Anatomical Landmark Technique Research Articles

Static Ultrasonographic Assessment for Central Venous Catheterization Reduces Catheter Dysfunction in the Emergency Department

Objective: This study aimed to investigate the effect of a static ultrasonographic (US) examination of the central venous structures before central venous catheterization (CVC) and the success of the procedure. Materials and Methods: In this prospective study, patients who underwent CVC, in an emergency department (ED), were divided into two groups: patients who underwent CVC using the anatomical landmark technique (n = 34) and patients who underwent CVC using a static US examination (n = 33). The procedure times, success rates, and number of catheters used were compared. Results: A total of 67 patients who underwent CVC were included in the study. Compared with the anatomical landmark technique, the static US examination had a higher procedural success rate ( P = .001), fewer total interventions ( P = .001), and fewer postprocedural catheter dysfunctions ( P = .048). While there was no difference in the duration of the CVC between groups ( P = .222), the total time spent was longer using a static US examination ( P = .022). Conclusion: The static US examination was a practical, easy-to-apply method that could be used for CVC placement in an ED. This study demonstrated sonography had a high success rate in CVC procedures and contributed to a reduction in the number of interventions and catheters used.

Validating the anatomical landmark technique for bedside tunneled central venous catheter placement in the medical intensive care unit.

A non-tunneled dialysis catheter (nTDC) is often the vascular access of choice to initiate dialysis in an intensive care unit (ICU). In the absence of contraindications, if a patient remains dialysis dependent beyond 2-weeks, the options are either to replace the nTDC with another nTDC or convert to a tunneled dialysis catheter (TDC). As a standard of care, TDCs are placed under fluoroscopic guidance. To determine if TDCs and other tunneled central venous catheters (tCVC) can be placed safely using anatomical landmark techniques without the use of fluoroscopy. Subjects that met a predetermined selection criteria underwent placement of tunneled catheters with the use of the anatomical landmark technique. We looked at various outcomes to determine the safety and effectiveness of this technique. One hundred eleven TDCs and other tCVCs were placed using the anatomical landmark technique in the intensive care unit. All but one (110/111) of the catheters placed had recommended tip placement confirmed by at least one blinded physician. Major complications encountered were bleeding (two cases), pneumothorax (one case), and line associated blood stream infection (one case). We did find a higher-than-expected rate of "unnecessary procedures" with 18/111 lines placed in patients who did not survive beyond 7 days after placement of the catheter. Using the anatomical landmark technique for bedside tunneled catheter placement can be an effective approach in the right population.

A Comparison of Techniques of Internal Jugular Vein Cannulation: Anatomical Landmark, Ultrasound Guided Pre-location, and Real-Time Ultrasound Guided.

The objective of our study is to compare the success rate, duration, and incidence of complications of a right internal jugular vein (IJV) cannulation by using three different techniques. A randomised controlled trial was conducted at atertiary care teaching hospital. A total of201 patients were randomly allocated to one of the following three groups (67 in each group). Techniques were categorised as anatomical landmark technique group (Group ALT), ultrasound guided pre-location group (Group USG-Pre), and real-time ultrasound-guided technique group (Group USG-RT). Central venous catheter insertion via three techniques. In 138 (73.01%) patients' IJV canulated in the first attempt, USG-RT, USG-Pre, and ALT were 51 (83.6%), 44 (72.1%), and 43 (64.2%), respectively. On the other hand, 37 (19.57%) patients were required in the second attempt, while only 14 (7.40%) patients were required in the third attempt for successful IJV cannulation. The success rates, as defined in our study, were only 138 (73%) as, in 51 (27%), we cannulated in more than a single attempt or switched to another technique. We found a significant difference in preparation time in all techniques as P-value <0.05, but no significant difference was found in venous access time, cannulation time, and duration of the procedure. Any technique can be used for IJV cannulation, but the most acceptable is the real-time US technique. However, no difference in the overall procedure time among all three techniques was noted, and no major incidence of complication was found.

Precise Terminology and Specified Catheter Insertion Length in Ultrasound-Guided Infraclavicular Central Vein Catheterization.

