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Haddad RN, Karmustaji F, Alloush R, Al Soufi M, Kasem M. Systematic approach to obtain axillary arterial access for pediatric heart catheterizations. Front Cardiovasc Med 2024; 11:1332152. [PMID: 38357517 PMCID: PMC10864575 DOI: 10.3389/fcvm.2024.1332152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
Background Axillary arterial access (AAA) in pediatric heart catheterizations is undervalued. Methods We retrospectively reviewed children with congenital heart diseases (CHDs) who received trans-axillary arterial catheterizations between January 2019 and February 2023. We aimed ultrasound-guided punctures in the proximal two-thirds of axillary arteries with diameters ≥2 mm to insert 7 cm/4 Fr short introducers. We administrated intra-arterial verapamil (1.25 mg) and heparin (100 UI/kg). We infiltrated per-operatively 2% lignocaine (10 mg) for arterial spasms, long sheaths use (≥5 Fr), and ≥60 min procedures in <3 kg patients. Results We identified 30 patients (66.7% males) with a median age of 1.1 months (IQR, 0.3-5.4), and a median weight of 3.1 kg (IQR, 2.7-3.7). 5/30 patients had six redo interventions after a median of 3.9 months (IQR, 1.7-5.1). Overall, 27/36 procedures were interventional, including 6 aortic valvuloplasties, 6 balloon angioplasties, and 15 stenting procedures. The median arterial axillary angiographic diameter was 2.6 mm (IQR, 2.4-3). Access was right-sided in 23/36 (63.9%) procedures and obtained using 21G/2.5 cm bevel needles in 25/36 (69.4%) procedures. No hemodynamical change occurred after introducing spasmolytic drugs. The median fluoroscopy time was 26.1 min (IQR, 19.2-34.8). There were two self-resolving arterial dissections, one sub-occlusive arterial thrombosis (resolved with 6 weeks of enoxaparin), and one occlusive arterial thrombosis (resolved with alteplase thrombolysis and 6 weeks of enoxaparin). Median follow-up was 11.7 months (IQR, 8-17.5). Four patients with complex univentricular hearts died from non-procedural causes at a median of 40 days (IQR, 31-161) postoperative. Conclusion Systematic approach for AAA is the key to success and unlocks the many potentials of trans-axillary pediatric cardiology interventions.
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Affiliation(s)
- Raymond N. Haddad
- M3C-Necker, Necker-Enfants Malades University Hospital, Assistance Publique—Hôpitaux de Paris (AP-HP), Paris, France
| | - Fatema Karmustaji
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Rasha Alloush
- Department of Pediatric Cardiology, Heart Centre of Excellence, Al Jalila Children’s Speciality Hospital, Dubai, United Arab Emirates
| | - Mahmoud Al Soufi
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Mohamed Kasem
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Fadumiye CO, Li J. Clinical education in regional anesthesia: current status and future directions. Int Anesthesiol Clin 2024; 62:86-93. [PMID: 38063040 DOI: 10.1097/aia.0000000000000425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Christopher O Fadumiye
- Department of Anesthesiology, the Medical College of Wisconsin, Milwaukee, Wisconsin
- Anesthesia Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | - Jinlei Li
- Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut
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Coviello A, Iacovazzo C, Piccione I, Posillipo C, Barone MS, Ianniello M, de Siena AU, Cirillo D, Vargas M. Impact of Ultrasound-Assisted Method on Success Rate of Spinal Anesthesia Performed by Novice Trainees: A Retrospective Comparative Study. J Pers Med 2023; 13:1515. [PMID: 37888126 PMCID: PMC10608531 DOI: 10.3390/jpm13101515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
In current practice, single-shot spinal anesthesia has traditionally been performed using the conventional surface-anatomic-Landmark-Guided technique. This "blind" technique has significant critical issues such as a high risk of complications due to the numerous attempts at spinal needle placement and the negative impact on the learning curve of the trainees. Ultrasound-Assisted spinal anesthesia could reduce these critical issues and allow trainees to perform the procedure more easily and with fewer complications for the patient. We performed a before-and-after monocentric retrospective comparative study at the University of Naples "Federico II" (Naples, Italy). Inclusion criteria were as follows: patients aged 18 years or older; ASA physical status between I and IV; and elective orthopedic surgery under single-shot spinal anesthesia performed by supervised trainees between January 2022 and December 2022. In the selected cohort, 88 patients were included in group A (Landmark-Guided spinal anesthesia) and 91 in group B (Ultrasound-Assisted spinal anesthesia). The number of attempts by trainees (p-value < 0.005), procedure performing time (<0.001), and patient discomfort (<0.001) were significantly lower in group B than in group A. Ultrasound-Assisted single-shot spinal anesthesia performed by novice trainees reduces the number of attempts, complication rate, periprocedural pain, and patient discomfort.
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Ekhtiari S, Phillips M, Dhillon D, Shahabinezhad A, Bhandari M. Understanding the Learning Curve of Carpal Tunnel Release With Ultrasound Guidance: A Review. Cureus 2023; 15:e41938. [PMID: 37588328 PMCID: PMC10425578 DOI: 10.7759/cureus.41938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/18/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is the most common compressive neuropathy and can be treated through carpal tunnel release (CTR) if nonoperative treatments fail. CTR can be performed through a variety of techniques, including traditional open, mini-open, endoscopic, and CTR with ultrasound guidance (CTR-US). The evidence on endoscopic CTR is mixed, due to a higher potential for nerve injury with endoscopic CTR compared to traditional open CTR. CTR-US offers the potential advantage of allowing the visualization of all key anatomical structures, combined with a very small incision and minimal soft tissue insult. As with any ultrasonographic technique or procedure, the learning curve needs to be considered for any provider considering adopting CTR-US. However, literature on ultrasound use around the wrist, including early evidence on the learning curve of CTR-US specifically, demonstrates this skill can be learned relatively quickly by providers with a wide range of prior experience in ultrasound and CTR. Overall, there is a need for high-quality studies comparing different CTR techniques, particularly CTR-US, as it offers the potential for considerable cost savings.
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Affiliation(s)
- Seper Ekhtiari
- Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR
| | - Mark Phillips
- Health Research Methodology, McMaster University, Hamilton, CAN
| | - Dalraj Dhillon
- Faculty of Health Sciences, McMaster University, Hamilton, CAN
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Appeadu M, Rosales R, Sherman AL, Irwin R, Tiozzo E, Price C. Interventional Spine Course: Improving Fluoroscopic Safety and Procedural Efficacy Among Physical Medicine and Rehabilitation Residents Using a Lecture and Model-Based Curriculum. Am J Phys Med Rehabil 2023; 102:625-629. [PMID: 36729909 DOI: 10.1097/phm.0000000000002160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT Therapeutic interventional techniques using fluoroscopy are often used in the management of spinal pain. Currently, there are no standardized means of instruction and assessment of fluoroscopic interventional spinal procedures for physiatry trainees. The aim of our study is to evaluate the utility of an interventional spine training course for physical medicine and rehabilitation residents in improving safety and efficacy when performing these procedures. We performed a prospective multiple cohort study analyzing interventional spine knowledge and procedural ability among physical medicine and rehabilitation residents after implementing a training course that used lectures, hands-on training, and video-recorded objective structured clinical examination self-assessments. Of the total of 28 physical medicine and rehabilitation residents over the 2-yr study period, each class saw a statistically significant improvement in mean objective structured clinical examination scores from pre-examination to postexamination ( P < 0.05). Written examination scores also had a statistically significant preimprovement to postimprovement in the postgraduate years 2 and 3 classes. Our study supports the use of an interventional spine course for physical medicine and rehabilitation residents, and by following the existing cohorts and adding more cohorts in the future, we will continue to demonstrate valuable and comprehensive results.
