Use of Ultrasound for Neuraxial Anesthesia<\/p>\n
Author Note:
\nNo conflicts of interest to disclose.<\/p>\n
Abstract
\nAbstract here; left-aligned. 150-200 words. Significance of problem. Key findings in literature.
\nKeywords: Ultrasound, neuraxial anesthesia, epidural, spinal<\/p>\n
Use of Ultrasound for Neuraxial Anesthesia
\nIntroduction of topic.
\nMilieu of Problem
\nSignificance of topic.
\nProblem Magnitude
\nSignificance of topic.
\nProblem Magnitude = There are X amount of laboring moms that are seen at UHTMC; we have the ability to improve SRNA comfort using ultrasound for neuraxial anesthesia, increasing utilization of ultrasound for neuraxial blocks, reducing the number of attempts for successful neuraxial anesthesia, and ultimately increasing patient satisfaction. Strong evidence from current literature supports the use of ultrasound for neuraxial anesthesia in reducing the number of attempts for successful neuraxial anesthesia.
\nIOM 6 Aims – Efficient, equitable (obese, patients with structural spinal cord abnormalities (scoliosis) ), and patient-centered.
\nThis can improve the efficiency of anesthesia care by reducing the amount of time required for neuraxial anesthesia, reducing the number of attempts in obese patients; together resulting in increased patient satisfaction.
\nProblem statement = The use of ultrasound for neuraxial anesthesia is under-utilized at University Health-Truman Medical Center.
\nAdd literature support.
\nMeasurable problem =
\nSecondary problems =
\nPlan =
\nImpact =
\nUniversity Health Truman Medical Center
\nMission: University Health is an academic health center providing accessible, state-of-the-art quality healthcare to our community regardless of the ability to pay. (meet the mission statement by the state-of-the-art quality healthcare through implementation of US for neuraxial anesthesia; which is at the forefront of anesthesia practice. Nearly \u00bd of all babies born in KC annually are at UH-TMC; by implementing US for neuraxial we have the opportunity to improve the quality of care provided to these patients with fewer attempts. University Health Truman Medical Center School of Nurse Anesthesia (UH-TMCSONA).<\/p>\n
Drivers and Stakeholders
\nDrivers and stakeholders are the individual, group of individuals, or organizations that support implementation of this project both inside and outside of the University Health Truman Medical Center School of Nurse Anesthesia. Internal drivers for this project include the extensive literature support for neuraxial anesthesia, anesthesia department leadership, and education leadership within the school of nurse anesthesia, which has pushed for further implementation of ultrasound training or utilization. External drivers include the Council of Accreditation (COA), which has recently implemented a minimum requirement for the number of cases utilizing ultrasound for vascular access (venous, arterial, or central) and regional anesthesia (neuraxial, truncal, and peripheral blocks) to maintain Student Registered Nurse Anesthetist (SRNA) education with current anesthesia practice. Key stakeholders include the educational leadership in the anesthesia department, anesthesia department leadership, anesthesia department staff, and SRNAs.
\nPurpose
\nThe purpose of this project is to improve the knowledge of SRNAs regarding the use of ultrasound to perform neuraxial anesthesia, maintain education with current anesthesia practice, and improve the delivery of care through a reduction of attempts for neuraxial anesthesia. The scholarly project was guided by the PICOT: In SRNAs, does the education of neuraxial ultrasound technique compared to baseline knowledge increase knowledge, comfort, and utilization of ultrasound for neuraxial anesthesia within three months? Project outcomes include increased SRNA comfort utilizing ultrasound for neuraxial anesthesia, increased utilization of ultrasound for neuraxial anesthesia at University Health Truman Medical Center, and decreased number of attempts for neuraxial anesthesia.
\nSearch Method
\nA review of literature was completed utilizing PubMed, EBSCO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Google Scholar exploring the use of ultrasound for neuraxial anesthesia. A detailed chart was completed to explain the different searches and articles that were discovered (see Appendix A). MeSH search terms that were utilized for PubMed include: neuraxial anesthesia and ultrasound with the following filters: English language, age adult 19+, research article, human species, and published within ten years. A search of EBSCO was conducted using the general search terms: ultrasound, epidural anesthesia, spinal anesthesia, and neuraxial anesthesia; search limiters include anesthesia, spinal anesthesia, spinal, epidural anesthesia, epidural, academic journals, English language, and published within five years. General search terms utilized for the CINAHL database include ultrasound, epidural anesthesia, spinal anesthesia, neuraxial anesthesia; search limiters include: academic journals, evidenced-based, spinal anesthesia, epidural anesthesia, ultrasonography, anesthesia, English language, and published within ten years. A search of Google Scholar was conducted utilizing the general search terms ultrasound, neuraxial anesthesia, epidural anesthesia, spinal anesthesia. Search limiters include within last five years and search terms included in the article title. Articles were excluded if they were not pertinent to ultrasound, spinal anesthesia, epidural anesthesia, adult population, and full-text was not available. Use of a PRISMA flow diagram (see Appendix B) was completed to explain the selection process for the articles that were included into the literature review.
\nReview of Literature
\nSupporting Evidence
\nFirst Theme
\nFirst theme discussion.
