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Obstetric Analgesia
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
The adult epidural needle is usually 16 G and 9 cm in length, with markings at 1 cm in length. The Tuohy needle is specially designed with a curved bevelled tip. This tip design helps in better perception as the needle tip pierces the various tissue structures and also helps in the threading of the catheter.
Epicardial Access and Indications
Published in Andrea Natale, Oussama M. Wazni, Kalyanam Shivkumar, Francis E. Marchlinski, Handbook of Cardiac Electrophysiology, 2020
Jason S. Bradfield, Kalyanam Shivkumar
An alternative to a Tuohy needle is a micro-puncture needle utilized in some centers. The potential benefit of this needle is its small caliber potentially limiting the size of any inadvertent RV access. One study found that despite similar rates of inadvertent RV puncture, the risk of developing a large pericardial effusion was significantly lower for the micro-puncture needle compared to the standard large-bore needle (8.1% vs. 0.9%).27 The potential downside of such a technique may be some loss of tactile feedback when tenting the pericardium. A needle-in-needle technique has also been reported.28
Epidural Anesthesia
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand
After the tip of the needle has been inserted into the posterior epidural space, the procedure is the same as for the lumbar epidural anesthesia. Hazards of injuring the spinal dura are probably reduced with the use of a Tuohy needle due to the 45° insertion routes: the rounded part of the needle will impinge on the spinal dura (if the needle is inserted with its bevel in a horizontal plane and turned cephalad) rather than the cutting edge, as occurs via lumbar approaches (due to the 90° insertion route).20,147
Advances in CSF shunt devices and their assessment for the treatment of hydrocephalus
Published in Expert Review of Medical Devices, 2021
Kamran Aghayev, Sheikh MA Iqbal, Waseem Asghar, Bunyad Shahmurzada, Frank D. Vrionis
LPS are considered less invasive than ventricular shunts. Historically (and occasionally nowadays) they employed a simple thin elastic tube inserted into the lumbar subarachnoid space via Tuohy needle. The other end is placed into the peritoneal cavity. Thin diameter, long length and internal slit valve are the principal mechanisms to restrict the flow. However, it is highly recommended to use additional valve/reservoir because if not used LPS shunts may result in orthostatic over drainage and acquired Chiari I malformation [9–11]. Singh et al. have conducted a comparative study for VPS and LPS and demonstrated 45.2 and 16.2%, respectively. They also show significantly different infection rates of 16.9 and 5.4% (p = 0.01) [12]. In a different study, conducted on an analytical cohort of 1182 patients where 347 patients underwent LPS and 735 patients underwent VPS placement, comparative failure rates of were 34.6 and 31.7%, respectively [13]. In the light of the aforementioned studies, it can be concluded that different studies report varying failure rates for different shunts. However, it can be seen that VPS currently are the most common shunt type used by most neurosurgeons.
Comparing between ultrasound-assisted epidural catheter placement using Accuro and the use of ultrasound real time with acoustic puncture-assisted device to confirm epidural space end point
Published in Egyptian Journal of Anaesthesia, 2020
In group II a curved array probe (Sonosite Edge™ Bothell, WA, USA) 2–5 MHz was selected. After draping and positioning the patient, the probe was applied over the sacrum and scanning in a paramedian oblique sagittal plane was performed as described by Tran et al. The probe was then moved cephalad to count the intervertebral spaces till the chosen intervertebral level [1,2]. when an optimal view of the intevertebral space is reached the epidural anesthesia procedure using a real-time US Guided technique was performed. A 17 G Tuohy needle was carefully advanced to the interlaminar space, under real-time US guidance, until the tip pierces the ligamentum flavum. The Tuohy needle is connected to the APAD device through it’s transducer. The diaphragm of the transducer senses the pressure changes as the needle is advanced through the ligaments. A sensor in the device records change in pressure, this pressure changes is represented as audible acoustic signal and visual graphics displayed on the device monitor. This audible sound will help confirmation of the position of the Tuohy needle as it progresses under vision of the ultrasound and signals the loss of resistance when the tip of the needle pierces the ligamentum flavum.
Patient-controlled fascia iliaca compartment block versus fentanyl patient-controlled intravenous analgesia in patients undergoing femur fracture surgery
Published in Egyptian Journal of Anaesthesia, 2018
Shaimaa F. Mostafa, Gehan M. Eid, Rehab S. Elkalla
At the end of the surgical procedure, group II patients received an US-guided FICB [12]. The block was performed using a high-frequency 5–10MHz linear transducer Sonosite Micromaxx (SonoSite, Inc. Bothell, WA). Firstly, sonographic visualization of the two fascial planes, the fascia lata and the fascia iliaca was performed as two hyperechoic lines, with the probe positioned on the thigh just inferior to the inguinal ligament in a transverse orientation and one-third of the distance between the pubic tubercle and the anterior superior iliac spine. A Tuohy needle (PERIFIX, B. BRAUN, Melsungen, Germany) was introduced percutaneously from lateral-to-medial then directed parallel to the transducer to allow continuous visualization of full needle length. The needle tip was visualized penetrating firstly the fascia lata and then the fascia iliaca and a 20 G catheter was introduced for about 15cm past the needle tip then tunneled through the skin. A loading dose of 35ml levobupivacaine 0.125% was injected. The catheter was removed after 48h.