Incidence of Postdural Puncture Headache in Caesarian Section a Comparison between 25 Gauge Quincke and 25 Gauge Pencil Point Spinal Needles

INTRODUCTION: The history of anaesthesiology is a rich mosaic of interwoven events around the world that have created and defined the specialty. From the days of the ancient Greeks and Romans to the modern operating rooms, the care of the patients remain challenging. With the introduction of general anesthesia in 1846 to the development of regional techniques, anaesthesia has been a evolving specialty. The complications of general anaesthesia led to the discovery of regional anaesthesia. Spinal anesthesia developed in late 1800s with the work of Wynter, Quincke and Corning. The term “ spinal anaesthesia” was coined by Leonard Corning in 1885. Later in 1898, Karl August Bier injected 10 – 15 mg cocaine into subarachanoid space of seven patients, himself and his assistant Hildebrandt. Bier, Hildebrandt and four of the patients described symptoms associated with postdural puncture headache (PDPH). Bier was first to describe postdural puncture headache and attributed this headache to excessive loss of cerebro spinal fluid. It has been over one hundred years since Dr. Bier experienced and wrote about the first reported postdural puncture headache. The incidence of PDPH was as high as 66% with large gauge medium bevel cutting needles, which reduced to 3-25% with 25 gauge cutting needles which further reduced to 0-14% with 25 gauge pencil point needles. Thus, in the last 50 years with the development of fine gauge needles and needle tip modification, there is a significant reduction in the incidence of postdural puncture headache. The incidence of PDPH is high in obstetric population because of their young age, sex and wide spread use of central neuroaxial blocks. PDPH is the third most common reason for litigation in obstetric anaesthesia. Despite obvious advantages of regional over general anaesthesia for obstetrics, regional techniques was not popularized. The period from 1930 to 1950 has often been referred to “dark ages of obstetric anaesthesia”. In 1951, after the development of pencil point spinal needles by Whitacre and Hart, and changes in needle tip design, there was a significant reduction in incidence of postdural puncture headache. This randomized control study, was done in Government RSRM hospital, affiliated to Government Stanley Medical College, Chennai. The aim of the study is to compare the incidence of PDPH with 25 gauge Quincke and 25 gauge pencil point spinal needles in patients undergoing caesarian section under spinal anesthesia. AIM OF STUDY: To compare the incidence of postdural puncture headache with 25 gauge Quincke and 25 gauge pencil point spinal needles in patients undergoing caesarian section under spinal anesthesia. MATERIALS AND METHODS: Inclusion Criteria: 1. Patient age group 17 – 35 years. 2. Singelton uncomplicated pregnancy of gestational age > 32 weeks. 3. ASA 1, 2 patients. Exclusion Criteria: 1. Pregnancy induced hypertension. 2. Cardio vascular disorders. 3. Hypovolemia and shock. 4. Obesity. 5. Infection of the back. 6. Anticoagulant therapy. 7. Patients requiring more than one attempt. 8. Patients with history of migraine. MATERIALS: 1. 25 gauge Quincke and 25 gauge pencil point spinal needles. 2. 0.5% hyperbaric bupivacaine ampoules. 3. IV cannulae, monitors. 4. Drugs for general anaesthesia in case of inadequate block. 5. Emergency drugs. METHODS: 1. Patients were randomly divided into two groups by systematic randomization. 2. Group one : Patients who received spinal anaesthesia with 25G pencil point needle (study group). 3. Group two : Patients who received spinal anaesthesia with 25G Quincke needle (control group). 4. Written informed consent was obtained from all patients. 5. All techniques was done by third year postgraduate in Anaesthesiology. 6. Detailed history of present and past medical illness was obtained. 7. Routine urine and blood investigations were done. 8. General and systemic examinations were done. RESULTS: The study was conducted in Government RSRM Hospital, affiliated to Government Stanley medical college, Chennai. A random sample of 120 patients undergoing caesarian section under spinal anesthesia was selected from the population. Patients were randomized systematically by numbering them. All odd numbered patients were in the study (pencil point ) group and even numbered patients were in the control (Quincke) group. The continuous data was assessed by means and Standard Deviation (SD). The discrete data was assessed in number and percentage. Chi-square test and Fisher’s Exact test for determining the difference between groups. P value < 0.05 was considered statistically significant. SUMMARY: We studied the incidence of PDPH using two different spinal needles. Group one using 25 gauge non cutting (pencil point) spinal needle and group two using 25 gauge cutting spinal needle (Quincke) in patients under going elective or emergency caesarian section. There was no statistical significant differences between groups in demographic data. There was no significant difference in patients under going elective or emergency caesarian section between the two groups. There was statistically significant rate of decreased incidence of PDPH in the study group ( pencil point = 5%) compared to the control group (Quincke = 18.3% ). There was a statistically significant failure spinal anaesthesia in study group (pencil point = 16.7%) compared to the control group (Quincke = 3.3%). CONCLUSION: From this randomized control trial in 120 patients undergoing caesarian section, it was concluded that the incidence of PDPH was significantly low with 25 gauge non cutting bevel (pencil point = 5%) spinal needles compared with 25 gauge cutting bevel (Quincke = 18.3%) spinal needle. The incidence of failed spinal anaesthesia was significantly more in non cutting (pencil point= 16.7%) spinal needles than cutting (Quincke = 3.3%) spinal needles

Enabling Technologies for Co-Robotic Translational Ultrasound and Photoacoustic Imaging

