Real-time Ultrasound Guided Epidural Catheter Placement in Morbidly Obese Parturients after Unsuccessful Conventional Attempts
Alexandre Gnaho*, Clément Hoffmann, Sylvain Vico and Marc Emmanuel Gentili
Department of Anesthesia and Intensive care, Hôpital d’Instruction des Armées Begin, 69, Avenue de Paris, 94160 Saint Mandé, France
- *Corresponding Author:
- Alexandre Gnaho
Department of Anesthesia and Intensive care
Hôpital d’Instruction des Armées Begin
69, Avenue de Paris, 94160 Saint Mandé, France
Tel: +33(0) 6 6115 6998
Fax: +33(0) 1 4398 5401
E-mail: [email protected]
Received date: November 09, 2013; Accepted date: November 28, 2013; Published date: November 30, 2013
Citation: Gnaho A, Hoffmann C, Vico S,. Gentili ME (2013) Real-time Ultrasound Guided Epidural Catheter Placement in Morbidly Obese Parturients after Unsuccessful Conventional Attempts. J Anesth Clin Res 4:370. doi: 10.4172/2155-6148.1000370
Copyright: © 2013 Gnaho A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Several studies have emphasized the usefulness of preprocedural Ultrasound (US) assessment of lumbar spine. Despite those helpful informations this procedure may remain challenging. This report evaluates the effectiveness of a Real Time US Guided Epidural Anesthesia (RTUGEA) in morbidly obese patients as usual loss of resistance technique combined with a preinsertion US assessment of lumbar spine had failed.
We performed successfully RTUGEA, in ten morbidly obese parturients. The epidural space was identified in all patients and one to three attempts was necessary to reach the epidural space. The tip of Tuohy needle was not visible in 4 cases. We were able to identify the catheter in one out of ten cases. None inadvertent dural puncture was recorded. Recovery from epidural analgesia was uneventful in all cases.
To our knowledge, there is no published data on real time ultrasound guided epidural anesthesia in morbidly obese patients. Our data support the usefulness in morbidly obese patients of a RTUGEA for lumbar access. Further extended and randomized study is needed to assess safety and efficacy of such procedure.