 0.001). Conclusion: Prewarming at 43°C reduces the BCTdrop and maintains normothermia without impeding the perioperative routine patient flow. Microdialysis indicate better preserved parameters of microperfusion. Trial registration: ClinicalTrials.gov; ID: NCT02364219; Date of registration: 18-febr-2015

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