\nSecond Theme
\nSecond theme discussion.
\nThird Theme
\nThird theme discussion.
\nMajor Gaps in Knowledge
\nDiscussion of major gaps in knowledge that were discovered.
\nConclusion
\nConclusion and summarization of topic<\/p>\n
References
\nChin, A., Crooke, B., Heywood, L., Brijball, R., Pelecanos, A. M., & Abeypala, W. (2018). A randomised controlled trial comparing needle movements during combined spinal-epidural anaesthesia with and without ultrasound assistance. Anaesthesia, 73(4), 466-473. https:\/\/doi.org\/10.1111\/anae.14206
\nChin, K. J. (2018). Recent developments in ultrasound imaging for neuraxial blockade. Curr Opin Anaesthesiol, 31(5), 608-613. https:\/\/doi.org\/10.1097\/aco.0000000000000634
\nElsharkawy, H., Saasouh, W., Babazade, R., Soliman, L. M., Horn, J. L., & Zaky, S. (2019). Real-time ultrasound-guided lumbar epidural with transverse interlaminar view: Evaluation of an in-plane technique [Article]. Pain Medicine (United States), 20(9), 1750-1755. https:\/\/doi.org\/10.1093\/pm\/pnz026
\nGaur, A., Dedhia, J., & Bouazza\u2011Marouf, K. (2018). Ultrasound and central neuraxial blocks [Editorial]. Saudi Journal of Anaesthesia, 12(2), 175-177. https:\/\/doi.org\/10.4103\/sja.SJA_768_17
\nIn Chan, J. J., Ma, J., Leng, Y., Tan, K. K., Tan, C. W., Sultana, R., Sia, A. T. H., & Sng, B. L. (2021). Machine learning approach to needle insertion site identification for spinal anesthesia in obese patients. BMC Anesthesiology, 21(1). https:\/\/doi.org\/10.1186\/s12871-021-01466-8
\nJatuporn, P., Kanthida, T., Nalinee, K., Suttasinee, P., Pannawit, B., Kwanruthai, N., Somrutai, B., & Manoj Kumar, K. (2022). Real-time ultrasound-guided versus anatomic landmark-based thoracic epidural placement: A prospective, randomized, superiority trial. BMC Anesthesiology, 22(1), 1-11. https:\/\/doi.org\/10.1186\/s12871-022-01730-5
\nJiang, L., Zhang, F., Wei, N., Lv, J., Chen, W., & Dai, Z. (2020). Could preprocedural ultrasound increase the first-pass success rate of neuraxial anesthesia in obstetrics? A systematic review and meta-analysis of randomized controlled trials. Journal of Anesthesia, 34(3), 434-444. https:\/\/doi.org\/10.1007\/s00540-020-02750-6
\nKalagara, H., Nair, H., Kolli, S., Thota, G., & Uppal, V. (2021). Ultrasound imaging of the spine for central neuraxial blockade: A technical description and evidence update. Current Anesthesiology Reports, 11(3), 326-339. https:\/\/doi.org\/10.1007\/s40140-021-00456-3
\nKhan, M., Gupta, M., Sharma, S., & Kasaudhan, S. (2022). A comparative study of ultrasound assisted versus landmark technique for combined spinal-epidural anaesthesia in patients undergoing lower limb orthopaedic surgery. Indian Journal of Anaesthesia, 66(4), 272-277. https:\/\/doi.org\/10.4103\/ija.ija_775_21
\nLee, J.-H., Kim, D.-H., & Koh, W. U. (2021). Real-time ultrasound guided thoracic epidural catheterization: A technical review. Anesthesia and Pain Medicine, 16(4), 322-328. https:\/\/doi.org\/10.17085\/apm.21060
\nLi, J., Krishna, R., Zhang, Y., Lam, D., & Nalini, V. (2020). Ultrasound-guided neuraxial anesthesia. Current Pain and Headache Reports, 24. https:\/\/doi.org\/10.1007\/s11916-020-00895-3
\nOh, T. T., Ikhsan, M., Tan, K. K., Rehena, S., Han, N.-L. R., Sia, A. T. H., & Sng, B. L. (2019). A novel approach to neuraxial anesthesia: Application of an automated ultrasound spinal landmark identification. BMC Anesthesiology, 19(1). https:\/\/doi.org\/10.1186\/s12871-019-0726-6
\nPark, S. K., Bae, J., Yoo, S., Kim, W. H., Lim, Y. J., Bahk, J. H., & Kim, J. T. (2020). Ultrasound-assisted versus landmark-guided spinal anesthesia in patients with abnormal spinal anatomy: A randomized controlled trial. Anesth Analg, 130(3), 787-795. https:\/\/doi.org\/10.1213\/ane.0000000000004600
\nRavi, P., Naik, S., Joshi, M., & Singh, S. (2021). Real-time ultrasound-guided spinal anaesthesia vs pre- procedural ultrasound-guided spinal anaesthesia in obese patients. Indian Journal of Anaesthesia, 65(5), 356-361. https:\/\/doi.org\/10.4103\/ija.IJA_446_20
\nSadeghi, A., Patel, R., & Carvalho, J. C. A. (2021). Ultrasound-facilitated neuraxial anaesthesia in obstetrics. BJA Education, 21(10), 369-375. https:\/\/doi.org\/10.1016\/j.bjae.2021.06.003
\nShaylor, R., Saifi, F., Davidson, E., & Weiniger, C. F. (2016). High success rates using ultrasound for neuraxial block in obese patients. Isr Med Assoc J, 18(1), 36-39. https:\/\/www.ima.org.il\/MedicineIMAJ\/viewarticle.aspx?year=2016&month=01&page=36
\nSidiropoulou, T., Christodoulaki, K., & Siristatidis, C. (2021). Pre-procedural lumbar neuraxial ultrasound\u2014a systematic review of randomized controlled trials and meta-analysis. Healthcare, 9(4), 479. https:\/\/doi.org\/10.3390\/healthcare9040479
