No abstract

Use of the novel SonixGPS needle-tracking ultrasound system (UltraSonix, Richmond, BC, Canada) was not associated with a higher success rate of vascular puncture compared with the traditional ultrasound-guided technique. Assessment of mental task load significantly favored the use of the ultrasound GPS over the traditional ultrasound technique.

Superior laryngeal nerve block is a valuable technique for provision of upper airway anesthesia. In bilateral scans of 20 volunteers, we developed a technique for ultrasonographic visualization of the superior laryngeal nerve and key anatomical structures using a hockey stick-shaped 8 to 15 MHz transducer (HST15 to 8/20 linear probe, Ultrasonix, Richmond, BC, Canada). Subsequently, we simulated superior laryngeal nerve scanning and injection in bilateral injections in 2 cadavers. Ultrasound-guided in-plane advancement of a needle toward the superior laryngeal nerve and injection of 1 mL of green dye was achieved in all 4 attempts and confirmed by a postprocedural dissection performed by an anatomist. We conclude that ultrasound-guided superior laryngeal nerve block in humans may be feasible.

There was no difference in the incidence or severity of epistaxis following nasal intubation using the Parker Flex-Tip nasal ETT when compared with a standard nasal RAE ETT. This trial was registered at ClinicalTrials.gov, identifier: NCT02315677.

In volunteers, flexion with 10° dorsal table tilt and flexion with right rotation significantly increased the length of the ipsilateral PLL, compared with the standard flexed sitting position, as visualized by paramedian ultrasonography at the level of T9/10.

Purpose The SonixGPS TM is a novel needle tracking system that has recently been approved in Canada for ultrasound-guided needle interventions. It allows optimization of needle-beam alignment by providing a real-time display of current and predicted needle tip position. Currently, there is limited evidence on the effectiveness of this technique for performance of realtime spinal anesthesia. This case series reports performance of the SonixGPS system for real-time ultrasound-guided spinal anesthesia in elective patients scheduled for joint arthroplasty. Methods In this single-centre case series, 20 American Society of Anesthesiologists' class I-II patients scheduled for lower limb joint arthroplasty were recruited to undergo real-time ultrasound-guided spinal anesthesia with the SonixGPS after written informed consent. The primary outcome for this clinical cases series was the success rate of spinal anesthesia, and the main secondary outcome was time required to perform spinal anesthesia. Results Successful spinal anesthesia for joint arthroplasty was achieved in 18/20 patients, and 17 of these required only a single skin puncture. In 7/20 (35%) patients, dural puncture was achieved on the first needle pass, and in 11/20 (55%) patients, dural puncture was achieved with two or three needle redirections. Median (range) time taken to perform the block was 8 (5-14) min. The study procedure was aborted in two cases because our clinical protocol dictated using a standard approach if spinal anesthesia was unsuccessful after three ultrasound-guided insertion attempts. These two cases were classified as failures. No complications, including paresthesia, were observed during the procedure. All patients with successful spinal anesthesia found the technique acceptable and were willing to undergo a repeat procedure if deemed necessary. Conclusions This case series shows that real-time ultrasound-guided spinal anesthesia with the SonixGPS system is possible within an acceptable time frame. It proved effective with a low rate of failure and a low rate of complications. Our clinical experience suggests that a randomized trial is warranted to compare the SonixGPS with a standard block technique. Résumé Objectif Le SonixGPSTM est un système innovant de suivi de l'aiguille récemment approuvé au Canada pour les interventions échoguidées réalisées avec une aiguille. Cet appareil optimise l'alignement entre l'aiguille et le faisceau grâce à un affichage en temps réel du positionnement actuel et prévu de la pointe de l'aiguille. À l'heure actuelle, les données probantes concernant l'efficacité de cette technique pour réaliser une rachianesthésie en temps réel sont limitées. Cette série de cas porte sur la performance du système SonixGPS pour réaliser une rachianesthésie échoguidée en temps réel chez des patients devant subir une chirurgie non urgente d'arthroplastie.

In the porcine epidural model, spread of one ml of epidural dye solution is more extensive after a single bolus compared with short term infusion.

The role of ultrasound scanning in spinal anesthesia is principally limited to preprocedure imaging and identification of anatomical structures. We describe our experience with a real-time ultrasound technique for visualization and performance of spinal anesthesia. An initial cadaver study was performed in 5 unembalmed cadavers to develop a technique for real-time performance of ultrasound-guided spinal anesthesia via Taylor's approach (paramedian approach to the L5-S1 interspace). Subsequently, 10 patients scheduled for joint arthroplasty underwent real-time ultrasound-guided spinal anesthesia in the prone position. The relevant anatomy and the needletip were visualized easily and all spinals were effective for joint arthroplasty.