Posted: October 29th, 2022

Use of Ultrasound for Neuraxial Anesthesia

Use of Ultrasound for Neuraxial Anesthesia

Creator Observe:
No conflicts of curiosity to reveal.

Summary
Summary right here; left-aligned. 150-200 phrases. Significance of drawback. Key findings in literature.
Key phrases: Ultrasound, neuraxial anesthesia, epidural, spinal

Use of Ultrasound for Neuraxial Anesthesia
Introduction of matter.
Milieu of Drawback
Significance of matter.
Drawback Magnitude
Significance of matter.
Drawback Magnitude = There are X quantity of laboring mothers which are seen at UHTMC; we now have the flexibility to enhance SRNA consolation utilizing ultrasound for neuraxial anesthesia, rising utilization of ultrasound for neuraxial blocks, lowering the quantity of makes an attempt for profitable neuraxial anesthesia, and in the end rising affected person satisfaction. Robust proof from present literature helps the use of ultrasound for neuraxial anesthesia in lowering the quantity of makes an attempt for profitable neuraxial anesthesia.
IOM 6 Goals – Environment friendly, equitable (overweight, sufferers with structural spinal wire abnormalities (scoliosis) ), and patient-centered.
This may enhance the effectivity of anesthesia care by lowering the quantity of time required for neuraxial anesthesia, lowering the quantity of makes an attempt in overweight sufferers; collectively leading to elevated affected person satisfaction.
Drawback assertion = The use of ultrasound for neuraxial anesthesia is under-utilized at College Well being-Truman Medical Heart.
Add literature help.
Measurable drawback =
Secondary issues =
Plan =
Influence =
College Well being Truman Medical Heart
Mission: College Well being is an instructional well being heart offering accessible, state-of-the-art high quality healthcare to our neighborhood regardless of the flexibility to pay. (meet the mission assertion by the state-of-the-art high quality healthcare via implementation of US for neuraxial anesthesia; which is on the forefront of anesthesia follow. Almost ½ of all infants born in KC yearly are at UH-TMC; by implementing US for neuraxial we now have the chance to enhance the standard of care offered to those sufferers with fewer makes an attempt. College Well being Truman Medical Heart Faculty of Nurse Anesthesia (UH-TMCSONA).

Drivers and Stakeholders
Drivers and stakeholders are the person, group of people, or organizations that help implementation of this venture each inside and out of doors of the College Well being Truman Medical Heart Faculty of Nurse Anesthesia. Inner drivers for this venture embody the intensive literature help for neuraxial anesthesia, anesthesia division management, and training management throughout the college of nurse anesthesia, which has pushed for additional implementation of ultrasound coaching or utilization. Exterior drivers embody the Council of Accreditation (COA), which has just lately applied a minimal requirement for the quantity of circumstances using ultrasound for vascular entry (venous, arterial, or central) and regional anesthesia (neuraxial, truncal, and peripheral blocks) to keep up Scholar Registered Nurse Anesthetist (SRNA) training with present anesthesia follow. Key stakeholders embody the academic management within the anesthesia division, anesthesia division management, anesthesia division employees, and SRNAs.
Function
The aim of this venture is to enhance the information of SRNAs concerning the use of ultrasound to carry out neuraxial anesthesia, preserve training with present anesthesia follow, and enhance the supply of care via a discount of makes an attempt for neuraxial anesthesia. The scholarly venture was guided by the PICOT: In SRNAs, does the training of neuraxial ultrasound method in comparison with baseline information improve information, consolation, and utilization of ultrasound for neuraxial anesthesia inside three months? Mission outcomes embody elevated SRNA consolation using ultrasound for neuraxial anesthesia, elevated utilization of ultrasound for neuraxial anesthesia at College Well being Truman Medical Heart, and decreased quantity of makes an attempt for neuraxial anesthesia.
Search Technique
A assessment of literature was accomplished using PubMed, EBSCO, the Cumulative Index to Nursing and Allied Well being Literature (CINAHL), and Google Scholar exploring the use of ultrasound for neuraxial anesthesia. An in depth chart was accomplished to elucidate the completely different searches and articles that had been found (see Appendix A). MeSH search phrases that had been utilized for PubMed embody: neuraxial anesthesia and ultrasound with the next filters: English language, age grownup 19+, analysis article, human species, and printed inside ten years. A search of EBSCO was performed utilizing the final search phrases: ultrasound, epidural anesthesia, spinal anesthesia, and neuraxial anesthesia; search limiters embody anesthesia, spinal anesthesia, spinal, epidural anesthesia, epidural, educational journals, English language, and printed inside 5 years. Basic search phrases utilized for the CINAHL database embody ultrasound, epidural anesthesia, spinal anesthesia, neuraxial anesthesia; search limiters embody: educational journals, evidenced-based, spinal anesthesia, epidural anesthesia, ultrasonography, anesthesia, English language, and printed inside ten years. A search of Google Scholar was performed using the final search phrases ultrasound, neuraxial anesthesia, epidural anesthesia, spinal anesthesia. Search limiters embody inside final 5 years and search phrases included within the article title. Articles had been excluded in the event that they weren’t pertinent to ultrasound, spinal anesthesia, epidural anesthesia, grownup inhabitants, and full-text was not out there. Use of a PRISMA move diagram (see Appendix B) was accomplished to elucidate the choice course of for the articles that had been included into the literature assessment.
Evaluate of Literature
Supporting Proof
First Theme
First theme dialogue.
Second Theme
Second theme dialogue.
Third Theme
Third theme dialogue.
Main Gaps in Data
Dialogue of main gaps in information that had been found.
Conclusion
Conclusion and summarization of matter