Background and Objectives: As the latest research encourages the ultrasound-guided infraclavicular central venous approach, due to the lateral puncture site displacement, in comparison to the anatomical landmark technique based on subclavian vein catheterization, the need to re-calculate the optimal catheter insertion length and possibly to rename the punctuated vessel emerges. Although naming a particular anatomical structure is a nomenclature issue, a suboptimal catheter position can be associated with multiple life-threatening complications and must be avoided. The main study objective is to determine the optimal catheter insertion length by the most proximal ultrasound-guided, in-plane infraclavicular central vein approach, to compare results with the anatomical landmark technique based on subclavian vein catheterization and to clarify the punctuated anatomical structure. Materials and Methods: 109 patients were enrolled in this study. All procedures were performed according to the same catheterization protocol. In order to determine optimal insertion length, chest X-ray scans with an existing catheter were performed. The definition of punctuated vessel was based on computer tomography and evaluated by radiologists. Independent predictors for optimal insertion length were identified, prediction equations were generated. Results: The optimal catheter insertion length is approximately 1.5 cm longer than estimated by Pere's formula and can be accurately calculated based on anthropometric data. Computed tomography revealed: five cases with subclavian vein puncture and three cases with axillary vein puncture. Conclusions: Even the most proximal ultrasound-guided infraclavicular central vein access does not guarantee subclavian vein catheterization. A more accurate term could be infraclavicular central venous access, with the implication that the entry point could be through either subclavian or axillary veins. The optimal insertion length is approximately 1.5 cm deeper than the length determined for the anatomical landmark technique based on subclavian vein catheterization.

Comparison of Landmark Versus ECG-Guided Technique for Correct Insertion of Central Venous Catheter in Paediatric Patients Undergoing Cardiothoracic Surgery

Background: Central venous catheters are inserted in internal jugular vein during cardiac surgeries in all patients. However, the length of the catheter should be correctly estimated and the tip of the CVC should be correctly placed to avoid various complications. &#x0D; The primary objective of this study is to compare anatomical landmark technique versus using ECG-guided technique for the correct insertion length of the Central Venous Catheter.&#x0D; Methods: Prospective, randomized, interventional study was conducted on 72 patients of &lt;12 years age. Patients were randomly allotted to two groups of 36 patients each (landmark and ECG). After induction, CVC cannulation was performed using either of the techniques in right IJV in all patients. Correct position of CVC was checked by obtaining post operative chest X rays in all patients. CVC tip position within 0.5cm above/below or at carina was considered as correct position. Using student t-tests and Chi square-tests analyses were performed.&#x0D; Results: In landmark group, CVC was positioned correctly in 22(61.11%) out of 36 patients as compared to 33 (91.67%) in the ECG group, (P = 0.006). The mean depth of CVC insertion was 9.05±1.66 and 8.26±1.41 in the landmark and ECG group respectively (P= 0.032). The landmark group had 12 (33.33%) patients with complications during the procedure, as compared to 3(8.33%) in the ECG-guided group, (P = 0.020).&#x0D; Conclusion: ECG-guided CVC insertion, a simple bedside technique was found more accurate with lesser complications for CVC tip placement than the landmark technique. ECG-guided CVC placement is therefore relatively more accurate, efficient, and safe.

Comparative Study Between Conventional Landmark Versus Ultrasound-Guided Paravertebral Block in Patients Undergoing Laparoscopic Cholecystectomy: A Randomized Controlled Study.

Thoracic paravertebral block (TPVB) has emerged as an effective and safe regional technique for providing postoperative analgesia. We aimed to compare the ease and efficacy of conventional landmark and ultrasound-guided (USG) paravertebral blocks for postoperative analgesia in patients undergoing laparoscopic cholecystectomy. This was a randomized controlled study. Seventy-six patients of either sex, age 18-40 years, body mass index (BMI) 18-29 kg/m2, American Society of Anesthesiologists physical status classifications I and II posted for elective laparoscopic cholecystectomy under general anesthesia were randomly allocated into two groups of 38 each. Patients in group A were administered a paravertebral block using the anatomical landmark technique (ALT), and group B using an ultrasound-guided paravertebral block in the sitting position. In both groups, 20 ml of 0.5% bupivacaine injection was administered at the T7 vertebral level on the right side. The primary outcome was the first-pass success rate. Secondary outcomes were the number of passes and attempts, duration of analgesia, visual analog scale (VAS) score for pain during 24 h postoperatively and complications if any, were recorded. No patients were excluded in the study. Demographic characteristics were comparable in both groups. The number of passes was less in group B (1.45±0.5) compared to group A (2.42±0.95) and was reported to be statistically significant (p = 0.001). The number of attempts was less in group B (1.00±0) as compared to group A (1.29±0.46) and was statistically significant (p = 0.001). The duration of analgesia was longer in group B (530.00±326.33 minutes) compared to group A (345.60±252.95 minutes) and was observed to be statistically significant (p<0.05). The VAS score was significantly lower in group B (1.87±0.78, 2.24 ±0.82) compared to group A (2.42±0.72, 3.13±1.07) at the secondand fourth hours, respectively (p = 0.001). Conclusion: We concluded that paravertebral block using an ultrasound-guided technique is more efficacious than the conventional landmark technique for postoperative analgesia in patients undergoing laparoscopic cholecystectomy.

