Extension Tube Research Articles

COMPARISON OF THE EFFECTS OF STANDARD NOZZLES AND EXTENSION TUBES ON THE EROSION OF PMMA USING PULSATING WATER JET TECHNOLOGY

The study of bone cement disintegration is important for advancing orthopedic and trauma surgery outcomes. Bone cement, commonly used in joint replacement procedures, plays a vital role in fixation implants. However, the long-term stability and integrity of bone cement are critical for the success of these procedures. This study focuses on the use of ultrasonic pulsating water jet technology for the selective removal of bone cement, aiming to provide a precise and efficient method for revision surgeries. The disintegration efficiency is measured in terms of depth, width and volume of the disintegrated bone cement as a result of variations in the nozzle geometry, supply pressure and traverse speed. Two different nozzle types, the standard nozzle insert and nozzle with an extension tube of 100 mm having a diameter of 0.3 mm, are used. Two supply pressure levels were taken as 10 and 20 MPa with five levels of traverse speeds as 0.5, 1, 1.5, 2 and 2.5 mm/s. The results showed an increased disintegration efficiency for all experimental conditions using an extension tube nozzle as compared to a standard nozzle (20 – 25% in terms of disintegration volume). Also, the disintegration efficiency increased with higher pressure level values (8.2 mm3 and 4.85 mm3 for p = 20 and 10 MPa, respectively) and lower traverse speed values. The results showed a promising direction in terms of the utilization of an ultrasonic pulsating jet with a modified nozzle type for higher bone cement disintegration efficiency.

Experiences and barriers with home bladder manometry in the pediatric neurogenic bladder population: A qualitative study

Patients with neurogenic bladder are at risk of developing renal deterioration secondary to increased intravesical pressures. To date, urodynamics is the gold standard test to properly assess bladder dynamics. Home bladder manometry is a low-cost and simple method to evaluate bladder pressures and volumes during clean intermittent catheterization (CIC). Previous literature has shown that home manometry measurements correlate with urodynamic pressures and hydronephrosis on ultrasound. However, no studies have evaluated the challenges and barriers faced by caregivers with the process. Our objective was to investigate the experiences and perceptions of caregivers, healthcare providers, and nurses with home manometry. We conducted semi-structured interviews and focus group discussions with 23 stakeholders. Stakeholders included caregivers of pediatric spina bifida neurogenic bladder patients, providers, and nursing staff. Grounded Theory Methods were used to analyze transcripts and identify preliminary concepts that described attitudes towards the current home bladder manometry process. Interview participants were composed of 10 (43%) caregivers, 9 (40%) healthcare providers, and 4 (17%) nursing staff. The mean age was 39 years (range 26-66). The four themes identified during discussions were perspectives on home manometry, patient-specific characteristics, challenges with home manometry, and learning experience. All caregivers expressed understanding and agreement with the purpose and importance of home manometry. Emergent concepts identified as targets for improvement were the need for standardization of teaching processes with focus on hands-on practice, understanding of patient characteristics and the home environment that make the process more challenging, and the need for appropriate materials including extension tubing and catheters. Home bladder manometry is a feasible and beneficial way for neurogenic bladder patients to monitor their bladder pressures and volumes at home. This qualitative study offers valuable insights into the experiences and viewpoints of caregivers, healthcare providers, and nurses regarding both home manometry and the general experience with CIC.

