Ultrasound And Regional Anesthesia Feb 2009

Ultrasound and Regional Anesthesia Jim Sparrow, MD UAB Anesthesia Grand Rounds February 9, 2009

Topics We Will Cover ,[object Object],[object Object],[object Object],[object Object]

Why This is Important ,[object Object],[object Object]

Introduction to the Basic Physics and Terminology of Ultrasound

Ultrasound Waves ,[object Object],[object Object],[object Object],[object Object],[object Object]

Ultrasound Wave Propagation ,[object Object],[object Object],[object Object],[object Object],[object Object]

Acoustic Velocity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

How is an Image Created from Soundwaves?

Image Creation ,[object Object],[object Object],[object Object],[object Object],[object Object]

Two Determinates of Ultrasound Image Quality ,[object Object],[object Object],[object Object],[object Object]

Signal Intensity ,[object Object],[object Object],[object Object]

Ultrasound Wave Interaction with Tissues ,[object Object],[object Object],[object Object],[object Object],[object Object]

Reflection of Ultrasound Waves ,[object Object],[object Object],[object Object],[object Object]

Refraction ,[object Object],[object Object],[object Object],[object Object],[object Object]

Optimal Image Resolution is a Balance

Attenuation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

5.0 Bone 1.3-3.3 Muscle 1.0 Kidney 0.5-0.94 Liver 0.63 Fat 0.18 Blood 0.002 Water Attenuation Coefficient (dB/cm at 1MHz) Body Tissue 7.8 Bone 1.71 Muscle 1.63 Kidney 1.65 Blood 1.65 Liver 1.34 Fat 0.18 Lung 0.0004 Air Acoustic Impedance (10 6 Rayls) Body Tissue

Attenuation and Frequency ,[object Object]

Overcoming Loss of Signal from Attenuation ,[object Object],[object Object],[object Object],[object Object],[object Object]

The Holy Grail: Better Resolution ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Axial Resolution ,[object Object],[object Object],[object Object]

Lateral Resolution ,[object Object],[object Object],[object Object]

Temporal Resolution ,[object Object],[object Object],[object Object],[object Object],[object Object]

Review of Ultrasound Technology ,[object Object],[object Object],[object Object],[object Object]

Basic Techniques of Ultrasound Guidance in Regional Anesthesia

All Ultrasound Guided Blocks Involve Three Steps 2 : ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Imaging Plane Options ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The ART 3 of Scanning ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Where is The Needle Coming From? ,[object Object],[object Object],[object Object],[object Object]

Advantages ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Disadvantages ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Reviewing the Basic Ultrasound Techniques

Literature Review: Ultrasound Use in Regional Anesthesia

Methods ,[object Object],[object Object],[object Object],[object Object],[object Object]

Basis of the Liu’s Review Article ,[object Object],[object Object],[object Object],[object Object]

Ultrasound Guided Upper Extremity Anesthesia ,[object Object],[object Object],[object Object],[object Object],[object Object]

Ultrasound Guided Upper Extremity Anesthesia Continued: Any Advantages? ,[object Object],[object Object],[object Object],[object Object],[object Object]

Bucking the Trend: Infraclavicular Blocks ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Ultrasound Guided Lower Extremity Anesthesia ,[object Object],[object Object],[object Object],[object Object],[object Object]

Local Anesthetic Volume in Lower Extremity Nerve Blockade ,[object Object],[object Object]

First Do No Harm ! ,[object Object],[object Object],[object Object]

Is There Evidence of Benefit in the Use of Ultrasound Guidance? ,[object Object],[object Object],[object Object],[object Object]

Is There a Safety Benefit in Using Ultrasound Guidance? ,[object Object],[object Object],[object Object],[object Object]

The Question Remains : Given that there is no definitive evidence of increased efficacy or safety benefit with the use of Ultrasound Guidance, is this a passing fad or is US guidance here to stay?

Sparrow’s Predictions ,[object Object],[object Object],[object Object]

Sparrow’s Beliefs ,[object Object],[object Object],[object Object],[object Object],[object Object]

Questions, Comments…..Standing Ovation……Call for an Encore?

Bibliography ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Ultrasound And Regional Anesthesia Feb 2009

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