The suprascapular nerve block (SScNB) is easily administered using a landmark-based technique: A cadaveric study to assess nerve staining post-injection.

The suprascapular nerve is an ideal target for nerve blockade to alleviate shoulder pain given its widespread innervation to the shoulder girdle. To widen availability of this treatment, we investigate whether an anatomical landmark technique can be adopted by novice injectors to provide efficacious blockade. Five injectors were recruited with varying experience. 10 shoulders of Thiel embalmed cadavers were injected with blue dye. Written instructions and an illustration of the Dangoisse landmark technique were provided prior to injection. Cadavers were dissected and the presence or absence of dye staining reported by three observers and a consensus agreement reached. Dissection demonstrated diffuse staining in the suprascapular fossa. 90% of shoulders had adequate staining of the suprascapular nerve directly, or distal branches, which would provide adequate anaesthesia. Inter-observer agreement was good (k = 0.73) for staining at the supraspinous fossa and excellent (k = 0.87) for staining distally. The technique was performed by novice injectors with a good success rate. This technique is reproducible by a range of clinicians to effectively provide anaesthesia of the SScN. Within a resource strained healthcare environment greater uptake of this technique is likely to be of benefit to a wider group of patients.

THE SUPRASCAPULAR NERVE BLOCK (SSCNB) IS EASILY ADMINISTERED USING A LANDMARK-BASED TECHNIQUE: A CADAVERIC STUDY TO ASSESS NERVE STAINING POST-INJECTION

The suprascapular nerve is an ideal target for nerve blockade to alleviate shoulder pain given its widespread innervation to the shoulder girdle. Many techniques have been described. To widen the availability of this treatment we investigate whether an anatomical landmark technique can be easily learned by novice injectors to provide efficacious blockade.Five injectors were recruited with varying experience; from the novice medical student to an orthopaedic consultant. Five torsos (10 shoulders) were used. A single page of written instruction and illustration of the Dangoisse landmark technique was provided prior to injection of a Thiel embalmed cadaver bilaterally. A pre-mixed injectate with blue dye was used. Cadavers were dissected and the presence or absence of dye staining reported by 3 observers and a consensus agreement reached.Dissection demonstrated diffuse staining in the suprascapular fossa. 90% of shoulders were found to have adequate staining of the suprascapular nerve directly, or its distal branches, in a manner which would provide adequate anaesthesia. The inter-observer agreement was good (k = 0.73) for staining at the supraspinous fossa and excellent (k=0.87) for staining distally. The technique was easily performed by novice injectors with a 100% success rate.We demonstrate that this technique is reproducible by a range of clinicians to effectively provide anaesthesia of the SScN. The main risks are ineffective block (10% in this series) and of intravascular injection. Within a resource strained healthcare environment greater uptake of this technique is likely to be of benefit to a wider array of patients.

Complications and its risk factors of percutaneous subclavian vein catheters in pediatric patients: enhancing the outcomes of a university hospital in a low-income and middle-income country

ObjectiveAssessing central venous catheter-related complications with regular feedback and investigating risk factors are mandatory to enhance outcomes. The aim of this study is to assess our experience in the management...

