Cesarean deliveries receiving spinal anesthesia with intrathecal morphine are associated with post-operative hypothermia. Lorazepam has been proposed as a reversal agent for treating intrathecal morphine-associated post-cesarean hypothermia. Midazolam is a benzodiazepine familiar to most anesthesia providers and is frequently administered in the perioperative period. We present a post-cesarean delivery spinal anesthesia-associated hypothermia patient successfully treated with intravenous midazolam.
IntroductionNeuraxial procedures are performed by many specialties among a wide variety of patients. Palpation is the standard practice to locate a target insertion site. Procedural difficulty may prompt the use of alternative modalities. In a 2020 feasibility study, a neuraxial imaging device called VerTouch was shown to be reliable and easy to learn. In this study, we compared VerTouch to palpation and ultrasound (US).MethodsAn investigator-initiated prospective, randomised study was conducted on a labour and delivery ward at a large tertiary care hospital. Participants were randomised to either palpation, US or the VerTouch device. The primary endpoint was the total number of redirections. Secondary endpoints included the number of reinsertions and the total procedure time.Results95 patients were enrolled and 81 completed the study. The VerTouch group required fewer redirections (0.72 vs 2.35 and 2.81, p=0.041) and reinsertions (0.11 vs 0.50 and 0.96, p=0.017) without prolonging the overall procedure time (8.66 mins vs 7.88 and 9.81, p=0.121) when compared to palpation and US, respectively.ConclusionThis study supports the potential for VerTouch to improve procedural success for patients who might otherwise require radiology referral and for providers who may lack the resources or training to accommodate US guidance. The results also demonstrate the potential value in clinician involvement in the development of technology from the point of inception through implementation into clinical practice.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations鈥揷itations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.