\nTubinis, M. D., Lester, S. A., Schlitz, C. N., Morgan, C. J., Sakawi, Y., & Powell, M. F. (2019). Utility of ultrasonography in identification of midline and epidural placement in severely obese parturients. Minerva Anestesiol, 85(10), 1089-1096. https:\/\/doi.org\/10.23736\/s0375-9393.19.13617-6
\nUrfalio\u011flu, A., Bilal, B., \u00d6ks\u00fcz, G., Bakacak, M., Boran, \u00d6. F., & \u00d6ks\u00fcz, H. (2017). Comparison of the landmark and ultrasound methods in cesarean sections performed under spinal anesthesia on obese pregnants. Journal of Maternal-Fetal & Neonatal Medicine, 30(9), 1051-1056. https:\/\/doi.org\/10.1080\/14767058.2016.1199677
\nUyel, Y., & Kilicaslan, A. (2021). Preprocedural ultrasonography versus landmark-guided spinal anesthesia in geriatric patients with difficult anatomy: A prospective randomized trial [Article]. Eurasian Journal of Medicine, 53(1), 9-14. https:\/\/doi.org\/10.5152\/eurasianjmed.2020.20215
\nVadhanan, P., Rajendran, I., & Rajasekar, P. (2020). Ultrasound-guided caudal epidural anesthesia in adults for anorectal procedures. Anesthesia: Essays & Researches, 14(2), 239-242. https:\/\/doi.org\/10.4103\/aer.AER_60_20
\nVallejo, M. C. (2018). Pre-procedure neuraxial ultrasound in obstetric anesthesia. Journal of Anesthesia and Perioperative Medicine (JAPM), 5(2), 85-91. https:\/\/doi.org\/https:\/\/doi.org\/10.24015\/JAPM.2017.0050
\nYoung, B., Onwochei, D., & Desai, N. (2021). Conventional landmark palpation vs. preprocedural ultrasound for neuraxial analgesia and anaesthesia in obstetrics \u2013 a systematic review and meta\u2010analysis with trial sequential analyses. Anaesthesia, 76(6), 818-831. https:\/\/doi.org\/10.1111\/anae.15255<\/p>\n
Appendix A<\/p>\n
Search Methods<\/p>\n
Database\tSearch terms used\tNumber of articles\tNumber of included articles\tNumber of excluded articles\tSearch term years
\nPubMed\tMeSH: Neuraxial Anesthesia AND Ultrasound<\/p>\n
39<\/p>\n
7<\/p>\n
32<\/p>\n
2012-2022<\/p>\n
EBSCO \tGeneral
\nUltrasound, Epidural Anesthesia OR Spinal Anesthesia OR Neuraxial Anesthesia<\/p>\n
189
\n11
\n178<\/p>\n
2017-2023
\nCINAHL\tGeneral:
\nUltrasound, Epidural Anesthesia OR Spinal Anesthesia
\n121<\/p>\n
3<\/p>\n
118<\/p>\n
2012-2022<\/p>\n
Google Scholar\tGeneral:
\nUltrasound AND Neuraxial Anesthesia OR Epidural Anesthesia OR Spinal Anesthesia<\/p>\n
150
\n8
\n142
\n2017-2022<\/p>\n
Appendix B<\/p>\n
Figure 1: PRISMA Flow Diagram of the Review of Literature: describes databases utilized and searched, number of abstracts screened, and full text articles included<\/p>\n
Appendix C Theoretical Framework<\/p>\n
Appendix D Literature Matrix
\n#\t\tStudy Variable\tStrengths\tLimitations\tImplications\/
\nRecommendations
\n1.\tArticle reference in APA format:
\nChin, A., Crooke, B., Heywood, L., Brijball, R., Pelecanos, A. M., & Abeypala, W. (2018). A randomised controlled trial comparing needle movements during combined spinal-epidural anaesthesia with and without ultrasound assistance. Anaesthesia, 73(4), 466-473. https:\/\/doi.org\/10.1111\/anae.14206<\/p>\n
Type of Evidence: Randomized controlled trial<\/p>\n
Design: Prospective, Randomized controlled trial<\/p>\n
Level and Quality of Evidence: Level II
\nIndependent Variable:
\nUtilization of ultrasound for CSE
\nDependent Variable:
\nFirst-pass success (a single needle insertion with no redirections) and procedure difficulty.<\/p>\n
Demographics:
\nTwo-hundred and eighteen women were included in the random allocation, and 215 included in the final analysis.<\/p>\n
:
\nReliability\/Precision:
\nSample size was calculated based on data from Grau et al. [13]. Using a 5% level of significance, 90% power and a pooled standard deviation of 0.69, a total of 215 women were required for a difference of 0.3puncture attempts between groups.<\/p>\n
Validity\/
\nAccuracy:
\nAssociation between categorical variables was examined using Pearson Chi-squared tests of association. Fischer\u2019s exact test was used when the assumptions of the Chi-square test were not met. Student\u2019s t-test was used to show the differences between groups for para-metric continuous variables. Mann\u2013Whitney U-tests were used for non-parametric continuous variables. To account for analyzing multiple outcomes, we corrected using the Benjamini\u2013Yekutieli method (four tests). Binary logistic regression was used to model first-pass success. Use of ultrasound, ease of spinous process palpation, ease of iliac crest palpation, body mass index and seniority of anesthetist were included in the initial model, and variables removed using backwards elimination. Use of ultrasound was forced to remain in the model. Tests were declared statistically significant data<0.05 (two-sided)