Among many medical imaging modalities, medical ultrasound possesses its unique advantages of non-ionizing, real-time, and non-invasive properties. With its safeness, ease of use, and cost-effectiveness, ultrasound imaging has been used in a wide variety of diagnostic applications. Photoacoustic imaging is a hybrid imaging modality merging light and ultrasound, and reveals the tissue metabolism and molecular distribution with the utilization of endo- and exogenous contrast agents. With the emergence of photoacoustic imaging, ultrasound and photoacoustic imaging can comprehensively depict not only anatomical but also functional information of biological tissue. To broaden the impact of translational ultrasound and photoacoustic imaging, this dissertation focuses on the development of enabling technologies and the exploration of associated applications. The goals of these technologies are; (1) Enabling Technologies for Translational Photoacoustic Imaging. We investigated the potential of maximizing the access to translational photoacoustic imaging using a clinical ultrasound scanner and a low-cost light source, instead of widely used customized data acquisition system and expensive high power laser. (2) Co-robotic Ultrasound and Photoacoustic Imaging. We introduced a co-robotic paradigm to make ultrasound/photoacoustic imaging more comprehensive and capable of imaging deeper with higher resolution and wider field-of-view.(3) Advancements on Translational Photoacoustic Imaging. We explored the new use of translational photoacoustic imaging for molecular-based cancer detection and the sensing of neurotransmitter activity in the brain. Together, these parts explore the feasibility of co-robotic translational ultrasound and photoacoustic imaging

Embedded wireless intracranial pressure monitoring implant at microwave frequencies

Intracranial Pressure (ICP) monitoring is a significant tool that aids in the management of neurological disorders like hydrocephalus, head trauma, tumors, colloid cysts, cerebralhematomas etc. ICP is the pressure exerted on the rigid, bony skull by its constituents that are brain, cerebrospinal fluid, and the cerebral blood. Increased ICP can lead to brain damage, disability, and death. Various modalities have been developed for the monitoring of ICP in hospitals and in ambulatory conditions. Currently, only catheter based systems have made it to the clinical practice. The catheter based systems can only be used in a hospital setting, and have a limited useful life due to drift and risk of infection.The motivation for this research was the intent to develop a completely implantable, wireless ICP monitoring implant that can provide long-term monitoring of the pressure in ambulatory conditions. The uniqueness of this work is accentuated by the ability of the implant to transmit at 2.4 GHz. These implants have undergone a battery of tests in the in-vitro and invivo (canine) studies during which the feasibility of microwave transmission through scalp was established. Long-term animal studies were conducted to determine the integrity,biocompatibility, and the performance of the implant in a biological environment. Animal studies for long durations with epidural implants showed a thickening of the dura mater undersensor area. Therefore, the effect of dural thickness on the sensitivity of pressure sensing mechanism was simulated. The histo-pathological examination of the tissue specimens thatwere excised at the termination of an animal study showed the presence of lymphocytes, and fibrous tissue which is a normal immunological reaction to a foreign body. These tests did not reveal any toxicity due to the presence of the implant. In the animal studies that were conducted with sub-dural implants, a correlation coefficient of 0.94 and better was determined between the gold standard for ICP monitoring and our implant. In our latest animal study a sub-dural implant has been successfully tested in an animal for a duration of one month, thus proving the reliability of the implant packaging and its performance for a long-duration ICP monitoring application. This study also underscores the applicability of our ICP implant for monitoring of traumatic brain injuries, among other applications.Ph.D., Biomedical Engineering -- Drexel University, 200

Haptics: Science, Technology, Applications

This open access book constitutes the proceedings of the 13th International Conference on Human Haptic Sensing and Touch Enabled Computer Applications, EuroHaptics 2022, held in Hamburg, Germany, in May 2022. The 36 regular papers included in this book were carefully reviewed and selected from 129 submissions. They were organized in topical sections as follows: haptic science; haptic technology; and haptic applications

Advancements and Breakthroughs in Ultrasound Imaging

Ultrasonic imaging is a powerful diagnostic tool available to medical practitioners, engineers and researchers today. Due to the relative safety, and the non-invasive nature, ultrasonic imaging has become one of the most rapidly advancing technologies. These rapid advances are directly related to the parallel advancements in electronics, computing, and transducer technology together with sophisticated signal processing techniques. This book focuses on state of the art developments in ultrasonic imaging applications and underlying technologies presented by leading practitioners and researchers from many parts of the world

Hysterectomy

This book is intended for the general and family practitioners, as well as for gynecologists, specialists in gynecological surgery, general surgeons, urologists and all other surgical specialists that perform procedures in or around the female pelvis, in addition to intensives and all other specialities and health care professionals who care for women before, during or after hysterectomy. The aim of this book is to review the recent achievements of the research community regarding the field of gynecologic surgery and hysterectomy as well as highlight future directions and where this field is heading. While no single volume can adequately cover the diversity of issues and facets in relation to such a common and important procedure such as hysterectomy, this book will attempt to address the pivotal topics especially in regards to safety, risk management as well as pre- and post-operative care

Volume 30, issue 6

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research. Visit the journal website at http://canjsurg.ca/ for more.https://ir.lib.uwo.ca/cjs/1220/thumbnail.jp

Hepatic Surgery

Longmire, called it a "hostile" organ because it welcomes malignant cells and sepsis so warmly, bleeds so copiously, and is often the ?rst organ to be injured in blunt abdominal trauma. To balance these negative factors, the liver has two great attributes: its ability to regenerate after massive loss of substance, and its ability, in many cases, to forgive insult. This book covers a wide spectrum of topics including, history of liver surgery, surgical anatomy of the liver, techniques of liver resection, benign and malignant liver tumors, portal hypertension, and liver trauma. Some important topics were covered in more than one chapter like liver trauma, portal hypertension and pediatric liver tumors