Dataset Information

Usefulness of a visual aid in achieving optimal positioning for spinal anesthesia: a randomized trial.

ABSTRACT: Optimal patient positioning is perceived as an essential factor to increase the success of performing neuraxial blockade. The primary objective of this study was to evaluate the benefit of using a visual image in addition to verbal instructions in order to optimize positioning for spinal block.This was a prospective randomized controlled trial on 85 adult patients undergoing lower limb joint replacements at a tertiary academic hospital. Group 1(n =?43) randomized to receive standardized verbal instructions; Group 2 (n =?42) received standardized verbal instructions in conjunction with visual aids to achieve positioning for spinal anesthesia. The primary outcome measure was the time taken to successful dural puncture. Secondary endpoints were the number of skin punctures, number of intervertebral levels attempted, success at the first intervertebral space attempted and satisfaction of patients and anesthesiologists.The unadjusted geometric mean time taken for the procedure using verbal instruction alone was 301 s (95% CI: 236-385) compared to 183 s (95% CI: 143-235) when both verbal and visual instructions were used. Out of the participants in group 2, 90% required ?2 skin punctures and 10% required ?3 skin punctures compared to 65% and 35% of the participants in group 1 respectively (p =?0.001). Group 1 required a second anesthesiologist to successfully complete the procedure in 6 patients out of 43 (14%) patients whereas the first anesthesiologist was noted to be successful in all the 42 cases in group 2 (p =?0.03). There were no significant differences in the satisfaction scores of anesthesiologists or patients between the groups. First-pass success was strongly associated with patient satisfaction (Odds ratio: 5.2; 95% CI: 1.0-9.5, p =?0.049).Use of a visual aid in addition to verbal instructions to optimize positioning for a spinal block, significantly reduces the time taken for the procedure by an average of 2 min, reduces the number of skin punctures and increases the success rate of the first anesthesiologist. First pass success was strongly associated with patient satisfaction.This study was retrospectively registered 30 August 2016, with the Australian New Zealand Clinical trials registry (ACTRN12616001197426).

SUBMITTER: Gurunathan U

PROVIDER: S-EPMC5775525 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Usefulness of a visual aid in achieving optimal positioning for spinal anesthesia: a randomized trial.

Gurunathan Usha U Kunju Shakeel Meeran SM Hay Karen Elizabeth KE van Alphen Sharyn S

BMC anesthesiology 20180120 1

<h4>Background</h4>Optimal patient positioning is perceived as an essential factor to increase the success of performing neuraxial blockade. The primary objective of this study was to evaluate the benefit of using a visual image in addition to verbal instructions in order to optimize positioning for spinal block.<h4>Methods</h4>This was a prospective randomized controlled trial on 85 adult patients undergoing lower limb joint replacements at a tertiary academic hospital. Group 1(n = 43) randomiz ...[more]

PMID: 29352812

Similar Datasets

Project description:Background In stable coronary artery disease, medications are used for 2 purposes: cardiovascular risk reduction and symptom improvement. In clinical trials and clinical practice, medication use is often not optimal. The ORBITA (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina) trial was the first placebo-controlled trial of percutaneous coronary intervention. A key component of the ORBITA trial design was the inclusion of a medical optimization phase, aimed at ensuring that all patients were treated with guideline-directed truly optimal medical therapy. In this study, we report the medical therapy that was achieved. Methods and Results After enrollment into the ORBITA trial, all 200 patients entered a 6-week period of intensive medical therapy optimization, with initiation and uptitration of risk reduction and antianginal therapy. At the prerandomization stage, the median number of antianginals established was 3 (interquartile range, 2-4). A total of 195 patients (97.5%) reached the prespecified target of ≥2 antianginals; 136 (68.0%) did not stop any antianginals because of adverse effects, and the median number of antianginals stopped for adverse effects per patient was 0 (interquartile range, 0-1). Amlodipine and bisoprolol were well tolerated (stopped for adverse effects in 4/175 [2.3%] and 9/167 [5.4%], respectively). Ranolazine and ivabradine were also well tolerated (stopped for adverse effects in 1/20 [5.0%] and 1/18 [5.6%], respectively). Isosorbide mononitrate and nicorandil were stopped for adverse effects in 36 of 172 (20.9%) and 32 of 141 (22.7%) of patients, respectively. Statins were well tolerated and taken by 191 of 200 (95.5%) patients. Conclusions In the 12-week ORBITA trial period, medical therapy was successfully optimized and well tolerated, with few drug adverse effects leading to therapy cessation. Truly optimal medical therapy can be achieved in clinical trials, and translating this into longer-term clinical practice should be a focus of future study. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02062593.

Project description:BackgroundAnticoagulant therapy during pregnancy is widely used due to the increasing awareness of maternal hypercoagulability. Few studies have reported the use of minimally invasive spinal anesthesia in these parturients. The objective of this study was to evaluate the safety and feasibility of minimally invasive spinal anesthesia in parturients with anticoagulation therapy undergoing cesarean section.MethodsThis was a randomized, controlled study conducted in 239 parturients using anticoagulants and undergoing selective cesarean section. 37 parturients withdrew, and finally parturients received spinal anesthesia using 27gauge pen type fine spinal needles (experimental group, n = 110) and 22gauge traditional spinal needles (control group, n = 92). The primary efficacy outcomes included low back pain (LBP) and postdural puncture headache (PDPH) after delivery. Secondary efficacy outcomes included visual analogue scale during subarachnoid puncture (VASdural), difference between visual analogue scale (VAS) during peripheral venipuncture and VASdural (∆VAS), VAS of back puncture point 24, 48 and 72 h after operation (VASdural-24 h, VASdural-48 h and VASdural-72 h, respectively), maternal satisfaction and hospitalization stay.ResultsNo parturient had PDPH and was suspected with spinal or intracranial haematoma in two groups. There was no significant difference in VASlbp-24 h, VASlbp-48 h and VASlbp-72 h (P = 0.056; P = 0.813; P = 0.189, respectively) between two groups. In experimental group, VASdural (P = 0.017), ∆VAS (P = 0.001) and VASdural-24 h (P < 0.0001) were lower, whereas maternal satisfaction was higher (P = 0.046). There was no significant difference in VASdural-48 h, VASdural-72 h, urination function, strength recovery and hospitalization stay (P = 0.069; P = 0.667; P = 0.105; P = 0.133; P = 0.754, respectively) between the two groups.ConclusionsMinimally invasive spinal anesthesia provided lower VASdural, VASdrual-24 h and a higher maternal satisfaction. Hence, it is considered as a safe, reliable and reasonable option for cesarean section parturients during maternal anticoagulation therapy with normal platelet count and coagulation time.Trial registrationThis study was registered at www.ClinicalTrials.gov at November 11th, 2016 ( NCT02987192 ).

Dataset Information

Usefulness of a visual aid in achieving optimal positioning for spinal anesthesia: a randomized trial.

Publications

Usefulness of a visual aid in achieving optimal positioning for spinal anesthesia: a randomized trial.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets