Epidural catheter placement in children: comparing a novel approach using ultrasound guidance and a standard loss-of-resistance technique

Willschke, Harald; Marhofer, Peter; Bosenberg, A.T.; Johnston, S.; Wanzel, Oliver; Sitzwohl, Christian; Kettner, Stephan C.; Kapral, Stephan

doi:10.1093/bja/ael121

Cited by 149 publications

(120 citation statements)

References 31 publications

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“…* tissues that allow the beam to pass easily (e.g., containing fluids or blood) create only little echo (hypoechoic) and appear black on the screen, while tissues that allows less beam to pass (e.g., fat and bone) create stronger echoes (hyperechoic) and thus appear white on the screen; * * linear transducers have a higher frequency (10)(11)(12)(13)(14)(15) and are usually used for superficial structures; curved transducers have a lower frequency (4)(5)(6)(7)(8) and are usually used for deeper structures. This paper highlights current and potential future applications of ultrasound in the field of anesthesiology.…”

Section: Figure 1: Concept Of Ultrasonographymentioning

confidence: 99%

“…Willschke et al [15] evaluated ultrasound guidance for epidural catheter placement in children below six years, found that ultrasonography is helpful in reducing bone contacts, faster epidural placement, and offered direct visualization of neuraxial structures and the spread of local anesthetic inside the epidural space. Again, it needs highly skilled hands.…”

Section: Neuraxial and Chronic Pain Proceduresmentioning

confidence: 99%

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Lung Ultrasound in the Critically Ill

Cho

2017

Korean J Crit Care Med

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Ultrasound is a safe, portable, relatively inexpensive, and easily accessible imaging modality, making it a useful diagnostic and monitoring tool in medicine. Anesthesiologists encounter a variety of emergent situations and may benefit from the application of such a rapid and accurate diagnostic tool in their routine practice. This paper reviews current and potential applications of ultrasound in anesthesiology in order to encourage anesthesiologists to learn and use this useful tool as an adjunct to physical examination. Ultrasound-guided peripheral nerve blockade and vascular access represent the most popular ultrasound applications in anesthesiology. Ultrasound has recently started to substitute for CT scans and fluoroscopy in many pain treatment procedures. Although the application of airway ultrasound is still limited, it has a promising future. Lung ultrasound is a well-established field in point-of-care medicine, and it could have a great impact if utilized in our ORs, as it may help in rapid and accurate diagnosis in many emergent situations. Optic nerve sheath diameter (ONSD) measurement and transcranial color coded duplex (TCCD) are relatively new neuroimaging modalities, which assess intracranial pressure and cerebral blood flow. Gastric ultrasound can be used for assessment of gastric content and diagnosis of full stomach. Focused transthoracic (TTE) and transesophageal (TEE) echocardiography facilitate the assessment of left and right ventricular function, cardiac valve abnormalities, and volume status as well as guiding cardiac resuscitation. Thus, there are multiple potential areas where ultrasound can play a significant role in guiding otherwise blind and invasive interventions, diagnosing critical conditions, and assessing for possible anatomic variations that may lead to plan modification. We suggest that ultrasound training should be part of any anesthesiology training program curriculum.

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Section: Figure 1: Concept Of Ultrasonographymentioning

confidence: 99%

Section: Neuraxial and Chronic Pain Proceduresmentioning

confidence: 99%

Lung Ultrasound in the Critically Ill

Cho

2017

Korean J Crit Care Med

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“…9 Although surface ultrasonography is a non-invasive tool that can be used in awake patients, its usefulness for thoracic epidural imaging is limited because of the narrow thoracic intervertebral spaces and the oblique trajectory needed for ultrasound imaging in this region. 10,11 Transesophageal echocardiography (TEE) has the theoretical potential to overcome this age-related barrier by obtaining images of spinal canal stuctures using the intervertebral disc as an acoustic window.…”

Section: Résumé Objectif Les Objectifs De Cette éTude éTaient De Détementioning

confidence: 99%

Utility of transesophageal echocardiography in identifying spinal canal structures and epidural catheter position: a prospective observational study of intraoperative hemodynamics and postoperative analgesia

Goswami

Kumar

Puri

et al. 2016

Can J Anesth/J Can Anesth

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“…of these studies, 13 were excluded because they did not provide blinded assessment or sample size justification. [1][2][3][4][5][6][7][8][9][10][11][12][13] of the remaining 15 RCTs, seven compared US to traditional adjunctive modalities for peripheral nerve blocks (Table i), while eight compared stimulating to non-stimulating perineural catheters (Table ii).…”

Section: Search Strategy and Selection Criteriamentioning

confidence: 99%

Ultrasonography and stimulating perineural catheters for nerve blocks: a review of the evidence

Tran

Muñoz

Russo

et al. 2008

Can J Anesth/J Can Anesth

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Purpose: This narrative review summarizes the evidence derived from randomized controlled trials (RCTs) offering blinded assessment and sample size justification, in order to determine the benefits associated with adjunctive ultrasonography (US) and stimulating perineural catheters for nerve blocks. Source:The literature search for this review was conducted during the second week of December 2007 using the MEDLINE (January 1950 to November 2007 and EMBASE (January 1980 to November 2007) databases. For US-guided peripheral and neuraxial blocks, the following medical subject heading (MeSH) terms were searched: "nerve block", "epidural anesthesia", "epidural analgesia", "epidural injection", "epidural space", "spinal anesthesia", and "spinal injection", the results were combined with "ultrasonography" (MeSH term) and "ultrasound" (key word). For stimulating perineural catheters, the following MeSH terms were cross referenced with the MeSH term, "nerve block": "peripheral catheterization", "indwelling catheterization", "catheterization", and keywords, "nerve catheter" and "continuous". Subsequently, the result of this search was combined to "stimulating" (key word). Fifteen RCTs, offering blinded assessment and sample size justification, were retained for analysis.Principal findings: For axillary blocks, US guidance yields a higher success rate than a double-injection, transarterial and a triple-injection, neurostimulation-guided technique. Compared to a quadruple-stimulation technique, no major differences can be found. The addition of nerve stimulation to US guidance offers no clear benefits for axillary blocks. For femoral blocks, compared to neurostimulation, echoguidance is associated with a local anesthetic (LA) sparing effect (up to 42%). In children, US guidance yields a LA sparing effect and a longer duration of action for lower extremity nerve blocks.Compared to their blind counterparts, stimulating catheters seem to offer limited clinical benefits. Despite providing a sparing effect on LA and opioid consumption, stimulating catheters are not associated with a decrease in side effects or analgesiarelated expenditures. Conclusions Sources : La recherche de littérature pour cet article de synthèse a été menée la deuxième semaine de décembre 2007 dans les bases de données MEDLINE (janvier 1950 à novembre 2007) et EMBASE (janvier 1980 à novembre 2007). Pour les blocs périphériques et neuraxiaux échoguidés, les termes MeSH suivants ont été recherchés : « nerve block », « epidural anesthesia », « epidural analgesia », « epidural injection », « epidural space », « spinal anesthesia » et « spinal injection », et ont été associés à « ultrasonography »

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Epidural catheter placement in children: comparing a novel approach using ultrasound guidance and a standard loss-of-resistance technique

Cited by 149 publications

References 31 publications

Lung Ultrasound in the Critically Ill

Lung Ultrasound in the Critically Ill

Utility of transesophageal echocardiography in identifying spinal canal structures and epidural catheter position: a prospective observational study of intraoperative hemodynamics and postoperative analgesia

Ultrasonography and stimulating perineural catheters for nerve blocks: a review of the evidence

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