Assessment of Image Quality and Child Acceptance for DSLR, Bridge and Smartphone Cameras Used in Dental Photography (A Comparative Study)

Digital photography is of huge importance during the course of dental treatments. It’s indispensable for recording data, patient motivation, communication with the lab etc. Many photography equipment are available and used in dentistry. Using digital photography is obtaining a footstep in pediatric dentistry. The purpose of this study is to evaluate the quality of dental images made by different digital photography mediums commonly used in dental clinics and measure the acceptance of children towards dental photography. Materials and Methods: in this study images produced by Three DSLR (digital single lens reflex) cameras along their prober lenses, one bridge camera and two smartphones with different sensor sizes were evaluated, based upon the sharpness, quality, color fidelity, and general context of the photographs. The participants were divided into three main groups: under-graduate students; graduated dentists and graduated dentists with photography experience. 20 pediatric patients were imaged using the aforementioned equipment. Results: DSLRs with macro lenses and ring flashes scored the highest means with statistically significant differences (p<0.05). From 20 pediatric patient photographed by each equipment used in this study 18 child accepted smartphone photography Conclusion: Older DSLRS are still usable for dental photography. Kit lenses or extension tubes with camera built in flashes are not appropriate for dental photography. Bridge cameras and smartphones are not adequate for dental photography.

Effects of Nozzle Retraction Elimination on Spray Distribution in Middle-Posterior Turbinate Regions: A Comparative Study.

The standard multi-dose nasal spray pump features an integrated actuator and nozzle, which inevitably causes a retraction of the nozzle tip during application. The retraction stroke is around 5.5 mm and drastically reduces the nozzle's insertion depth, which further affects the initial nasal spray deposition and subsequent translocation, potentially increasing drug wastes and dosimetry variability. To address this issue, we designed a new spray pump that separated the nozzle from the actuator and connected them with a flexible tube, thereby eliminating nozzle retraction during application. The objective of this study is to test the new device's performance in comparison to the conventional nasal pump in terms of spray generation, plume development, and dosimetry distribution. For both devices, the spray droplet size distribution was measured using a laser diffraction particle analyzer. Plume development was recorded with a high-definition camera. Nasal dosimetry was characterized in two transparent nasal cavity casts (normal and decongested) under two breathing conditions (breath-holding and constant inhalation). The nasal formulation was a 0.25% w/v methyl cellulose aqueous solution with a fluorescent dye. For each test case, the temporospatial spray translocation in the nasal cavity was recorded, and the final delivered doses were quantified in five nasal regions. The results indicate minor differences in droplet size distribution between the two devices. The nasal plume from the new device presents a narrower plume angle. The head orientation, the depth at which the nozzle is inserted into the nostril, and the administration angle play crucial roles in determining the initial deposition of nasal sprays as well as the subsequent translocation of the liquid film/droplets. Quantitative measurements of deposition distributions in the nasal models were augmented with visualization recordings to evaluate the delivery enhancements introduced by the new device. With an extension tube, the modified device produced a lower spray output and delivered lower doses in the front, middle, and back turbinate than the conventional nasal pump. However, sprays from the new device were observed to penetrate deeper into the nasal passages, predominantly through the middle-upper meatus. This resulted in consistently enhanced dosing in the middle-upper turbinate regions while at the cost of higher drug loss to the pharynx.

The Relationship Between Acute-Phase Circuit Occlusion and Blood Calcium Concentration in an Ex Vivo Continuous Renal Replacement Therapy Model.

