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Chienkun Ting - One of the best experts on this subject based on the ideXlab platform.
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Optically Guided Epidural Needle Placement Using 405-nm Wavelength for Accurate Puncture
Nature Publishing Group, 2019Co-Authors: Su-man Lin, Meiyung Tsou, Cihun-siyong Alex Gong, Tai-an Chiang, Chienkun TingAbstract:Abstract Several approaches of locating the Epidural space have been proposed. However, loss of Resistance method (LOR) remains the most common method for Epidural anesthesia. Different optical signals were received from the ligamentum flavum and the Epidural space allows operator to pinpoint position of the Needle and determine whether the Needle tip has entered the Epidural space. Optical signals throughout the penetration process was recorded and position of Needle tip was confirmed with a C-arm fluoroscopy. 60 lumbar punctures were performed in 20 vivo porcine models, and success rate of locating the Epidural space with the optical auxiliary is calculated statistically. The data are expressed in mean ± SD. During all the lumber puncture processes, the strength of optical signals received decreased significantly while the Needle tip penetrates the ligamentum flavum and entered the Epidural space. The strength of optical signal received when Needle tip was in the ligamentum flavum was 1.38 ± 0.57. The signal strength at Epidural space was 0.46 ± 0.35. Strength of signal decreased by 67% when entered Epidural space, and there is no significant differences in decrease of strength from data obtained from thevertebrae (lumbar segments)L2-L3, L3-L4, and L4-L5. Finally, we calculated with assistance of the proposed optical auxiliary, the success rate for guiding the Needle tip to the Epidural space using was as high as 87%. It is evidently believed that the optical auxiliary equipped is visualized to assist operators inserting Needle accurately and efficiently into Epidural space during Epidural anesthesia operation
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eyes on the Needle identification and confirmation of the Epidural space
Asian Journal of Anesthesiology, 2017Co-Authors: Weinung Teng, Meiyung Tsou, Wenkuei Chang, Chienkun TingAbstract:Epidural catheters are used to provide effective intraoperative and postoperative analgesia. Standard Epidural catheterization techniques rely on palpation of surface anatomy and the experience of the anesthesiologist. Failure to correctly place an Epidural catheter can lead to inadequate analgesia and serious complications, such as dural puncture headache. Exciting new devices and techniques are being developed for identification of the Epidural space and confirmation of catheter entry. This article reviews and describes the recent research findings. The devices and techniques are categorized into three sections: devices that modify the loss of resistance technique; visual confirmation using the Epidural Needle; and confirmation of placement of the Epidural catheter.
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fiber Needle swept source optical coherence tomography system for the identification of the Epidural space in piglets
Anesthesiology, 2015Co-Authors: Wenchuan Kuo, Meiyung Tsou, Kuangyi Chang, Yin Chang, Mengchun Kao, Weinung Teng, Chienkun TingAbstract:BACKGROUND: Epidural Needle insertion is traditionally a blind technique whose success depends on the experience of the operator. The authors describe a novel method using a fiber-Needle-based swept-source optical coherence tomography (SSOCT) to identify Epidural space. METHODS: An optical fiber probe was placed into a hollow 18-gauge Tuohy Needle. It was then inserted by an experienced anesthesiologist to continuously construct a series of two-dimensional SSOCT images by mechanically rotating the optical probe. To quantify this observation, both the average SSOCT signal intensities and their diagnostic potentials were assessed. The insertions were performed three times into both the lumbar and thoracic regions of five pigs using a paramedian approach. RESULTS: A side-looking SSOCT is constructed to create a visual image of the underlying structures. The image criteria for the identification of the Epidural space from the outside region were generated by the analysis of a training set (n = 100) of ex vivo data. The SSOCT image criteria for in vivo Epidural space identification are high sensitivity (0.867 to 0.965) and high specificity (0.838 to 0.935). The mean value of the average signal intensities exhibits statistically significant differences (P < 0.01) and a high discriminatory capacity (area under curve = 0.88) between the Epidural space and the outside tissues. CONCLUSIONS: This is the first study to introduce a SSOCT fiber probe embedded in a standard Epidural Needle. The authors anticipate that this technique will reduce the occurrence of failed Epidural blocks and other complications such as dural punctures.
