An observational study of factors leading to difficulty in resident anaesthesiologists identifying the epidural space in obstetric patients

Faitot, Valentina; Ourchane, R.; Dahmani, Souhayl; Magheru, M.; Nebout, S.; Gomas, F.; Katz, Ariel; Salomon, L. J.; Keïta-Meyer, Hawa

doi:10.1016/j.ijoa.2010.11.008

Cited by 26 publications

(29 citation statements)

References 15 publications

(23 reference statements)

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“…These procedures are facilitated by the clinician's ability to identify the patient's midline to direct needle placement into the epidural or intrathecal space. This localization process may be problematic when patients are obese, pregnant, or have spinal abnormalities, including misalignment or degenerative changes [3][4][5][6][7]. Ultrasound can be used to gain a more accurate understanding of a patient's spinal anatomy, leading to fewer needle insertion attempts and spinal needle manipulations, and improve patient satisfaction [3,5,6,[8][9][10][11][12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Teaching sonoanatomy to anesthesia faculty and residents: utility of hands-on gel phantom and instructional video training models

VanderWielen

Harris

Galgon

et al. 2015

Journal of Clinical Anesthesia

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Section: Introductionmentioning

confidence: 99%

Teaching sonoanatomy to anesthesia faculty and residents: utility of hands-on gel phantom and instructional video training models

VanderWielen

Harris

Galgon

et al. 2015

Journal of Clinical Anesthesia

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“…No risk factors were derived as predictive of misidentifi cation of interspinous level in this study, although several factors such as Body Mass Index, spinal abnormality, and anatomical landmark quality have been shown to be associated with diffi cult neuraxial block 14 . Our study verifi ed the accuracy of identifi cation of the lumbar interspinous level by palpation and did not search for an alternative technique to improve the accuracy of interspinous space estimation.…”

Section: Discussionmentioning

confidence: 82%

Identificação dos espaços interespinhosos lombares por palpação e avaliados por radiografias

Tanaka¹,

Irikoma²,

Kokubo³

2013

Rev. Bras. Anestesiol.

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Background and objectives: Palpation has been shown to be rather inaccurate at identifying lumbar interspinous spaces in neuraxial anesthesia. The aim of this study is to assess the accuracy of the determination of the lumbar interspinous spaces by anesthesiologist's palpation using postoperative X-rays in obstetric patients. Methods: We reviewed the anesthetic record and the post-operative abdominal X-rays of the cesarean sections. We indwelled the epidural catheter for post-operative one-shot analgesia. We included combined spinal and epidural anesthesia cases and compared the interspinous level which the anesthesiologist recorded and the epidural catheter insertion level confi rmed by abdominal X-ray for each case. We also evaluated the factors (age, body weight, height, Body Mass Index, gestational age, and the type of surgery [planned / emergency]) leading to misidentifi cation of interspinous level. Results: Nine hundred and sixty seven cesarean sections were performed and a total of 835 cases were evaluated. The levels of the puncture documented by the anesthesiologists were in agreement with the actual catheter insertion levels in 563 (67%) cases. When the anesthesiologists aimed at L2-3 level, we found the catheter insertion at L1-2 in 5 cases (4.9%), none of which had any post-operative neurological defi cits. No variables evaluated were signifi cantly associated with misidentifi cation of interspinous level by the anesthesiologists. Conclusions: There was a discrepancy between the anesthesiologists' estimation by palpation and the actual catheter insertion level shown in X-rays. It seems to be safer to choose the interspinous level L3-4 or lower in spinal anesthesia.

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“…En raison du panicule adipeux parfois conséquent et de l'infiltration des tissus mous, la recherche de l'EPD est plus difficile chez la parturiente obèse [9] en raison des fausses impressions de perte de résistance (faux positifs).…”

Section: Recherche De L'epd Difficile : Nombreux Faux Positifsunclassified

Bloc neuroaxiaux chez la parturiente obèse

Hesbois

Fuzier

Heintzelmann

et al. 2015

Le Praticien en Anesthésie Réanimation

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An observational study of factors leading to difficulty in resident anaesthesiologists identifying the epidural space in obstetric patients

Cited by 26 publications

References 15 publications

Teaching sonoanatomy to anesthesia faculty and residents: utility of hands-on gel phantom and instructional video training models

Teaching sonoanatomy to anesthesia faculty and residents: utility of hands-on gel phantom and instructional video training models

Identificação dos espaços interespinhosos lombares por palpação e avaliados por radiografias

Bloc neuroaxiaux chez la parturiente obèse

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