Background and objective Continuous renal replacement therapy (CRRT) is a blood purification therapy modalityfor the treatment of renal failure in critically ill hospitalized patients with multiorgan dysfunction, effectively preventing uremia and multiple organ failure while improving renal function. However, the perfusion of patient blood through extracorporeal circulation often results in unexpected early occlusion of the CRRT circuit or hemofilter,leading to frequent interruptions in CRRT and wastage of medical resources. Moreover, clinical research on such circuit occlusions is limited. In Japan, CRRT circuits require long-term perfusion, often lasting 24 hours or more, indicating the need for a model capable of inducing occlusion at any arbitrary time; this model can evaluate various aspects, including causes and underlying mechanisms, and contribute to the development of an occlusion prediction method. Hence, we hypothesized the need for a model for inducing occlusion at arbitrary time points. Consequently, we strove to develop an ex vivo circuit occlusion model involving the injection of calcium into circulating citrated animal blood to evaluate the relationship between the amount of calcium chloride injected, circuit occlusion time, and changes in circuit pressure over time. Methods We developed a circuit occlusion model using a commercially available CRRT circuit, polysulfone membrane hemofilter, heating extension tube, and thermostatic water bath, along withcommercially available citrated bovine whole blood. The circuit was filled with blood over a 10-min duration using a roller pump and was occluded after a specific period by varying the flow rate of calcium injected into bovine whole blood. Additionally, continuous injection of 1 mEq/mL calcium chloride into the circuit was maintained while bovine whole blood circulated. Measurements were performed at each calcium injection flow rate (2, 3, and 4 mL/h), with each measurement performed five times. The group that did not receive calcium injection was used as the control (0 mL/h: Con), and the experiment was performed three times. Groups were defined as "0, 2, 3, and 4" for each calcium injection flow rate. The relationship among the amount of calcium chloride injected, circuit occlusion time, and changes in circuit pressure over time was evaluated. Furthermore, blood tests and blood viscoelastic tests were performed at arbitrary times. Results The circuit occlusion time varied with each calcium injection flow rate, and a significant difference was observed between each group (p<0.05). Circuit pressure gradually changed at four minbefore occlusion when calcium was injected at 2, 3, and 4 mL/h, with a more rapid change at one minbefore occlusion. We measured circuit pressure at four and one minbefore occlusion (-4 min, and -1 min, respectively), and at the time of circuit occlusion (0 min) in the Con and 4 mL/h groups. Significant differences were observed in AP between -4 min and 0 min and -1 min and 0 min at a calcium flow rate of 4 mL/h. Additionally, significant differences were seen in prefilter and return pressures between -4 min and 0 min, -4 min and -1 min, and -1 min and 0 min at a calcium flow rate of 4 mL/h (p<0.05). Conclusions Our proposed model accurately estimated the occlusion time based on changes in circuit pressure. This model can be used to create various experimental systems depending on the desired occlusion time.

Supplemental tube feeding: qualitative study of patient perspectives in advanced pancreatic cancer

ObjectivesMalnutrition is associated with poor quality of life and survival outcomes for patients with cancer, but is challenging to prevent or treat in pancreatic cancer due to the multifactorial drivers...

A vertebrate Vangl2 translational variant required for planar cell polarity

First described in the milkweed bug Oncopeltus Fasciatus, planar cell polarity (PCP) is a developmental process essential for embryogenesis and development of polarized structures in Metazoans. This signaling pathway involves a set of evolutionarily conserved genes encoding transmembrane (Vangl, Frizzled, Celsr) and cytoplasmic (Prickle, Dishevelled) molecules. Vangl2 is of major importance in embryonic development as illustrated by its pivotal role during neural tube closure in human, mouse, Xenopus and zebrafish embryos. Here, we report on the molecular and functional characterization of a Vangl2 isoform, Vangl2-Long, containing an N-terminal extension of about 50 amino-acids, that arises from an alternative near-cognate AUA translation initiation site, lying upstream of the conventional start codon. While missing in Vangl1 paralogs and in all invertebrates, including Drosophila, this N-terminal extension is conserved in all vertebrate Vangl2 sequences. We show that Vangl2-Long belongs to a multimeric complex with Vangl1 and Vangl2. Using morpholino oligonucleotides to specifically knockdown Vangl2-Long in Xenopus, we found that this isoform is functional and required for embryo extension and neural tube closure. Furthermore, both Vangl2 and Vangl2-Long must be correctly expressed for the polarized distribution of the PCP molecules Pk2 and Dvl1, and for centriole rotational polarity in ciliated epidermal cells. Altogether, our study suggests that Vangl2-Long significantly contributes to the pool of Vangl2 molecules present at the plasma membrane to maintain PCP in vertebrate tissues.