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Affiliation(s)
- Michael Appeadu
- From the Department of Physical Medicine and Rehabilitation, University of Miami/Jackson Memorial Hospital, Miami, Florida
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Sonawane K, Dixit H, Mehta K, Thota N, Gurumoorthi P. "Knowing It Before Blocking It," the ABCD of the Peripheral Nerves: Part C (Prevention of Nerve Injuries). Cureus 2023; 15:e41847. [PMID: 37581128 PMCID: PMC10423097 DOI: 10.7759/cureus.41847] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/16/2023] Open
Abstract
"A clever person solves the problem. A wise person avoids it" (Albert Einstein). There is no convincing evidence that any modality 100% effectively prevents nerve injury. The risk of nerve injury remains the same even with the ultrasound due to limitations in the resolution of images and inter-operator and inter-patient differences. In a nutshell, caution is required when dealing with precious nerves in the perioperative period, either during peripheral nerve blocks (PNBs), patient positioning, or surgery. Identifying pre-existing nerve injury, either due to trauma or an existing neuropathy, and preventing further nerve injury should be an important goal in providing safe regional anesthesia (RA). Multimodal monitoring is key to avoiding multifactorial nerve injuries. The use of triple guidance (ultrasound + peripheral nerve stimulator + injection pressure monitor) during PNBs further improves the safety of RA. The ultrasound helps in real-time visualization of the nerve, needle, and drug spread; the peripheral nerve stimulator helps confirm the target nerves; and the injection pressure monitor helps avoid nerve injury. Such multimodalities can also give the confidence to administer PNB without risk of nerve injury. This article is part of the comprehensive overview of the essential understanding of peripheral nerves before blocking them. It describes various preventive measures to avoid peripheral nerve injuries while administering PNBs. It will help readers understand the importance of prevention in each step to avoid perioperative PNIs.
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Affiliation(s)
- Kartik Sonawane
- Anesthesiology, Ganga Medical Centre and Hospitals, Pvt. Ltd, Coimbatore, IND
| | - Hrudini Dixit
- Anesthesiology, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, IND
| | - Kaveri Mehta
- Anesthesia and Critical Care, Corniche Hospital, Abu Dhabi, ARE
| | - Navya Thota
- Anesthesiology, Ganga Medical Centre and Hospitals, Pvt. Ltd, Coimbatore, IND
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Ultrasound-Guided Injections: Preprocedure Planning. Regen Med 2023. [DOI: 10.1007/978-3-030-75517-1_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
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Hauglum SD, Miller AB, Vera C, Alves S. Ultrasound improves percutaneous needle cricothyrotomy success in the novice anesthesia provider compared to the landmark technique. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2023. [DOI: 10.1016/j.tacc.2023.101211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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A quadruple peripheral nerve block outside the OR for anterior cruciate ligament reconstruction reduces the OR occupancy time. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07246-2. [PMID: 36469051 DOI: 10.1007/s00167-022-07246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/22/2022] [Indexed: 12/07/2022]
Abstract
PURPOSE The use of regional anesthesia (RA) for anterior cruciate ligament (ACL) reconstruction reduces morphine consumption, the time spent in the post-anesthesia care unit (PACU) and the hospital readmission rate. However, RA failures due to delays in the induction of anesthesia and its unpredictable success rate (Cuvillon et al. Ann Fr Anesth 29:710-715, 2010; Jankowski et al. Anesth Analg 10.1213/01.ANE.0000081798.89853.E7) can lead to disorganization of the operating room (OR) schedule. The hypothesis is that performing RA outside the OR will significantly reduce the OR occupancy time relative to using general anesthesia (GA). The primary objective was to compare the OR occupancy time between RA and GA when performing ACL reconstruction. METHODS This was a retrospective, single-center study of data collected prospectively from consecutive patients operated by a single surgeon between January 2019 and December 2020. The patients undergoing ACL reconstruction were divided into two groups based on the type of anesthesia they received (GA, RA). RA consisted of a quadruple peripheral nerve block (femoral, sciatic, obturator and lateral femoral cutaneous nerves). The durations of the perioperative stages of the patient's journey in the OR suite were compared between these two groups. RESULTS The analysis involved 469 ACL reconstructions: 356 GA and 113 RA. The two groups were comparable in age, gender and ASA score (American Society of Anesthesiologists). The OR occupancy time for ACL reconstruction with RA was reduced by a mean of 13 min (70 ± 12 SD vs. 83 ± 14 SD; P < 0.0001) and the PACU time by 41 min relative to GA (P < 0.0001). The entry-incision time was reduced by an average of 8 min and the end-exit time by 3 min (P < 0.0001). The care time in the PACU was reduced from 84 ± 35 to 46 ± 26 min (P < 0.0001). However, performing anesthesia outside the OR (i.e., in a RA block room) did not reduce the turnover time (n.s). CONCLUSION Performing RA outside the OR reduced the OR occupancy time by nearly 20% relative to using GA for ACL reconstructions. LEVEL OF EVIDENCE Level IV.
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Description of an Ultrasound-Guided Erector Spinae Plane Block and Comparison to a Blind Proximal Paravertebral Nerve Block in Cows: A Cadaveric Study. Animals (Basel) 2022; 12:ani12172191. [PMID: 36077911 PMCID: PMC9454813 DOI: 10.3390/ani12172191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/10/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary One of the most common surgical procedures performed in cattle is abdominal surgery, and this procedure is routinely performed in the standing adult animal. This procedure is performed using local anaesthetic techniques in order to eliminate pain and reduce the need for chemical and physical restraints. One of the most common locoregional anaesthetic techniques is the proximal paravertebral nerve block, in which a local anaesthetic is used to desensitize the nerves providing sensation to the flank region. The use of ultrasound-guided techniques has been demonstrated in multiple species, including humans, to be more accurate, safe and efficacious than traditional blind techniques. The aim of this paper was to develop an ultrasound-guided block that would target the nerves desensitized in the paravertebral nerve block of the flank. Additionally, our study aimed to evaluate the two techniques (blind and ultrasound-guided) in cow cadavers. The use of ultrasound guidance resulted in an apparent improvement in accuracy, and the blind technique remains a reliable approach. Further studies are warranted to develop and to evaluate the ultrasound-guided technique in live animals. Abstract The proximal paravertebral nerve block is commonly used to provide anaesthesia to the flank during standing surgical procedures in adult cattle. It has been reported that additional anaesthetic infiltration may be necessary to provide complete anaesthesia. In humans as well as animal species, another technique—the ultrasound (US)-guided erector spinae plane block (ESPB)—has been described. The goal of the present study was to develop and investigate an US-guided ESPB in comparison to a blind proximal paravertebral nerve block (PPNB) in cow cadavers. In 10 cadaver specimens, injections of methylene blue-lidocaine (1:1) were performed at the level of T13, L1 and L2 vertebras, on one side doing an ESPB block and, on the other side, a PPNB. Five cadavers were injected with high (40 mL per injection for PPNB and 20 mL for ESPB) and five with low (20 and 15 mL, respectively) volumes of injectate. For the ESPB, the ultrasound probe was oriented craniocaudally, and the ventral-cranial aspect of the articular processes (T13, L1 and L2) was targeted for injection. The dye spreading was evaluated by dissection. The landmarks for US-guided injection were easily visualized; however, injections were accidentally performed at T12, T13 and L1. Nevertheless, L2 was stained in 60% of ESPBs. Epidural spreading was observed with both techniques and all volumes. Viscera puncture was reported in two PPNBs. The ESPB resulted in similar nerve staining compared to the PPNB while using a lower volume of injectate. Even better staining is expected with a T13-L2 instead of a T12-L1 ESPB approach. Further studies are warranted to evaluate the clinical efficacy.