\nBias:
\nNot listed
\nMethodology:
\nPre-specified sub-group analyses included the effect of ability to palpate landmarks on technical performance (24 tests), and the effect of BMI on the difficulty of CSE (four tests). Post hoc sub-group analyses included association between composite landmark sand technical performance (12 tests), satisfaction and needle movements (six tests), VNRS and needle movements (three tests), technical performance and seniority of anesthetist (eight tests), interspace difference and palpating difficulty (one test), palpation difficulty and image quality (one test), and spinous process palpation and paresthesia (two tests).
\n\tReliability\/Precision:
\nThe anesthetists did not perform the ultrasound themselves.
\nValidity\/
\nAccuracy:
\nThe anesthetists did not perform the ultrasound themselves.
\nBias:
\nThey did not control for whether a consultant or registrar performed the CSE, which may have added bias incase selection according to anticipated difficulty. <\/p>\n
Methodology: Recruited women aged>18 years and>37 weeks\u2019 gestation who were scheduled for elective caesarean section under CSE anesthesia. We did not recruit women who were unable to provide fully informed consent<\/p>\n
There were no significant differences between the groups with respect to the secondary outcomes of block quality, patient pain, satisfaction, or procedural complications.<\/p>\n
Article reference in APA format:
\nChin, K. J. (2018). Recent developments in ultrasound imaging for neuraxial blockade. Curr Opin Anaesthesiol, 31(5), 608-613. https:\/\/doi.org\/10.1097\/aco.0000000000000634<\/p>\n
Type of Evidence:<\/p>\n
Design:<\/p>\n
Level and Quality of Evidence:
\nIndependent Variable:<\/p>\n
Dependent Variable:<\/p>\n
Demographics:\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:
\nReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:<\/p>\n
2.\tArticle reference in APA format:
\nElsharkawy, H., Saasouh, W., Babazade, R., Soliman, L. M., Horn, J. L., & Zaky, S. (Aberra et al.). Real-time Ultrasound-Guided Lumbar Epidural with Transverse Interlaminar View: Evaluation of an In-Plane Technique [Article]. Pain Medicine (United States), 20(9), 1750-1755-1755. https:\/\/doi.org\/10.1093\/pm\/pnz026<\/p>\n
Type of Evidence: Descriptive<\/p>\n
Design: Prospective Observational Pilot Trial<\/p>\n
Level and Quality of Evidence: Level IV\tIndependent Variable:
\nUse of Ultrasound for epidural placement using in-plane approach<\/p>\n
Dependent Variable:
\nEpidural placement success<\/p>\n
Demographics:
\nASA physical status, Age, sex, height, and weight:\tReliability\/Precision:
\nProviders had extensive experience with ultrasonography<\/p>\n
Validity\/Accuracy:
\nUtilized 95% CI<\/p>\n
Bias:
\nNot identified in the study<\/p>\n
Methodology:
\nAcknowledgement of limitations of the study\tReliability\/Precision:
\nLack of reliability tools utilized<\/p>\n
Validity\/Accuracy:
\nSmall sample size of 22<\/p>\n
Power factor was not calculated to determine sample size<\/p>\n
Bias:
\nBias could have been introduced by the provider regarding difficulty of epidural placement<\/p>\n
Methodology:
\nLack of randomization or controlled trial<\/p>\n
Only able to descriptively analyze the study
\nAll providers had previous experience and training with ultrasonography<\/p>\n
63.6% of patients found the technique satisfactory or very satisfactory<\/p>\n
Success rate was 95% with the epidural space being identified in 100% of patients
\n3.\tArticle reference in APA format:
\nGaur, A., Dedhia, J., & Bouazza\u2011Marouf, K. (2018). Ultrasound and central neuraxial blocks [Editorial]. Saudi Journal of Anaesthesia, 12(2), 175-177. https:\/\/doi.org\/10.4103\/sja.SJA_768_17<\/p>\n
Type of Evidence:<\/p>\n
Design:<\/p>\n
Level and Quality of Evidence:
\nIndependent Variable:<\/p>\n
Dependent Variable:<\/p>\n
Demographics:\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:
\nReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:<\/p>\n
4.\tArticle reference in APA format:
\nIn Chan, J. J., Ma, J., Leng, Y., Tan, K. K., Tan, C. W., Sultana, R., Sia, A. T. H., & Sng, B. L. (2021). Machine learning approach to needle insertion site identification for spinal anesthesia in obese patients. BMC Anesthesiology, 21(1). https:\/\/doi.org\/10.1186\/s12871-021-01466-8<\/p>\n
Type of Evidence: Prospective Cohort Study<\/p>\n
Design: Cohort Study<\/p>\n
Level and Quality of Evidence: Level IV
\nIndependent Variable:
\nUltrasound for determining needle insertion\/landmarks.<\/p>\n
Dependent Variable:
\nSuccess rate for spinal anesthesia.