Comparison of two types of extension tubes for people with Parkinson’s disease in advanced treatment with levodopa–entacapone–carbidopa intestinal gel infusions: a prospective, crossover quality study

BackgroundWithin Parkinson’s disease (PD) management, a pivotal juncture often arises when individuals with PD (PwP) necessitate advanced therapies to stabilise symptom fluctuations and reduce off-periods, which are intrinsic to living...

Accuracy of Injection Dose of Amyloid PET Agent Using Radiopharmaceutical Activity Suppliers

This study aimed to identify disposable items with low amyloid positron emission tomography (PET) agent radioactivity adsorption for accurate injections using a radiopharmaceutical activity supplier. First, we investigated disposable items currently used for amyloid PET agent injection. Next, we measured the residual radioactivity rates of amyloid PET agents on three-way stopcocks, extension tubes, butterfly needles, and indwelling needles to identify disposable items with low radioactivity adsorption. Finally, we evaluated the accuracy of amyloid PET agent injection using the selected disposable items and a radiopharmaceutical activity supplier. The polybutadiene extension tube exhibited a significantly lower residual activity rate than that of the polyvinyl chloride extension tube. Similarly, the indwelling needles showed significantly lower residual activity rate than that of butterfly needles. The dose indicated by a radiopharmaceutical activity supplier was 184.1 MBq, while the dose calibrator measured the radioactivity which flowed into the vial as 170.2 MBq, resulting in an administration accuracy of 8.2%. To ensure accurate amyloid PET agent injections, we recommend using polybutadiene extension tubes and indwelling needles due to their lower radioactivity adsorption.

Real gas effects on the dynamics of a reactive diffusion layer: Application to the study of spontaneous ignition limit of pressurized hydrogen jet

The spontaneous ignition of hydrogen accidentally released from pressurized equipment poses safety risk to the utilization of hydrogen as an energy carrier. This work aims at studying the pressure and temperature dependent real gas effects, resulting from the high-pressure conditions in the storage facility, on the spontaneous ignition. Numerical simulations were performed based on a one-dimensional diffusion layer ignition model applied to the head of the hydrogen jet into air. The real gas effects were considered in the equation of state, thermodynamics, transport properties, and mass action law. The critical pressure of spontaneous ignition was determined for both unconfined releases through round holes and confined releases through extension tubes. The results demonstrate satisfactory agreement with experimental data. In unconfined releases, real gas effects lead to higher critical pressures. The relative difference was 10% for a 0.6 mm hole and increased drastically as the hole size was decreased. In confined releases, the critical pressure was relatively low and the real gas effects were negligible. The real gas effects manifest mainly through the equation of state and thermodynamics. The density and frozen sound speed of hydrogen are under-predicted and over-predicted by the ideal gas model, respectively. This delays the volumetric expansion competing with the heat release process, and thus results in easier ignition for ideal gas than for real gas. The present results demonstrate that real gas effects should at least be considered in the equation of state and thermodynamic functions for accurate simulation of highly pressurized hydrogen injection.

Buried bumper syndrome in percutaneous endoscopic gastrostomy with a jejunal extension tube in patients undergoing levodopa–carbidopa intestinal gel treatment

BackgroundLevodopa–carbidopa intestinal gel (LCIG) treatment is an effective Parkinson’s disease (PD) treatment that requires percutaneous endoscopic gastrostomy with a jejunal extension tube (PEG-J). Buried bumper syndrome (BBS) is an uncommon but significant complication of PEG-J for LCIG.Case presentationA 71-year-old man had been undergoing LCIG therapy for PD since a PEG-J was implemented at our department two years previously. He presented with appetite loss. Computed tomography showed that the gastrostomy bumper was buried in the gastric wall. The patient was surgically treated with the simultaneous removal and replacement of PEG-J. Postoperative gastrocutaneous fistula occurred, which was conservatively treated.ConclusionsNotably, patients and medical staff should be aware that patients with PD on LCIG treatment have a high risk of BBS in PEG-J and that there might be some patients with latent BBS. When simultaneous removal and replacement surgery is performed, establishing a new route at the stomach and abdominal wall is recommended.