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Er S, Baskan S, Akcay M, Akcay F, Zengin M. Effects of hydrodissection on anesthesia characteristics in ultrasound guided infraclavicular brachial plexus blockade. Medicine (Baltimore) 2022; 101:e29241. [PMID: 35687774 PMCID: PMC9276429 DOI: 10.1097/md.0000000000029241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/16/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The development of ultrasonography technology and its widespread application have increased peripheral nerve block applications, especially in limb surgeries, since it reduces complication rates and increases success rates in peripheral nerve block applications. However, even experienced physicians need to direct a large number of needles and injections for adequate local anesthetic spread, which can cause accidental vascular puncture and local anesthetic systemic toxicity. Such complications can be prevented by hydrodissection and a safer and successful anesthesia can be provided to patients in this study, it was aimed to investigate the effects of hydrodissection on anesthesia characteristics in the infraclavicular brachial plexus blockade. MATERIALS AND METHODS Ninety patients were included in our study after approval by the Ethics Committee. These patients were randomly divided into 2 groups (Group I: Infraclavicular brachial plexus blockade with normal method and Group II: infraclavicular brachial plexus blockade with hydrodissection). After obtaining patient consent, monitoring and vascular access were provided. Group I patients were mixed with 30 mL of local anesthetic mixture (15 mL of distilled water and 15 mL of 0.5% bupivacaine), and Group II patients were treated with 15 mL of distilled water by hydrodissection and 15 mL of 0.5% bupivacaine anesthesia resident. Block characteristics were evaluated and recorded every 5 minutes for the first 30 minutes by a blinded observer. The sensory block score was 7, the total score was 14 or above, and the block was considered successful, and the patient was ready for surgery. Postoperative block removal times, analgesia, and complications were evaluated and recorded. RESULTS A significant difference was found between the sensory and motor block onset times and postoperative VAS scores between the normal and hydrodissection groups (P < .05). There were no significant differences in terms of block application times, postoperative block removal times, and complications between the groups. CONCLUSION In this study, it has been shown that hydrodissection in peripheral nerve blocks does not lag in terms of block success and characteristics compared to normal methods, whereas anesthetists with less experience in peripheral nerve block experience obtain safer and more successful results in practice.
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Affiliation(s)
- Samet Er
- Halil Sivgin Cubuk State Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey
| | - Semih Baskan
- Ankara City Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey
| | - Murat Akcay
- Ankara City Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey
| | - Feryal Akcay
- Ankara City Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey
| | - Musa Zengin
- University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey
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Yoosaf SS, Umer Mohamed Z, Sugashini V, Ravindran GC, Kumar L. Role of Handedness in Conducting an Ultrasound-Guided Procedure: A Comparative Study. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221092975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Sonography is widely used by clinicians to provide imaging assistance in guiding invasive procedures. Many sonography users tend to prefer their dominant hand to operate the needle and their nondominant hand on the ultrasound transducer. The aim was this study was to determine whether the dominant hand guiding the needle achieves a faster time to target during ultrasound-guided procedures compared with the nondominant hand. Materials and Methods: Forty novice sonography users, medical students, were randomized to participate in the study. Twenty medical students used a Sonosite® ultrasound equipment system and the other 20 used a Mindray® ultrasound equipment system. Following a video education training session, an informed consent was obtained from each participant. In each equipment group, participants were randomly allocated to either a right-handed needle and a left-handed transducer preference or a left-handed needle and right-handed transducer preference group. A total of ten participants were in each group. A timer was started when the ultrasound transducer came in contact with the phantom model and stopped when the needle reached the target. This simulated task was repeated ten times by the participants. The hand arrangement for the needle and transducer was then switched and the task repeated another ten times by each participant. Results: Handedness was observed over multiple attempts and “time to target” was recorded for groups with both hand preferences and varied ultrasound equipment systems. The most significant finding was that the difference in time was statistically significant between the groups, when comparing the first and fifth procedural attempts. Conclusion: In this novice group of users, despite training for ultrasound-guided procedures using phantom models, irrespective of the ultrasound equipment system, or hand preference, there was no difference in the time to target.
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Affiliation(s)
- Shifa Shajahan Yoosaf
- Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Kochi, India
| | - Zubair Umer Mohamed
- Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Kochi, India
| | - Veerasamy Sugashini
- Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Kochi, India
| | - Greeshma C. Ravindran
- Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Kochi, India
| | - Lakshmi Kumar
- Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Kochi, India
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Chin A, Foster DJ, Pelecanos AM, Eley VA. A retrospective observational study of patient analgesia outcomes when regional anaesthesia procedures are performed by consultants versus supervised trainees. Anaesth Intensive Care 2022; 50:197-203. [PMID: 35301865 DOI: 10.1177/0310057x211039233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
At teaching hospitals, consultants must provide effective supervision, including appropriate selection of teaching cases, such that the outcomes achieved by trainees are similar to that of consultants. Numerous studies in the surgical literature have compared patient outcomes when surgery is performed by consultant surgeons or surgical trainees but, to our knowledge, none exist in the field of anaesthesia. We aimed to compare analgesia outcomes of regional anaesthesia when performed by supervised trainees versus consultants. We designed a retrospective observational study using registry data. The primary outcome was inadequate analgesia, defined as a numerical rating scale (NRS) for pain >5 reported at any time in the post-anaesthesia care unit (PACU). Secondary outcomes included the maximum pain NRS, pain experienced in the PACU, and the requirement for systemic opioid analgesia in the PACU. Of the 1814 patients analysed, the primary proceduralist was a consultant for 514 (28.3%) patients and a trainee for 1300 (71.7%) patients. All trainees were supervised by an on-site consultant. There were no statistically significant differences between consultants and supervised trainees in terms of the primary outcome (NRS >5 in 24.9% and 24.5% of patients, respectively; P = 0.84) and secondary outcomes. Compared to trainees, consultants had a slightly higher rate of patients with a body mass index >30 kg/m2, an American Society of Anesthesiologists Physical Status Classification of 3 or 4, nerve blocks performed under general anaesthesia, paravertebral/neuraxial blocks and blocks with perineural catheter placement. Regional anaesthesia performed by supervised trainees can achieve similar analgesia outcomes to consultant-performed procedures.
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Affiliation(s)
- Adrian Chin
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Daniel J Foster
- Department of Anaesthesia, Cairns Hospital, Cairns, Australia
| | - Anita M Pelecanos
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Victoria A Eley
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Jain D, Hussain SY, Ayub A. Comparative evaluation of landmark technique and ultrasound-guided caudal epidural injection in pediatric population: A systematic review and meta-analysis. Paediatr Anaesth 2022; 32:35-42. [PMID: 34752689 DOI: 10.1111/pan.14332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 08/17/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Caudal block is a common regional anesthesia technique in pediatrics with landmark method predominantly being practiced. Ultrasound-guided technique provides real-time visualization of the structures and injection while performing caudal block. We performed this meta-analysis to determine the utility of ultrasound in caudal blocks in children over the landmark-based technique. METHODS Randomized controlled trials comparing ultrasound-guided caudal blocks and landmark technique in pediatrics were searched from databases-PubMed, Embase, Scopus, and CENTRAL from inception until August 2020. The primary objective was success rate between the two techniques and secondary objectives included time to perform the block, first puncture success, and complications. RESULTS Five trials with 904 participants were included for this meta-analysis. There was no difference in success rate between the two techniques (Risk ratio-1.07; 95% CI [0.97, 1.18]; p = .15). Time to perform the block was similar (Mean difference-8.88 s; 95% CI [-21.64, 39.40; p = .57) while first puncture success was higher with ultrasound-guided technique (Risk ratio-1.31; 95% CI [1.15, 1.49]; p = .0001). Complications like vascular puncture and needle misplacement were lower in the ultrasound group, and no serious complications were seen in any patient. Needle visualization and sacral canal distension were seen in 82% and 97.5% of the cases, respectively, in ultrasound group. CONCLUSION Ultrasound-guided caudal injection does not improve the success rate or time to perform the block but results in higher first puncture success and lower incidence of complications compared to landmark technique.