References
Chin, A., Crooke, B., Heywood, L., Brijball, R., Pelecanos, A. M., & Abeypala, W. (2018). A randomised managed trial evaluating needle actions throughout mixed spinal-epidural anaesthesia with and with out ultrasound help. Anaesthesia, 73(four), 466-473. https://doi.org/10.1111/anae.14206
Chin, Okay. J. (2018). Current developments in ultrasound imaging for neuraxial blockade. Curr Opin Anaesthesiol, 31(5), 608-613. https://doi.org/10.1097/aco.0000000000000634
Elsharkawy, H., Saasouh, W., Babazade, R., Soliman, L. M., Horn, J. L., & Zaky, S. (2019). Actual-time ultrasound-guided lumbar epidural with transverse interlaminar view: Analysis of an in-plane method [Article]. Ache Drugs (United States), 20(9), 1750-1755. https://doi.org/10.1093/pm/pnz026
Gaur, A., Dedhia, J., & Bouazza‑Marouf, Okay. (2018). Ultrasound and central neuraxial blocks [Editorial]. Saudi Journal of Anaesthesia, 12(2), 175-177. https://doi.org/10.4103/sja.SJA_768_17
In Chan, J. J., Ma, J., Leng, Y., Tan, Okay. Okay., Tan, C. W., Sultana, R., Sia, A. T. H., & Sng, B. L. (2021). Machine studying strategy to needle insertion website identification for spinal anesthesia in overweight sufferers. BMC Anesthesiology, 21(1). https://doi.org/10.1186/s12871-Zero21-01466-Eight
Jatuporn, P., Kanthida, T., Nalinee, Okay., Suttasinee, P., Pannawit, B., Kwanruthai, N., Somrutai, B., & Manoj Kumar, Okay. (2022). Actual-time ultrasound-guided versus anatomic landmark-based thoracic epidural placement: A potential, randomized, superiority trial. BMC Anesthesiology, 22(1), 1-11. https://doi.org/10.1186/s12871-Zero22-01730-5
Jiang, L., Zhang, F., Wei, N., Lv, J., Chen, W., & Dai, Z. (2020). Might preprocedural ultrasound improve the first-pass success charge of neuraxial anesthesia in obstetrics? A scientific assessment and meta-analysis of randomized managed trials. Journal of Anesthesia, 34(Three), 434-444. https://doi.org/10.1007/s00540-Zero20-02750-6
Kalagara, H., Nair, H., Kolli, S., Thota, G., & Uppal, V. (2021). Ultrasound imaging of the backbone for central neuraxial blockade: A technical description and proof replace. Present Anesthesiology Reviews, 11(Three), 326-339. https://doi.org/10.1007/s40140-Zero21-00456-Three
Khan, M., Gupta, M., Sharma, S., & Kasaudhan, S. (2022). A comparative examine of ultrasound Helped versus landmark method for mixed spinal-epidural anaesthesia in sufferers present process decrease limb orthopaedic surgical procedure. Indian Journal of Anaesthesia, 66(four), 272-277. https://doi.org/10.4103/ija.ija_775_21
Lee, J.-H., Kim, D.-H., & Koh, W. U. (2021). Actual-time ultrasound guided thoracic epidural catheterization: A technical assessment. Anesthesia and Ache Drugs, 16(four), 322-328. https://doi.org/10.17085/apm.21060
Li, J., Krishna, R., Zhang, Y., Lam, D., & Nalini, V. (2020). Ultrasound-guided neuraxial anesthesia. Present Ache and Headache Reviews, 24. https://doi.org/10.1007/s11916-Zero20-00895-Three
