Preanesthetic Clinic Research Articles

Effectiveness and Validity of Preoperative Ultrasonographic Airway Assessment and Clinical Screening Tests to Predict Difficult Laryngoscopy: A Prospective, Observational Study.

The anticipation of a challenging airway can be demanding in emergency care settings. Due to the patient's clinical condition, executing the pre-intubation clinical screening tests during the management of the airway in an emergency situation can besometimes troublesome. Ultrasonographic airway assessment may become a helpful tool, but no specific sonographic measurements can precisely visualize the prospect of meeting a difficult airway. Therefore, the present study aimed to verdict some correlation between preoperative sonographic airway assessment parameters and the Cormack-Lehane (CL) grading at laryngoscopic view in patients undergoing general anesthesia with endotracheal intubation. Thisobservational study was conducted on 150 elective surgery subjects undergoing general anesthesia. The clinician in the pre-anesthetic clinic performed clinical airway and ultrasonographic airway assessments to predict difficult intubation and correlated with the CL grade viewed at laryngoscopy in the operative room during intubation. The parameters assessed were sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). In this study, the incidence of difficult intubation was 13.3%. The Mallampatti Grading (MPG) showed the maximum receiver operating characteristic (ROC) and area under the curve (AUC) among the clinical predictors, with 86.7% sensitivity. At the same time, the skin-to-hyoid distance has the maximum ROC among the sonographic parameters, and the skin-to-thyroid isthmus has the utmost sensitivity to predict difficult laryngoscopy. Among the clinical predictors, MPG and the sonographic parameters, like the skin-to-hyoid distance and skin-to-thyroid isthmus, are favorable predictors of difficult laryngoscopy.

Development and internal validation of an algorithm to predict intraoperative risk of inadvertent hypothermia based on preoperative data

Intraoperative hypothermia increases perioperative morbidity and identifying patients at risk preoperatively is challenging. The aim of this study was to develop and internally validate prediction models for intraoperative hypothermia occurring despite active warming and to implement the algorithm in an online risk estimation tool. The final dataset included 36,371 surgery cases between September 2013 and May 2019 at the Vienna General Hospital. The primary outcome was minimum temperature measured during surgery. Preoperative data, initial vital signs measured before induction of anesthesia, and known comorbidities recorded in the preanesthetic clinic (PAC) were available, and the final predictors were selected by forward selection and backward elimination. Three models with different levels of information were developed and their predictive performance for minimum temperature below 36 °C and 35.5 °C was assessed using discrimination and calibration. Moderate hypothermia (below 35.5 °C) was observed in 18.2% of cases. The algorithm to predict inadvertent intraoperative hypothermia performed well with concordance statistics of 0.71 (36 °C) and 0.70 (35.5 °C) for the model including data from the preanesthetic clinic. All models were well-calibrated for 36 °C and 35.5 °C. Finally, a web-based implementation of the algorithm was programmed to facilitate the calculation of the probabilistic prediction of a patient’s core temperature to fall below 35.5 °C during surgery. The results indicate that inadvertent intraoperative hypothermia still occurs frequently despite active warming. Additional thermoregulatory measures may be needed to increase the rate of perioperative normothermia. The developed prediction models can support clinical decision-makers in identifying the patients at risk for intraoperative hypothermia and help optimize allocation of additional thermoregulatory interventions.

A Real-Time Artificial Intelligence-Assisted System to Predict Weaning from Ventilator Immediately after Lung Resection Surgery.

Assessment of risk before lung resection surgery can provide anesthesiologists with information about whether a patient can be weaned from the ventilator immediately after surgery. However, it is difficult for anesthesiologists to perform a complete integrated risk assessment in a time-limited pre-anesthetic clinic. We retrospectively collected the electronic medical records of 709 patients who underwent lung resection between 1 January 2017 and 31 July 2019. We used the obtained data to construct an artificial intelligence (AI) prediction model with seven supervised machine learning algorithms to predict whether patients could be weaned immediately after lung resection surgery. The AI model with Naïve Bayes Classifier algorithm had the best testing result and was therefore used to develop an application to evaluate risk based on patients’ previous medical data, to assist anesthesiologists, and to predict patient outcomes in pre-anesthetic clinics. The individualization and digitalization characteristics of this AI application could improve the effectiveness of risk explanations and physician–patient communication to achieve better patient comprehension.