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Affiliation(s)
- Dhruv Jain
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sana Yasmin Hussain
- Department of Anaesthesiology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Arshad Ayub
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Kim DM, Seo JS, Jeon IH, Cho C, Koh KH. Detection of Rotator Cuff Tears by Ultrasound: How Many Scans Do Novices Need to Be Competent? Clin Orthop Surg 2021; 13:513-519. [PMID: 34868501 PMCID: PMC8609212 DOI: 10.4055/cios20259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/02/2021] [Accepted: 02/02/2021] [Indexed: 11/21/2022] Open
Abstract
Background Ultrasound is commonly used for evaluating rotator cuff tears. However, little training in ultrasound imaging is provided during orthopedic residents’ training period. Therefore, we performed this study to determine how many ultrasound scans are required for orthopedic residents to be competent and self-confident in the diagnosis of supraspinatus tendon tears and to investigate whether senior residents outperformed junior residents. Methods We studied two third-year residents who had no previous experience of shoulder ultrasound and evaluated their ability to detect rotator cuff pathologies. Their learning curves were plotted using a cumulative summation analysis with a 20% acceptable failure rate compared to arthroscopic findings. Downward, upward, and horizontal cumulative summation trends indicated incompetence, exceptional competence, and competence, respectively. The diagnostic accuracy of third-year residents was compared with that of second-year residents and the number of cases required to gain self-confidence was evaluated. Results Cumulative summation analysis showed that after 26–28 scans, residents achieved the competence to correctly diagnose supraspinatus tears: an upward trend was observed from the beginning for full-thickness tears and a downward trend was observed for partial-thickness tears. Sensitivity and specificity were 0.95 and 0.79, respectively, for third-year residents and 0.91 and 0.58, respectively, for second-year residents. Residents reported self-confidence after 30 ultrasound scans for the detection of rotator cuff tears. Conclusions The number of scans that novices needed to be competent for detecting rotator cuff tears was approximately 30 cases, and the diagnostic accuracy of third-year residents was significantly higher than that of second-year residents.
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Affiliation(s)
- Dong Min Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Seong Seo
- Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Changho Cho
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Jayanti S, Juergens C, Makris A, Hennessy A, Nguyen P. The Learning Curves for Transradial and Ultrasound-Guided Arterial Access: An Analysis of the SURF Trial. Heart Lung Circ 2021; 30:1329-1336. [PMID: 33722490 DOI: 10.1016/j.hlc.2021.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/17/2020] [Accepted: 02/03/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Historically, coronary angiography and percutaneous coronary intervention involved accessing the femoral artery via palpation. However, recently there has been a trend towards using a transradial approach and ultrasound guidance for arterial access. Studies have shown that these techniques respectively improve major bleeding rates and access outcomes. There have been no studies conducted that assess the time it takes to train operators to attain proficiency. This sub-analysis of the Standard versus Ultrasound-guided Radial and Femoral access in coronary angiography and intervention (SURF) trial aims to assess the number of procedures required to attain proficiency in ultrasound-guided transradial and transfemoral access. METHODS The SURF trial randomised 1,388 patients undergoing coronary angiography and/or percutaneous coronary intervention into standard or ultrasound-guidance and radial or femoral access in a 2×2 factorial design. Operators who participated in this trial were required to have performed at least 50 standard and 10 ultrasound-guided punctures for each of transradial and transfemoral access. Cases were then chronologically ordered and stratified into groups of five, from which the primary endpoint measured was a progression in mean access time and first-pass success rates. RESULTS Across all operators, there was a reduction in mean access time between procedures one to five and six to 10 with ultrasound-guided femoral punctures (60.5 secs-51.5 secs, p=0.029) and between procedures 11 to 15 and 16 to 20 ultrasound-guided radial punctures (74s to 62.5 secs, p=0.082). This trend was more obvious in trainees, with significant reductions in mean access time between procedures one to five and six to 10 from 73.5 to 53.5 seconds (p<0.001) for ultrasound-guided femoral access and from 99.5 seconds to 60 seconds (p=0.024) for ultrasound-guided radial access. There were no trends with standard transradial access. CONCLUSION The numbers required to attain competency in ultrasound-guided femoral and radial access are 15 and 25 punctures, respectively. Fifty (50) punctures appear adequate for proficiency in a standard transradial approach. These numbers are useful in incorporating into training program for advanced trainees and interventionalists.
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Affiliation(s)
- Sumedh Jayanti
- South-Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Sydney, NSW, Australia.
| | - Craig Juergens
- South-Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Sydney, NSW, Australia; Liverpool Hospital, Sydney, NSW, Australia
| | - Angela Makris
- Liverpool Hospital, Sydney, NSW, Australia; Western Sydney University, Liverpool Hospital, Sydney, NSW, Australia
| | - Annemarie Hennessy
- Liverpool Hospital, Sydney, NSW, Australia; Western Sydney University, Liverpool Hospital, Sydney, NSW, Australia
| | - Phong Nguyen
- Liverpool Hospital, Sydney, NSW, Australia; Western Sydney University, Liverpool Hospital, Sydney, NSW, Australia
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Schmidt G, Gerlinger C, Endrikat J, Gabriel L, Müller C, Baus S, Volk T, Findeklee S, Solomayer EF, Hamza A, Ströder R. Teaching breast ultrasound skills including core-needle biopsies on a phantom enhances undergraduate student's knowledge and learning satisfaction. Arch Gynecol Obstet 2021; 304:197-202. [PMID: 33728537 PMCID: PMC8164585 DOI: 10.1007/s00404-021-06016-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/23/2021] [Indexed: 11/25/2022]
Abstract
Purpose To investigate whether a training program on breast ultrasound skills including core-needle biopsies to undergraduate students can improve medical knowledge and learning satisfaction. Methods Medical students attending mandatory classes at the Medical School of the University of Saarland received a supplemental theoretical and hands-on training program on ultrasound (US) breast screening and on US-guided core-needle biopsy using an agar–agar phantom. Experienced breast specialists and ultrasound examiners served as trainers applying Peyton’s 4-step training approach. The students’ theoretical knowledge and hands-on skills were tested before and after the training program, using a multiple-choice questionnaire (MCQ), the Objective Structured Clinical Examination (OSCE) and a student curriculum evaluation. Results The MCQ results showed a significant increase of the student’s theoretical knowledge (50.2–75.2%, p < 0.001). After the course, the OSCE showed a mean total of 17.3/20 points (86.5%), confirming the practical implementation of the new skills. The student curriculum evaluation in general was very positive. A total of 16/20 questions were rated between 1.2 and 1.7 (very good) and 3 questions were rated as 2.1 (good). Conclusion Undergraduate student’s medical education can be enhanced by teaching breast US skills.
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Affiliation(s)
- G Schmidt
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany.
| | - C Gerlinger
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
| | - J Endrikat
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
| | - L Gabriel
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
| | - C Müller
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
| | - S Baus
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
| | - T Volk
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
| | - Sebastian Findeklee
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
- MVZ Fertility Center Hamburg, 20095, Hamburg, Germany
| | - E F Solomayer
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
| | - A Hamza
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
- Department of Gynecology, Obstetrics, Kantonsspital Baden AG, 5404, Baden, Switzerland
| | - R Ströder
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
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Navas de Solis C, Gilmour LJ, Coleman MC, Watts AE, Bevevino KE, Glass KG, Hardy J, Chaney KP. Effectiveness of a digital interactive multimedia tutorial for preparing veterinary students to perform ultrasonography in horses. J Am Vet Med Assoc 2021; 258:165-169. [PMID: 33405987 DOI: 10.2460/javma.258.2.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the effectiveness of a digital interactive multimedia tutorial (DIMT) for preparing veterinary students to perform ultrasonography in horses. SAMPLE 42 third-year veterinary students. PROCEDURES Students were randomly assigned to 3 instructional methods: independent study (ie, 45 minutes to read a highlighted textbook chapter), lecture (ie, 45-minute lecture by a faculty member), or digital interactive multimedia tutorial (DIMT; ie, 45-minute narrated, interactive module). Written and practical tests were administered after each instruction session. For the practical test, each student was required to obtain a series of ultrasound images of a live horse, and images were later scored for quality by an individual unaware of the instructional method used. RESULTS Higher-quality ultrasound images were obtained by veterinary students who had reviewed the DIMT rather than the analogous information in textbook chapters. No difference in scores was identified between students in the lecture group and those in the DIMT group. Students' perceptions suggested that practical instruction facilitated by clinicians was a key component of learning how to perform ultrasonography in horses. CONCLUSIONS AND CLINICAL RELEVANCE Results supported the use of DIMTs in preparing veterinary students to perform ultrasonography in horses.