Oh, T. T., Ikhsan, M., Tan, Okay. Okay., Rehena, S., Han, N.-L. R., Sia, A. T. H., & Sng, B. L. (2019). A novel strategy to neuraxial anesthesia: Utility of an automatic ultrasound spinal landmark identification. BMC Anesthesiology, 19(1). https://doi.org/10.1186/s12871-Zero19-0726-6
Park, S. Okay., Bae, J., Yoo, S., Kim, W. H., Lim, Y. J., Bahk, J. H., & Kim, J. T. (2020). Ultrasound-Helped versus landmark-guided spinal anesthesia in sufferers with irregular spinal anatomy: A randomized managed trial. Anesth Analg, 130(Three), 787-795. https://doi.org/10.1213/ane.0000000000004600
Ravi, P., Naik, S., Joshi, M., & Singh, S. (2021). Actual-time ultrasound-guided spinal anaesthesia vs pre- procedural ultrasound-guided spinal anaesthesia in overweight sufferers. Indian Journal of Anaesthesia, 65(5), 356-361. https://doi.org/10.4103/ija.IJA_446_20
Sadeghi, A., Patel, R., & Carvalho, J. C. A. (2021). Ultrasound-facilitated neuraxial anaesthesia in obstetrics. BJA Schooling, 21(10), 369-375. https://doi.org/10.1016/j.bjae.2021.06.003
Shaylor, R., Saifi, F., Davidson, E., & Weiniger, C. F. (2016). Excessive success charges utilizing ultrasound for neuraxial block in overweight sufferers. Isr Med Assoc J, 18(1), 36-39. https://www.ima.org.il/MedicineIMAJ/viewarticle.aspx?yr=2016&month=01&web page=36
Sidiropoulou, T., Christodoulaki, Okay., & Siristatidis, C. (2021). Pre-procedural lumbar neuraxial ultrasound—a scientific assessment of randomized managed trials and meta-analysis. Healthcare, 9(four), 479. https://doi.org/10.3390/healthcare9040479
Tubinis, 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 overweight parturients. Minerva Anestesiol, 85(10), 1089-1096. https://doi.org/10.23736/s0375-9393.19.13617-6
Urfalioğlu, A., Bilal, B., Öksüz, G., Bakacak, M., Boran, Ö. F., & Öksüz, H. (2017). Comparability of the landmark and ultrasound strategies in cesarean sections carried out below spinal anesthesia on overweight pregnants. Journal of Maternal-Fetal & Neonatal Drugs, 30(9), 1051-1056. https://doi.org/10.1080/14767058.2016.1199677
Uyel, Y., & Kilicaslan, A. (2021). Preprocedural ultrasonography versus landmark-guided spinal anesthesia in geriatric sufferers with troublesome anatomy: A potential randomized trial [Article]. Eurasian Journal of Drugs, 53(1), 9-14. https://doi.org/10.5152/eurasianjmed.2020.20215
Vadhanan, 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
Vallejo, M. C. (2018). Pre-procedure neuraxial ultrasound in obstetric anesthesia. Journal of Anesthesia and Perioperative Drugs (JAPM), 5(2), 85-91. https://doi.org/https://doi.org/10.24015/JAPM.2017.0050
Younger, B., Onwochei, D., & Desai, N. (2021). Typical landmark palpation vs. preprocedural ultrasound for neuraxial analgesia and anaesthesia in obstetrics – a scientific assessment and meta‐Assessment with trial sequential analyses. Anaesthesia, 76(6), 818-831. https://doi.org/10.1111/anae.15255