Pre-anesthetic clinic internship: new teaching method of pre-anesthesia evaluation for undergraduates.

BackgroundThis study aimed to observe the effect of internship in a pre-anesthetic clinic on the teaching quality of pre-anesthesia evaluation for undergraduates.MethodsA total of 120 undergraduates from July 2017 to July 2018 in the anesthesia department of our hospital were randomly divided into two groups: pre-anesthetic clinic internship teaching group (n = 60) and traditional teaching group (n = 60). The knowledge in the pre-anesthesia evaluation teaching chapters was evaluated between the two groups of undergraduates.ResultsThere were no significant differences in the demographic information between the two groups. The scores in the case analysis and theoretical knowledge test in the pre-anesthetic clinic internship teaching group were significantly higher than those in the traditional teaching group. In addition, the students' satisfaction with the curriculum design was significantly higher in the pre-anesthetic clinic internship teaching group than in the traditional teaching group.ConclusionPre-anesthetic clinic internships can improve the quality of pre-anesthesia assessment teaching for undergraduates.

Assessment of Proportion of Surgical Patients with

Obstructive sleep apnea is the most common type of sleep disorder breathing.90%of them remain undiagnosed. These patients may be associated with an increased risk of perioperative complications. Our objective was to evaluate the proportion of surgical patients with risk of undiagnosed Obstructive sleep apnea. After research ethics board approval, patient attending preanesthetic clinic were asked to fill the STOP-Bang questionnaire. Prospective observational study is used with the sample size of 70 patients and the study duration is 4 months. In 70 patients, the proportion of surgical patients with the increased(intermediate-high) of developing Obstructive sleep apnea is 78%(55 patients) This study is conducted to find out the percentage of surgical patients having undiagnosed Obstructive sleep apnea can be identified and treated to prevent perioperative complications.

Upper limb dimensions in adults presenting for elective surgery \u2013 implications for blood pressure measurement

BackgroundArm conicity is associated with non-invasive blood pressure (NIBP) measurement error and may be avoided by using finger cuffs. Predicting arm conicity may help decisions regarding NIBP measurement techniques.MethodsWe obtained upper limb measurements of adults presenting to the Pre-Anesthetic Clinic to determine: the suitability of arm and finger cuff sizes; the best anthropometric predictor of arm conicity based on the right arm slant angle; the incidence of a right arm slant angle < 83 degrees. Right mid-arm circumference (MAC) was compared to recommended cuff sizes and finger circumference compared to available cuffs. Slant angle was calculated from the measurements obtained. Linear regression was used to determine the better predictor of right arm slant angle. Correlation coefficients were calculated and R2 values compared.ResultsFour hundred fifty-four patients participated and 453 had cone-shaped arms. One participant (0.2, 95% CI 0.0–1.2) had a MAC outside the recommended cuff range. Twenty-five participants (5.5, 95% CI 3.6–8.0) had a middle finger circumference greater than the largest ClearSight™ cuff. Body mass index (BMI), weight and right MAC all had low to moderate correlation with right arm slant angle (r = − 0.49, − 0.39, − 0.48, all p < 0.001) and regression revealed R2 values of 0.24, 0.15 and 0.23. Six participants (1.3, 95% CI 0.5–2.9) had a slant angle < 83 degrees.ConclusionCurrent NIBP equipment caters for most patients, based on the traditional measure of MAC. The utility of finger cuffs is limited by cuff size. BMI and right MAC showed the most promise in predicting arm conicity.

Assessing Patients' Knowledge on Anesthesia Services at Tamale Teaching Hospital.

Anesthesia is one of the most significant developments of modern medicine that allows treatment involving unbearable pain to be performed while the person is relaxed, asleep, and with no memory of the procedure. However, patients around the world have little or limited knowledge regarding anesthesia. It is in view of that, this study was undertaken to assess patients’ knowledge on anesthesia services at a preanesthetic clinic and recovery wards of a teaching hospital in Northern Ghana. Descriptive quantitative survey was used to identify patients’ knowledge about anesthesia services with the purpose to observe, describe, and document the situation as it naturally occurs. Data obtained from 100 participants were double entered into Microsoft Excel spreadsheet and validated for data errors. Data were then coded and exported to SPSS version 20.0 for Windows for analysis. Descriptive statistics such as frequencies and percentages were used to describe data. The results showed that 53% of participants were aware of anesthesia services as opposed to 47%. However, 30% of the respondents could not identify the type of anesthesia services, while 68% did not know the route of administration of anesthetic agents. Most importantly, 51% had no idea of what an anesthetist is, while 33% knew nothing about the role anesthetists play in the health delivery system. As a result, 26% thought an anesthetist is the theatre nurse, while 25% were of the view that the doctor doubles as the anesthetist. Anesthetists must therefore make conscious efforts to disseminate information before and after surgeries and follow-up clients who underwent anesthesia to provide for continuity of care. This may include preparation of leaflets, brochures, videos, and handouts to improve patients’ knowledge and attitude and to disseminate it to all departments in the hospital where anesthesia services are provided.