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Hewson DW, Knudsen R, Shanmuganathan S, Ferguson E, Hardman JG, Bedforth NM, McCahon RA. Effect of mental rotation skills training on ultrasound-guided regional anaesthesia task performance by novice operators: a rater-blinded, randomised, controlled study. Br J Anaesth 2020; 125:168-174. [DOI: 10.1016/j.bja.2020.04.090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/03/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022] Open
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Schwartz CM, Ivancic RJ, McDermott SM, Bahner DP. Designing a Low-Cost Thyroid Ultrasound Phantom for Medical Student Education. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1545-1550. [PMID: 32143859 DOI: 10.1016/j.ultrasmedbio.2020.01.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 05/11/2023]
Abstract
Using ultrasound for the diagnostic workup of thyroid lesions is a widely accepted technique. An inexpensive phantom model of thyroid lesions would be an invaluable tool for engaging medical students in learning the diagnostic algorithm for thyroid lesions and how to perform fine needle aspiration (FNA). The aim of this study was to devise an inexpensive and reproducible training phantom model for thyroid lesion detection, image interpretation and in vitro FNA using ultrasound guidance. A simple phantom model imitating benign cystic lesions, intermediately suspicious lesions and highly suspicious lesions was developed using a chicken breast, red seedless grapes, pimento olives and blackberries. The phantom was constructed for a total cost of $4.09 per unit and constructed in approximately 3 min. Nine models were constructed in total, demonstrating that the model design is replicable. This thyroid FNA phantom is an inexpensive, easy-to-produce model that allows medical students to practice measuring lesions and performing FNAs using ultrasonography. Future studies could be explored to assess this model's role in medical student education.
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Affiliation(s)
- Cynthia M Schwartz
- Department of Otolaryngology, Head and Neck Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Ryan J Ivancic
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Sean M McDermott
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - David P Bahner
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio, USA.
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Park SJ, Kim HJ, Yang HM, Yoon KB, Lee KY, Ha T, Jang H, Kim SH. Impact of simulation-based anesthesiology training using an anesthetized porcine model for ultrasound-guided transversus abdominis plane block. J Int Med Res 2020; 48:300060519896909. [PMID: 32223646 PMCID: PMC7133415 DOI: 10.1177/0300060519896909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 12/04/2019] [Indexed: 11/15/2022] Open
Abstract
Objective This study was performed to assess the impact of simulation-based training for ultrasound-guided transversus abdominis plane (TAP) block using anesthetized pigs. Methods In this prospective study, 23 participating residents (10 in their second year, 13 in their third year) underwent simulation-based training for ultrasound-guided TAP block. The residents completed standard questionnaires comprising 10 multiple-choice questions regarding essential general knowledge of abdominal ultrasound and TAP block before and after the training session. On a 5-point Likert scale, they reported their levels of comfort with the use of ultrasound and block equipment, subject/operator positioning, proper block technique, image documentation, needle handling, anxiety, and their overall confidence with the procedure. Results Compared with those before training, the comfort levels of the residents significantly improved for all measures except needle handling. The participants also indicated significantly reduced anxiety regarding performance of the TAP block technique. Conclusion The use of anesthetized pigs in simulation-based training for ultrasound-guided TAP block improves procedural knowledge and confidence while reducing the associated anxiety in anesthesiology trainees.
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Affiliation(s)
- Sang Jun Park
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Joo Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hun-Mu Yang
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Bong Yoon
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ki-Young Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Taehoon Ha
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hun Jang
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Shin Hyung Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Kim TE, Tsui BCH. Simulation-based ultrasound-guided regional anesthesia curriculum for anesthesiology residents. Korean J Anesthesiol 2018; 72:13-23. [PMID: 30481945 PMCID: PMC6369343 DOI: 10.4097/kja.d.18.00317] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 11/27/2018] [Indexed: 01/22/2023] Open
Abstract
Proficiency in ultrasound-guided regional anesthesia (UGRA) requires the practitioner to acquire cognitive and technical skills. For anesthesiology residents, an assortment of challenges has been identified in learning UGRA skills. Currently, a validated UGRA curriculum for residents does not exist, and the level of UGRA proficiency achieved during residency training can vary considerably. Simulated practice has been shown to enhance proficiency in UGRA, and a competency-based education with simulation training has been endorsed for anesthesiology residents. The objective of this review is to outline simulation-based training that can be implemented in a UGRA curriculum and to explore educational tools like gamification to facilitate competency in regional anesthesiology.
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Affiliation(s)
- T Edward Kim
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Ban C H Tsui
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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An observational study of skill retention and practice adoption after a workshop on ultrasound-guided neuraxial anaesthesia. Eur J Anaesthesiol 2018; 35:801-803. [DOI: 10.1097/eja.0000000000000840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lobo V, Stromberg AQ, Rosston P. The Sound Games: Introducing Gamification into Stanford's Orientation on Emergency Ultrasound. Cureus 2017; 9:e1699. [PMID: 29159006 PMCID: PMC5690465 DOI: 10.7759/cureus.1699] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Point-of-care ultrasound is a critical component of graduate medical training in emergency medicine. Innovation in ultrasound teaching methods is greatly needed to keep up with a changing medical landscape. A field-wide trend promoting simulation and technology-enhanced learning is underway in an effort to improve patient care, as well as patient safety. In an effort to both motivate students and increase their skill retention, training methods are shifting towards a friendly competition model and are gaining popularity nationwide. In line with this emerging trend, Stanford incorporated the Sound Games – an educational ultrasound event with a distinctly competitive thread – within its existing two-day point-of-care ultrasound orientation course for emergency medicine interns. In this study, we demonstrate successful implementation of the orientation program, significant learning gains in participants, and overall student satisfaction with the course.
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Affiliation(s)
- Viveta Lobo
- Department of Emergency Medicine, Stanford University School of Medicine
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Kim TE, Ganaway T, Harrison TK, Howard SK, Shum C, Kuo A, Mariano ER. Implementation of clinical practice changes by experienced anesthesiologists after simulation-based ultrasound-guided regional anesthesia training. Korean J Anesthesiol 2017; 70:318-326. [PMID: 28580083 PMCID: PMC5453894 DOI: 10.4097/kjae.2017.70.3.318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/29/2016] [Accepted: 11/29/2016] [Indexed: 11/21/2022] Open
Abstract
Background Anesthesiologists who have finished formal training and want to learn ultrasound-guided regional anesthesia (UGRA) commonly attend 1 day workshops. However, it is unclear whether participation actually changes clinical practice. We assessed change implementation after completion of a 1 day simulation-based UGRA workshop. Methods Practicing anesthesiologists who participated in a 1 day UGRA course from January 2012 through May 2014 were surveyed. The course consisted of clinical observation of UGRA procedures, didactic lectures, ultrasound scanning, hands-on perineural catheter placement, and mannequin simulation. The primary outcome was the average number of UGRA blocks per month reported at follow-up versus baseline. Secondary outcomes included preference for ultrasound as the nerve localization technique, ratings of UGRA teaching methods, and obstacles to performing UGRA. Results Survey data from 46 course participants (60% response rate) were included for analysis. Participants were (median [10th–90th percentile]) 50 (37–63) years old, had been in practice for 17 (5–30) years, and were surveyed 27 (10–34) months after their UGRA training. Participants reported performing 24 (4–90) blocks per month at follow-up compared to 10 (2–24) blocks at baseline (P < 0.001). Compared to baseline, more participants at follow-up preferred ultrasound for nerve localization. The major obstacle to implementing UGRA in clinical practice was time pressure. Conclusions Participation in a 1 day simulation-based UGRA course may increase UGRA procedural volume by practicing anesthesiologists.
