Real‐time ultrasound‐guided spinal anesthesia in patients with a challenging spinal anatomy: two case reports

Chin, Ki Jinn; Chan, Vincent; Ramlogan, Reva; Perlas, Anahi

doi:10.1111/j.1399-6576.2009.02112.x

Cited by 49 publications

(39 citation statements)

References 14 publications

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“…Some studies have shown increased success rates when ultrasound is used in patients with obscured landmarks or difficult anatomy [19–21]. However, this might involve teaching both SpA and the use of an ultrasound machine to trainees at the same time, which may be an even bigger challenge.…”

Section: Discussionmentioning

confidence: 99%

Procedural Complications of Spinal Anaesthesia in the Obese Patient

Wenk

Weiß

Möllmann

et al. 2012

Anesthesiology Research and Practice

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Background. Complications of spinal anaesthesia (SpA) range between 1 and 17%. Habitus and operator experience may play a pivotal role, but only sparse data is available to substantiate this claim. Methods. 161 patients were prospectively enrolled. Data such as spread of block, duration of puncture, number of trials, any complication, operator experience, haemodynamic parameters, was recorded and anatomical patient habitus assessed. Results. Data from 154 patients were analyzed. Success rate of SpA in the group of young trainees was 72% versus 100% in the group of consultants. Trainees succeeded in patients with a normal habitus in 83.3% of cases versus 41.3% when patients had a difficult anatomy (P = 0.02). SpA in obese patients (BMI ≥ 32) was associated with a significantly longer duration of puncture, an increased failure ratio when performed by trainees (almost 50%), and an increased number of bloody punctures. Discussion. Habitus plays a pivotal role for SpA efficiency. In patients with obscured landmarks, failure ratio in unexperienced operators is high. Hence, patient prescreening as well as adequate choice of operators may be beneficial for the success rate of SpA and contribute to less complications and better patient and trainee satisfaction.

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Section: Discussionmentioning

confidence: 99%

Procedural Complications of Spinal Anaesthesia in the Obese Patient

Wenk

Weiß

Möllmann

et al. 2012

Anesthesiology Research and Practice

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“…In particular this technique avoids the potential for error in the process of having to “remember” the degree of cephalad to caudad and lateral to medial angulation required after pre-puncture skin marking. To date we can find only one case report [10] and one report of a series of 10 patients [11] where the technique of real time ultrasound guided spinal anaesthesia has been employed. The aim of this single center prospective observational study was to investigate the feasibility of performing a systematic method for real-time ultrasound guided paramedian access to the subarachnoid space with the spinal needle inserted in the plane (in-plane) of the ultrasound beam by a single operator.…”

Section: Introductionmentioning

confidence: 99%

Real-Time Ultrasound-Guided Spinal Anaesthesia: A Prospective Observational Study of a New Approach

Conroy

Luyet²,

McCartney³

et al. 2013

Anesthesiology Research and Practice

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Identification of the subarachnoid space has traditionally been achieved by either a blind landmark-guided approach or using prepuncture ultrasound assistance. To assess the feasibility of performing spinal anaesthesia under real-time ultrasound guidance in routine clinical practice we conducted a single center prospective observational study among patients undergoing lower limb orthopaedic surgery. A spinal needle was inserted unassisted within the ultrasound transducer imaging plane using a paramedian approach (i.e., the operator held the transducer in one hand and the spinal needle in the other). The primary outcome measure was the success rate of CSF acquisition under real-time ultrasound guidance with CSF being located in 97 out of 100 consecutive patients within median three needle passes (IQR 1–6). CSF was not acquired in three patients. Subsequent attempts combining landmark palpation and pre-puncture ultrasound scanning resulted in successful spinal anaesthesia in two of these patients with the third patient requiring general anaesthesia. Median time from spinal needle insertion until intrathecal injection completion was 1.2 minutes (IQR 0.83–4.1) demonstrating the feasibility of this technique in routine clinical practice.

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“…31 Real-time ultrasound-guided LP is most often performed using a longitudinal (in-plane), paramedian approach. [31][32][33][34][35][36][37] One prospective study using a conventional curvilinear transducer and a longitudinal paramedian approach demonstrated a 97% success rate with a median of 3 needle passes (interquartile range 1-6). 34 Although small studies describing real-time ultrasound guidance appear promising, lumbar spine mapping to mark the needle insertion site is currently the most common technique with the largest body of supporting evidence.…”

Section: Literature Reviewmentioning

confidence: 99%

Ultrasound guidance for lumbar puncture

et al. 2016

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Purpose of review: To review the literature and describe techniques to use ultrasound to guide performance of lumbar puncture (LP). Recent findings:Ultrasound evaluation of the lumbar spine has been shown in randomized trials to improve LP success rates while reducing the number of attempts and the number of traumatic taps. Summary: Ultrasound mapping of the lumbar spine reveals anatomical information that is not obtainable by physical examination, including depth of the ligamentum flavum, width of the interspinous spaces, and spinal bone abnormalities, including scoliosis. Using static ultrasound, the lumbar spine anatomy is visualized in transverse and longitudinal planes and the needle insertion site is marked. Using real-time ultrasound guidance, the needle tip is tracked in a paramedian plane as it traverses toward the ligamentum flavum. Future research should focus on efficient methods to train providers, costeffectiveness of ultrasound-guided LP, and the role of new needle-tracking technologies to facilitate the procedure. Neurol Clin Pract 2016;6:358-368 P oint-of-care ultrasound is being increasingly used to guide bedside procedures. For certain bedside procedures, such as central venous catheterization, use of ultrasound guidance is now considered the standard of care. For other procedures, such as lumbar puncture (LP), ultrasound can facilitate performance of the procedure by revealing underlying anatomy. Although many clinicians can perform LP based on landmarks with high success rates, an increasing body of evidence supports the use of ultrasound guidance, particularly in obese patients with less palpable landmarks. A recent study demonstrated a 19% failure rate of LPs performed in a neurology clinic when landmarks alone were used. A strong correlation between body mass index (BMI) and procedure failure was shown with half of the failed LPs in patients with a BMI .35.

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Real‐time ultrasound‐guided spinal anesthesia in patients with a challenging spinal anatomy: two case reports

Cited by 49 publications

References 14 publications

Procedural Complications of Spinal Anaesthesia in the Obese Patient

Procedural Complications of Spinal Anaesthesia in the Obese Patient

Real-Time Ultrasound-Guided Spinal Anaesthesia: A Prospective Observational Study of a New Approach

Ultrasound guidance for lumbar puncture

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