scholarly journals Using Computed Tomography Scans and Patient Demographic Data to Estimate Thoracic Epidural Space Depth

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Alyssa Kosturakis ◽  
Jose Soliz ◽  
Jackson Su ◽  
Juan P. Cata ◽  
Lei Feng ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Epidural Catheter ◽  
Epidural Space ◽  
Depth Measurement ◽  
Thoracic Epidural ◽  
Patient Demographics ◽  
Loss Of Resistance ◽  
Computed Tomography Scans ◽  
The Mean ◽  
Epidural Catheters

Background and Objectives. Previous studies have used varying methods to estimate the depth of the epidural space prior to placement of an epidural catheter. We aim to use computed tomography scans, patient demographics, and vertebral level to estimate the depth of the loss of resistance for placement of thoracic epidural catheters. Methods. The records of consecutive patients who received a thoracic epidural catheter were reviewed. Patient demographics, epidural placement site, and technique were collected. Preoperative computed tomography scans were reviewed to measure the skin to epidural space distance. Linear regression was used for a multivariate analysis. Results. The records of 218 patients were reviewed. The mean loss of resistance measurement was significantly larger than the mean computed tomography epidural space depth measurement by 0.79 cm (p<0.001). Our final multivariate model, adjusted for demographic and epidural technique, showed a positive correlation between the loss of resistance and the computed tomography epidural space depth measurement (R2=0.5692, p<0.0001). Conclusions. The measured loss of resistance is positively correlated with the computed tomography epidural space depth measurement and patient demographics. For patients undergoing thoracic or abdominal surgery, estimating the loss of resistance can be a valuable tool.

scholarly journals Measurements of Epidural Space Depth Using Preexisting CT Scans Correlate with Loss of Resistance Depth during Thoracic Epidural Catheter Placement

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Nathaniel H. Greene ◽  
Benjamin G. Cobb ◽  
Ken F. Linnau ◽  
Christopher D. Kent
Keyword(s):  
Epidural Catheter ◽  
Strong Association ◽  
Epidural Catheter Placement ◽  
Thoracic Epidural ◽  
Thoracic Surgical Procedures ◽  
Spine Imaging ◽  
Thoracic Epidural Catheter ◽  
Loss Of Resistance ◽  
Resolution Imaging ◽  
Epidural Catheters

Background.Thoracic epidural catheters provide the best quality postoperative pain relief for major abdominal and thoracic surgical procedures, but placement is one of the most challenging procedures in the repertoire of an anesthesiologist. Most patients presenting for a procedure that would benefit from a thoracic epidural catheter have already had high resolution imaging that may be useful to assist placement of a catheter.Methods.This retrospective study used data from 168 patients to examine the association and predictive power of epidural-skin distance (ESD) on computed tomography (CT) to determine loss of resistance depth acquired during epidural placement. Additionally, the ability of anesthesiologists to measure this distance was compared to a radiologist, who specializes in spine imaging.Results.There was a strong association between CT measurement and loss of resistance depth (P<0.0001); the presence of morbid obesity (BMI>35) changed this relationship (P=0.007). The ability of anesthesiologists to make CT measurements was similar to a gold standard radiologist (all individualICCs>0.9).Conclusions.Overall, this study supports the examination of a recent CT scan to aid in the placement of a thoracic epidural catheter. Making use of these scans may lead to faster epidural placements, fewer accidental dural punctures, and better epidural blockade.

scholarly journals PROSPECTIVE RANDOMIZED COMPARITIVE STUDY ON USAGE OF EPISURE AUTODETECT SYRINGE VERSUS GLASS SYRINGE IN LOWER THORACIC EPIDURALANALGESIA

2020 ◽  
pp. 24-25
Author(s):  
N.Rajanalini M.D ◽  
Fathima KSMB
Keyword(s):  
Epidural Space ◽  
Demographic Data ◽  
Data Depth ◽  
Thoracic Epidural ◽  
Patient Demographics ◽  
Glass Syringe ◽  
Group I ◽  
Loss Of Resistance ◽  
Patient Demographic Data ◽  
American Society

Episure & AutoDetect syringe (EAS), a spring-loaded syringe, is a new loss-of-resistance syringe used to identify epidural space. It has an advantage of subjective and objective confirmation in identifying epidural space over glass syringe (GS) for beginners. We compared the performance of EAS with that of GS for identifying epidural space in lower thoracic epidurals. Methods: A total of 40 American Society of Anesthesiolgists I-II patients aged 18-60 years requiring lower thoracic epidural analgesia for surgery were randomised into Group I (EAS): Epidural identified using EAS and Group II (GS) epidural identified with GS. Patient demographic data, depth to epidural space (cm) was noted Results: There were no differences in patient demographics or depth to the epidural space between the two groups. When epidural was identified in fewer attempts, the time needed to identify epidural space was quicker with EAS . Conclusion: Using EAS allowed reliable and quick identification of the epidural space in lower thoracic epidural technique as compared to use of glass syringe.

