Effect of table tilt and spine flexion–rotation on the acoustic window of the lumbar spine in pregnant women

Sebbag, Ilana; Tang, Raymond; Gunka, V.; Sahota, JagPaul; Vaghadia, Himat; Sawka, Andrew

doi:10.1016/j.bjane.2018.01.003

Cited by 3 publications

(1 citation statement)

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“…A seated position with a flexed back is a widely used position and variations of this position have been studied and proposed as improvements. [1][2][3][4][5][6] A subset of these studies have attempted to validate seated positions and variations, such as the addition of a dorsal table tilt, by measuring the dimensions of the ligamentum flavum 7 and the posterior longitudinal ligament 8 from ultrasound, which are hypothesized to correlate with the area available for dural puncture. Nevertheless, such measurements are typically performed on two-dimensional images acquired by a conventional ultrasound transducer, which are sensitive to transducer pressure and orientation.…”

Section: Résumémentioning

confidence: 99%

A comparative study on position and paramedian neuraxial access on healthy volunteers using three-dimensional models registered to lumbar spine ultrasound

Porto

Tang

Sawka

et al. 2020

Can J Anesth/J Can Anesth

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Purpose Optimizing patient position and needle puncture site are important factors for successful neuraxial anesthesia. Two paramedian approaches are commonly utilized and we sought to determine whether variations of the seated position would increase the chance of puncture success. Methods We simulated paramedian needle passes on three-dimensional lumbar spine models registered to volumetric ultrasound data acquired from ten healthy volunteers in three different positions: 1) prone; 2) seated with thoracic and lumbar flexion; and 3) seated as in position 2, but with a 10°dorsal tilt. Simulated paramedian needle passes from the right side performed on validated models were used to determine L2-3 and L3-4 neuraxial target size and success. We selected two paramedian puncture sites according to standard anesthesia textbook descriptions: 10 mm lateral and 10 mm caudal from inferior edge of the superior spinous process as described

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