Accuro ultrasound-based system with computer-aided image interpretation compared to traditional palpation technique for neuraxial anesthesia placement in obese parturients undergoing cesarean delivery: a randomized controlled trial

Ni, Xiu; Li, Meng-zhu; Zhou, Shuangqiong; Xu, Zhendong; Zhang, Yueqi; Yu, Yibing; Su, Jing; Zhang, Limin; Liu, Zhiqiang

doi:10.1007/s00540-021-02922-y

Cited by 14 publications

(28 citation statements)

References 22 publications

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“…The classical palpation method for neuraxial analgesia (spinal, epidural, or combined spinal-epidural (CSE)) may be questioned though it remains the first choice for clinical practice. [ 76 ] Especially, in bariatric patients where obesity obscures anatomical landmarks along with positioning challenges. Anesthesiologists can experience difficulty in appreciating the midline and vertebral interspaces.…”

Section: Regional Analgesiamentioning

confidence: 99%

“…Anesthesiologists can experience difficulty in appreciating the midline and vertebral interspaces. [ 76 ] Multiple attempts are often required, and excessive adipose tissue can increase the incidence of false-positive loss of resistance during epidural placement. Furthermore, obese patients are more likely to experience a longer procedure time, a higher incidence of accidental dural puncture, a higher incidence of epidural venous puncture, and higher overall failure and complication rates during neuraxial anesthesia placement.…”

Section: Regional Analgesiamentioning

confidence: 99%

“…Furthermore, obese patients are more likely to experience a longer procedure time, a higher incidence of accidental dural puncture, a higher incidence of epidural venous puncture, and higher overall failure and complication rates during neuraxial anesthesia placement. [ 76 77 ] Neuraxial US (pre-procedural or real-time) can be used to identify the intervertebral space(s), the midline for insertion, determine the depth from the skin to the epidural space, the best needle insertion point, and the best angle for needle insertion. [ 77 ] This leads to decrease of the number of attempts required for epidural placement, the risk for epidural hematoma, and post-surgical low back pain.…”

Section: Regional Analgesiamentioning

confidence: 99%

“…Not only the use of preprocedural US examination has helped the anesthesiologists but also the use of real-time US. Ni et al [ 76 ] compared the US-based system with computer-aided image interpretation to traditional palpation technique for neuraxial anesthesia placement in obese parturients undergoing cesarean delivery. The study showed that the first insertion success rate was significantly higher, and the time taken to identify the needle puncture site was less in the US group.…”

Section: Regional Analgesiamentioning

confidence: 99%

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The role of ultrasonography in anesthesia for bariatric surgery

et al. 2022

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Bariatric surgeries are effective long-term management for morbid obesity with its adverse sequelae. Anesthesia of bariatric surgeries poses unique challenges for the anesthesiologist in every step starting with vascular access till tracheal extubation. The usage of ultrasound in anesthesia is becoming more prevalent with a variety of benefits, especially in the obese population. Ultrasound is successfully used for obtaining vascular access, with more than 15 million catheters placed in the United States alone. Ultrasound can also be used to predict difficult intubation, as it can confirm the tracheal intubation and assess the gastric content to prevent pulmonary aspiration. Ultrasound is also used in the management of mechanically ventilated patients to monitor lung aeration and to identify respiratory complications during positive pressure ventilation. Moreover, intraoperative echocardiography helps to discover the pulmonary embolism and guides the fluid therapy. Finally, ultrasound can be used to perform neuraxial and fascial plane block with a less overall time of the procedures and minimal complications. The wide use of ultrasound in bariatric anesthesia reflects the learning curve of the anesthesiologists and their mounting efforts to provide safe anesthesia utilizing the updated technology. In this review, we highlight the role of ultrasonography in anesthesia of bariatric surgery and discuss the recent guidelines.

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Section: Regional Analgesiamentioning

confidence: 99%

Section: Regional Analgesiamentioning

confidence: 99%

Section: Regional Analgesiamentioning

confidence: 99%

Section: Regional Analgesiamentioning

confidence: 99%

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The role of ultrasonography in anesthesia for bariatric surgery

et al. 2022

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“…In the present case, a portable handheld AI enhanced ultrasound device played a key role in successfully placing an epidural catheter in a parturient with extreme obesity (BMI = 64.5 kg/m 2 ), proving to be superior to palpation and conventional spine ultrasound imaging [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Artificial intelligence enhanced ultrasound (AI-US) in a severe obese parturient: a case report

et al. 2022

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Background Neuraxial anesthesia in obese parturients can be challenging due to anatomical and physiological modifications secondary to pregnancy; this led to growing popularity of spine ultrasound in this population for easing landmark identification and procedure execution. Integration of Artificial Intelligence with ultrasound (AI-US) for image enhancement and analysis has increased clinicians' ability to localize vertebral structures in patients with challenging anatomical conformation. Case presentation We present the case of a parturient with extremely severe obesity, with a Body Mass Index (BMI) = 64.5 kg/m2, in which the AI-Enabled Image Recognition allowed a successful placing of an epidural catheter. Conclusions Benefits gained from AI-US implementation are multiple: immediate recognition of anatomical structures leads to increased first-attempt success rate, making easier the process of spinal anesthesia execution compared to traditional palpation methods, reducing needle placement time for spinal anesthesia and predicting best needle direction and target structure depth in peridural anesthesia.

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Échorepérage et échoguidage pour les anesthésies neuraxiales

Aveline¹

2022

Anesthésie & Réanimation

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Accuro ultrasound-based system with computer-aided image interpretation compared to traditional palpation technique for neuraxial anesthesia placement in obese parturients undergoing cesarean delivery: a randomized controlled trial

Cited by 14 publications

References 22 publications

The role of ultrasonography in anesthesia for bariatric surgery

The role of ultrasonography in anesthesia for bariatric surgery

Artificial intelligence enhanced ultrasound (AI-US) in a severe obese parturient: a case report

Échorepérage et échoguidage pour les anesthésies neuraxiales

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