Comparative evaluation of subclavian vein catheterization by supraclavicular and infraclavicular approach

The present study was conducted in Department of Anaesthesia, Sardar Patel Medical College and PBM Hospital, Bikaner, with the aim of comparative evaluation of subclavian vein catheterization by supraclavicular and infraclavicular approach. There are three common routes of central venous catheterization i.e. subclavian, internal jugular and the femoral. Hence in our study we have done a comparative evaluation of supraclavicular and infraclavicular approach for SCV catheterization with primary objective of successful catheterization of SCV using anatomical landmark technique and secondary objective of first attempt success rate, time taken for cannulation and also record the incidence of complications related to either approach. In our study, 60 patients enrolled were randomly divided into two groups of 30 patients each. In Group A Infraclavicular SCV catheterization and in Group B Supraclavicular catheterisation was performed using anatomical landmark approach. Successful catheterization, first attempt success rate, time taken for venous access and catheterization, catheter malfunction or any other complication were recorded. In group A (IC) Maximum 63.33% were inserted in single attempt whereas minimum 10% required 3 or more attempts while in group B (IC) maximum 93.33% were inserted in single attempt whereas minimum 3.33% needed 3 or more attempts, and the difference was found statistically significant. Overall successful catheterization was 90% in Group A and 96% in Group B while 93 % when combined for both groups. Mean time taken for insertion was observed more (6.67 ± 1.44 min.) in group A whereas less (4.47 ± 1.01min.) in group B, and the difference was found statistically highly significant. We conclude that SC approach of SCV catheterization is better as comparable to IC approach in terms of landmarks accessibility, success rate, time taken and rate of complications.

INTERNAL JUGULAR VEIN CATHETERIZATION “A COMPARATIVE STUDY OF REAL-TIME ULTRASOUND - GUIDED TECHNIQUE VERSUS CONVENTIONAL LANDMARK GUIDED TECHNIQUE.”

Background and Aim: Central venous catheter placement is a frequently performed procedure in emergency and intensive care units. we aimed to compare real-time ultrasound guided (USG) and the conventional anatomical landmark (LM) technique for the insertion of internal jugular vein catheters. Materials and method: Patients requiring IJV catheterization were prospectively recruited over a period of 1 and half year. It is a single blinded prospective randomised study involving total of 48 cases meeting inclusion criteria were randomly allocated in two groups, 24 patients to each group. Number of attempts, success rate, venous access time, IJV catheterization time and complications were observed in each group. All data were analysed by proper statistical test using SPSS-29 software. The data was analysed by computing percentages and descriptive statistics as mean, standard deviation and standard error of mean. The difference of mean between two techniques is tested using independent Student t-test. For all tests, p value of &lt;0.05 was considered signicant. The nding of this study indicates that internal jugular vein catheterization gui Conclusion: ded by real-time USG results in higher 1st pass success rate, reduced number of cannulation attempt and fewer complication

Usage of augmented reality for interventional neuraxial procedures: A phantom-based study.

Neuraxial access is necessary for an array of procedures in anaesthesia, interventional pain medicine and neurosurgery. The commonly used anatomical landmark technique is challenging and requires practical experience. We aimed to evaluate the technical feasibility of an augmented reality-guided approach for neuraxial access and tested the hypothesis that its use would improve success as the primary outcome. As secondary outcomes, we measured accuracy and the procedural duration compared with the classical landmark approach. A randomised phantom-based study. The three-dimensional image of a thoracolumbar phantom spine model with the surrounding soft tissue was created with a neurosurgical planning workstation and ideal trajectories to the epidural space on the levels T10-L1 were planned using a paramedian approach. Both the three-dimensional holographic image of the spine and the trajectories were transferred to an augmented reality-headset. Four probands (two anaesthesiologists, one neuroradiologist and one stereotactic neurosurgeon) performed 20 attempts, 10 each of either conventional landmark or augmented reality-guided epidural punctures, where anatomical level, side and sequence of modality were all randomised. Accuracy was assessed by measuring Euclidean distance and lateral deviation from the predefined target point. Success of epidural puncture on the first attempt was compared between the conventional and the augmented reality-guided approaches. Success was achieved in 82.5% of the attempts using augmented reality technique, compared with 40% with the conventional approach [ P = 0.0002, odds ratio (OR) for success: 7.07]. Euclidean distance (6.1 vs. 12 mm, P < 0.0001) and lateral deviation (3.7 vs. 9.2 mm, P < 0.0001) were significantly smaller using augmented reality. Augmented reality-guided puncture was significantly faster than with the conventional landmark approach (52.5 vs. 67.5 s, P = 0.0015). Augmented reality guidance significantly improved the accuracy and success in an experimental phantom model of epidural puncture. With further technical development, augmented reality guidance might prove helpful in anatomically challenging neuraxial procedures.