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Affiliation(s)
- T Edward Kim
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Toni Ganaway
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - T Kyle Harrison
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Steven K Howard
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Cynthia Shum
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Alex Kuo
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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Visuospatial Ability as a Predictor of Novice Performance in Ultrasound-guided Regional Anesthesia. Anesthesiology 2015; 123:1188-97. [DOI: 10.1097/aln.0000000000000870] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Background
Visuospatial ability correlates positively with novice performance of simple laparoscopic tasks. The aims of this study were to identify whether visuospatial ability could predict technical performance of an ultrasound-guided needle task by novice operators and to describe how emotional state, intelligence, and fear of failure impact on this.
Methods
Sixty medical student volunteers enrolled in this observational study. The authors used an instructional video to standardize training for ultrasound-guided needle advancement in a turkey breast model and assessed volunteers’ performance independently by two assessors using composite error score (CES) and global rating scale (GRS). The authors assessed their “visuospatial ability” with mental rotation test (MRT), group embedded figures test, and Alice Heim group ability test. Emotional state was judged with UWIST Mood Adjective Checklist (UMACL), and fear of failure and general cognitive ability were judged with numerical reasoning test.
Results
High CES scores (high error rate) were associated with low MRT scores (ρ = −0.54; P < 0.001). Better GRS scores were associated with better MRT scores (ρ = 0.47; P < 0.001). Regarding emotions, GRS scores were low when anxiety levels were high (ρ = −0.35; P = 0.005) and CES scores (errors) were low when individuals reported feeling vigorous and active (ρ = −0.30; P = 0.01).
Conclusions
An MRT predicts novice performance of an ultrasound-guided needling task on a turkey model and as a trait measure could be used as a tool to focus training resources on less-able individuals. Anxiety adversely affects performance. Therefore, both may prove useful in directing targeted training in ultrasound-guided regional anesthesia.
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Johnson B, Herring A, Stone M, Nagdev A. Performance accuracy of hand-on-needle versus hand-on-syringe technique for ultrasound-guided regional anesthesia simulation for emergency medicine residents. West J Emerg Med 2015; 15:641-6. [PMID: 25247033 PMCID: PMC4162719 DOI: 10.5811/westjem.2014.7.21717] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 07/07/2014] [Indexed: 11/12/2022] Open
Abstract
Introduction Ultrasound-guided nerve blocks (UGNB) are increasingly used in emergency care. The hand-on-syringe (HS) needle technique is ideally suited to the emergency department setting because it allows a single operator to perform the block without assistance. The HS technique is assumed to provide less exact needle control than the alternative two-operator hand-on-needle (HN) technique; however this assumption has never been directly tested. The primary objective of this study was to compare accuracy of needle targeting under ultrasound guidance by emergency medicine (EM) residents using HN and HS techniques on a standardized gelatinous simulation model. Methods This prospective, randomized study evaluated task performance. We compared needle targeting accuracy using the HN and HS techniques. Each participant performed a set of structured needling maneuvers (both simple and difficult) on a standardized partial-task simulator. We evaluated time to task completion, needle visualization during advancement, and accuracy of needle tip at targeting. Resident technique preference was assessed using a post-task survey. Results We evaluated 60 tasks performed by 10 EM residents. There was no significant difference in time to complete the simple model (HN vs. HS, 18 seconds vs. 18 seconds, p=0.93), time to complete the difficult model (HN vs. HS, 56 seconds vs. 50 seconds, p=0.63), needle visualization, or needle tip targeting accuracy. Most residents (60%) preferred the HS technique. Conclusion For EM residents learning UGNBs, the HN technique was not associated with superior needle control. Our results suggest that the single-operator HS technique provides equivalent needle control when compared to the two-operator HN technique.
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Affiliation(s)
- Brian Johnson
- Alameda Health System, Highland Hospital, Department of Emergency Medicine, Oakland, California
| | - Andrew Herring
- Alameda Health System, Highland Hospital, Department of Emergency Medicine, Oakland, California
| | - Michael Stone
- Brigham and Women's Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Arun Nagdev
- Alameda Health System, Highland Hospital, Department of Emergency Medicine, Oakland, California
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Udani AD, Kim TE, Howard SK, Mariano ER. Simulation in teaching regional anesthesia: current perspectives. Local Reg Anesth 2015; 8:33-43. [PMID: 26316812 PMCID: PMC4540124 DOI: 10.2147/lra.s68223] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The emerging subspecialty of regional anesthesiology and acute pain medicine represents an opportunity to evaluate critically the current methods of teaching regional anesthesia techniques and the practice of acute pain medicine. To date, there have been a wide variety of simulation applications in this field, and efficacy has largely been assumed. However, a thorough review of the literature reveals that effective teaching strategies, including simulation, in regional anesthesiology and acute pain medicine are not established completely yet. Future research should be directed toward comparative-effectiveness of simulation versus other accepted teaching methods, exploring the combination of procedural training with realistic clinical scenarios, and the application of simulation-based teaching curricula to a wider range of learner, from the student to the practicing physician.
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Affiliation(s)
- Ankeet D Udani
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - T Edward Kim
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA ; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Steven K Howard
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA ; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA ; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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Mills AM, Raja AS, Marin JR. Optimizing diagnostic imaging in the emergency department. Acad Emerg Med 2015; 22:625-31. [PMID: 25731864 DOI: 10.1111/acem.12640] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 01/09/2015] [Accepted: 02/03/2015] [Indexed: 12/15/2022]
Abstract
While emergency diagnostic imaging use has increased significantly, there is a lack of evidence for corresponding improvements in patient outcomes. Optimizing emergency department (ED) diagnostic imaging has the potential to improve the quality, safety, and outcomes of ED patients, but to date, there have not been any coordinated efforts to further our evidence-based knowledge in this area. The objective of this article is to discuss six aspects of diagnostic imaging to provide background information on the underlying framework for the 2015 Academic Emergency Medicine consensus conference, "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." The consensus conference aims to generate a high priority research agenda for emergency diagnostic imaging that will inform the design of future investigations. The six components herein will serve as the group topics for the conference: 1) patient-centered outcomes research; 2) clinical decision rules; 3) training, education, and competency; 4) knowledge translation and barriers to image optimization; 5) use of administrative data; and 6) comparative effectiveness research: alternatives to traditional CT use.
