Near-Infrared Tracking System for Epidural Catheter Placement

Chiu, Sheila; Bristow, Sandee J.

doi:10.1097/aap.0b013e31824c0310

Cited by 6 publications

(4 citation statements)

References 18 publications

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“…The last two layers (i.e., the ligamentum flavum and the ES) have a relevant difference in terms of densities; thus, the anesthesiologist perceives a tactile sensation called LOR when the needle breaches the ligamentum flavum and reaches the ES. Over the last years, both imaging-based techniques (e.g., ultrasound-based techniques, X-ray imaging techniques, near-infrared tracking systems) [ 9 , 10 , 11 , 12 ] and instrumented systems able to detect the LOR [ 13 , 14 , 15 , 16 , 17 , 18 ] have been investigated to guide the needle to the ES. However, a large part of the epidural analgesia procedures is performed blindly; thus, their success is operator-dependent [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Soft System Based on Fiber Bragg Grating Sensor for Loss of Resistance Detection during Epidural Procedures: In Silico and In Vivo Assessment

Tommasi

Presti

Virgili

et al. 2021

Sensors

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Epidural analgesia represents a clinical common practice aiming at pain mitigation. This loco-regional technique is widely used in several applications such as labor, surgery and lower back pain. It involves the injections of anesthetics or analgesics into the epidural space (ES). The ES detection is still demanding and is usually performed by the techniques named loss of resistance (LOR). In this study, we propose a novel soft system (SS) based on one fiber Bragg grating sensor (FBG) embedded in a soft polymeric matrix for LOR detection during the epidural puncture. The SS was designed to allow instrumenting the syringe’s plunger without relevant modifications of the anesthetist’s sensations during the procedure. After the metrological characterization of the SS, we assessed the capability of this solution in detecting LOR by carrying it out in silico and in clinical settings. For both trials, results revealed the capability of the proposed solutions in detecting the LOR and then in recording the force exerted on the plunger.

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Section: Introductionmentioning

confidence: 99%

Soft System Based on Fiber Bragg Grating Sensor for Loss of Resistance Detection during Epidural Procedures: In Silico and In Vivo Assessment

Tommasi

Presti

Virgili

et al. 2021

Sensors

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“…used an infrared light emitting guidewire to facilitate threading of an epidural catheter to a desired vertebral level, in cadavers. [95] The potential advantage is the ability to guide placement of epidural catheters distantly from the needle tip, to the desired dermatomal level. However, the signal was diminished in obese patients, and when the catheter passed under-lamina or diverged from midline.…”

Section: Discussionmentioning

confidence: 99%

Localization of epidural space: A review of available technologies

Elsharkawy

Sonny

Chin

2017

J Anaesthesiol Clin Pharmacol

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Although epidural analgesia is widely used for pain relief, it is associated with a significant failure rate. Loss of resistance technique, tactile feedback from the needle, and surface landmarks are traditionally used to guide the epidural needle tip into the epidural space (EDS). The aim of this narrative review is to critically appraise new and emerging technologies for identification of EDS and their potential role in the future. The PubMed, Cochrane Central Register of Controlled Clinical Studies, and Web of Science databases were searched using predecided search strategies, yielding 1048 results. After careful review of abstracts and full texts, 42 articles were selected to be included. Newer techniques for localization of EDS can be broadly classified into techniques that (1) guide the needle to the EDS, (2) identify needle entry into the EDS, and (3) confirm catheter location in EDS. An ideal method should be easy to learn and perform, easily reproducible with high sensitivity and specificity, identifies inadvertent intrathecal and intravascular catheter placements with ease, feasible in perioperative setting and have a cost-benefit advantage. Though none of them in their current stages of development qualify as an ideal method, many show tremendous potential. Some techniques are useful in patients with difficult spinal anatomy and infants, and thus are complementary to traditional methods. In addition to improving the existing technology, future research should aim at proving the superiority of these techniques over traditional methods, specifically regarding successful EDS localization, better safety profile, and a favorable cost-benefit ratio.

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“…An accurate catheter tip position is important for drug delivery and spreading epidural anesthesia. Fluoroscopy [ 18 ], motor and sensory-stimulating catheters [ 19 ], and near-infrared light [ 20 ] have been used to predict clinical catheter function. However, these types of equipment are not applied routinely in epidural anesthesia and have some safety concerns, especially in obstetric applications.…”

Section: Discussionmentioning

confidence: 99%

In vivo images of the epidural space with two- and three-dimensional optical coherence tomography in a porcine model

Kuo¹,

Kao²,

Tsou

et al. 2017

PLoS ONE

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BackgroundNo reports exist concerning in vivo optical coherence tomography visualization of the epidural space and the blood patch process in the epidural space. In this study, we produced real-time two-dimensional and reconstructed three-dimensional images of the epidural space by using optical coherence tomography in a porcine model. We also aimed to produce three-dimensional optical coherence tomography images of the dura puncture and blood patch process.MethodsTwo-dimensional and three-dimensional optical coherence tomography images were obtained using a swept source optical coherence tomography (SSOCT) system. Four laboratory pigs were intubated and ventilated after the induction of general anesthesia. An 18-gauge Tuohy needle was used as a tunnel for the optical coherence tomography probe to the epidural space. Two-dimensional and three-dimensional reconstruction optical coherence tomography images of the epidural space were acquired in four stages.ResultsIn stage 1, real-time two-dimensional and reconstructed three-dimensional optical coherence tomography of the lumbar and thoracic epidural space were successfully acquired. In stage 2, the epidural catheter in the epidural space was successfully traced in the 3D optical coherence tomography images. In stage 3, water injection and lumbar puncture were successfully monitored in all study animals. In stage 4, 10 mL of fresh blood was injected into the epidural space and two-dimensional and three-dimensional optical coherence tomography images were successfully acquired.ConclusionsThese animal experiments suggest the potential capability of using an optical coherence tomography-based imaging needle in the directed two-dimensional and three-dimensional visualization of the epidural space. More investigations involving humans are required before optical coherence tomography can be recommended for routine use. However, three-dimensional optical coherence tomography may provide a novel, minimally invasive, and safe way to observe the spinal epidural space, epidural catheter, lumbar puncture hole, and blood patch.

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Near-Infrared Tracking System for Epidural Catheter Placement

Abstract: Many variables such as obesity, paravertebral and extraforaminal catheter locations, and intervening bony structures can impede the application of NER technology for epidural catheter placements. Further optimization of the technology for clinical use is necessary.

Cited by 6 publications

References 18 publications

Soft System Based on Fiber Bragg Grating Sensor for Loss of Resistance Detection during Epidural Procedures: In Silico and In Vivo Assessment

Soft System Based on Fiber Bragg Grating Sensor for Loss of Resistance Detection during Epidural Procedures: In Silico and In Vivo Assessment

Localization of epidural space: A review of available technologies

In vivo images of the epidural space with two- and three-dimensional optical coherence tomography in a porcine model

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