\nDemographics:
\nFemale patients above 21\u2009years old who required spinal anesthesia for Cesarean section with a BMI of more than 30\u2009kg\/m2. \tReliability\/Precision:
\nThirty-eight patients (79.1, 95% CI 65.0 – 89.5%) had successful dural puncture at first attempt (\u2018First-attempt group\u2019), whereas the rest were successful only after two (n =\u20096 or 12.5%), three (n =\u20092 or 4.2%), and four (n =\u20092 or 4.2%) puncture attempts (\u2018Not at first attempt group\u2019). The BMIs between successful first attempt group and \u2018not at first attempt group\u2019 did not show significant difference.<\/p>\n
Validity\/
\nAccuracy: The scanning duration of L3\/4 interspinous space and the posterior complex were 21.0 [IQR: 17.0, 32.0] secs and 11.0 [IQR: 5.0, 22.0] secs respectively. With that, the average number of puncture attempts was 1.3, with a standard deviation of 0.75. The Pearson\u2019s correlation coefficient and Cronbach\u2019s alpha between the program recorded depth of the skin to posterior complex and the clinician measured depth was 0.915 and 0.956, respectively<\/p>\n
Bias: No bias discussed in the article.<\/p>\n
Methodology: The mean age of patients was 32.3\u2009\u00b1\u20094.8 (ranged 22 – 44) years, with an average BMI of 35.0\u2009\u00b1\u20094.5\u2009kg\/m2.
\nReliability\/Precision:
\nNot discussed in the article.<\/p>\n
Validity\/
\nAccuracy:
\n1. The study aimed to recruit obese patients with BMI above 30\u2009kg\/m2. As compared with previous study on obstetric women with BMI below 30\u2009kg\/m2 [19], the difference in BMI resulted in a lower first attempt success rate, probably due to the lower image quality of ultrasound images in obese patients.
\n2.<\/p>\n
Bias: n\/a<\/p>\n
Methodology: The exclusion criteria were a history of scoliosis or spinal instrumentation, allergy to ultrasound transmission gel, and patients with visible wound or injury to the lumbar spine.<\/p>\n
5.\tArticle reference in APA format:
\nJatuporn, P., Kanthida, T., Nalinee, K., Suttasinee, P., Pannawit, B., Kwanruthai, N., Somrutai, B., & Manoj Kumar, K. (2022). Real-time ultrasound-guided versus anatomic landmark-based thoracic epidural placement: a prospective, randomized, superiority trial [article]. BMC Anesthesiology, 22(1), 1-11. https:\/\/doi.org\/10.1186\/s12871-022-01730-5<\/p>\n
Type of Evidence:<\/p>\n
Design:<\/p>\n
Level and Quality of Evidence:
\nIndependent Variable:<\/p>\n
Dependent Variable:<\/p>\n
Demographics:\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:
\nReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:<\/p>\n
Article reference in APA format:
\nJiang, L., Zhang, F., Wei, N., Lv, J., Chen, W., & Dai, Z. (2020). Could preprocedural ultrasound increase the first-pass success rate of neuraxial anesthesia in obstetrics? A systematic review and meta-analysis of randomized controlled trials. Journal of Anesthesia, 34(3), 434-444. https:\/\/doi.org\/10.1007\/s00540-020-02750-6<\/p>\n
Type of Evidence:<\/p>\n
Design:<\/p>\n
Level and Quality of Evidence:\tIndependent Variable:<\/p>\n
Dependent Variable:<\/p>\n
Demographics:\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:
\nReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:<\/p>\n
Article reference in APA format:
\nKalagara, H., Nair, H., Kolli, S., Thota, G., & Uppal, V. (2021). Ultrasound imaging of the spine for central neuraxial blockade: A technical description and evidence update. Current Anesthesiology Reports, 11(3), 326-339. https:\/\/doi.org\/10.1007\/s40140-021-00456-3<\/p>\n
Type of Evidence:<\/p>\n
Design:<\/p>\n
Level and Quality of Evidence:
\nIndependent Variable:<\/p>\n
Dependent Variable:<\/p>\n
Demographics:\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:
\nReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:<\/p>\n
6.\tArticle reference in APA format:
\nKhan, M., Gupta, M., Sharma, S., & Kasaudhan, S. (2022). A comparative study of ultrasound assisted versus landmark technique for combined spinal-epidural anaesthesia in patients undergoing lower limb orthopaedic surgery [Article]. Indian Journal of Anaesthesia, 66(4), 272-277. https:\/\/doi.org\/10.4103\/ija.ija_775_21<\/p>\n
