On the Edge of the Ultrasound Screen: Regional Anesthesiologists Diagnosing Nonneural Pathology

Sites, Brian D.; Spence, Brian C.; Gallagher, John D.; Beach, Michael L.

doi:10.1016/j.rapm.2006.06.248

Cited by 15 publications

(11 citation statements)

References 28 publications

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“…In addition, recent discussion has been voiced concerning the management of unexpected findings during ultrasound-guided blocks. 48 There is a view that when performing an ultrasound-guided nerve block, the anesthesiologist should also perform a pre-procedure scan of the perineural region for pathology and appropriately interpret any abnormal appearance. 49 This calls the ability to distinguish normal from abnormal further into question, as well as whether sufficient expertise for appropriate diagnosis and management exists.…”

Section: Resultsmentioning

confidence: 99%

Article de synthèse: considérations anatomiques pour l’échoguidage lors de l’anesthésie régionale du cou et des membres supérieurs

Soeding

Eizenberg

2009

Can J Anesth/J Can Anesth

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Purpose The purpose of this narrative review is to describe an anatomical approach for residents-in-training and anesthesiologists who are learning techniques of ultrasound-guided regional anesthesia of the neck and upper limb Sources Relevant articles relating anatomy and anatomical variation to the emerging practice of ultrasoundguided regional anesthesia for the neck and upper limb were sourced via both Medline and PubMed databases. Also, our approach to teaching ultrasound technique has developed from using anatomical resources and cadaveric workshops. This approach emphasizes precise image acquisition, a detailed knowledge of anatomy and anatomical variations, and, importantly, visual interpretation of sonographic landmarks based on pattern recognition when interpreting sonograms. Principal findings Typical sonographic patterns orient the examiner to nerve position, which is necessary for executing successful regional anesthesia of the neck and upper limb. Only by understanding the typical anatomical arrangement can the examiner then visually interpret any individual anatomical variation that may occur. Conclusion Simple sonographic anatomical patterns can provide a strategy to correctly locate nerves when performing ultrasound-guided cervical and brachial plexus anesthesia. RésuméObjectif L'objectif de ce compte-rendu narratif est de de´crire une approche anatomique destine´e aux re´sidents en formation et aux anesthe´siologistes qui apprennent les techniques d'anesthe´sie re´gionale du cou et des membres supe´rieurs par e´choguidage. Sources Les articles pertinents traitant de l'anatomie et des variations anatomiques dans la pratique e´mergente de l'anesthe´sie re´gionale du cou et des membres supe´rieurs par e´choguidage ont e´te´tire´s des bases de donne´es Medline et PubMed. De plus, notre approche de l'enseignement des techniques e´choguide´es a e´volue´graˆce au recours ad es ressources anatomiques et des ateliers sur des cadavres. Cette approche met l'accent sur l'obtention d'images pre´cises, une connaissance de´taille´e de l'anatomie et des variations anatomiques et, composante importante, l'interpre´tation visuelle de points de repe`res e´chographiques selon une reconnaissance des configurations lors de l'interpre´tation des e´chogrammes. Constatations principales Les configurations e´chog-raphiques typiques fournissent des informations al 'examinateur quant a`la position des nerfs, ce qui est ne´cessaire a`la re´alisation d'une anesthe´sie re´gionale du cou et des membres supe´rieurs re´ussie. Il faut que l'examinateur comprenne la disposition anatomique typique pour ensuite pouvoir interpre´ter de façon visuelle les variations anatomiques individuelles potentielles.

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Section: Resultsmentioning

confidence: 99%

Article de synthèse: considérations anatomiques pour l’échoguidage lors de l’anesthésie régionale du cou et des membres supérieurs

Soeding

Eizenberg

2009

Can J Anesth/J Can Anesth

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“…For instance, deep (femoral) venous thromboses as well as atherosclerosis of the femoral and (bilateral) carotid arteries have been diagnosed during routine scans. 14 In all these cases, the incidental findings altered either intraoperative management (cancellation of surgery and avoidance of thigh tourniquet for bilateral carotid and femoral atherosclerosis, respectively) or postoperative care (systemic anticoagulation for femoral vein thrombosis).…”

Section: Discussionmentioning

confidence: 99%

Incidental detection of bowel herniation with ultrasonography and fluoroscopy during a caudal block

