Predicting difficult and traumatic lumbar punctures

Shah, Kaushal; McGillicuddy, Daniel C.; Spear, Jeffrey; Edlow, Jonathan A.

doi:10.1016/j.ajem.2006.11.025

Cited by 18 publications

(22 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In another report including 52 adult patients, an abdominal circumference greater than 94 cm or a BMI greater than 26 were associated with greater difficulty in the identification of the intervertebral space and in performing a LP 7 . Overweight and age were also identified as predictors of greater difficulty when carrying out LP in patients with a BMI >30 and age >65 years 8 . Importantly, in the United States 34.9% of people suffer from obesity 9 , whereas in Mexico the prevalence of obesity is 39.7%, and other 29% of the adult population are overweight 10 .…”

Section: Introductionmentioning

confidence: 98%

Impact of Obesity on Lumbar Puncture Outcomes in Adults with Acute Lymphoblastic Leukemia and Lymphoma: Experience at an Academic Reference Center

Jaime‐Pérez

Sotomayor-Duque

Aguilar-Calderón

et al. 2019

IJHOSCR

View full text Add to dashboard Cite

Background: Lumbar puncture (LP) is a hematology procedure that can require repeated attempts leading to traumatic LP (TLP), which has been related to the central nervous system (CNS) relapse. LP success can depend on the size and anatomy of the patient and the skill of the hematologist. The main objective was to determine the influence of body mass index (BMI) on LP outcomes. Materials and Methods: Adults with lymphoid malignancies requiring LP were included prospectively over one year; hematology residents performed most procedures. A 22-gauge Quincke needle was employed. Comparison between non-traumatic vs. traumatic LPs according to BMI, CNS relapse, and residents’ year was performed. Results: Fifty-four patients with a mean age of 31.5±15.57 years were included. Diagnosis was Acute Lymphoblastic Leukemia-B (74%), Acute Lymphoblastic Leukemia-T (13%) and Non-Hodgkin Lymphoma (13%). 227 LPs were performed, 121 (53.3%) successful, 98 (43.2%) traumatic, 11 (11.2%) TLPs were macroscopically detectable and 87 (88%) microscopic; 8 (3.5%) were dry-taps. Median time between punctures was 11 days (1-202). Median BMI was 25 (22.8-39.6). Main indication for LP was prophylactic (74.5%); 39.2% were performed by first-year, 35.2% by second-year, 19.6% by third-year hematology residents. No difference (p = 0.145) for a TLP was found among residents. A BMI ≥30 (p = 0.040), non-palpable intervertebral space (p = 0.001) and more than one attempt (p = 0.001) were significant for TLP. TLP was not associated with CNS relapse (p = 0.962). Conclusion: Obesity predicted a TLP. A traumatic puncture did not increase the risk of CNS relapse at one-year follow-up.

show abstract

Section: Introductionmentioning

confidence: 98%

Impact of Obesity on Lumbar Puncture Outcomes in Adults with Acute Lymphoblastic Leukemia and Lymphoma: Experience at an Academic Reference Center

Jaime‐Pérez

Sotomayor-Duque

Aguilar-Calderón

et al. 2019

IJHOSCR

View full text Add to dashboard Cite

show abstract

“…The procedure is somewhat painful, time consuming, and may be difficult, especially in patients who are overweight, uncooperative, or in those with a history of spine surgery (36). Patients may be reluctant to undergo the procedure because they view it as invasive.…”

Section: Ct/lpmentioning

confidence: 99%

Clinical Guidelines for the Emergency Department Evaluation of Subarachnoid Hemorrhage

Meurer

Walsh

Vilke

et al. 2016

The Journal of Emergency Medicine

View full text Add to dashboard Cite

, Abstract-Background: Subarachnoid hemorrhage (SAH) is frequently caused by the rupture of an intracranial aneurysmal vessel or arteriovenous malformation, leading to a cascade of events that can result in severe disability or death. When evaluating for this diagnosis, emergency physicians have classically performed a noncontrast computed tomography (NCCT) scan, followed by a lumbar puncture (LP). Recently, however, as CT technology has advanced, many studies have questioned the necessity of the LP in the SAH diagnostic algorithm and have instead advocated for noninvasive techniques, such as NCCT alone or NCCT with CT angiogram (CTA). Objective: The primary goal of this literature search was to determine the appropriate emergency department (ED) management of patients with suspected SAH. Methods: A MEDLINE literature search from October 2008 to June 2015 was performed using the keywords computed tomography AND subarachnoid hemorrhage AND lumbar puncture, while limiting the search to human studies written in the English language. General review articles and single case reports were omitted. Each of the selected articles then underwent a structured review. Results: Ninety-one articles were identified, with 31 papers being considered appropriate for analysis. These studies then underwent a rigorous review from which recommendations were developed. Conclusions: The literature search supports that NCCT followed by CTA is a reasonable approach in the evaluation of ED patients with possible SAH. Ó 2016 Elsevier Inc.

show abstract

“…Some studies have shown that anatomical signs behind the patient have a diagnostic value in predicting the ease of noraxial techniques 6,7. Previous studies showed that the anatomical signs of the back, visibility of vertebrae and the radiological features of the lumbar vertebrae are two independent factors predicting the spinal anesthesia outcome and the anesthetist’s experience was not a determining factor in the difficulty of performing the technique 8,9. Shankar et al described the insufficient gap between the spinal vertebrae as the only problem for this technique 10…”

Section: Introductionmentioning

confidence: 99%

Anatomical predicting factors of difficult spinal anesthesia in patients undergoing cesarean section: An observational study

Atashkhoei¹,

Samudi²,

Abedini

et al. 2019

Pak J Med Sci

View full text Add to dashboard Cite

Objectives:Although Spinal anesthesia is the most common and safe anesthetic method for patients undergoing cesarean section, difficult access to it is a frequent problem in operating theaters. The predictive factors for the difficulty of spinal anesthesia in patients undergoing cesarean section were investigated.Methods:A total of 110 pregnant women, single-stranded, aged 18-40 years old and ASA class I or II candidates for elective cesarean section with spinal anesthesia were studied. Demographic information, body appearance, ability to bend the back of the patient was recoded. Also the position of the anatomical landmarks of the lumbar spine, the presence or absence of deformity in the spinal column lumbar was recorded for all patients.Results:The correlation coefficient of age, weight, body mass index, general body appearance, retention ability, anatomical signs of the spinal column (touching the spinous process) and the interval between the vertebra with the difficulty of spinal anesthesia were statistically significant (p<0.05). Complications after spinal anesthesia had a statistically significant relationship with the difficulty of performing spinal blockade (p: 0.006).Conclusion:Increasing age, weight, body mass index, reducing the ability to bend the waist, the non-touching of the spinous process and interstitial space causes the difficulty of performing spinal anesthesia in patients undergoing cesarean section. The results can contribute to determining and designing a spinal blockade scoring system based on the patient’s characteristics and effective factors before the surgery, to facilitate the technique by anesthesiologist.

show abstract

Predicting difficult and traumatic lumbar punctures

Cited by 18 publications

References 5 publications

Impact of Obesity on Lumbar Puncture Outcomes in Adults with Acute Lymphoblastic Leukemia and Lymphoma: Experience at an Academic Reference Center

Impact of Obesity on Lumbar Puncture Outcomes in Adults with Acute Lymphoblastic Leukemia and Lymphoma: Experience at an Academic Reference Center

Clinical Guidelines for the Emergency Department Evaluation of Subarachnoid Hemorrhage

Anatomical predicting factors of difficult spinal anesthesia in patients undergoing cesarean section: An observational study

Contact Info

Product

Resources

About