Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore.
Department of Electrical and Comupter Engineering, Faculty of Engineering, National University of Singapore, Singapore, Singapore.
BMC Anesthesiol. 2019 Apr 16;19(1):57. doi: 10.1186/s12871-019-0726-6.
Neuraxial procedures are commonly performed for therapeutic and diagnostic indications. Currently, they are typically performed via palpation-guided surface landmark. We devised a novel intelligent image processing system that identifies spinal landmarks using ultrasound images. Our primary aim was to evaluate the first attempt success rate of spinal anesthesia using landmarks obtained from the automated spinal landmark identification technique.
In this prospective cohort study, we recruited 100 patients who required spinal anesthesia for surgical procedures. The video from ultrasound scan image of the L3/4 interspinous space in the longitudinal view and the posterior complex in the transverse view were recorded. The demographic and clinical characteristics were collected and analyzed based on the success rates of the spinal insertion.
Success rate (95%CI) for dural puncture at first attempt was 92.0% (85.0-95.9%). Median time to detection of posterior complex was 45.0 [IQR: 21.9, 77.3] secs. There is good correlation observed between the program-recorded depth and the clinician-measured depth to the posterior complex (r = 0.94).
The high success rate and short time taken to obtain the surface landmark with this novel automated ultrasound guided technique could be useful to clinicians to utilise ultrasound guided neuraxial techniques with confidence to identify the anatomical landmarks on the ultrasound scans. Future research would be to define the use in more complex patients during the administration of neuraxial blocks.
This study was retrospectively registered on clinicaltrials.gov registry ( NCT03535155 ) on 24 May 2018.
神经轴突程序通常用于治疗和诊断目的。目前，它们通常通过触诊引导的表面标志进行。我们设计了一种新的智能图像处理系统，该系统使用超声图像识别脊柱标志。我们的主要目的是评估使用自动脊柱标志识别技术获得的标志进行脊柱麻醉的首次尝试成功率。
在这项前瞻性队列研究中，我们招募了 100 名需要进行脊柱麻醉的手术患者。记录了 L3/4 棘突间空间的矢状面和后复合体的横断面超声扫描图像的视频。根据脊柱插入的成功率收集和分析了人口统计学和临床特征。
首次尝试硬膜外穿刺的成功率（95%CI）为 92.0%（85.0-95.9%）。检测到后复合体的中位数时间为 45.0 [IQR：21.9，77.3] 秒。程序记录的深度与临床医生测量的后复合体深度之间存在良好的相关性（r=0.94）。
这种新的自动超声引导技术获取表面标志的高成功率和短时间，可使临床医生有信心利用超声引导的神经轴突技术在超声扫描上识别解剖标志。未来的研究将定义在更复杂的患者中在神经轴突阻滞管理中的使用。
这项研究于 2018 年 5 月 24 日在 clinicaltrials.gov 注册（NCT03535155）。