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Affiliation(s)
- Angela M. Mills
- The Department of Emergency Medicine; University of Pennsylvania; Philadelphia PA
| | - Ali S. Raja
- The Department of Emergency Medicine; Massachusetts General Hospital; Boston MA
- Center for Evidence Based Imaging and Department of Radiology; Brigham and Women's Hospital; Boston MA
| | - Jennifer R. Marin
- The Departments of Pediatrics and Emergency Medicine; University of Pittsburgh School of Medicine; Pittsburgh PA
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Yadav N, Garg R, Kohli S. Awareness of the ultrasound guided regional anaesthesia among anaesthesia residents in India: A questionnaire-based study. Indian J Anaesth 2014; 58:752-4. [PMID: 25624544 PMCID: PMC4296365 DOI: 10.4103/0019-5049.147175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Naveen Yadav
- Department of Anaesthesia, JPNATC, Delhi, India
- Address for correspondence: Dr. Naveen Yadav, Room No. 316, JPNATC, AIIMS, Raj Nagar, Delhi, India. E-mail:
| | - Rakesh Garg
- Department of Anaesthesia, BRAIRCH, AIIMS, Delhi, India
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Brascher AK, Blunk JA, Bauer K, Feldmann R, Benrath J. Comprehensive Curriculum for Phantom-Based Training of Ultrasound-Guided Intercostal Nerve and Stellate Ganglion Blocks. PAIN MEDICINE 2014; 15:1647-56. [DOI: 10.1111/pme.12365] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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P Souza Neto E, Grousson S, Duflo F, Tahon F, Mottolese C, Dailler F. Ultrasonographic anatomic variations of the major veins in paediatric patients. Br J Anaesth 2014; 112:879-84. [PMID: 24520009 DOI: 10.1093/bja/aet482] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The aim of our study was to describe the anatomic relationships in internal jugular (IJV), subclavian (SCV), and femoral (FV) vein sites. METHODS One hundred and forty-two children had a two-dimensional (2D) ultrasound (US) evaluation of IJV, SCV, and FV sites. They were enrolled according to their age: 0-1 month old (n=9), 1 month old to 2 yr old (n=61), 2-6 yr old (n=22), 6-12 yr old (n=32), and 12-18 yr old (n=18). RESULTS We found about 7.7% variation for the IJV. The most common anatomic variations were a lateral (nine children) or anterior (nine children) position of the IJV to the carotid artery. Regardless of the age category, about 9.8% of the anatomic variations were found for the FV. The most common anatomic variation in our study was that the FV ran anteromedially to the femoral artery (17 children). Anatomic variation of the SCV, regardless of age category, was about 7.4%. The most common anatomic variation was the SCV, which ran medially (10 children) to the subclavian artery. CONCLUSIONS The relevant percentages of anatomic variations obtained for all these areas support at least a systematic US screening before attempting to obtain central venous access, ideally using a US-guided technique.
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Affiliation(s)
- E P Souza Neto
- Hospices Civils de Lyon, Groupement Hospitalier Est, Hôpital Neurologique Pierre Wertheimer, Service d'Anesthésie Réanimation, 59 boulevard Pinel, Bron 69677, Cedex, France
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Lorello G, Cook D, Johnson R, Brydges R. Simulation-based training in anaesthesiology: a systematic review and meta-analysis. Br J Anaesth 2014; 112:231-45. [DOI: 10.1093/bja/aet414] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Comparison of the Development of Performance Skills in Ultrasound-Guided Regional Anesthesia Simulations With Different Phantom Models. Simul Healthc 2013; 8:368-75. [DOI: 10.1097/sih.0b013e318299dae2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gupta RK, Lane J, Allen B, Shi Y, Schildcrout JS. Improving Needle Visualization by Novice Residents During an In-Plane Ultrasound Nerve Block Simulation Using an In-Plane Multiangle Needle Guide. PAIN MEDICINE 2013; 14:1600-7. [DOI: 10.1111/pme.12160] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Collins GB, Fanou EM, Young J, Bhogal P. A comparison of free-hand vs laser-guided long-axis ultrasound techniques in novice users. Br J Radiol 2013; 86:20130026. [PMID: 23873905 DOI: 10.1259/bjr.20130026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The increasing use of point-of-care ultrasonography for targeted procedures justifies a device that helps both novices in training and experts perform the long-axis needle approach. The initial success of traditional needle guidance devices in reducing the time of target procedures is not universal and they can be cumbersome. We aim to investigate whether the less bulky and previously untested laser guide can succeed in reducing procedure time in novice ultrasonographers. METHODS 82 medical students with no ultrasound experience volunteered. Random allocation determined whether, during a targeted procedure in a turkey breast and olive phantom, participants were assisted by the laser guide or not. The time taken to pierce the target was recorded at 1-cm depth. RESULTS The mean procedure time in the laser-assisted (LA) group was 25.1 s (14.0 s; 18.0-25.0 s). The mean procedure time in the free-hand group was 45.5 s (23.0 s; 7.0-55.0 s). The procedure time in the LA group was significantly reduced (p<0.01). CONCLUSION The laser guide significantly improved procedure times. It is felt that the cheaper, smaller, easy to integrate, sterile and more user-friendly laser guidance unit may be a better alternative to the needle guide in improving procedure times for the novice ultrasonographer or to assist the expert, during training for, or performance of, ultrasound-guided targeted procedures. ADVANCES IN KNOWLEDGE Following from the prototype paper, this is the first study to investigate the effectiveness of attaching a laser-guidance device to an ultrasound probe. The device succeeded in reducing the procedure times of targeted procedures.
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Affiliation(s)
- G B Collins
- University College London Medical School, University College London, London, UK.
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Viscasillas J, Benigni L, Brodbelt D, Alibhai H. Use of needle enhancing software to improve injection technique amongst inexperienced anaesthetists performing ultrasound-guided peripheral nerves blocks in dogs. Vet Anaesth Analg 2013; 40:e83-90. [PMID: 23621354 DOI: 10.1111/vaa.12043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 12/04/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine if the use of needle enhancing software facilitate injection technique in ultrasound-guided peripheral nerve blocks. STUDY DESIGN Prospective, blinded, randomized controlled trial. ANIMALS Eight hind limbs from canine cadavers. METHODS The limbs were randomly allocated to two groups; software on (group I) and software off (group II). Eight anaesthetists with no previous experience of ultrasound-guided regional anaesthesia were recruited. Thirty-six procedures were carried out (18 per group). After sciatic nerve visualisation via ultrasonography, the anaesthetist introduced a needle guided by ultrasonography. When the tip of the needle was considered by the anaesthetist to be as close as possible to the nerve without touching it, 0.05 mL of methylene blue dye was injected. Parameters evaluated included: number of attempts to visualise the needle with ultrasonography, time spent to perform the technique, subjective evaluation of ease of needle visualisation, proximity of the tip of the needle to the nerve, and, at dissection of the leg, inoculation site of the dye in relation to the nerve. RESULTS Significant differences between groups were identified in relation to the number of attempts (group I: median 1, IQR: 1 - 1 attempts versus group II: median 1, IQR: 1 - 4 attempts, p = 0.019), and the relationship between the dye and the nerve during hind limb dissection (72.2% of the nerves were stained in group I versus 16.6% in group II, p = 0.003). No significant difference between groups was observed with respect to the time taken to perform the procedure (group I: median 25.5, IQR: 18.4 - 44.3 seconds versus group II: median 35.7, IQR: 18.6-78.72 seconds, p = 0.31), subjective evaluation of the needle visualization (p = 0.45) or distance between the tip of the needle and the nerve as measured from the ultrasound screen (p = 0.23). CONCLUSIONS AND CLINICAL RELEVANCE This study identified greater success rate in nerve staining when the needle enhancing software was used. The results suggest that the use of this technique could improve injection technique amongst inexperienced anaesthetists performing ultrasound-guided peripheral nerve blocks in dogs.
