Transcript Ultrasound in Obstetric Anaesthesia

Ultrasound in Obstetric AnaesthesiaNeuraxial Blockade
Dr John Loughrey
The Rotunda Hospital
Dublin
•Dober dan
•To bo dobro predavanje !
Labour Epidural Rates
The Rotunda Hospital 67%
USA 66%
Ireland 33%
Europe 25%
American College of
Obstetrics & Gynecology
‘labour results in severe pain for many
women. There is no other circumstance
where it is considered acceptable for a
person to experience untreated severe pain,
amenable to safe intervention, while under
a physician's care.’
Methods of Maintaining Epidural
Analgesia
• Intermittent ‘Top-Ups’
• Continuous infusions (8-12 mls/hr)
• Patient Controlled (PCEA)
– ± Background infusion
Epidural Patient-Controlled
Analgesia
PCEA use: ~40% USA
Bucklin BA. Anesthesiology 2005;103:645-53
PCEA vs Continuous Epidural
infusion van der Vyver. BJA. 2002
• 9 Studies of 640 patients
• Continuous vs PCEA with no basal rate
• PCEA groups
– Less local anaesthetic
– Less leg weakness
– Fewer anaesthetic interventions
Benefits of Minimising Local
Anaesthetic Usage
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Patient Satisfaction
Ability to Void increased
Less Hypotension
Obstetric Outcome improved
Ambulation
Ultrasound in Obstetric Anaesthesia
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Central Vascular Access
Abdominal field blocks eg: TAP
Pre-Anaesthesia clinic eg: scoliosis
Neuraxial Imaging
Pain Procedures eg: Sacroiliac/ Symphysis Injection
– Arch Physical Med & Rehab. Sept 2007.88(9) E45-6.
– SOAP. 2009. A-206. Shannon J, Harmon D.
Technique
Equipment Cost
“In the kingdom of the blind,
the one-eyed man is King.”
D. Erasmus 1466-1536.
“An idiot with an ultrasound probe is still an idiot.”
“ Evidence on Ultrasound-guided catheterisation of
the epidural space is limited in amount, but suggests
that it is safe and may be helpful in achieving correct
placement.”
Ultrasound in Neuraxial Anaesthesia
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Identifying Correct Lumbar Interspace
Identifying Skin Puncture site
Measuring depth to Epidural Space
Identifying aberrant Anatomy
Lumbar Interspace Selection
Reynolds F (2001).
Damage to the conus medullaris following spinal
anaesthesia.
Anaesthesia 2001; 56: 238-247.
Schlotterbeck H, Schaeffer R, Dow WA, et al (2008).
Ultrasonographic control of the puncture level for
lumbar neuraxial block in obstetric anaesthesia.
British Journal of Anaesthesia 2008; 100: 230-4.
Technique
Technique
Technique
Efficacy of ultrasound imaging in
obstetric epidural anesthesia .
J Clin Anesth. 2002
Thomas Grau, Rudiger Wolfgang Leipold , Renate Conradi, Eike
Martin , Johann Motsch.
Ultrasound Using the Transverse
Approach to the Lumbar Spine
Provides Reliable Landmarks for
Labor Epidurals.
Anesthesia & Analgesia. May.2007.
Cristian Arzola, Sharon Davies, Ayman Rofaeel, Jose Carvalho.
Arzola et al. A&A. May 2007.
May2008
Gaining Experience
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Appropriate specification equipment
Use in non-neuraxial anaesthesia
Outpatient evaluations
Pre-puncture imaging
“ Gentlemen…this is no humbug!”
Hvala lepa !