The Experts below are selected from a list of 8076 Experts worldwide ranked by ideXlab platform
Cynthia A Wong - One of the best experts on this subject based on the ideXlab platform.
-
the volume of Blood for epidural Blood Patch in obstetrics a randomized blinded clinical trial
Anesthesia & Analgesia, 2011Co-Authors: Michael J. Paech, Dorota A. Doherty, Tracey Christmas, Cynthia A WongAbstract:BACKGROUND:Our aim in this multinational, multicenter, randomized, blinded trial was to determine the optimum of 3 volumes of autologous Blood for an epidural Blood Patch.METHODS:Obstetric patients requiring epidural Blood Patch after unintentional dural puncture during epidural catheter insertion w
-
the volume of Blood for epidural Blood Patch in obstetrics a randomized blinded clinical trial
Anesthesia & Analgesia, 2011Co-Authors: M J Paech, Dorota A. Doherty, Tracey Christmas, Cynthia A WongAbstract:Background Our aim in this multinational, multicenter, randomized, blinded trial was to determine the optimum of 3 volumes of autologous Blood for an epidural Blood Patch. Methods Obstetric patients requiring epidural Blood Patch after unintentional dural puncture during epidural catheter insertion were allocated to receive 15, 20, or 30 mL of Blood, stratified for the timing of epidural Blood Patch and center. Participants were followed for 5 days. The primary study end point was a composite of permanent or partial relief of headache, and secondary end points included permanent relief, partial relief, persisting headache severity, and low back pain during or after the procedure. Results One hundred twenty-one women completed the study. The median (interquartile range) volume administered was 15 (15-15), 20 (20-20), and 30 (22-30) mL, with 98%, 81%, and 54% of groups 15, 20, and 30 receiving the allocated volume. Among groups 15, 20, and 30, respectively, the incidence of permanent or partial relief of headache was 61%, 73%, and 67% and that of complete relief of headache was 10%, 32%, and 26%. The 0- to 48-hour area under the curve of headache score versus time was highest in group 15. The incidence of low back pain during or after the epidural Blood Patch was similar among groups and was of low intensity, although group 15 had the highest postprocedural back pain scores. Serious morbidity was not reported. Conclusions Although the optimum volume of Blood remains to be determined, we believe these findings support an attempt to administer 20 mL of autologous Blood when treating postdural puncture headache in obstetric patients after unintentional dural puncture.
-
efficacy of a prophylactic epidural Blood Patch in preventing post dural puncture headache in parturients after inadvertent dural puncture
Anesthesiology, 2004Co-Authors: Barbara M Scavone, Cynthia A Wong, John T Sullivan, Edward Yaghmour, Saadia S Sherwani, Robert J MccarthyAbstract:Background:Postdural puncture headache (PDPH) occurs in up to 80% of parturients who experience inadvertent dural puncture during epidural catheter placement. The authors performed a randomized double blind study to assess the effect of prophylactic epidural Blood Patch on the incidence of PDPH and
D G Fellows - One of the best experts on this subject based on the ideXlab platform.
-
magnetic resonance imaging of cerebrospinal fluid leak and tamponade effect of Blood Patch in postdural puncture headache
Anesthesia & Analgesia, 1997Co-Authors: Shermeen Vakharia, P S Thomas, A E Rosenbaum, J J Wasenko, D G FellowsAbstract:This prospective study examined the efficacy of magnetic resonance imaging (MRI) in visualizing cerebrospinal fluid (CSF) leak in patients with postdural puncture headache (PDPH) and determining the spread of the Blood Patch in the epidural space and the extent of tamponade on the thecal sac. After obtaining institutional review board approval, five patients with symptomatic PDPH after 3 days of failed conservative treatment were included in this study. MRI using proton density (PD) and T2-weighted imaging was performed on all patients and CSF flow studies were done on one patient. All patients received 20 mL of Blood in the epidural space. They remained supine for 45 min, and repeat MRI studies were performed. Extent of the spread of Blood in the epidural space was measured. A visual analog scale of 0-10 was used to evaluate the headache. All patients had severe postural headache with nausea/vomiting. PreBlood Patch MRI showed extrathecal CSF and hemosiderosis indicating the site of dural puncture in four patients. The postprocedure MRI demonstrated the Blood Patch as a large extradural collection with anterior displacement of the thecal sac, the mean spread being 4.6 intervertebral spaces. The tamponade effect of the Blood Patch was observed on PD, T2-weighted, and CSF flow images. All patients experienced immediate resolution of their symptoms. This study suggests that using MRI, the site of the CSF leak, the tamponade effect of the Blood Patch, and its spread in the epidural space can be documented.