Cervical and High Thoracic Ligamentum Flavum Frequently Fails to Fuse in the Midline

2003 ◽  
Vol 99 (6) ◽  
pp. 1387-1390 ◽  
Author(s):  
Philipp Lirk ◽  
Christian Kolbitsch ◽  
Guenther Putz ◽  
Joshua Colvin ◽  
Hans Peter Colvin ◽  
...  
Keyword(s):  
Ligamentum Flavum ◽  
Epidural Needle ◽  
Complete Fusion ◽  
Thoracic Epidural ◽  
Loss Of Resistance ◽  
Ligamenta Flava ◽  
Mean Width ◽  
Human Cadavers ◽  
The Mean ◽  
High Thoracic Epidural

Background Cervical and high thoracic epidural anesthesia and analgesia have gained increasing importance in the treatment of painful conditions and as components of anesthetics for cardiac and breast surgery. In contrast to the hanging-drop technique, the loss-of-resistance technique is thought to rely on the penetration of the ligamentum flavum. However, the exact morphology of the ligamentum flavum at different vertebral levels remains controversial. Therefore, the aim of this study was to investigate the incidence and morphology of cervical and high thoracic ligamentum flavum mid-line gaps in embalmed cadavers. Methods Vertebral column specimens were obtained from 52 human cadavers. On each dissected level, ligamentum flavum mid-line gaps were recorded and evaluated with respect to shape and size. Results The following variations were encountered: complete fusion in the mid-line, mid-line fusion with a gap in the caudal part, mid-line gap, and mid-line gap with widened caudal end. The incidence of mid-line gaps at the following levels was: C3-C4: 66%, C4-C5: 58%, C5-C6: 74%, C6-C7: 64%, C7-T1: 51%, Th1-Th2: 21%, Th2-Th3: 11%, Th3-Th4: 4%, Th4-Th5: 2%, and Th5-Th6: 2%. The mean width of mid-line gaps was 1.0 +/- 0.3 mm. Conclusions In conclusion, the present study shows that gaps in the ligamenta flava are frequent at cervical and high thoracic levels but become rare at the T3/T4 level and below, such that one cannot always rely on the ligamentum flavum as a perceptible barrier to epidural needle placement at these levels.

Patient-Controlled Epidural Analgesia/Continuous Epidural Catheters

2016 ◽  
Author(s):  
Devin Peck
Keyword(s):  
Epidural Catheter ◽  
Local Anesthetics ◽  
Catheter Placement ◽  
Labor Pain ◽  
Abdominal Incision ◽  
Tumor Spread ◽  
Epidural Catheter Placement ◽  
Thoracic Epidural ◽  
Cord Injury ◽  
Epidural Catheters

Although useful for management of many types of pain, the most common indication for epidural catheter placement is for management of labor pain. High lumbar and thoracic epidural catheter placement has gained increasing popularity in recent years for the management of postoperative pain. The technique is most commonly employed for procedures in which a thoracic or an extensive abdominal incision is anticipated. Absolute contraindications for epidural catheter placement include patient refusal, uncorrected hypovolemia, increased intracranial pressure, local infection at the planned site of insertion, and patient allergy to amide/ester local anesthetics. Relative contraindications include coagulopathy, an uncooperative patient, severe anatomic abnormalities of the spine, sepsis, and hypertension. The advantages include attenuation of the sympathetic response to surgical stimulation and pain; effects on the cardiovascular, respiratory, and gastrointestinal systems; thromboprotective effects; and possibly limitation of tumor spread. The risks of epidural catheter placement include epidural hematoma, infection, nerve or spinal cord injury, dural puncture, or respiratory or cardiovascular depression from a high block. Epidural opioids provide analgesia without causing motor or sympathetic blockade. Epidurally administered local anesthetics may result in decreased postoperative ileus, nausea, vomiting, and sedation, which can be associated with opioids. Local anesthetics and opioids act additively or synergistically and, when used together, can lead to a reduction in the dose of each drug. 

Prediction of the Distance from Skin to Mid-Thoracic Epidural Space by Computed Tomography

2005 ◽  
Vol 48 (6) ◽  
pp. 605 ◽  
Author(s):  
Sung Jin Lee ◽  
Seung Ho Choi ◽  
Min Soo Kim ◽  
Yang Sik Shin
Keyword(s):  
Computed Tomography ◽  
Epidural Space ◽  
Thoracic Epidural

Frontonasal and Craniofrontonasal Dysplasia: Preoperative Quantitative Description of the Cranio-Orbito-Zygomatic Region Based on Computed and Conventional Tomography

1994 ◽  
Vol 31 (2) ◽  
pp. 97-105 ◽  
Author(s):  
Stephanie M Moffat ◽  
Jeffrey C. Posnick ◽  
Gaylene E. Pron ◽  
Derek C. Armstrong
Keyword(s):  
Computed Tomography ◽  
Clinical Presentation ◽  
Matched Control ◽  
Quantitative Description ◽  
Frontonasal Dysplasia ◽  
Orbital Wall ◽  
Computed Tomography Scans ◽  
Conventional Tomography ◽  
The Mean ◽  
Medial Orbital Wall

