Ultrasound‐guided “saline myelogram”: Confirmation of intrathecal drug delivery despite “dry tap” in infants for spinal anesthesia and spinal therapeutics

Alrayashi, Walid; Berde, Charles B.

doi:10.1111/pan.14443

Cited by 1 publication

(3 citation statements)

References 6 publications

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“…In the hands of an experienced sonographer, this view can provide continuous visualization of the spinal needle as it approaches the infant spine (figure 4, online supplemental file 1). Injection of fluid into the intrathecal space can also be visualized as enlargement of the intrathecal space in this view in real time 31…”

Section: Discussionmentioning

confidence: 99%

“…However, continuous US imaging for uninterrupted visualization of the needle and relevant anatomy is feasible (figure 4, also see online supplemental video) and has many potential benefits: It eliminates the need to accurately measure the depth of the spinal canal, allows for needle redirection toward a visible target, and can limit needle advancement into undesirable structures such as the spinal cord. Additionally, injection of saline or medications can be visually confirmed at the desired target location in the intrathecal space 31. Intuitively, this technique could result in improved success rates for infant SA.…”

Section: Discussionmentioning

confidence: 99%

“…Both of these studies used preprocedural rather than continuous US guidance. Alrayashi and Berde described US-guided ‘saline myelogram’ to confirm intrathecal placement of the spinal needle before delivering SA or other intrathecal drugs 31. Other review articles comment on the visibility of infant spinal structures with US, identify potential pitfalls, and note the feasibility of continuous US guidance for SA in adults, but do not specifically discuss its use for infant SA 24 36 37…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound-guided spinal anesthesia in infants: a narrative review

Baskin

Berde

Saravanan

et al. 2022

Reg Anesth Pain Med

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Background/importanceInfant spinal anesthesia has many potential benefits. However, the delivery of infant spinal anesthesia is technically challenging. The landmark-based technique has not changed for over a century. Advancements in ultrasound technology may provide an opportunity to improve infant spinal procedures.ObjectiveOur primary objective is to conduct a comprehensive review of the current literature on ultrasonography for spinal anesthesia in infants. Given the narrow scope of this topic, our secondary objective is to review the current literature on ultrasonography for lumbar puncture in infants.Evidence reviewWe reviewed all papers related to the use of ultrasound for infant spinal anesthesia. Two large databases were searched with key terms. Eligibility criteria were full-text articles in English. For our secondary objective, we searched one large database for key terms relating to ultrasonography and infant lumbar puncture. Eligibility criteria were the same.FindingsOur primary search retrieved six articles. These consisted of four review articles, one case report, and one retrospective observational study. Our secondary search retrieved fourteen articles. These consisted of five randomized control trials, four prospective studies, three retrospective studies, and two review papers.ConclusionsUltrasound yields high-quality images of the infant spine. Most literature regarding ultrasound for infant spinal procedures arises from emergency medicine or interventional radiology specialties. The literature on ultrasound for infant spinal anesthesia is extremely limited, but shows promise. Future studies are needed in order to determine whether ultrasound can improve the success rate for delivery of infant spinal anesthesia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%