Ultrasound Imaging Facilitates Spinal Anesthesia in Adults With Difficult Surface Anatomic Landmarks

Chin, Ki Jinn; Perlas, Anahi; Chan, Vincent; Brown-Shreves, Danielle; Koshkin, Arkadiy; Vaishnav, Vandana

doi:10.1097/01.sa.0000414261.89578.38

Cited by 30 publications

(45 citation statements)

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“…112 Much of the work in this area has been in the obstetric population, although in an orthopedic population of patients with difficult anatomy (a mixture of obese patients and patients with scoliosis or previous lumbar spine surgery), ultrasound was shown to improve first attempt success rates, reduce needle insertion attempts and needle passes, and shorten the time to perform spinal anesthesia. 113 The ultrasound estimated depth to the epidural space appears to correlate well with the actual needle distance, at least in obese parturients. 114 Description of the ultrasound technique is beyond the scope of this article, and we refer readers to existing reviews on the topic.…”

Section: Regional Anesthesia In the Obese Patientmentioning

confidence: 86%

Perioperative management of the severely obese patient: a selective pathophysiological review

Cullen

Ferguson

2012

Can J Anesth/J Can Anesth

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Section: Regional Anesthesia In the Obese Patientmentioning

confidence: 86%

Perioperative management of the severely obese patient: a selective pathophysiological review

Cullen

Ferguson

2012

Can J Anesth/J Can Anesth

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“…8 The success rate with first puncture was also 65% with pre-procedural ultrasound, albeit this population had poorly defined landmarks. 5 Since multiple skin punctures and needle redirects are associated with an increased risk of complications, such as spinal hematoma, post-dural puncture headache, and neural injury, it is important for any novel technique to have a high success rate with the first skin puncture. 5,9,10 Interestingly, successful dural puncture occurred in 7/20 (35%) cases with the first needle pass, which is better than the 27% success rate that Chin et al 5 reported with pre-procedure ultrasound and the 30% success rate that Conroy et al 8 reported with conventional ultrasound.…”

Section: Discussionmentioning

confidence: 99%

“…3 In addition, there is less familiarity and greater perceived difficulty of spinal sonoanatomy compared with sonoanatomy for other blocks. 4,5 Recently, a novel SonixGPS TM electromagnetic needle tracking system (Ultrasonix, Richmond, BC, Canada) that provides a real-time display of current and projected needle tip positions has been approved by Health Canada for US-guided needle interventions. Cadaver trials and one case report suggest that needle tip visibility down to the ligamentum flavum may be possible with the SonixGPS system.…”

Section: Résumé Objectif Le Sonixgpsmentioning

confidence: 99%

Single-operator real-time ultrasound-guided spinal injection using SonixGPS™: a case series

Brinkmann

Tang

Sawka

et al. 2013

Can J Anesth/J Can Anesth

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Purpose The SonixGPS TM is a novel needle tracking system that has recently been approved in Canada for ultrasound-guided needle interventions. It allows optimization of needle-beam alignment by providing a real-time display of current and predicted needle tip position. Currently, there is limited evidence on the effectiveness of this technique for performance of realtime spinal anesthesia. This case series reports performance of the SonixGPS system for real-time ultrasound-guided spinal anesthesia in elective patients scheduled for joint arthroplasty. Methods In this single-centre case series, 20 American Society of Anesthesiologists' class I-II patients scheduled for lower limb joint arthroplasty were recruited to undergo real-time ultrasound-guided spinal anesthesia with the SonixGPS after written informed consent. The primary outcome for this clinical cases series was the success rate of spinal anesthesia, and the main secondary outcome was time required to perform spinal anesthesia. Results Successful spinal anesthesia for joint arthroplasty was achieved in 18/20 patients, and 17 of these required only a single skin puncture. In 7/20 (35%) patients, dural puncture was achieved on the first needle pass, and in 11/20 (55%) patients, dural puncture was achieved with two or three needle redirections. Median (range) time taken to perform the block was 8 (5-14) min. The study procedure was aborted in two cases because our clinical protocol dictated using a standard approach if spinal anesthesia was unsuccessful after three ultrasound-guided insertion attempts. These two cases were classified as failures. No complications, including paresthesia, were observed during the procedure. All patients with successful spinal anesthesia found the technique acceptable and were willing to undergo a repeat procedure if deemed necessary. Conclusions This case series shows that real-time ultrasound-guided spinal anesthesia with the SonixGPS system is possible within an acceptable time frame. It proved effective with a low rate of failure and a low rate of complications. Our clinical experience suggests that a randomized trial is warranted to compare the SonixGPS with a standard block technique. Résumé Objectif Le SonixGPSTM est un système innovant de suivi de l'aiguille récemment approuvé au Canada pour les interventions échoguidées réalisées avec une aiguille. Cet appareil optimise l'alignement entre l'aiguille et le faisceau grâce à un affichage en temps réel du positionnement actuel et prévu de la pointe de l'aiguille. À l'heure actuelle, les données probantes concernant l'efficacité de cette technique pour réaliser une rachianesthésie en temps réel sont limitées. Cette série de cas porte sur la performance du système SonixGPS pour réaliser une rachianesthésie échoguidée en temps réel chez des patients devant subir une chirurgie non urgente d'arthroplastie.

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“…In morbidly obese parturients, Singh et al (19) cients with ultrasound (especially in experienced hands), pre-procedure ultrasound-guidance can be particularly valuable in cases where obesity, technical difficulty is anticipated and as a rescue to the blind technique when technical/anatomic difficulty is encountered. Chin et al (20) examined the effect of using ultrasound to guide spinal anesthesia in obese orthopedic patients with poorly palpable spinous processes, and moderate to severe lumbar scoliosis or previous lumbar spine surgery, and showed successful dural puncture was achieved after the first needle insertion in 65% of cases in the ultrasound group compared to only 32% in the landmark group. The efficacy and safety of pre-procedure neuraxial ultrasound has been clearly demonstrated in multiple clinical studies (Table 2) (5,(21)(22)(23)(24).…”

Section: Neuraxial Ultrasound For Obesity and Difficult Landmarks/anamentioning

confidence: 99%

Pre-Procedure Neuraxial Ultrasound in Obstetric Anesthesia

Vallejo¹

2018

J Anesth Perioper Med

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Aim of review:To determine the current state of pre-procedure neuraxial ultrasound in obstetric anesthesia practice. Methods: The PubMed and Scopus databases were searched for the keywords "neuraxial", or "epidural", or "spinal" or "ultrasound", combined with "obstetric anesthesia". A current review of original studies, systematic reviews, and meta-analysis within the past decade were included in the analysis. Recent findings: Pre-procedure ultrasound imaging enhances successful neuraxial placement through determination of the optimal vertebral interspace, identification of the midline, location of the optimal insertion point, best angle for needle insertion, and accurate depth for needle advancement to the epidural or intrathecal space. In the experienced clinician, neuraxial ultrasound imaging can be of particular benefit in parturients with difficult anatomy and/or landmarks. Conclusion: Neuraxial ultrasound imaging reduces the risk of failed or traumatic lumbar punctures and epidural catheterizations, the number of insertion attempts, and needle redi-

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Ultrasound Imaging Facilitates Spinal Anesthesia in Adults With Difficult Surface Anatomic Landmarks

Cited by 30 publications

References 0 publications

Perioperative management of the severely obese patient: a selective pathophysiological review

Perioperative management of the severely obese patient: a selective pathophysiological review

Single-operator real-time ultrasound-guided spinal injection using SonixGPS™: a case series

Pre-Procedure Neuraxial Ultrasound in Obstetric Anesthesia

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