The unoperated cranio-orbito-zygomatic complex of 18 children (mean 4.7 years) with frontonasal dysplasia (FND) and 12 children (mean 1.1 years) with craniofrontonasal dysplasia (CFND) was quantified by 15 standard measurements performed on either computed tomography scans or facial tomograms. The results were compared with age-matched control values. In the FND group, the mean anterior interorbital and mid-interorbital distances were significantly increased at 148% and 118% of normal, and in the CFND patients, at 177% and 140% of normal. Excessive medial orbital wall protrusion (mean, 145% of normal in FND and 177% in CFND), shortened zygomatic arch lengths (mean, 94% of normal In FND and 91% in CFND), and reduced cephalic lengths (mean, 96% of normal in FND and 83% in CFND) were all observed. An expanded interzygomatic buttress distance was documented only in the CFND group, at 111% of normal. The clinical presentation of craniofacial deformities such as FND and CFND can be objectively described by a numerical analysis of the bony pathology.

scholarly journals Union Rate on Hinge Side after Open-Door Laminoplasty Using Maxillofacial Titanium Miniplate

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Koopong Siribumrungwong ◽  
Theerasan Kiriratnikom ◽  
Boonsin Tangtrakulwanich
Keyword(s):  
Computed Tomography ◽  
Cervical Canal ◽  
Open Door ◽  
Union Rate ◽  
Japanese Orthopedic Association ◽  
Computed Tomography Scans ◽  
Before And After ◽  
The Mean ◽  
Scan Data ◽  
Titanium Miniplate

Background. One of the important complications of open-door laminoplasty is a premature laminoplasty closure. In order to prevent premature laminoplasty closure many techniques have been described and a titanium miniplate is one of the instruments to maintain cervical canal expansion. This study was performed to evaluate the effectiveness of titanium miniplates on the union rate for open-door laminoplasty.Materials and Methods. We performed open-door laminoplasty in 68 levels of fourteen patients using maxillofacial titanium miniplates. Axial computed tomography scans were obtained at 6 months postoperatively to evaluate the union rates of the hinge side. The Japanese Orthopedic Association (JOA) score was used to compare the clinical outcomes before and after surgery.Results. Computed tomography scan data was available on 68 levels in 14 patients. There were no premature closures of the hinge or miniplate dislodgements. The union rate on the hinge side was 70.5% (48/68). The mean JOA score increased significantly from 7.0 before surgery to 10.2, 12.2, and 13.0 after surgery at 1, 3, and 6 months, respectively.Conclusion. Open-door laminoplasty using maxillofacial titanium miniplates can provide union rates comparable to other techniques. It can maintain canal expansion without failures, dislodgements, and premature closures.

Percutaneous CT-Guided Cryoablation of the Bilateral Pudendal Nerves for Palliation of Intractable Pain Related to Pelvic Neoplasms

2020 ◽  
Vol 37 (8) ◽  
pp. 619-623 ◽  
Author(s):  
John David Prologo ◽  
Sivasai Manyapu ◽  
Zachary L. Bercu ◽  
Ashmit Mittal ◽  
Jason W. Mitchell
Keyword(s):  
Computed Tomography ◽  
Pelvic Pain ◽  
Pudendal Nerve ◽  
Intractable Pain ◽  
Pelvic Neoplasms ◽  
Ct Guided ◽  
Patient Demographics ◽  
Pain Scores ◽  
The Mean ◽  
Mean Time

Objectives: The purpose of this report is to describe the effect of computed tomography–guided bilateral pudendal nerve cryoablations on pain and time to discharge in the setting of acute hospitalizations secondary to refractory pelvic pain from cancer. Methods: Investigators queried the medical record for patients who underwent pudendal nerve cryoablation using the Category III Current Procedural Technology code assignment 0442T or Category I code 64640 for cases prior to 2015. The resulting list was reviewed, and procedures performed on inpatients for intractable pelvic pain related to neoplasm were selected. The final cohort was then analyzed with regard to patient demographics, procedure details, technical success, safety, pain scores, and time to discharge. Results: Ten patients underwent cryoablation by 3 operators for palliation of painful pelvic neoplasms between June 2014 and January 2019. All probes were satisfactorily positioned and freeze cycles undertaken without difficulty. There were no procedure-related complications or adverse events. The mean difference in pre- and posttreatment worst pain scores was significant (n = 5.20, P = .003). The mean time to discharge following the procedure was 2.3 days. Conclusion: Computed tomography–guided percutaneous cryoablation of the bilateral pudendal nerves may represent a viable option in the setting of acute hospitalization secondary to intractable pain in patients with pelvic neoplasms.

scholarly journals Radiological analysis of the position of epidural catheters in the thoracic epidural space

2014 ◽  
Vol 67 (Suppl) ◽  
pp. S51 ◽  
Author(s):  
Mun Gyu Kim ◽  
Si Young Ok ◽  
Se Kwang Park ◽  
Ho Bum Cho ◽  
Sang Ho Kim
Keyword(s):  
Epidural Space ◽  
Thoracic Epidural ◽  
Epidural Catheters ◽  
Radiological Analysis
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