Dugani

Tran

Finlayson

2011

Can J Anesth/J Can Anesth

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Background In contrast to fluoroscopy, ultrasonography allows visualization of structures such as muscles, tendons, vessels, and nerves. We describe a case where ultrasonography in conjunction with fluoroscopy led to the incidental diagnosis of bowel herniation in a patient undergoing a caudal block. Clinical features A 71-yr-old woman presented to our chronic pain clinic with a long-standing history of coccydynia for which she had undergone a partial coccygectomy. A trial caudal block was planned. Fluoroscopy of the lower sacral area revealed the presence of a gas bubble inferoposteriorly to the coccygeal remnant. A confirmatory ultrasound scan revealed a hollow structure compatible with bowel. The procedure was abandoned. Subsequently, a non-enhanced computed tomographic scan of the pelvis confirmed the diagnosis of large bowel herniation. The patient was referred to a colorectal surgeon, and she subsequently underwent successful laparoscopic repair of the coccygeal hernia. Conclusion Ultrasonography can be a valuable adjunct in identifying non-neural pathologies in patients undergoing interventional procedures in chronic pain management. This case report highlights the importance of being vigilant for unanticipated pathologies during ultrasound examinations while performing chronic pain block procedures. RésuméContexte Contrairement a la fluoroscopie, l'e´chographie permet de visualiser des structures telles que les muscles, les tendons, les vaisseaux et les nerfs. Nous de´crivons un cas dans lequel l'e´chographie, en conjonction a`la fluoroscopie, a mene´au diagnostic secondaire d'une hernie intestinale chez une patiente subissant un bloc caudal. É léments cliniques Une femme de 71 ans s'est pre´sente´e a`notre clinique de douleur chronique avec des ante´ce´dents de coccygodynie de longue date, affection pour laquelle elle avait subi une coccygectomie partielle. Un bloc caudal d'essai avait e´te´pre´vu. L'imagerie par fluoroscopie de la zone sacre´e infe´rieure a re´ve´le´la pre´sence d'une bulle de gaz infe´rieure et poste´rieure au coccyx restant. Un e´chogramme de confirmation a re´ve´le´la pre´sence d'une structure vide compatible avec l'intestin. L'intervention a éte´annule´e. Par la suite, une tomographie sans rehaussement du bassin a confirme´le diagnostic d'une hernie intestinale importante. La patiente a e´te´re´fe´re´e à un chirurgien colorectal, et elle a par la suite subi avec succe`s une herniorraphie coccygienne par laparoscopie. Conclusion L'e´chographie peut constituer un ajout pre´cieux pour identifier des pathologies non neurales chez les patients subissant des interventions effractives pour la prise en charge de la douleur chronique. Cette pre´sentation de cas souligne l'importance de garder l'oeil ouvert pour de´tecter des pathologies impre´vues pendant les examens par e´chographie re´alise´s pour un bloc pour la douleur chronique.Compared with fluoroscopy, ultrasonography allows for more accurate visualization of various anatomic structures, including muscles, tendons, vessels, a...

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“…7 In each instance, the anesthetic and/or surgical management was altered. Figure 1 is an example of a carotid plaque incidentally found during the performance of an interscalene block.…”

Section: Atherosclerosismentioning

confidence: 99%

“…In another example, on detecting a femoral artery plaque in a patient presenting for total knee arthroplasty, it was jointly decided by the surgery and anesthesia teams not to use a tourniquet during the procedure. 7 The most useful (and simplest) clue for the anesthesiologist indicating the presence of vascular pathology is the identification of a hyperechoic area within the lumen of a blood vessel that is associated with a dropout shadow. If a dropout shadow is noted, consider changing the machine settings from a musculoskeletal application to a vascular-specific setting and lowering the gain to help reduce artifactual speckles within the vessel lumen.…”

Section: Atherosclerosismentioning

confidence: 99%

Clinical Sonopathology for the Regional Anesthesiologist

Sites

Macfarlane

Sites

et al. 2010

Regional Anesthesia and Pain Medicine

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The use of ultrasound to facilitate regional anesthesia is an evolving area of clinical, education, and research interests. As our community's experience grows, it has become evident that anesthesiologists performing "routine" ultrasound-guided blocks may very well be confronted with atypical or even pathologic anatomy. As an educational resource for anesthesiologists, the following articles present examples of common sonopathology that may be encountered during ultrasound-guided regional anesthesia. This present article describes sonopathology related to blood vessels and nerves.

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On the Edge of the Ultrasound Screen: Regional Anesthesiologists Diagnosing Nonneural Pathology

Cited by 15 publications

References 28 publications

Article de synthèse: considérations anatomiques pour l’échoguidage lors de l’anesthésie régionale du cou et des membres supérieurs

Article de synthèse: considérations anatomiques pour l’échoguidage lors de l’anesthésie régionale du cou et des membres supérieurs

Incidental detection of bowel herniation with ultrasonography and fluoroscopy during a caudal block

Clinical Sonopathology for the Regional Anesthesiologist

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