Adding an extension piece to the end of the purge side arm of the Impella device can prevent the incidence of the cassette breaking and decrease the Impella device failure rate: Impact of practice change on patient outcome.

Background: Impella 5.5® with Smart Assist is a minimally invasive Left Ventricular Assist Devices (LVAD) approved by the Food and Drug Administration (FDA) for treating ongoing cardiogenic shock for up to 14 days. The Impella® intends to reduce ventricular workload and provide the circulatory support necessary for myocardial recovery.Research Question: Compared to standard practice, does adding an extension piece to the purge tube side arm of the Impella® Device decrease the incidence of device failure and positively impact the health outcome of adult patients receiving Impella® support?Study Design and Methods: A retrospective chart review of ICU patients was done at a tertiary care center from August 2018 to August 2022 to assess the differences in patient outcomes related to Impella® Device utilization before and after the implementation of the extension piece to the purge tube sidearm. Among patients reviewed, a total of 20 were included in our review, with seven not having the purge tube side arm extension added, while 13 patients had the extension.Results: The two study groups had no significant difference in patient health outcomes. Additionally, there were no instances of device failure requiring explanation without the extension tubing. However, there were no cases of the purge cassette cracking with the addition of the extension tubing.Conclusion: The addition of extension tubing to the purge cassette of the Impella® Device did not impact patient health outcomes or the incidence of device failure. There was a complete reduction in the incidence of the purge cassette cracking, which could reduce the potential for infection or device failure over a long period of mechanical support. There is a need for long-term prospective studies to confirm the results.

Methodological errors due to a non-cylindrical surface in a Jones-type cell with a removable center extension tube

The article shows an idealized model of a Jones-type cell with a removable central extension tube. Two main factors leading to the cylindricity distortion of the inner surface of the cell are considered. These are radial displacement and tube diameter inequality. Based on the finite element method (FEM), errors in measuring the resistance of a liquid column caused by the non-uniformity of the current density distribution inside the cell were determined. The methodological error with respect to the idealized model was estimated for each factor separately and in combination. The Authors show that at a radial displacement of 0.6 mm, the error can reach 0.1 %. The same error value occurs when the inequality of the diameters is only 20 μm.

Certification of extension tubes for medical use according to TIS 2385-2551

The extension tube is a medical device for delivering substances into or out of the body through blood vessels of the patient. To ensure the safety of users and promote the domestic production, the industrial product standard of extension tubes was established as Thai Industrial Standard (TIS) No. 2385-2551: Extension tubes for medical use. Bever Medical Industry (BMI) is a medical device company that manufactures and markets medical supplies for single use. At present, the overall physical requirements standard of extension tubes has not been accredited according to ISO/IEC 17025. This study aims to certify the physical test of extension tubes for medical use and to implement the laboratory quality management system according to ISO/IEC 17025. We set up a laboratory to perform the physical test of extension tubes according to TIS 2385-2551. The measuring equipment was applied appropriately and calibrated by accredited laboratories to ISO/IEC17025 related to metrological traceability. The established laboratory performed the evaluation of measurement uncertainty for some testing and reported the results to the customer as a test certification report. In this study, a total of 1.75 million pieces of extension tubes have been certified the quality improvements. Therefore, it is valuable for entrepreneurs, importers, and exporters in both domestic and international markets.