Knowledge and perceptions about perioperative stroke: a cross-sectional survey of patients scheduled for non-neurologic and non-cardiac surgery.

Perioperative stroke is associated with significant morbidity and mortality yet patients may not be aware of their risk or receive appropriate counselling. Our objectives were to 1) compare patient's perceived vs calculated risk of stroke; 2) determine level of worry; and 3) assess prior discussion about perioperative stroke risk amongst elective patients undergoing non-cardiac, non-neurologic surgery. Over a consecutive four-week period, surveys were distributed at two pre-anesthetic clinics to adult patients scheduled for non-cardiac, non-neurologic surgery. The survey included questions about demographics, perioperative stroke risk factors, patient perception of their quantitative and qualitative stroke risk, level of worry about stroke, and risk discussions. We identified independent predictors of risk underestimation amongst medium- and high-risk patients. Six hundred patients completed the survey (response rate 78%). Of these, 479, 104, and 15 patients were classified as low-, medium-, and high-risk, respectively (with two patients missing this data point). Most medium- (86%) and high-risk (80%) patients did not identify their elevated risk. Amongst medium- and high-risk patients, independent predictors of risk underestimation were lower education and absence of kidney disease. Medium- and high-risk patients were more worried than low-risk patients about perioperative stroke (median [interquartile range] visual analogue scale score 2 [0.5-4] vs 1 [0-2], P = 0.001). Fewer than half of patients had discussed perioperative stroke previously (40%, 23%, and 12% of high-, medium-, and low-risk patients, respectively). Patients at higher risk of stroke frequently underestimate their risk of perioperative stroke. The majority of patients had not discussed perioperative stroke prior to anesthetic consultation.

Awareness and concern towards anesthesia among patients undergoing surgical procedure: A cross-sectional study at pre-anesthetic clinic of a Teaching Hospital

Background: With the advent of anesthesia, surgery is no longer a race against the clock and surgeons. Many studies in the past have demonstrated limited knowledge among patients about various aspects of anesthesia.Objectives: To assess the awareness and concern of elective surgical patients towards anesthesia.Methodology: A cross-sectional questionnaire survey was conducted over two months’ period in adult patients of age eighteen years and above. Two hundred surgical patients accessing services at the pre-anesthesia check-up clinic were interviewed using 12 questions assessing demographic characteristics, educational status and their knowledge about anesthesia.Results: Out of 200 patients, only 32% knew that anesthesiologists provide anesthesia. It was found that 63% didn’t have any knowledge about the types of anesthesia. The most common fear among the participants about anesthesia was the fear of pain during surgery.Conclusion: The study showed poor knowledge of patients regarding anesthesia.

É improvável que a cirurgia seja suficiente para que o paciente pare de fumar 24 horas antes da internação hospitalar

The need for surgery can be a decisive factor for long-term smoking cessation. On the other hand, situations that precipitate stress could precipitate smoking relapse. The authors decided to study the impact of a surgery on the patient's effort to cease smoking for, at least, 24h before hospital admission and possible relapse on the last 24h before hospital admission for ex-smokers.Smoker, ex-smokers and non-smokers adults, either from pre-anesthetic clinic or recently hospital admitted for scheduled elective surgeries that were, at most, 6h inside the hospital buildings were included in the study. The patients answered a questionnaire at the ward or at the entrance of the operating room (Admitted group) or at the beginning of the first pre-anesthetic consultation (Clinic group) and performed CO measurements.241 patients were included, being 52 ex-smokers and 109 never smokers and 80 non-smokers. Smokers had higher levels of expired carbon monoxide than non-smokers and ex-smokers (9.97±6.50 vs. 2.26±1.65 vs. 2.98±2.69; p=0.02). Among the smokers, the Clinic group had CO levels not statistically different of those on the Admitted group (10.93±7.5 vs. 8.65±4.56; p=0.21). The ex-smokers presented with no significant differences for the carbon monoxide levels between the Clinic and Admitted groups (2.9±2.3 vs. 2.82±2.15; p=0.45).A medical condition, such as a surgery, without proper assistance is unlikely to be enough for a patient to stop smoking for, at least, 24h prior to admission. The proximity of a surgery was not associated with smoking relapse 24h before the procedure.