-
magnetic resonance imaging of cerebrospinal fluid leak and tamponade effect of Blood Patch in postdural puncture headache
Anesthesia & Analgesia, 1997Co-Authors: Shermeen Vakharia, A E Rosenbaum, J J Wasenko, Sebastian P Thomas, D G FellowsAbstract:This prospective study examined the efficacy of magnetic resonance imaging (MRI) in visualizing cerebrospinal fluid (CSF) leak in patients with postdural puncture headache (PDPH) and determining the spread of the Blood Patch in the epidural space and the extent of tamponade on the thecal sac.After obtaining institutional review board approval, five patients with symptomatic PDPH after 3 days of failed conservative treatment were included in this study. MRI using proton density (PD) and T2-weighted imaging was performed on all patients and CSF flow studies were done on one patient. All patients received 20 mL of Blood in the epidural space. They remained supine for 45 min, and repeat MRI studies were performed. Extent of the spread of Blood in the epidural space was measured. A visual analog scale of 0-10 was used to evaluate the headache. All patients had severe postural headache with nausea/vomiting. PreBlood Patch MRI showed extrathecal CSF and hemosiderosis indicating the site of dural puncture in four patients. The postprocedure MRI demonstrated the Blood Patch as a large extradural collection with anterior displacement of the thecal sac, the mean spread being 4.6 intervertebral spaces. The tamponade effect of the Blood Patch was observed on PD, T2-weighted, and CSF flow images. All patients experienced immediate resolution of their symptoms. This study suggests that using MRI, the site of the CSF leak, the tamponade effect of the Blood Patch, and its spread in the epidural space can be documented. (Anesth Analg 1997;84:585-90)
Kenichiro Shimoji - One of the best experts on this subject based on the ideXlab platform.
-
epidural Blood Patch for treatment of spontaneous intracranial hypotension
Acta Anaesthesiologica Scandinavica, 2002Co-Authors: Noriko Waguri, Misao Tomita, Keiko Hayatsu, K. Okamoto, Kenichiro ShimojiAbstract:Spontaneous intracranial hypotension is an uncommon disease caused by cerebrospinal fluid leakage. We reported a case of a 42-year-old male with postural headache who was diagnosed as having spontaneous intracranial hypotension. His headache did not completely improve by conservative therapies, so he underwent an autologous epidural Blood Patch. The site of cerebrospinal fluid restoration was identified at the level from the C2 to Th7 epidural space by 111In-DPTA cisternography and computed tomography coupled with myelography, and cervical EBP was performed. Because cerebrospinal fluid drops from the catheter, it is useful to identify the location of the catheter tip under contrast injection X-ray. Rapid and dramatic relief from the headache was obtained, and no serious complications occurred.
-
epidural Blood Patch for treatment of spontaneous intracranial hypotension
Acta Anaesthesiologica Scandinavica, 2002Co-Authors: Noriko Waguri, Misao Tomita, Keiko Hayatsu, K. Okamoto, Kenichiro ShimojiAbstract:Spontaneous intracranial hypotension is an uncommon disease caused by cerebrospinal fluid leakage. We reported a case of a 42-year-old male with postural headache who was diagnosed as having spontaneous intracranial hypotension. His headache did not completely improve by conservative therapies, so he underwent an autologous epidural Blood Patch. The site of cerebrospinal fluid restoration was identified at the level from the C2 to Th7 epidural space by 111In-DPTA cisternography and computed tomography coupled with myelography, and cervical EBP was performed. Because cerebrospinal fluid drops from the catheter, it is useful to identify the location of the catheter tip under contrast injection X-ray. Rapid and dramatic relief from the headache was obtained, and no serious complications occurred.
Dajie Wang - One of the best experts on this subject based on the ideXlab platform.
-
successful treatment of spontaneous intracranial hypotension due to prominent cervical cerebrospinal fluid leak with cervical epidural Blood Patch
Pain Medicine, 2015Co-Authors: Eugene Wang, Dajie WangAbstract:Objective To report a case of successful treatment of a patient with spontaneous intracranial hypotension correlated with MRI finding of cerebrospinal fluid (CSF) leak with extradural collection at the upper cervical spinal level. Design Case report. Setting An academic tertiary pain management center. Methods Fluoroscopically guided placement of an 18-gauge epidural needle into epidural space at the C7–T1 level was performed; an epidural catheter (Braun Perifix 20G) was advanced to C2 level (first Patch) and C3 level (second Patch). An epidurogram with Omnipaque injections confirmed contrast in the posterior and lateral epidural space. Autologous venous Blood was then administered through the catheter. Results This patient received two lumbar epidural Blood Patches without lasting relief. Given the radiographic evidence of prominent CSF leak with extradural fluid collection at C1–2 level, the patient was then treated with a cervical epidural Blood Patch, which provided headache pain relief lasting 6 months. A second cervical epidural Blood Patch was performed, and the patient has been headache-free for nearly one year to date. Conclusion Based on the successful treatment of this patient's spontaneous intracranial hypotension, we advocate that patients undergo epidural Blood Patches to target the site of any CSF leak identified by imaging studies to improve the efficacy of this intervention. This case demonstrates that cervical epidural Blood Patch, despite its inherent risks, may be more effective than lumbar epidural Blood Patch in treatment of cervical CSF leak.
Raymond J Cook - One of the best experts on this subject based on the ideXlab platform.
-
intracranial hypotension caused by cervical cerebrospinal fluid leak treatment with epidural Blood Patch
Anesthesia & Analgesia, 2004Co-Authors: Michael J Cousins, David Brazier, Raymond J CookAbstract:This report describes treatment with cervical epidural Blood Patch of low cerebrospinal fluid (CSF) pressure headache resulting from spontaneous CSF leak via a tear in a cervical dural cuff. The leak was diagnosed by a dynamic computed tomography (CT)-myelography study followed by gadolinium enhanced magnetic resonance imaging(MRI)-scan. The epidural needle was inserted with the aid of image intensifier and CT-scan to guide the needle to the precise site of the CSF leak. Blood mixed with gadolinium was injected, and subsequent MRI scanning provided the first description of spread of Blood after cervical epidural Blood Patch.