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discriminant analysis for anaesthetic decision making an intelligent recognition system for Epidural Needle insertion
BJA: British Journal of Anaesthesia, 2012Co-Authors: Mercedes Susan Mandell, Chienkun Ting, Y Chang, P T Chen, M Y Tsou, K H ChanAbstract:Background. Incorrect placement of Epidural catheters causes medical complications. We used linear discriminant analysis (LDA) to develop an intelligent recognition system (i-RS) in order to guide Epidural placement and reduce physician error. Methods. We analysed real-time dual-wavelength fibreoptic data recorded from the end of an Epidural Needle in a live porcine model. Two categories of tissue layers were necessary for correct placement of catheter: Epidural space and ligamentum flavum. The data were tested using linear, quadratic and logistic parametric analysis to identify which method could distinguish the two anatomical structures. Results. LDA was the best fit for our model. There was 80% sensitivity and specificity for correct anatomical identification. Error rates based on cross-validation were 17.0% for the Epidural space and 18.6% for ligamentum flavum. Error rates were greater with the 532 nm compared with 650 nm wavelength. Conclusions. The sensitivity and specificity of LDA for identifying the correct anatomical structure was similar to a physician who is an expert in Epidural placement. Overall performance of an i-RS could be improved by expanding the database for decision-making and adding a category of uncertainty. This would reduce complications caused by incorrect Epidural placement.
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eyes in the Needle novel Epidural Needle with embedded high frequency ultrasound transducer Epidural access in porcine model
Anesthesiology, 2011Co-Authors: Huihua Kenny Chiang, Meiyung Tsou, Susan M Mandell, Qifa Zhou, Kirk K Shung, Chienkun TingAbstract:Epidural blockade is an effective technique to control pain caused by surgery and labor and delivery.1–3 A loss of resistance to air or fluid is the most common method used to identify the Epidural space.1,2,4 However, approximately 1–3% of Epidural Needle insertions result in accidental dural puncture.5,6 Investigators have used force or pressure monitoring,7,8 electrical stimulation,9,10 and an optical method11,12 to improve the accuracy of Epidural Needle placement. However, it is difficult to use the monitoring information to create a visual image of the underlying structures.13 In contrast, ultrasound can distinguish tissue types and therefore build a visual image of the axial anatomy.14 Recently, investigators used surface ultrasound to estimate the distance between the skin and the Epidural space and determine the optimal Needle trajectory.14–16 Although surface ultrasound has improved the accuracy of Epidural placement, practical limitations still exist.17,18 Notably, the resolution is inadequate to distinguish tissue layers that the Needle passes through.14 To improve tissue resolution, we developed an ultrasound-embedded Epidural Needle by inserting a high-frequency transducer into the hollow chamber of a conventional Epidural Needle. This study presents preliminary findings using the ultrasound-embedded Needle in a porcine model. We show that our technique can distinguish neuraxial tissue planes and estimate the distance between the transducer and Epidural space in real time.
Bernhard Moriggl - One of the best experts on this subject based on the ideXlab platform.
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cervical and high thoracic ligamentum flavum frequently fails to fuse in the midline
Anesthesiology, 2003Co-Authors: Philipp Lirk, Hans Peter Colvin, L Kirchmair, Gabriele Putz, Joshua Colvin, Josef Rieder, Christian Keller, Christian Kolbitsch, Ingo H Lorenz, Bernhard MorigglAbstract: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. 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. 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. 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
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cervical and high thoracic ligamentum flavum frequently fails to fuse in the midline
Anesthesiology, 2003Co-Authors: Philipp Lirk, Hans Peter Colvin, L Kirchmair, Gabriele Putz, Joshua Colvin, Josef Rieder, Christian Keller, Christian Kolbitsch, Ingo H Lorenz, Bernhard MorigglAbstract: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.
Barbara L Leighton - One of the best experts on this subject based on the ideXlab platform.
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injecting saline through the Epidural Needle decreases the iv Epidural catheter placement rate during combined spinal Epidural labour analgesia
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2003Co-Authors: Farida Gadalla, Sunghee Rhim Lee, Kue C Choi, Jill Fong, Matthew C Gomillion, Barbara L LeightonAbstract:To determine if injecting 10 mL saline before Epidural catheter threading (pre-cannulation Epidural fluid injection) can decrease the incidence ofiv Epidural catheter placement during combined spinal-Epidural (CSE) labour analgesia. One hundred healthy women requesting CSE labour analgesia with either fentanyl 20 μg or sufentanil 10 μg were prospectively randomized to receive either no Epidural injection (dry group,n = 50) or Epidural 10 mL saline injection (saline group,n = 50) before Epidural catheter placement. A nylon multiport catheter was then threaded 3–5 cm into the Epidural space and the Needle was removed. We diagnosediv catheter placement if blood was freely aspirated, if the mother became tachycardic after injection of epinephrine 15 μg, or if intracardiac air was heard (using ultrasound) after injection of air 1.5 mL. Intravenous Epidural catheter placement occurred in one saline and ten dry group patients (P < 0.01). No complications of excessive cephalad intrathecal opioid spread (i.e., difficulty swallowing, hypoxemia, or respiratory arrest) occurred. Injecting 10 mL or saline through the Epidural Needle after intrathecal opioid injection and before threading the catheter significantly decreased accidental venous catheter placement without any apparent increase in complications from excessive cephalad intrathecal opioid spread.