Type of Evidence:<\/p>\n
Design:<\/p>\n
Level and Quality of Evidence:
\nIndependent Variable:<\/p>\n
Dependent Variable:<\/p>\n
Demographics:\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:
\nReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:<\/p>\n
Article reference in APA format:
\nLee, J.-H., Kim, D.-H., & Koh, W. U. (2021). Real-time ultrasound guided thoracic epidural catheterization: a technical review. Anesthesia and Pain Medicine, 16(4), 322-328. https:\/\/doi.org\/10.17085\/apm.21060<\/p>\n
Type of Evidence:<\/p>\n
Design:<\/p>\n
Level and Quality of Evidence:
\nIndependent Variable:<\/p>\n
Dependent Variable:<\/p>\n
Demographics:\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:
\nReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:<\/p>\n
7.\tArticle reference in APA format:
\nLi, J., Krishna, R., Zhang, Y., Lam, D., & Nalini, V. (2020). Ultrasound-guided neuraxial anesthesia. Current Pain and Headache Reports, 24. https:\/\/doi.org\/10.1007\/s11916-020-00895-3<\/p>\n
Type of Evidence:<\/p>\n
Design:<\/p>\n
Level and Quality of Evidence:
\nIndependent Variable:<\/p>\n
Dependent Variable:<\/p>\n
Demographics:\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:
\nReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:<\/p>\n
8.\tArticle reference in APA format:
\nOh, T. T., Ikhsan, M., Tan, K. K., Rehena, S., Han, N.-L. R., Sia, A. T. H., & Sng, B. L. (2019). A novel approach to neuraxial anesthesia: application of an automated ultrasound spinal landmark identification. BMC Anesthesiology, 19(1). https:\/\/doi.org\/10.1186\/s12871-019-0726-6<\/p>\n
Type of Evidence:<\/p>\n
Design:<\/p>\n
Level and Quality of Evidence:
\nIndependent Variable:<\/p>\n
Dependent Variable:<\/p>\n
Demographics:\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:
\nReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:<\/p>\n
Article reference in APA format:
\nPark, S. K., Bae, J., Yoo, S., Kim, W. H., Lim, Y. J., Bahk, J. H., & Kim, J. T. (2020). Ultrasound-assisted versus landmark-guided spinal anesthesia in patients with abnormal spinal anatomy: A randomized controlled trial. Anesth Analg, 130(3), 787-795. https:\/\/doi.org\/10.1213\/ane.0000000000004600<\/p>\n
Type of Evidence:<\/p>\n
Design:<\/p>\n
Level and Quality of Evidence:
\nIndependent Variable:<\/p>\n
Dependent Variable:<\/p>\n
Demographics:\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:
\nReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:<\/p>\n
9.\tArticle reference in APA format:
\nRavi, P., Naik, S., Joshi, M., & Singh, S. (2021). Real-time ultrasound-guided spinal anaesthesia vs pre- procedural ultrasound-guided spinal anaesthesia in obese patients [Article]. Indian Journal of Anaesthesia, 65(5), 356-361. https:\/\/doi.org\/10.4103\/ija.IJA_446_20<\/p>\n
Type of Evidence:<\/p>\n
Design:<\/p>\n
Level and Quality of Evidence:
\nIndependent Variable:<\/p>\n
Dependent Variable:<\/p>\n
Demographics:\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:
\nReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:<\/p>\n
Article reference in APA format:
\nSadeghi, A., Patel, R., & Carvalho, J. C. A. (2021). Ultrasound-facilitated neuraxial anaesthesia in obstetrics. BJA Education, 21(10), 369-375. https:\/\/doi.org\/10.1016\/j.bjae.2021.06.003<\/p>\n
Type of Evidence:<\/p>\n
Design:<\/p>\n
Level and Quality of Evidence:
\nIndependent Variable:<\/p>\n
Dependent Variable:<\/p>\n
Demographics:\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:
\nReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology:<\/p>\n
10.\tArticle reference in APA format:
\nShaylor, R., Saifi, F., Davidson, E., & Weiniger, C. F. (2016). High Success Rates Using Ultrasound for Neuraxial Block in Obese Patients. Isr Med Assoc J, 18(1), 36-39.<\/p>\n
Type of Evidence: Cohort study<\/p>\n
Design: Cohort Study<\/p>\n
Level and Quality of Evidence: Level IV
\nIndependent Variable:
\nUtilization of ultrasound for spinal anesthesia
\nDependent Variable: First-pass success (a single needle insertion with no redirections) and procedure difficulty.