Surgery is unlikely to be enough for a patient to stop smoking 24 h prior to hospital admission

IntroductionThe need for surgery can be a decisive factor for long-term smoking cessation. On the other hand, situations that precipitate stress could precipitate smoking relapse. The authors decided to study the impact of a surgery on the patient's effort to cease smoking for, at least, 24h before hospital admission and possible relapse on the last 24h before hospital admission for ex-smokers. MethodsSmoker, ex-smokers and non-smokers adults, either from pre-anesthetic clinic or recently hospital admitted for scheduled elective surgeries that were, at most, 6h inside the hospital buildings were included in the study. The patients answered a questionnaire at the ward or at the entrance of the operating room (Admitted group) or at the beginning of the first pre-anesthetic consultation (Clinic group) and performed CO measurements. Results241 patients were included, being 52 ex-smokers and 109 never smokers and 80 non-smokers. Smokers had higher levels of expired carbon monoxide than non-smokers and ex-smokers (9.97±6.50 vs. 2.26±1.65 vs. 2.98±2.69; p=0.02). Among the smokers, the Clinic group had CO levels not statistically different of those on the Admitted group (10.93±7.5 vs. 8.65±4.56; p=0.21). The ex-smokers presented with no significant differences for the carbon monoxide levels between the Clinic and Admitted groups (2.9±2.3 vs. 2.82±2.15; p=0.45). ConclusionA medical condition, such as a surgery, without proper assistance is unlikely to be enough for a patient to stop smoking for, at least, 24h prior to admission. The proximity of a surgery was not associated with smoking relapse 24h before the procedure.

Clinical Audit on the Practice of Documentation at Preanesthetic Evaluation in a Specialized University Hospital.

Background:Performing preanesthetic evaluation, documenting, and keeping readily accessible record are responsibilities of anesthetists. Documentation can improve overall patient outcome. It also has an irreplaceable role in medico-legal aspects. Documentation is one of the challenges of providing quality care.Aim:The aim of this study was to evaluate the quality of documentation practice during preanesthetic visits.Materials and Methods:This clinical audit was conducted in the University of Gondar Hospital. Predefined 22 practice quality indicators were prepared according to modified global quality index.Statistical Analysis:Descriptive statistics was performed using SPSS version 20.Results:A total of 122 preanesthetic evaluation tools (PAETs) were reviewed. None of PAETs found fully completed according to the indicators. Trends differ between elective and emergency conditions. Indicators with high completion rate (>90%) were signed a consent, medical history, history of medication, allergy, anesthesia and surgery, cardiopulmonary examination, airway examination, preoperative diagnosis, and planned procedure. Anesthetic plan, vital signs, a name, per-oral status, premedication, and age were found with below average (<50%) completion rate.Conclusions:Documentation practice during the preanesthetic visit was below the standard. Unclear instructions should be replaced with standardized contents. Providing regular trainings on clinical documentation for students and staffs, and introducing modern electronic-based documentation system and preanesthetic clinics may improve the practice.

Role of preoperative investigations in elderly patients undergoing oncosurgical procedures - A retrospective review audit.

Background and Aims:The aim of the study was to evaluate the efficacy and usefulness of the current practice of various investigations and consultations being done during preanesthetic evaluation in patients undergoing oncosurgical procedures in our hospital. We also evaluated the delay caused due to these and its value in predicting postoperative complications.Material and Methods:The preanesthetic charts of 300 elderly patients >65 years of age were reviewed, and the incidence of abnormal investigations and number of consultations advised were noted. The incidence and predictive values of these were assessed.Results:More than half the number of patients had more than one comorbidity and were advised various consultations based on history, National Institute of Clinical and Health Excellence (NICE) guidelines, and institutional protocol. Multiple visits to preanesthetic clinic were required in patients who had abnormal thyroid tests or respiratory complaints which was the main reason for delay in scheduling surgery. However, despite multiple comorbidities not more than 12.7% of the blood tests ordered were found to be abnormal. Abnormal blood tests were not significantly associated with higher incidence of postoperative complications.Conclusion:Blood investigations do not predict postoperative complication rate and do not influence anesthetic management of elderly patients undergoing oncosurgical procedures but are rather influenced by surgical procedure and presence of comorbidities. Hence, preanesthetic clinic should assess patients based on other predictive tests rather than relying on blood investigations alone.