Accuracy of Lumbosacral Pedicle Screw Placement in Dogs: A Novel 3D Printed Patient-Specific Drill Guide versus Freehand Technique in Novice and Expert Surgeons.

The aim of this study was to compare the accuracy of pedicle screw placement at the canine lumbosacral junction using a novel unilateral three-dimensional printed patient-specific guide (3D-PSG) versus a freehand drilling technique. Additionally, accuracy of screw placement between a novice and an experienced surgeon was determined. Preoperative computed tomography images from 20 lumbosacral cadaveric specimens were used to design a novel unilateral 3D-PSG for the L7 and sacral vertebrae which was printed in acryl-nitrile butadiene styrene plastic. A novice and an expert surgeon each placed 3.5mm cortical screws in 10 cadavers; on the left using the unilateral 3D-PSG and by the freehand (anatomic landmark) technique on the right. Sixty screws were placed using the unilateral 3D-PSG and 60 using the freehand technique. There was no statistical difference in accuracy for the comparison between methods performed by the expert (p = 0.679) and novice (p = 0.761) surgeon, nor between an expert and novice surgeon overall (p = 0.923). Unexpectedly, the use of a unilateral 3D-PSG increased variability for the expert surgeon in our study (p = 0.0314). Using a novel unilateral 3D-PSG did not improve the accuracy of screw placement for lumbosacral stabilization by a novice surgeon compared with an expert surgeon in lumbar spine surgery. This may reflect a suboptimal PSG design.

Compare the Efficacy and Safety of Modified Combined Short and Long Axis Method versus Oblique Axis Method for Right Internal Jugular Vein Catheterization in Adult Patients (The MCSLOA Trial): Study Protocol of a Randomized Controlled Trial.

BackgroundUltrasound-guided internal jugular vein (IJV) catheterization has become a standard procedure as it yields a higher success rate and fewer mechanical complications compared with an anatomical landmark technique. There are several common methods for ultrasound guidance IJV catheterization, such as short-axis out-of-plane, long-axis in-plane and oblique axis in-plane, but these technologies are still developing. It is important to further study the application of different ultrasound-guided IJV puncture techniques and find an effective and safe ultrasound-guided puncture technique.MethodsA China randomized, open-label, parallel, single center, positive-controlled, non-inferiority clinical trial will evaluate 190 adult patients undergoing elective surgery and need right jugular vein catheterization. Study participants randomized in a 1:1 ratio into control and experimental groups. The control group will take the oblique axis in-plane method for IJV catheterization. The experimental group will take the Modified combined short and long axis method. The primary endpoint of the trial is the rate of one-time successful guidewire insertion without posterior wall puncture (PWP). Secondary endpoints are the number of needle insertion attempts, the total success rate, the procedure time, and mechanical complications.ConclusionThis randomized controlled trial will evaluate the effectiveness and safety of Modified combined short and long axis method and oblique axis in-plane method for right IJV catheterization in adult patients.

Abstract No.: ABS2471: Comparison of landmark versus ECG-guided technique for correct insertion of central venous catheter in paediatric patients undergoing cardiothoracic surgery

Background & Aims:Central venous catheters (CVC), commonly indicated in paediatric patients during cardiac surgeries can cause various complications if not correctly positioned. Objective of this study was to compare correct placement of the CVC tip using anatomical landmark technique with ECG-guided technique.Methods:A prospective, randomised interventional study was conducted on 72 patients of <12 years age, randomly allotted to two groups of 36 patients each (landmark and ECG). After induction, central venous cannulation was performed in right IJV in all patients using either of the techniques. Post operative chest X rays were obtained in all patients and correct position of CVC was checked. CVC tip position within 0.5cm above/ below or at carina was considered as correct position. Analyses were performed using Student’s t-tests and Chi square-tests.Results:It was found that 22 (61.11%) in the landmark group were positioned correctly as compared to 33 (91.67%) in the ECG group (p = 0.006). The mean depth of CVC insertion was 9.05±1.66 in landmark group and 8.26±1.41 in the ECG group (p= 0.032). The landmark group had 12 (33.33%) participants with complications during the procedure, compared to 3 (8.33%) in the ECG-guided group (p = 0.020).Conclusion:ECG-guided technique was found to be more accurate for CVC tip placement than the anatomical landmark technique. ECG-guided technique had less complications than the anatomical landmark technique. Hence, ECG-guided CVC placement is relatively accurate, efficient, and safe.ParameterLandmark Group (n=36)ECG Group (n=36) P Age (in years)6.56±3.646.50±3.480.947Sex (M/F)21/1520/161.00Height (cm)114.04±22.95112.79±22.580.816Weight (kg)19.33±9.4019.83±8.480.810