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Affiliation(s)
- Jaime Viscasillas
- Veterinary Clinical Science, Royal Veterinary College, University of London, Hatfield, UK
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Ueda K, Puangsuvan S, Hove M, Bayman E. Ultrasound visual image-guided vs Doppler auditory-assisted radial artery cannulation in infants and small children by non-expert anaesthesiologists: a randomized prospective study †. Br J Anaesth 2013; 110:281-6. [DOI: 10.1093/bja/aes383] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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The Learning Curve Associated with the Epidural Technique Using the Episure™ AutoDetect™ Versus Conventional Glass Syringe. Anesth Analg 2013; 116:145-54. [DOI: 10.1213/ane.0b013e31826c7cad] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kilicaslan A, Topal A, Tavlan A, Erol A. A simple, feedback-based simulation model for ultrasound-guided regional anaesthesia. Indian J Anaesth 2012; 56:431-3. [PMID: 23087483 PMCID: PMC3469939 DOI: 10.4103/0019-5049.100851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Alper Kilicaslan
- Department of Anaesthesiology, Konya University, Meram Medical Faculty, 42100 Konya, Turkey
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Bhatia A, Lai J, Chan VW, Brull R. Pneumothorax as a Complication of the Ultrasound-Guided Supraclavicular Approach for Brachial Plexus Block. Anesth Analg 2010; 111:817-9. [DOI: 10.1213/ane.0b013e3181e42908] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Liu Y, Glass NL, Power RW. Technical communication: new teaching model for practicing ultrasound-guided regional anesthesia techniques: no perishable food products! Anesth Analg 2010; 110:1233-5. [PMID: 20142350 DOI: 10.1213/ane.0b013e3181cc558b] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is a pronounced learning curve for the technique of ultrasound-guided regional anesthesia. Practicing with a simulator model has been shown to speed the acquisition of these skills for various ultrasound-guided procedures. However, commercial models for ultrasound-guided regional anesthesia may be too costly or not readily available. Models using turkey breasts or tofu blocks have the disadvantage of containing perishable food products that can be a source for infection. We describe an alternative inexpensive model that is made from nonperishable components readily available in the operating room. METHODS The materials required include 1 clean used 500-mL bag of IV fluids, a bottle of Premisorb (TYCO Healthcare Group, Mansfield, MA), and a piece of foam material approximately 0.3 cm in diameter and 5 cm in length trimmed from operating room foam pads. After filling the IV bag with tap water and inserting the foam into the IV bag from the outlet port of the IV bag, one-third of a bottle of Premisorb (approximately 15 g) is poured into the IV bag. The outlet port of the bag is then sealed by taping the rubber stopper that originally came with the bag. RESULTS Premisorb, a solidifying agent frequently used to absorb irrigating fluids or blood in operating room suction canisters, produces a gel-like material in the IV bag. The foam inserted into the bag creates a relatively hyperechoic target. This gel-like substance in the bag will seal the holes created after multiple practice needle insertions, resulting in minimal leakage. The semitransparent nature of the gel allows the trainee to visualize the target directly and on the ultrasound screen. CONCLUSION The model we describe is inexpensive and easy to make from materials readily available in the operating room with the advantages of being nonperishable, easy to carry, and reusable.
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Affiliation(s)
- Yang Liu
- Department of Pediatric Anesthesiology, Texas Children's Hospital, Houston, TX 77030, USA.
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Ford S, Dosani M, Robinson AJ, Campbell GC, Ansermino JM, Lim J, Lauder GR. Defining the Reliability of Sonoanatomy Identification by Novices in Ultrasound-Guided Pediatric Ilioinguinal and Iliohypogastric Nerve Blockade. Anesth Analg 2009; 109:1793-8. [DOI: 10.1213/ane.0b013e3181bce5a5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Mariano ER, Afra R, Loland VJ, Sandhu NS, Bellars RH, Bishop ML, Cheng GS, Choy LP, Maldonado RC, Ilfeld BM. Continuous interscalene brachial plexus block via an ultrasound-guided posterior approach: a randomized, triple-masked, placebo-controlled study. Anesth Analg 2009; 108:1688-94. [PMID: 19372355 PMCID: PMC2745838 DOI: 10.1213/ane.0b013e318199dc86] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The posterior approach for placing continuous interscalene catheters has not been studied in a controlled investigation. In this randomized, triple-masked, placebo-controlled study, we tested the hypothesis that an ultrasound-guided continuous posterior interscalene block provides superior postoperative analgesia compared to a single-injection ropivacaine interscalene block after moderately painful shoulder surgery. METHODS Preoperatively, subjects received a stimulating interscalene catheter using an ultrasound-guided, in-plane posterior approach. All subjects received an initial bolus of ropivacaine. Postoperatively, subjects were discharged with oral analgesics and a portable infusion device containing either ropivacaine 0.2% or normal saline programmed to deliver a perineural infusion over 2 days. The primary outcome was average pain on postoperative day (POD) 1 (scale: 0-10). Secondary outcomes included least and worst pain scores, oral opioid requirements, sleep disturbances, patient satisfaction, and incidence of complications. RESULTS Of the 32 subjects enrolled, 30 perineural catheters were placed per protocol. Continuous ropivacaine perineural infusion (n = 15) produced a statistically and clinically significant reduction in average pain (median [10th-90th percentile]) on POD 1 compared with saline infusion (n = 15) after initial ropivacaine bolus (0.0 [0.0-5.0] versus 3.0 [0.0-6.0], respectively; P < 0.001). Median oral opioid consumption (oxycodone) was lower in the ropivacaine group than in the placebo group on POD 1 (P = 0.002) and POD 2 (P = 0.002). Subjects who received a ropivacaine infusion suffered fewer sleep disturbances than those in the placebo group (P = 0.005 on POD 0 and 1 nights) and rated their satisfaction with analgesia higher than subjects who received normal saline (P < 0.001). CONCLUSIONS Compared to a single-injection interscalene block, a 2-day continuous posterior interscalene block provides greater pain relief, minimizes supplemental opioid requirements, greatly improves sleep quality, and increases patient satisfaction after moderate-to-severe painful outpatient shoulder surgery.
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Affiliation(s)
- Edward R. Mariano
- Department of Anesthesiology, University of California, San Diego Medical Center, San Diego, California
| | - Robert Afra
- Department of Orthopedic Surgery, University of California, San Diego Medical Center, San Diego, California
| | - Vanessa J. Loland
- Department of Anesthesiology, University of California, San Diego Medical Center, San Diego, California
| | - NavParkash S. Sandhu
- Department of Anesthesiology, University of California, San Diego Medical Center, San Diego, California
| | - Richard H. Bellars
- Department of Anesthesiology, University of California, San Diego Medical Center, San Diego, California
| | - Michael L. Bishop
- Department of Anesthesiology, University of California, San Diego Medical Center, San Diego, California
| | - Gloria S. Cheng
- Department of Anesthesiology, University of California, San Diego Medical Center, San Diego, California
| | - Lynna P. Choy
- Department of Anesthesiology, University of California, San Diego Medical Center, San Diego, California
| | - Rosalita C. Maldonado
- Department of Anesthesiology, University of California, San Diego Medical Center, San Diego, California
| | - Brian M. Ilfeld
- Department of Anesthesiology, University of California, San Diego Medical Center, San Diego, California
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Mariano ER, Loland VJ, Ilfeld BM. Interscalene perineural catheter placement using an ultrasound-guided posterior approach. Reg Anesth Pain Med 2009; 34:60-3. [PMID: 19258989 PMCID: PMC2743892 DOI: 10.1097/aap.0b013e3181933af7] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The posterior approach to the brachial plexus--or cervical paravertebral block--has advantages over the anterolateral interscalene approach, but concerns regarding "blind" needle placement near the neuraxis have limited the acceptance of this useful technique. We present a technique to place an interscalene perineural catheter that potentially decreases neuraxial involvement with the use of ultrasound guidance. METHODS A 55-year-old man scheduled for total shoulder arthroplasty underwent placement of an interscalene perineural catheter. The posterior approach was selected to avoid the external jugular vein and anticipated sterile surgical field. Under in-plane ultrasound guidance, a 17-gauge insulated Tuohy-tip needle was inserted between the levator scapulae and trapezius muscles, and guided through the middle scalene muscle, remaining less than 2 cm below the skin throughout. Deltoid and biceps contractions were elicited at a current of 0.6 mA, and a 19-gauge stimulating catheter was advanced 5 cm beyond the needle tip, without a concomitant decrease in motor response. RESULTS The initial 40 mL 0.5% ropivacaine bolus via the catheter resulted in unilateral anesthesia typical of an interscalene block; and subsequent perineural infusion of 0.2% ropivacaine was delivered via portable infusion pump through postoperative day 4. CONCLUSIONS Continuous interscalene block using an ultrasound-guided posterior approach is an alternative technique that retains the benefits of posterior catheter insertion, but potentially reduces the risk of complications that may result from blind needle insertion.
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Affiliation(s)
- Edward R Mariano
- Department of Anesthesiology, University of California, San Diego, San Diego, CA 92103-8770, USA.
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