Abnormal routine preoperative test results and their perioperative anesthetic impact in patients aged 60 years and more: An observational study

Background and Aim: Physiology of the human body changes with aging making physicians more inclined toward the use of routine preoperative investigations in the elderly to detect hidden abnormalities. The present study was aimed to assess the prevalence of abnormal test results and their impact on anesthetic management among patients aged 60 years or more. Methods: This observational study was conducted during December 2016 to April 2017. Data were collected by prospectively screening the files of the patients attending preanesthetic evaluation clinic (PAEC). Demographic parameters, physical status, surgery grade, normal and different abnormal test results, and their impacts were noted. Data were expressed in absolute numbers, percentage scale, and number needed to investigate (NNI). Central tendencies and dispersions were calculated using INSTAT software. Results: Data from file of 181 patients (mean + standard deviation age 66.69 + 5.89 years; 82 [45.30%] female) were collected. The median American Society of Anesthesiologists physical status was II and 59.67% underwent National Institute of Clinical and Health Excellence Grade 1 surgery. Entire patient attended PAEC with routine investigations done; 125 (69.06%) had at least one abnormality. Out of total 1275 tests done, 241 (18.90%) results were abnormal. Only 27 (11.20%) abnormality had an impact; 21 (77.78%) did not alter preoperative/anesthetic management but led to further testing, unnecessary consultation, and mean 3.84 days delay. The NNI for detecting one significant impact was 255. Conclusion: Majority of the patients aged 60 years or more were having at least one abnormal test results in routine preoperative tests but had minimal impacts in perioperative anesthetic management. It caused unnecessary further testing, consultation, and delay. Age per se should not be a criterion for ordering routine preoperative testing. The clinical trial registration number was CTRI/2018/01/011235.

The Prevalence Of Different Comorbidities Among Patients Reporting To Preanaesthetic Clinic In A Tertiary Care Hospital: A Prospective Observational study

Introduction : The role of anaesthesiologist has changed from providing anaesthesia during surgery to the role of perioperative physician. The aim of preoperative assessment is to identify prevailing comorbidity, assessment of control of pre-existing disease and optimising patient for surgery. In order to provide safe anaesthesia it is of prime importance to identify the presence of disease in preoperative period. Aim : To determine the prevalence of different comorbidities among patients reporting to preanaesthetic clinic (PAC). Result : A total 5124 patients were studied in a period of 6 months. A total of 1724 comorbodities were identified in 1274 patients. Out of these 1374 diseases were identified for the first time in PAC. The most common abnormality detected was ECG changes. Discussion : Identification of pre-existing comorbidities in the preoperative clinic is imperative for optimal management of patient. Knowledge of pre-existing disease will help to formulate screening strategies in the preanaesthetic clinic. Conclusion : The finding of this study demonstrates the importance of a pre anesthetic clinic in detecting hidden co morbid condition in a sizeable patient population.

Anesthetic management of a patient with Marfan syndrome and severe aortic root dilatation undergoing cholecystectomy and partial hepatic resection

Due to high mortality associated with aortic dissection, anesthetic management of patients with Marfan syndrome with severe aortic root dilation is a challenging situation. We describe the anesthetic management of a patient with Marfan syndrome with severe aortic root dilation, who required major surgery like cholecystectomy with partial liver resection under general anesthesia. A 47-year-old female presented to pre-anesthetic clinic for cholecystectomy with partial hepatic resection for gall bladder carcinoma. Clinical features, transthoracic echocardiography and computed tomography of thorax supported a diagnosis of Marfan syndrome with severely dilated aortic root. Aortic dissection in patients with Marfan syndrome and severely dilated aortic root can be precipitated by major hemodynamic changes under anesthesia. Careful hemodynamic monitoring and avoidance of hemodynamic swings can prevent this life-threatening event.