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injecting saline through the Epidural Needle decreases the iv Epidural catheter placement rate during combined spinal Epidural labour analgesia
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2003Co-Authors: Farida Gadalla, Sunghee Rhim Lee, Kue C Choi, Jill Fong, Matthew C Gomillion, Barbara L LeightonAbstract:Purpose To determine if injecting 10 mL saline before Epidural catheter threading (pre-cannulation Epidural fluid injection) can decrease the incidence ofiv Epidural catheter placement during combined spinal-Epidural (CSE) labour analgesia.
Meiyung Tsou - One of the best experts on this subject based on the ideXlab platform.
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Optically Guided Epidural Needle Placement Using 405-nm Wavelength for Accurate Puncture
Nature Publishing Group, 2019Co-Authors: Su-man Lin, Meiyung Tsou, Cihun-siyong Alex Gong, Tai-an Chiang, Chienkun TingAbstract:Abstract Several approaches of locating the Epidural space have been proposed. However, loss of Resistance method (LOR) remains the most common method for Epidural anesthesia. Different optical signals were received from the ligamentum flavum and the Epidural space allows operator to pinpoint position of the Needle and determine whether the Needle tip has entered the Epidural space. Optical signals throughout the penetration process was recorded and position of Needle tip was confirmed with a C-arm fluoroscopy. 60 lumbar punctures were performed in 20 vivo porcine models, and success rate of locating the Epidural space with the optical auxiliary is calculated statistically. The data are expressed in mean ± SD. During all the lumber puncture processes, the strength of optical signals received decreased significantly while the Needle tip penetrates the ligamentum flavum and entered the Epidural space. The strength of optical signal received when Needle tip was in the ligamentum flavum was 1.38 ± 0.57. The signal strength at Epidural space was 0.46 ± 0.35. Strength of signal decreased by 67% when entered Epidural space, and there is no significant differences in decrease of strength from data obtained from thevertebrae (lumbar segments)L2-L3, L3-L4, and L4-L5. Finally, we calculated with assistance of the proposed optical auxiliary, the success rate for guiding the Needle tip to the Epidural space using was as high as 87%. It is evidently believed that the optical auxiliary equipped is visualized to assist operators inserting Needle accurately and efficiently into Epidural space during Epidural anesthesia operation
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eyes on the Needle identification and confirmation of the Epidural space
Asian Journal of Anesthesiology, 2017Co-Authors: Weinung Teng, Meiyung Tsou, Wenkuei Chang, Chienkun TingAbstract:Epidural catheters are used to provide effective intraoperative and postoperative analgesia. Standard Epidural catheterization techniques rely on palpation of surface anatomy and the experience of the anesthesiologist. Failure to correctly place an Epidural catheter can lead to inadequate analgesia and serious complications, such as dural puncture headache. Exciting new devices and techniques are being developed for identification of the Epidural space and confirmation of catheter entry. This article reviews and describes the recent research findings. The devices and techniques are categorized into three sections: devices that modify the loss of resistance technique; visual confirmation using the Epidural Needle; and confirmation of placement of the Epidural catheter.
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fiber Needle swept source optical coherence tomography system for the identification of the Epidural space in piglets
Anesthesiology, 2015Co-Authors: Wenchuan Kuo, Meiyung Tsou, Kuangyi Chang, Yin Chang, Mengchun Kao, Weinung Teng, Chienkun TingAbstract:BACKGROUND: Epidural Needle insertion is traditionally a blind technique whose success depends on the experience of the operator. The authors describe a novel method using a fiber-Needle-based swept-source optical coherence tomography (SSOCT) to identify Epidural space. METHODS: An optical fiber probe was placed into a hollow 18-gauge Tuohy Needle. It was then inserted by an experienced anesthesiologist to continuously construct a series of two-dimensional SSOCT images by mechanically rotating the optical probe. To quantify this observation, both the average SSOCT signal intensities and their diagnostic potentials were assessed. The insertions were performed three times into both the lumbar and thoracic regions of five pigs using a paramedian approach. RESULTS: A side-looking SSOCT is constructed to create a visual image of the underlying structures. The image criteria for the identification of the Epidural space from the outside region were generated by the analysis of a training set (n = 100) of ex vivo data. The SSOCT image criteria for in vivo Epidural space identification are high sensitivity (0.867 to 0.965) and high specificity (0.838 to 0.935). The mean value of the average signal intensities exhibits statistically significant differences (P < 0.01) and a high discriminatory capacity (area under curve = 0.88) between the Epidural space and the outside tissues. CONCLUSIONS: This is the first study to introduce a SSOCT fiber probe embedded in a standard Epidural Needle. The authors anticipate that this technique will reduce the occurrence of failed Epidural blocks and other complications such as dural punctures.