Comparative Study of the Efficacy and Safety of Ultrasound-guided and Landmark-based Paravertebral Block Technique in Patients undergoing Elective Unilateral Breast Surgery

Introduction: Identifying the Paravertebral Space (PVS) by its anatomical landmarks is associated with high failure rates and complications. With the advent of Ultrasonography (USG), failure rate has decreased leading to an increased interest in performing USG guided Thoracic Paravertebral Block (TPVB). Aim: To assess the efficacy and safety of ultrasound guided TPVB and its comparison with the landmark-based technique, in patients undergoing elective unilateral breast surgery. Materials and Methods: This cross-sectional study was carried out at Command Hospital, Pune from July 2014 to December 2015, on females between 18-70 years, accepted in American Society of Anaesthesiology (ASA) I-III for unilateral breast surgeries. Patients were divided into two groups with 40 subjects in each group. Group A subjects were treated with anatomical landmark technique and group B subjects with USG guided technique. The p-value &lt;0.05 was considered to be statistically significant. Results: Demographic parameters (age, height, weight and Body Mass Index (BMI) and the scheduled surgery were comparable in between the groups. In group A, success rate of the block was 82.5%, compared to 95% in group B (p-value &gt;0.05 using Fisher’s-exact test). Mean (SD) time taken for performing the block in group A was 371.10 (10.37) seconds while it was 613.73 (37.15) seconds in group B (p-value &lt;0.05 by two independent sample t-tests). No statistically significant difference was seen in haemodynamic parameters, except for the Heart Rate (HR) at 70, 80, 90 minutes after administering the block and at the end of surgery. Correlation analysis for quantitative variables with PVS depth (dependent variable), measured sonologically, showed very good linear correlation of PVS depth with weight (Pearson correlation coefficient, r=0.819, p-value &lt;0.001). BMI (r=0.884; p-value &lt;0.001). Conclusion: The success rate is higher with ultrasound guided TPVB compared to the landmark technique though statistically insignificant. But it is recommended to use ultrasound-guided TPVB for advantages such as lesser requirement of opioid supplementation, real time visualisation of the spread of drugs in PVS with lesser complication rates.

Comparison between ultrasound-guided and anatomical landmark-guided block of internal branch of the superior laryngeal nerve for awake fiber-optic intubation in suspected difficult intubation: a randomized controlled study

BackgroundAirway anesthesia is pivotal for successful awake intubation provided either topically or by nerve blocks. The widespread use of ultrasonography allows anesthesiologists to evaluate complex and varied anatomy before needle insertion. This study aims to evaluate the effect of ultrasound-guided technique for the block of the internal branch of the superior laryngeal nerve in difficult airway patients in comparison to blind anatomical technique. Sixty patients aged 18–60 years, of either sex, with the American Society of Anesthesiologists’ physical status (ASA) I–II were divided into two groups 30 patients of each. Group (L): using anatomical landmark technique to bilateral block internal branch of the superior laryngeal nerve (ibSLN) with 1 mL 2% Lidocaine and group (U): using ultrasound technique to bilateral block the ibSLN with 1 mL 2% Lidocaine. Assessment of the excellence of airway anesthesia during intubation by using the 5 points grading scale, time for intubation, effects on hemodynamic variables, and evaluation of patient awareness of pain and discomfort during fiber-optic intubation using numerical rating scale were compared.ResultsThe duration of tracheal intubation was shorter in the ultrasound group as compared to the anatomical group; also, patient comfort was significantly better in the ultrasound group besides the effect of tracheal intubation on hemodynamics which was significant with a higher peak value during intubation and post-intubation in the anatomical group compared to the ultrasound group.ConclusionsThis study concludes that an ultrasound-guided block of ibSLN used as a part of the preparation of the airway for awake fiber-optic intubation enhances the quality of airway anesthesia and patient tolerance during the procedure.

