Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University, Rome, Italy -
Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University, Rome, Italy.
Minerva Anestesiol. 2020 Jul;86(7):736-741. doi: 10.23736/S0375-9393.20.14031-8. Epub 2020 Mar 6.
The detection of epidural space is usually performed by the technique of loss of resistance (LOR) without technological support, although there are few commercial options. In this work, we aimed to assess the feasibility of a new, non-invasive, mechatronic system for LOR detection in clinical settings. The system allows monitoring the pressure exerted on the syringe plunger by the clinician during the puncture. The LOR is related to the mentioned pressure.
Pressure exerted on the syringe plunger by an expert anesthesiologist was monitored using the proposed system. 58 epidural punctures were performed on 34 patients using six configurations with different sensitivities and ranges of measurements. The system capability in LOR detection was evaluated comparing the LOR detected by the system with the feedback provided by the clinician. The procedure time was estimated using the system and without its use.
The detection of LOR is strongly related to the system configuration; it ranged from 93.3% to 27.7%, while 3 configurations never detected it. The procedure time showed a non-significant increase (p=0.56) using the proposed system (average time 71 s vs. 62 s).
The proposed mechatronic system successfully detected the LOR in the large part of cases using the configurations characterized by the best trade-off between system sensitivity and range of measurements. A non-significant increment of the procedure time is related to the use of the system.
硬膜外腔的检测通常是在没有技术支持的情况下通过阻力损失（LOR）技术进行的，尽管有一些商业选择。在这项工作中，我们旨在评估一种新的、非侵入性的机电系统在临床环境中用于 LOR 检测的可行性。该系统允许监测临床医生在穿刺过程中对注射器柱塞施加的压力。LOR 与所述压力有关。
使用提出的系统监测专家麻醉师对注射器柱塞施加的压力。在 34 名患者中进行了 58 次硬膜外穿刺，使用六种具有不同灵敏度和测量范围的配置进行。通过将系统检测到的 LOR 与临床医生提供的反馈进行比较，评估系统在 LOR 检测中的能力。使用和不使用系统估计了程序时间。
LOR 的检测与系统配置密切相关；它的范围从 93.3%到 27.7%，而有 3 种配置从未检测到它。使用提出的系统，程序时间显示出无显著性增加（p=0.56）（平均时间为 71 秒对 62 秒）。
提出的机电系统使用灵敏度和测量范围之间具有最佳折衷的配置成功地检测了大部分 LOR。程序时间的非显著性增加与系统的使用有关。