\nDemographics: Patients that were scheduled for ESWL
\nunder neuraxial block, were ASA physical status I-III and were
\nover 18 years old.\tReliability\/Precision:
\nAn overall success rate at the first attempt of 90.5% (CI 0.8\u20130.95) was achieved using ultrasound-guided neuraxial block. This block placement success rate was similar for all patients, regardless of BMI above versus below 30 kg\/m2.<\/p>\n
Validity\/Accuracy:
\nThe ease of palpation of anatomic landmarks, P = 0.001, and the ease of palpation of iliac crest, P < 0.001, differed significantly between the patients above versus below 30 kg\/m2. The reported verbal pain scores (VPS) due to block insertion was similar among all patients regardless of BMI category (above versus below 30 kg\/m2).<\/p>\n
Bias:
\nn\/a<\/p>\n
Methodology:
\nn\/a<\/p>\n
\tReliability\/Precision:
\nNot discussed in article.
\nValidity\/
\nAccuracy:
\nThe study had one experienced operator performing both ultrasound and spinal blocks.<\/p>\n
Bias:
\nBias could be introduced as the data were recorded by the practitioner.<\/p>\n
Methodology: Excluded patients with coagulopathy, thrombocytopenia, previous spine surgery or trauma, suspected or known neurological disease or anatomic malformation of neuraxial structures, or on anticoagulation drugs.<\/p>\n
11.\tArticle reference in APA format:
\nSidiropoulou, T., Christodoulaki, K., & Siristatidis, C. (2021). Pre-Procedural Lumbar Neuraxial Ultrasound\u2014A Systematic Review of Randomized Controlled Trials and Meta-Analysis. Healthcare, 9(4), 479. https:\/\/doi.org\/10.3390\/healthcare9040479 <\/p>\n
Type of Evidence: <\/p>\n
Design: <\/p>\n
Level and Quality of Evidence:
\n\tIndependent Variable: <\/p>\n
Dependent Variable: <\/p>\n
Demographics:\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias: <\/p>\n
Methodology:
\n\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology: <\/p>\n
12.\tArticle reference in APA format:
\nTubinis, M. D., Lester, S. A., Schlitz, C. N., Morgan, C. J., Sakawi, Y., & Powell, M. F. (2019). Utility of ultrasonography in identification of midline and epidural placement in severely obese parturients. Minerva Anestesiol, 85(10), 1089-1096. https:\/\/doi.org\/10.23736\/s0375-9393.19.13617-6 <\/p>\n
Type of Evidence: Randomized Controlled Trial<\/p>\n
Design: Randomized Controlled Trial<\/p>\n
Level and Quality of Evidence: Level II
\n\tIndependent Variable:
\nUtilization of ultrasound <\/p>\n
Dependent Variable:
\nTime for detection of midline <\/p>\n
Demographics: Severely obese parturients whose anatomic landmarks are difficult to palpate. \u201cSevere obesity\u201d as class II obesity (BMI 35 to 35.9 kg\/m2) and above.
\n\tReliability\/Precision:
\nData were summarized using either mean and standard deviation (SD) (for continuous outcomes) or counts and percentages (for categorical outcomes). Two-sample t-test was used to compare the ultrasonography and palpation groups on the primary endpoint. Linear regression was then used to test the relationship between midline identification method and time required for epidural placement, while controlling for provider experience (i.e., junior vs. senior resident) as well as interaction between experience and method. To assess whether the success of each midline identification method varied with patient BMI, linear regression was also used to test for an interaction between midline identification method and patient BMI. This model included main effects for method and patient BMI and controlled for provider level of experience.<\/p>\n
Validity\/Accuracy: Compared to palpation, ultrasonography required less time to place the epidural (6.2 minutes vs. 9.0 minutes; P<0.01), more time to locate midline (44.5 seconds vs. 30.9 seconds; P<0.01), and less total time for epidural placement (6.9 minutes vs. 9.5 minutes; P<0.01) (Table II, Figure 2). Patients in the ultrasonography group also required fewer needle passes (2.1 vs. 2.8; P=0.02). The epidural failure rates when the ultrasonography group was compared to the palpation group were not significantly different (4.0% vs. 9.3%; P=0.19)<\/p>\n
Bias: n\/a<\/p>\n
Methodology:
\nAll patients gave informed written consent to participate in this study. All severely obese patients admitted to our labor and delivery unit for expected vaginal delivery and requesting a labor epidural who did not meet the exclusion criteria were eligible for the study. Exclusion criteria were: 1) age less than 19 years old; 2) Body Mass Index (BMI) <35 kg\/m2; 3) diagnosis of coagulopathy or platelet count <80,000; 4) history of lumbar spine surgery; 5) diagnosis of scoliosis; 6) diagnosis of intracranial or spinal mass.
\n\tReliability\/Precision:
\nNot discussed in the article.
\nBias: The residents performing the epidural placement were aware of the study and the study group in which the patient was randomized. This knowledge might have affected the speed at which the epidural was placed.
\nThey did not require a full ultrasound examination of the lumbar spine, including measuring the depth from skin to epidural space.