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eyes in the Needle novel Epidural Needle with embedded high frequency ultrasound transducer Epidural access in porcine model
Anesthesiology, 2011Co-Authors: Huihua Kenny Chiang, Meiyung Tsou, Susan M Mandell, Qifa Zhou, Kirk K Shung, Chienkun TingAbstract:Epidural blockade is an effective technique to control pain caused by surgery and labor and delivery.1–3 A loss of resistance to air or fluid is the most common method used to identify the Epidural space.1,2,4 However, approximately 1–3% of Epidural Needle insertions result in accidental dural puncture.5,6 Investigators have used force or pressure monitoring,7,8 electrical stimulation,9,10 and an optical method11,12 to improve the accuracy of Epidural Needle placement. However, it is difficult to use the monitoring information to create a visual image of the underlying structures.13 In contrast, ultrasound can distinguish tissue types and therefore build a visual image of the axial anatomy.14 Recently, investigators used surface ultrasound to estimate the distance between the skin and the Epidural space and determine the optimal Needle trajectory.14–16 Although surface ultrasound has improved the accuracy of Epidural placement, practical limitations still exist.17,18 Notably, the resolution is inadequate to distinguish tissue layers that the Needle passes through.14 To improve tissue resolution, we developed an ultrasound-embedded Epidural Needle by inserting a high-frequency transducer into the hollow chamber of a conventional Epidural Needle. This study presents preliminary findings using the ultrasound-embedded Needle in a porcine model. We show that our technique can distinguish neuraxial tissue planes and estimate the distance between the transducer and Epidural space in real time.
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a new technique to assist Epidural Needle placement fiberoptic guided insertion using two wavelengths
Anesthesiology, 2010Co-Authors: Chienkun Ting, Meiyung Tsou, Pintarng Chen, Kuangyi Chang, Susan M Mandell, Kwokhon Chan, Yin ChangAbstract:Background: Up to 10% of Epidurals fail due to incorrect catheter placement. We describe a novel optical method to assist Epidural catheter insertion in a porcine model. Methods: Optical emissions were tested on ex vivo tissues from porcine paravertebral tissues to identify optical reflective spectra. The wavelengths of 650 and 532 nm differentiated Epidural space from the ligamentum flavum. We then used a hollow stylet that contained optical fibers to place Epidural Needles in anesthetized pigs. Real-time data were displayed on an oscilloscope and stored for analysis. A total of 50 punctures were done in four laboratory pigs. Data were expressed as mean SD. Results: Paired t test shows significant optical differences between the Epidural space and the ligamentum flavum at both 650 nm (P 0.001) and 532 nm (P 0.014). Mean magnitudes for 650 nm, 532 nm,andtheirratiowere3.5650.194,2.5420.145,and0.958 0.172 at Epidural space and 3.842 0.191, 2.563 0.131, and 1.228 0.244 at ligamentum flavum, respectively. There were no differences in the optical characteristics of the ligamentum flavum and Epidural space at different levels in the lumbar and thoracic region (two-way ANOVA P 0.05). Conclusions: This is the first study to introduce a new optical method to localize Epidural space in a porcine model. Epidural space could be identified by the changes in the reflective pattern of light emitted at 650 nm, which were specific for the ligamentum flavum and dural tissue. Real-time optical information successfully guided a modified Tuohy Needle into the Epidural space.
Philipp Lirk - One of the best experts on this subject based on the ideXlab platform.
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cervical and high thoracic ligamentum flavum frequently fails to fuse in the midline
Anesthesiology, 2003Co-Authors: Philipp Lirk, Hans Peter Colvin, L Kirchmair, Gabriele Putz, Joshua Colvin, Josef Rieder, Christian Keller, Christian Kolbitsch, Ingo H Lorenz, Bernhard MorigglAbstract: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. 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. 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. 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
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cervical and high thoracic ligamentum flavum frequently fails to fuse in the midline
Anesthesiology, 2003Co-Authors: Philipp Lirk, Hans Peter Colvin, L Kirchmair, Gabriele Putz, Joshua Colvin, Josef Rieder, Christian Keller, Christian Kolbitsch, Ingo H Lorenz, Bernhard MorigglAbstract: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.