Preparation/administration of push-dose versus continuous infusion epinephrine and phenylephrine: A simulation

BackgroundHypotension is a common problem in the emergency department (ED) and intensive care unit (ICU) and can increase risk for poor outcomes. Many EDs/ICUs utilize epinephrine and phenylephrine to treat hypotension and these medications are most often administered as a continuous infusion (CI). Push-dose (PD) is the administration of small medication doses as intermittent intravenous pushes (IVPs). There is limited information comparing the time required to prepare and administer PD versus CI and errors have been reported when preparing and administering these medications at bedside. This simulation study sought to estimate preparation and administration times and preparation and errors with PD and CI epinephrine and phenylephrine when prepared by an ED/ICU pharmacist. MethodsThis crossover simulation study took place in a simulation center at an academic medical center and utilized a multi-venous intravenous training arm kit equip with an 18-gauge intravenous line, an extension tubing set, and a luer-lock adapter. The primary outcome was total preparation and administration time in seconds. The secondary outcome was major preparation and administration errors, defined as errors causing a five-fold or greater overdose. ResultsIn total, 16 pharmacists participated, including nine ED and seven ICU pharmacists. PD had faster total preparation and administration time and administration time, but not preparation time; PD showed an approximate 70 s decrease in total preparation and administration time versus CI. PD had more major preparation and administration errors and six PD preparations (18.8%, 6/32) had at least one major preparation and administration error. CI, on the other hand, had no major preparation and administration errors. DiscussionThis simulation found faster total preparation and administration time with PD versus CI epinephrine and phenylephrine, but also found that PD had more major preparation and administration errors. Dilutional errors during medication preparation were the cause of 83.3% (5/6) of our overdoses. ConclusionThis simulation study showed that ED/ICU pharmacists had faster median total preparation and administration times for PD epinephrine and phenylephrine versus CI, but PD also had more preparation and administration errors.

Interactions among rainfall, fire, forbs and non-native grasses predict occupancy dynamics for the endangered Pacific pocket mouse (Perognathus longimembris pacificus) in a Mediterranean-type ecosystem

It is important to understand species-habitat relationships to implement effective adaptive management for rare species. However, it can be challenging to assess habitat associations and their relationships to abiotic stressors in dynamic habitats without the insights that can be gained from long-term monitoring. We report results from the first six years of extensive track tube monitoring of the largest two of three remaining extant populations of federally endangered Pacific pocket mouse (Perognathus longimembris pacificus) in a coastal Mediterranean-type ecosystem on Marine Corps Base, Camp Pendleton in southern California, USA. We used dynamic occupancy and structural equation modeling to assess potential drivers of population trends that included habitat, fire history, rainfall, disturbance, and the presence of other small mammals. We found that the variables that best predicted mouse occupancy were moderate to high forb and perennial herb cover (40–80%), and moderate to high open ground (20–70%) and low non-native grass cover (<20%), Non-native grass cover (>20%) was also a strong predictor of lower PPM colonization and increased extinction probabilities, with the extent of non-native grass cover being strongly influenced by annual rainfall and recency of fire. Our study adds to the growing literature on effects of invasive annual grasses on native species in Mediterranean-type ecosystems. We suggest that habitat management could be based upon promotion of open forb and perennial herb dominated habitats with reduction of non-native grasses by prescribed fire and other methods. These types of spatial and temporal monitoring programs can support land managers by creating a monitoring and management feedback loop. They can reveal landscape and environmental variables associated with species persistence, inform habitat management goals, and help managers to assess the success of management actions on populations of conservation concern.

Experimental investigation on shock wave propagation and spontaneous ignition of high-pressure hydrogen release through a sho (ϸ)-shaped extension tube into the atmosphere

The geometry of the extension tube has a great influence on the shock wave propagation and spontaneous ignition of high-pressure hydrogen release in this paper, piezoelectric pressure transducers, photodiodes and a high-speed camera are used to study the shock wave propagation and spontaneous ignition of high-pressure hydrogen released to the downstream sho (ϸ)-shaped extension tube. Experimental results show that the intensity of the leading shock wave is weakened due to the presence of branches when it propagates in the straight section of the sho-shaped tube, and a strong reflected shock wave is generated in the bend section. Spontaneous ignition is more prone to occur in the bend section than in the straight section, with a large optical signal value and long flame duration. However, due to the complex structure of the extension tube, there are still cases of the hydrogen flame extinguishing inside the tube even under high burst pressure. The flame detection time after the leading shock wave at the measured positions decreases with increasing burst pressure, and the time in the bend section is greater than that of the straight section. Radial flame expansion, flame separation, downstream flame extinction and upstream flame development, primary jet fire and secondary jet fire are successively observed outside the tube.

Detection of the Vesical Arteries Using Three-dimensional Digital Subtraction Angiography Relevant to Intra-arterial Infusion Chemotherapy for Bladder Cancer Using Double-balloon Catheters.

This study aims to assess and measure the origin of the superior vesical artery and its distance from the anterior trunk of the internal iliac artery, to which the anticancer drug is infused via double-balloon-occluded arterial infusion bladder-preserving therapy for locally invasive bladder cancer. The 160 pelvic sides of 80 patients were analyzed. Double-balloon catheters were bilaterally introduced into the contralateral superior gluteal artery via the internal iliac arteries using a bilateral transfemoral approach. The proximal balloon is placed at the internal iliac artery, proximally from superior gluteal artery bifurcation, whereas the distal balloon at the origin of the superior gluteal artery to isolate the anterior trunk of the internal iliac artery discharging to the targeted vesical arteries between the balloons. The side hole between the distal and proximal balloons was adjusted at the origin of the anterior trunk of the internal iliac artery to allow clear visualization of the angiographic flow into the bladder. After the distal and proximal balloons were inflated, three-dimensional rotational digital subtraction angiography was performed by simultaneous contrast injection from one extension tube connected to bilateral catheters. The distance (X) between the origins of anterior trunk of the internal iliac artery and superior vesical artery was measured on three-dimensional digital subtraction angiography images, and the origin of the inferior vesical artery was investigated. All superior vesical artery originated from anterior trunk of the internal iliac artery. The mean x was 7.2 mm (range 1.0-22.0 mm). All inferior vesical arterys branched from anterior trunk of the internal iliac artery or its branches. Superior vesical artery commonly originates from the proximal portion of anterior trunk of the internal iliac artery close to superior gluteal artery bifurcation.

WEO Newsletter.

WEO Newsletter.

The versatility of the transnasal sphenopalatine ganglion block.

Dear Editor, We read with great interest the article by Ferjani et al.1 on how a patient’s headache from a postoperative spinal dural tear was successfully relieved with a bilateral transnasal sphenopalatine ganglion block. This is a simple and valuable technique that was discovered in 1908, but few anesthesiology or pain physicians are familiar with the block and its versatility. Intranasal devices for the administration of the transnasal sphenopalatine ganglion block are available but are expensive and might not be readily available at all institutions. To safely and inexpensively perform the transnasal sphenopalatine ganglion block to treat headaches and also extend the treatment to other types of pain, we have created our own device from supplies that are readily accessible in most medical facilities. For our transnasal sphenopalatine ganglion block applicator, we attached a 3-mL syringe (filled with 4% lidocaine hydrochloride solution) to one side of intravenous extension tubing with a stopcock, and we attached a hollow cotton swab dipped into 5% lidocaine ointment to the other side of the tubing. The patients position themselves supine with neck extension and hemodynamic monitoring. The applicator is gently advanced perpendicular to the patient’s nostril until the tip reaches the back of the nasal pharynx and gentle resistance is met. Lidocaine 4% is administered slowly under low pressure through the cotton-tipped applicator until the medication is felt in the back of the throat. A second applicator is then inserted into the opposite nostril, and the medication is administered as before. Symptoms are evaluated 15 minutes after insertion. If the symptoms are not sufficiently relieved, this procedure is repeated up to 2 more times. In our experience, this transnasal sphenopalatine ganglion block has successfully relieved the pain amenable to sphenopalatine ganglion blockade; importantly, this approach has not had a technical failure.