Appendix A

Search Strategies

Database Search phrases used Quantity of articles Quantity of included articles Quantity of excluded articles Search time period years
PubMed MeSH: Neuraxial Anesthesia AND Ultrasound

39

7

32

2012-2022

EBSCO Basic
Ultrasound, Epidural Anesthesia OR Spinal Anesthesia OR Neuraxial Anesthesia

189
11
178

2017-2023
CINAHL Basic:
Ultrasound, Epidural Anesthesia OR Spinal Anesthesia
121

Three

118

2012-2022

Google Scholar Basic:
Ultrasound AND Neuraxial Anesthesia OR Epidural Anesthesia OR Spinal Anesthesia

150
Eight
142
2017-2022

Appendix B

Determine 1: PRISMA Circulate Diagram of the Evaluate of Literature: describes databases utilized and searched, quantity of abstracts screened, and full textual content articles included

Appendix C Theoretical Framework

Appendix D Literature Matrix
# Research Variable Strengths Limitations Implications/
Suggestions
1. Article reference in APA format:
Chin, A., Crooke, B., Heywood, L., Brijball, R., Pelecanos, A. M., & Abeypala, W. (2018). A randomised managed trial evaluating needle actions throughout mixed spinal-epidural anaesthesia with and with out ultrasound help. Anaesthesia, 73(four), 466-473. https://doi.org/10.1111/anae.14206

Kind of Proof: Randomized managed trial

Design: Potential, Randomized managed trial

Stage and High quality of Proof: Stage II
Impartial Variable:
Utilization of ultrasound for CSE
Dependent Variable:
First-pass success (a single needle insertion with no redirections) and process problem.

Demographics:
Two-hundred and eighteen ladies had been included within the random allocation, and 215 included within the ultimate Assessment.

:
Reliability/Precision:
Pattern measurement was calculated primarily based on knowledge from Grau et al. [13]. Utilizing a 5% stage of significance, 90% energy and a pooled customary deviation of Zero.69, a complete of 215 ladies had been required for a distinction of Zero.3puncture makes an attempt between teams.

Validity/
Accuracy:
Affiliation between categorical variables was examined utilizing Pearson Chi-squared checks of affiliation. Fischer’s actual check was used when the assumptions of the Chi-square check weren’t met. Scholar’s t-test was used to point out the variations between teams for para-metric steady variables. Mann–Whitney U-tests had been used for non-parametric steady variables. To account for analyzing a number of outcomes, we corrected utilizing the Benjamini–Yekutieli methodology (4 checks). Binary logistic regression was used to mannequin first-pass success. Use of ultrasound, ease of spinous course of palpation, ease of iliac crest palpation, physique mass index and seniority of anesthetist had been included within the preliminary mannequin, and variables eliminated utilizing backwards elimination. Use of ultrasound was compelled to stay within the mannequin. Assessments had been declared statistically vital knowledge<Zero.05 (two-sided)
Bias:
Not listed
Methodology:
Pre-specified sub-group analyses included the impact of means to palpate landmarks on technical efficiency (24 checks), and the impact of BMI on the problem of CSE (4 checks). Put up hoc sub-group analyses included affiliation between composite landmark sand technical efficiency (12 checks), satisfaction and needle actions (six checks), VNRS and needle actions (three checks), technical efficiency and seniority of anesthetist (eight checks), interspace distinction and palpating problem (one check), palpation problem and picture high quality (one check), and spinous course of palpation and paresthesia (two checks).
Reliability/Precision:
The anesthetists didn’t carry out the ultrasound themselves.
Validity/
Accuracy:
The anesthetists didn’t carry out the ultrasound themselves.
Bias:
They didn’t management for whether or not a guide or registrar carried out the CSE, which can have added bias incase choice based on anticipated problem.

Methodology: Recruited ladies aged>18 years and>37 weeks’ gestation who had been scheduled for elective caesarean part below CSE anesthesia. We didn’t recruit ladies who had been unable to supply totally knowledgeable consent

There have been no vital variations between the teams with respect to the secondary outcomes of block high quality, affected person ache, satisfaction, or procedural problems.

Article reference in APA format:
Chin, Okay. J. (2018). Current developments in ultrasound imaging for neuraxial blockade. Curr Opin Anaesthesiol, 31(5), 608-613. https://doi.org/10.1097/aco.0000000000000634

Kind of Proof:

Design:

Stage and High quality of Proof:
Impartial Variable:

Dependent Variable:

Demographics: Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:
Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:

2. Article reference in APA format:
Elsharkawy, H., Saasouh, W., Babazade, R., Soliman, L. M., Horn, J. L., & Zaky, S. (Aberra et al.). Actual-time Ultrasound-Guided Lumbar Epidural with Transverse Interlaminar View: Analysis of an In-Aircraft Method [Article]. Ache Drugs (United States), 20(9), 1750-1755-1755. https://doi.org/10.1093/pm/pnz026

Kind of Proof: Descriptive

Design: Potential Observational Pilot Trial

Stage and High quality of Proof: Stage IV Impartial Variable:
Use of Ultrasound for epidural placement utilizing in-plane strategy

Dependent Variable:
Epidural placement success

Demographics:
ASA bodily standing, Age, intercourse, top, and weight: Reliability/Precision:
Suppliers had intensive expertise with ultrasonography

Validity/Accuracy:
Utilized 95% CI

Bias:
Not recognized within the examine

Methodology:
Acknowledgement of limitations of the examine Reliability/Precision:
Lack of reliability instruments utilized

Validity/Accuracy:
Small pattern measurement of 22

Energy issue was not calculated to find out pattern measurement

Bias:
Bias may have been launched by the supplier concerning problem of epidural placement

Methodology:
Lack of randomization or managed trial

Solely in a position to descriptively analyze the examine
All suppliers had earlier expertise and coaching with ultrasonography

63.6% of sufferers discovered the method passable or very passable

Success charge was 95% with the epidural house being recognized in 100% of sufferers
Three. Article reference in APA format:
Gaur, A., Dedhia, J., & Bouazza‑Marouf, Okay. (2018). Ultrasound and central neuraxial blocks [Editorial]. Saudi Journal of Anaesthesia, 12(2), 175-177. https://doi.org/10.4103/sja.SJA_768_17

Kind of Proof:

Design:

Stage and High quality of Proof:
Impartial Variable:

Dependent Variable:

Demographics: Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:
Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:

four. Article reference in APA format:
In Chan, J. J., Ma, J., Leng, Y., Tan, Okay. Okay., Tan, C. W., Sultana, R., Sia, A. T. H., & Sng, B. L. (2021). Machine studying strategy to needle insertion website identification for spinal anesthesia in overweight sufferers. BMC Anesthesiology, 21(1). https://doi.org/10.1186/s12871-Zero21-01466-Eight

Kind of Proof: Potential Cohort Research

Design: Cohort Research

Stage and High quality of Proof: Stage IV
Impartial Variable:
Ultrasound for figuring out needle insertion/landmarks.

Dependent Variable:
Success charge for spinal anesthesia.
Demographics:
Feminine sufferers above 21 years outdated who required spinal anesthesia for Cesarean part with a BMI of greater than 30 kg/m2. Reliability/Precision:
Thirty-eight sufferers (79.1, 95% CI 65.Zero – 89.5%) had profitable dural puncture at first try (‘First-attempt group’), whereas the remainder had been profitable solely after two (n = 6 or 12.5%), three (n = 2 or four.2%), and 4 (n = 2 or four.2%) puncture makes an attempt (‘Not at first try group’). The BMIs between profitable first try group and ‘not at first try group’ didn’t present vital distinction.

Validity/
Accuracy: The scanning length of L3/four interspinous house and the posterior advanced had been 21.Zero [IQR: 17.0, 32.0] secs and 11.Zero [IQR: 5.0, 22.0] secs respectively. With that, the typical quantity of puncture makes an attempt was 1.Three, with a normal deviation of Zero.75. The Pearson’s correlation coefficient and Cronbach’s alpha between this system recorded depth of the pores and skin to posterior advanced and the clinician measured depth was Zero.915 and Zero.956, respectively

Bias: No bias mentioned within the article.

Methodology: The imply age of sufferers was 32.Three ± four.Eight (ranged 22 – 44) years, with a mean BMI of 35.Zero ± four.5 kg/m2.
Reliability/Precision:
Not mentioned within the article.