Value of Specialized Preanesthetic Clinic for Cardiac and Major Vascular Surgery Patients

In a complicated and specialized population, such as patients undergoing cardiac and major vascular procedures, patients, clinicians, and hospitals may be best served and resources conserved with a specialized preanesthesia clinic. A specialized preanesthesia clinic for cardiac and major vascular procedures has a focused staff usually consisting of practitioners with cardiac and major vascular surgical care experience designed to address the patient evaluation, the information gathering, the necessary consultations, the required testing, and specific needs for the day of cardiac and major vascular surgery. Specialized preanesthesia clinics increase patient satisfaction and may also provide cost containment by decreasing the amount of indiscriminate ordering of expensive preoperative tests and potentially may decrease patient litigation. Resident trainee education can also be enhanced by a specialized preanesthesia clinic for cardiac and major vascular rotations. The ultimate goal of a specialized preanesthesia clinic is to ensure a safe and efficient perioperative cardiac and major vascular surgical experience in complicated patients undergoing complex procedures.

Use of the BATHE Method in the Preanesthetic Clinic Visit

In the primary care setting, use of the BATHE (Background, Affect, Trouble, Handling, and Empathy) method of interviewing has been shown to increase patient satisfaction. This technique is a brief psychotherapeutic method used to address patients' physical and psychosocial problems. The BATHE technique has not been evaluated in the perioperative setting as a way of improving patient satisfaction. In this study, we sought to determine whether satisfaction could be enhanced by use of the BATHE technique during the preoperative evaluation by anesthesiologists. Fifty cardiac and 50 general surgery patients were interviewed in the preanesthesia clinic (PAC) of an academic hospital. They were randomly enrolled in the BATHE group or the control group and asked to complete an anonymous satisfaction survey after their visit. This survey was modified from current studies and not validated elsewhere. The relative influence of the BATHE condition was examined as it pertained to interview duration, patient satisfaction, and patient report of the BATHE items being asked. Ninety-two percent of patients approached by the study group voluntarily enrolled. Patients interviewed using the BATHE method reported being asked about all BATHE questions significantly more often than control patients: t(98)=19.10, P=0.001 (95% confidence interval [CI]=2.59, 3.20). Patients in the BATHE group were more satisfied with their visit to the PAC than those in the control group: t(98)=5.37, P=0.001 (95% CI=0.19, 0.41). The use of the BATHE method did not significantly increase the amount of time physicians spent evaluating patients: t(98)=0.110, P=0.912 (95% CI=-1.519, 1.359). Use of the BATHE method in an academic medical center's cardiac and general PAC showed promising results in this preliminary study. A validated and fully developed survey instrument is needed before we can convincingly conclude that the BATHE method is an effective way of improving patient satisfaction.

Patient′s experiences and satisfaction with preanesthesia services: A prospective audit

Background:Patient satisfaction with the medical services is an important indicator of quality of healthcare but is seldom given importance in our country. It is difficult to measure patient satisfaction, especially in pre- and perioperative period.Materials and Methods:We conducted this audit by means of a questionnaire designed to assess preanesthetic clinic services in a large government hospital. A total of 200 patients were randomly selected to respond to a multiple item questionnaire.Statistical Analysis:A database was created and analyzed using Microsoft Excel.Results:95% patients filled the proforma. Most of the patients (60%) were not aware of the purpose of visit to preanesthetic clinic. Majority of them were attended in time by the doctors but most of them (60%) received fitness after 2 to 3 visits. Majority was not explained about the preanesthesia instructions. Most of them were not satisfied by amenities in hospital. Several studies have shown that a thorough preoperative examination can be as effective as an anxiolytic premedication and can increase quality of care. In our study, location of preanesthetic clinic and unable to get fitness in first visit (because of lack of coordination between doctors of various specialties) were the major hindrances.Conclusion:Measures should be taken to improve the functioning of preanesthesia clinic and patient satisfaction.

Ultrasonography as a Preoperative Assessment Tool: Predicting the Feasibility of Central Neuraxial Blockade

A woman with severe ankylosing spondylitis presented to the preanesthetic clinic before total hip arthroplasty. She had required general anesthesia with fiberoptic intubation after failed attempts at spinal anesthesia for previous hip surgery. Using a portable ultrasound unit, we identified an open L4-5 interlaminar space and offered the patient an ultrasound-guided spinal anesthetic. Dural puncture with a single needle pass was subsequently achieved with the aid of preprocedural ultrasound imaging. Ultrasound may be a useful preoperative assessment tool for assessing the feasibility of central neuraxial blockade when technical difficulty is anticipated.