Central venous catheterization site choice based on anatomical landmark technique: a systematic review and meta-analysis.

Internal jugular vein catheterization (IJVC) and subclavian vein catheterization (SCVC) have been the most preferred central venous catheterizations (CVC) clinically. Individual preference and institutional routine dominate the traditional CVC choice; however, it is lack of high-level evidence. We sought to provide better clinical strategy for CVC site choice based on anatomical landmark technique between IJVC and SCVC. We systematically reviewed eligible studies from PubMed, OVID, Cochrane and ClinicalTrials.Gov till February 2020. The primary outcomes were catheterization time and overall success rate, and the secondary outcomes were the first-attempt success rate and the instant mechanical complications. Ethical problems are not applicable. A total of 3378 patients from 7 studies were included in the analyses. Neither difference was found on the catheterization time (SMD 95% CI: -0.095-0.124, p = 0.792), nor any difference on the overall success rate (RR = 1.017, 95% CI: 0.927-1.117, p = 0.721, I2 = 89.6%) between the 2 procedures. However, subgroup analyses showed overall success rate of IJVC was significantly lower than that of SCVC (RR = 0.906, 95% CI: 0.850-0.965, p = 0.002) in adults. The first-attempt success rate of IJVC group was higher in the adults (RR = 1.472, 95% CI: 1.004-2.156, p = 0.047). No significance was detected in arterial injury (RR = 1.137, 95% CI: 0.541-2.387, p = 0.735) and pneumothorax (RR = 0.600, 95% CI: 0.32-1.126, p = 0.112) between the two procedures. Hematoma was significantly more in IJVC group than that in SCVC group (RR = 2.824, 95% CI: 1.181-6.751, p = 0.02). Compared with IJVC, SCVC shows a higher overall success rate while a lower first-attempt success rate in adults, and has involved with less hematoma. CRD42020165444.

Landmark guided internal jugular vein catheterization in infants undergoing congenital heart surgery

Objectives: Central venous catheterization is an important procedure for infants undergoing heart surgery. Ultrasound-guided methods have been shown to decrease failure and complications. The goal of the present study was investigate the effect of anatomical landmark technique during internal jugular vein access in low-weight infants undergoing congenital heart surgery. Methods: A total 98 infants (median age was 16.5 days, median weight was 3275 g) who underwent internal jugular vein catheterization between January 2017 and October 2019 were retrospectively analyzed. All catherizations were performed by a pediatric heart surgeon. Data including demographic characteristics of the infants, success rate, and catheter-related adverse events were recorded. Results: Success rate was 94.9% (n = 93). There were three arterial puncture (3.1%) and hematoma occurred in five patients (5.1%). Central venous catheterization of 78 (79.6%) patients were successful at the first attempt. Conclusions: Our study suggest that landmark technique still seems useful by experienced operators and is safe and effective in infants weighing less than 5 kg undergoing congenital heart surgery.

Anatomic Landmark Technique Thoracic Paravertebral Nerve Block as a Sole Anesthesia for Modified Radical Mastectomy in a Resource-Poor Setting: A Clinical Case Report

Mastectomy is mostly performed as definitive management for resectable breast cancer. Implementing paravertebral nerve block for patients with metastasis features of cancer to lungs and other organs, patients with co-morbidity, geriatrics, and malnourished individuals will eliminate the risks and complications of general anesthesia. Though thoracic paravertebral block is an established technique as postoperative pain management for breast surgery, there is no conclusive evidence on its use as a sole anesthetic for modified radical mastectomy. In this case report, we present a 33-year-old woman who underwent a successful modified radical mastectomy for stage IIIb breast cancer associated with clinical and radiological features of metastasis to the lung under a multiple injection landmark technique paravertebral nerve block. We believe that the anatomic landmark technique paravertebral nerve block can be used as an alternative anesthetic technique for modified radical mastectomy in a resource-limited setting for patients who are expected to have a high risk of perioperative complications under general anesthesia.