Validity/
Accuracy:
1. The examine aimed to recruit overweight sufferers with BMI above 30 kg/m2. As in contrast with earlier examine on obstetric ladies with BMI under 30 kg/m2 [19], the distinction in BMI resulted in a decrease first try success charge, most likely because of the decrease picture high quality of ultrasound photos in overweight sufferers.
2.

Bias: n/a

Methodology: The exclusion standards had been a historical past of scoliosis or spinal instrumentation, allergy to ultrasound transmission gel, and sufferers with seen wound or harm to the lumbar backbone.

5. Article reference in APA format:
Jatuporn, P., Kanthida, T., Nalinee, Okay., Suttasinee, P., Pannawit, B., Kwanruthai, N., Somrutai, B., & Manoj Kumar, Okay. (2022). Actual-time ultrasound-guided versus anatomic landmark-based thoracic epidural placement: a potential, randomized, superiority trial [article]. BMC Anesthesiology, 22(1), 1-11. https://doi.org/10.1186/s12871-Zero22-01730-5

Kind of Proof:

Design:

Stage and High quality of Proof:
Impartial Variable:

Dependent Variable:

Demographics: Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:
Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:

Article reference in APA format:
Jiang, L., Zhang, F., Wei, N., Lv, J., Chen, W., & Dai, Z. (2020). Might preprocedural ultrasound improve the first-pass success charge of neuraxial anesthesia in obstetrics? A scientific assessment and meta-analysis of randomized managed trials. Journal of Anesthesia, 34(Three), 434-444. https://doi.org/10.1007/s00540-Zero20-02750-6

Kind of Proof:

Design:

Stage and High quality of Proof: Impartial Variable:

Dependent Variable:

Demographics: Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:
Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:

Article reference in APA format:
Kalagara, H., Nair, H., Kolli, S., Thota, G., & Uppal, V. (2021). Ultrasound imaging of the backbone for central neuraxial blockade: A technical description and proof replace. Present Anesthesiology Reviews, 11(Three), 326-339. https://doi.org/10.1007/s40140-Zero21-00456-Three

Kind of Proof:

Design:

Stage and High quality of Proof:
Impartial Variable:

Dependent Variable:

Demographics: Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:
Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:

6. Article reference in APA format:
Khan, M., Gupta, M., Sharma, S., & Kasaudhan, S. (2022). A comparative examine of ultrasound Helped versus landmark method for mixed spinal-epidural anaesthesia in sufferers present process decrease limb orthopaedic surgical procedure [Article]. Indian Journal of Anaesthesia, 66(four), 272-277. https://doi.org/10.4103/ija.ija_775_21

Kind of Proof:

Design:

Stage and High quality of Proof:
Impartial Variable:

Dependent Variable:

Demographics: Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:
Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:

Article reference in APA format:
Lee, J.-H., Kim, D.-H., & Koh, W. U. (2021). Actual-time ultrasound guided thoracic epidural catheterization: a technical assessment. Anesthesia and Ache Drugs, 16(four), 322-328. https://doi.org/10.17085/apm.21060

Kind of Proof:

Design:

Stage and High quality of Proof:
Impartial Variable:

Dependent Variable:

Demographics: Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:
Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:

7. Article reference in APA format:
Li, J., Krishna, R., Zhang, Y., Lam, D., & Nalini, V. (2020). Ultrasound-guided neuraxial anesthesia. Present Ache and Headache Reviews, 24. https://doi.org/10.1007/s11916-Zero20-00895-Three

Kind of Proof:

Design:

Stage and High quality of Proof:
Impartial Variable:

Dependent Variable:

Demographics: Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:
Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:

Eight. Article reference in APA format:
Oh, T. T., Ikhsan, M., Tan, Okay. Okay., Rehena, S., Han, N.-L. R., Sia, A. T. H., & Sng, B. L. (2019). A novel strategy to neuraxial anesthesia: software of an automatic ultrasound spinal landmark identification. BMC Anesthesiology, 19(1). https://doi.org/10.1186/s12871-Zero19-0726-6

Kind of Proof:

Design:

Stage and High quality of Proof:
Impartial Variable:

Dependent Variable:

Demographics: Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:
Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:

Article reference in APA format:
Park, S. Okay., Bae, J., Yoo, S., Kim, W. H., Lim, Y. J., Bahk, J. H., & Kim, J. T. (2020). Ultrasound-Helped versus landmark-guided spinal anesthesia in sufferers with irregular spinal anatomy: A randomized managed trial. Anesth Analg, 130(Three), 787-795. https://doi.org/10.1213/ane.0000000000004600

Kind of Proof:

Design:

Stage and High quality of Proof:
Impartial Variable:

Dependent Variable:

Demographics: Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:
Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:

9. Article reference in APA format:
Ravi, P., Naik, S., Joshi, M., & Singh, S. (2021). Actual-time ultrasound-guided spinal anaesthesia vs pre- procedural ultrasound-guided spinal anaesthesia in overweight sufferers [Article]. Indian Journal of Anaesthesia, 65(5), 356-361. https://doi.org/10.4103/ija.IJA_446_20

Kind of Proof:

Design:

Stage and High quality of Proof:
Impartial Variable:

Dependent Variable:

Demographics: Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:
Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:

Article reference in APA format:
Sadeghi, A., Patel, R., & Carvalho, J. C. A. (2021). Ultrasound-facilitated neuraxial anaesthesia in obstetrics. BJA Schooling, 21(10), 369-375. https://doi.org/10.1016/j.bjae.2021.06.003

Kind of Proof:

Design:

Stage and High quality of Proof:
Impartial Variable:

Dependent Variable:

Demographics: Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:
Reliability/Precision:

Validity/Accuracy:

Bias:

Methodology:

10. Article reference in APA format:
Shaylor, R., Saifi, F., Davidson, E., & Weiniger, C. F. (2016). Excessive Success Charges Utilizing Ultrasound for Neuraxial Block in Overweight Sufferers. Isr Med Assoc J, 18(1), 36-39.

Kind of Proof: Cohort examine

Design: Cohort Research

Stage and High quality of Proof: Stage IV
Impartial Variable:
Utilization of ultrasound for spinal anesthesia
Dependent Variable: First-pass success (a single needle insertion with no redirections) and process problem.
Demographics: Sufferers that had been scheduled for ESWL
below neuraxial block, had been ASA bodily standing I-III and had been
over 18 years outdated. Reliability/Precision:
An total success charge on the first try of 90.5% (CI Zero.Eight–Zero.95) was achieved utilizing ultrasound-guided neuraxial block. This block placement success charge was related for all sufferers, regardless of BMI above versus under 30 kg/m2.

Validity/Accuracy:
The convenience of palpation of anatomic landmarks, P = Zero.Zero01, and the benefit of palpation of iliac crest, P < Zero.Zero01, differed considerably between the sufferers above versus under 30 kg/m2. The reported verbal ache scores (VPS) attributable to block insertion was related amongst all sufferers regardless of BMI class (above versus under 30 kg/m2).

Bias:
n/a

Methodology:
n/a

Reliability/Precision:
Not mentioned in article.
Validity/
Accuracy:
The examine had one skilled operator performing each ultrasound and spinal blocks.

Bias:
Bias could possibly be launched as the info had been recorded by the practitioner.

Methodology: Excluded sufferers with coagulopathy, thrombocytopenia, earlier backbone surgical procedure or trauma, suspected or identified neurological illness or anatomic malformation of neuraxial constructions, or on anticoagulation medicine.

11. Article reference in APA format:
Sidiropoulou, T., Christodoulaki, Okay., & Siristatidis, C. (2021). Pre-Procedural Lumbar Neuraxial Ultrasound—A Systematic Evaluate of Randomized Managed Trials and Meta-Assessment. Healthcare, 9(four), 479. https://doi.org/10.3390/healthcare9040479

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12. Article reference in APA format:
Tubinis, 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 overweight parturients. Minerva Anestesiol, 85(10), 1089-1096. https://doi.org/10.23736/s0375-9393.19.13617-6

Kind of Proof: Randomized Managed Trial

Design: Randomized Managed Trial

Stage and High quality of Proof: Stage II
Impartial Variable:
Utilization of ultrasound

Dependent Variable:
Time for detection of midline

Demographics: Severely overweight parturients whose anatomic landmarks are troublesome to palpate. “Extreme weight problems” as class II weight problems (BMI 35 to 35.9 kg/m2) and above.
Reliability/Precision:
Information had been summarized utilizing both imply and customary deviation (SD) (for steady outcomes) or counts and percentages (for categorical outcomes). Two-sample t-test was used to check the ultrasonography and palpation teams on the first endpoint. Linear regression was then used to check the connection between midline identification methodology and time required for epidural placement, whereas controlling for supplier expertise (i.e., junior vs. senior resident) in addition to interplay between expertise and methodology. To evaluate whether or not the success of every midline identification methodology diversified with affected person BMI, linear regression was additionally used to check for an interplay between midline identification methodology and affected person BMI. This mannequin included important results for methodology and affected person BMI and managed for supplier stage of expertise.

Validity/Accuracy: In comparison with palpation, ultrasonography required much less time to put the epidural (6.2 minutes vs. 9.Zero minutes; P<Zero.01), extra time to find midline (44.5 seconds vs. 30.9 seconds; P<Zero.01), and fewer complete time for epidural placement (6.9 minutes vs. 9.5 minutes; P<Zero.01) (Desk II, Determine 2). Sufferers within the ultrasonography group additionally required fewer needle passes (2.1 vs. 2.Eight; P=Zero.02). The epidural failure charges when the ultrasonography group was in comparison with the palpation group weren’t considerably completely different (four.Zero% vs. 9.Three%; P=Zero.19)

Bias: n/a

Methodology:
All sufferers gave knowledgeable written consent to take part on this examine. All severely overweight sufferers admitted to our labor and supply unit for anticipated vaginal supply and requesting a labor epidural who didn’t meet the exclusion standards had been eligible for the examine. Exclusion standards had been: 1) age lower than 19 years outdated; 2) Physique Mass Index (BMI) <35 kg/m2; Three) prognosis of coagulopathy or platelet rely <80,000; four) historical past of lumbar backbone surgical procedure; 5) prognosis of scoliosis; 6) prognosis of intracranial or spinal mass.
Reliability/Precision:
Not mentioned within the article.
Bias: The residents performing the epidural placement had been conscious of the examine and the examine group during which the affected person was randomized. This data might need affected the pace at which the epidural was positioned.
They didn’t require a full ultrasound examination of the lumbar backbone, together with measuring the depth from pores and skin to epidural house.
Methodology: Solely positioned spinous course of within the transverse aircraft to find out midline for two causes: 1) the spinous course of is an simply identifiable landmarks with minimal ultrasonography expertise, as confirmed by the success of our trainees; 2) finding midline is usually seen as one of the more difficult facets of lumbar epidural placement in severely overweight parturients

13. Article reference in APA format:
Urfalioğlu, A., Bilal, B., Öksüz, G., Bakacak, M., Boran, Ö. F., & Öksüz, H. (2017). Comparability of the landmark and ultrasound strategies in cesarean sections carried out below spinal anesthesia on overweight pregnants. Journal of Maternal-Fetal & Neonatal Drugs, 30(9), 1051-1056. https://doi.org/10.1080/14767058.2016.1199677

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14. Article reference in APA format:
Uyel, Y., & Kilicaslan, A. (2021). Preprocedural Ultrasonography Versus Landmark-Guided Spinal Anesthesia in Geriatric Sufferers with Troublesome Anatomy: A Potential Randomized Trial [Article]. Eurasian Journal of Drugs, 53(1), 9-14. https://doi.org/10.5152/eurasianjmed.2020.20215

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15. Article reference in APA format:
Vadhanan, 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

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Article reference in APA format:
Vallejo, M. C. (2018). Pre-procedure neuraxial ultrasound in obstetric anesthesia. Journal of Anesthesia and Perioperative Drugs (JAPM), 5(2), 85-91. https://doi.org/https://doi.org/10.24015/JAPM.2017.0050

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Article reference in APA format:
Younger, B., Onwochei, D., & Desai, N. (2021). Typical landmark palpation vs. preprocedural ultrasound for neuraxial analgesia and anaesthesia in obstetrics – a scientific assessment and meta‐Assessment with trial sequential analyses. Anaesthesia, 76(6), 818-831. https://doi.org/10.1111/anae.15255

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