\nMethodology: Only located spinous process in the transverse plane to determine midline for two reasons: 1) the spinous process is an easily identifiable landmarks with minimal ultrasonography experience, as proven by the success of our trainees; 2) locating midline is often seen as one of the more challenging aspects of lumbar epidural placement in severely obese parturients<\/p>\n
13.\tArticle reference in APA format:
\nUrfalio\u011flu, A., Bilal, B., \u00d6ks\u00fcz, G., Bakacak, M., Boran, \u00d6. F., & \u00d6ks\u00fcz, H. (2017). Comparison of the landmark and ultrasound methods in cesarean sections performed under spinal anesthesia on obese pregnants. Journal of Maternal-Fetal & Neonatal Medicine, 30(9), 1051-1056. https:\/\/doi.org\/10.1080\/14767058.2016.1199677 <\/p>\n
Type of Evidence: <\/p>\n
Design: <\/p>\n
Level and Quality of Evidence:
\n\tIndependent Variable: <\/p>\n
Dependent Variable: <\/p>\n
Demographics:\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias: <\/p>\n
Methodology:
\n\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology: <\/p>\n
14.\tArticle reference in APA format:
\nUyel, Y., & Kilicaslan, A. (2021). Preprocedural Ultrasonography Versus Landmark-Guided Spinal Anesthesia in Geriatric Patients with Difficult Anatomy: A Prospective Randomized Trial [Article]. Eurasian Journal of Medicine, 53(1), 9-14. https:\/\/doi.org\/10.5152\/eurasianjmed.2020.20215 <\/p>\n
Type of Evidence: <\/p>\n
Design: <\/p>\n
Level and Quality of Evidence:
\n\tIndependent Variable: <\/p>\n
Dependent Variable: <\/p>\n
Demographics:\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias: <\/p>\n
Methodology:
\n\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology: <\/p>\n
15.\tArticle reference in APA format:
\nVadhanan, P., Rajendran, I., & Rajasekar, P. (2020). Ultrasound-guided caudal epidural anesthesia in adults for anorectal procedures. Anesthesia: Essays & Researches, 14(2), 239-242. https:\/\/doi.org\/10.4103\/aer.AER_60_20 <\/p>\n
Type of Evidence: <\/p>\n
Design: <\/p>\n
Level and Quality of Evidence:
\n\tIndependent Variable: <\/p>\n
Dependent Variable: <\/p>\n
Demographics:\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias: <\/p>\n
Methodology:
\n\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias:<\/p>\n
Methodology: <\/p>\n
\tArticle reference in APA format:
\nVallejo, M. C. (2018). Pre-procedure neuraxial ultrasound in obstetric anesthesia. Journal of Anesthesia and Perioperative Medicine (JAPM), 5(2), 85-91. https:\/\/doi.org\/https:\/\/doi.org\/10.24015\/JAPM.2017.0050 <\/p>\n
Type of Evidence: <\/p>\n
Design: <\/p>\n
Level and Quality of Evidence:
\n\tIndependent Variable: <\/p>\n
Dependent Variable: <\/p>\n
Demographics:\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias: <\/p>\n
Methodology:
\n\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias: <\/p>\n
Methodology:<\/p>\n
\tArticle reference in APA format:
\nYoung, B., Onwochei, D., & Desai, N. (2021). Conventional landmark palpation vs. preprocedural ultrasound for neuraxial analgesia and anaesthesia in obstetrics \u2013 a systematic review and meta\u2010analysis with trial sequential analyses. Anaesthesia, 76(6), 818-831. https:\/\/doi.org\/10.1111\/anae.15255 <\/p>\n
Type of Evidence: <\/p>\n
Design: <\/p>\n
Level and Quality of Evidence:
\n\tIndependent Variable: <\/p>\n
Dependent Variable: <\/p>\n
Demographics:\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias: <\/p>\n
Methodology:
\n\tReliability\/Precision:<\/p>\n
Validity\/Accuracy:<\/p>\n
Bias: <\/p>\n
Methodology:<\/p>\n","protected":false},"excerpt":{"rendered":"
Use of Ultrasound for Neuraxial Anesthesia Author Note: No conflicts of interest to disclose. Abstract Abstract here; left-aligned. 150-200 words. Significance of problem. Key findings in literature. Keywords: […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6967],"tags":[6981,613,6983,3959],"class_list":["post-48329","post","type-post","status-publish","format-standard","hentry","category-writing-my-dissertation-in-a-day","tag-uk-best-nursing-assignment-writing-service-for-students","tag-best-dissertation-writing-services-uk","tag-help-with-dissertation-writing-london","tag-best-dissertation-writing-service-uk"],"_links":{"self":[{"href":"https:\/\/www.homeworkacetutors.com\/assessments\/wp-json\/wp\/v2\/posts\/48329","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.homeworkacetutors.com\/assessments\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.homeworkacetutors.com\/assessments\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.homeworkacetutors.com\/assessments\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.homeworkacetutors.com\/assessments\/wp-json\/wp\/v2\/comments?post=48329"}],"version-history":[{"count":0,"href":"https:\/\/www.homeworkacetutors.com\/assessments\/wp-json\/wp\/v2\/posts\/48329\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.homeworkacetutors.com\/assessments\/wp-json\/wp\/v2\/media?parent=48329"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.homeworkacetutors.com\/assessments\/wp-json\/wp\/v2\/categories?post=48329"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.homeworkacetutors.com\/assessments\/wp-json\/wp\/v2\/tags?post=48329"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}