Among various techniques of regional anesthesia, peripheral nerve blocks (PNB) consist in anesthetizing only one single limb or one specific anatomical area. A huge body of scientific evidence now demonstrates that PNBs are of major interest during perioperative patient care in many surgical specialties. As a matter of fact, PNBs are even frequently superior to general anesthesia. The most important benefits of PNBs are found in outpatient surgery (1), in orthopedic surgery (2), but also in improving the overall quality of postoperative analgesia (3), at rest but especially during mobilization (i.e. long lasting blocks, perineural catheters).
However, the PNB techniques require expertise and technical skills, since it is necessary to inject the local anesthetic in close vicinity of nerve trunks or nerve roots in order to interrupt the nerve impulses.
The overall safety of these techniques requires mastering all potential complications, which, although exceptional, can be major when they occur (i.e. nerve lesion, seizure, cardiac arrest, to name only the most serious). These complications may be caused either by a mechanical trauma (nerve damage by the needle), or by toxicity of the administered local anesthetic (all local anesthetics show neurological toxicity, and some also cardiac toxicity). To summarize, safety in regional anesthesia requires the ability to avoid injecting local anesthetic intraneurally as well as intravascularly, and in reducing the injected doses.
Historically speaking, PNBs were initially performed using a blind technique (seeking paresthesias), then more recently using nerve stimulation, and since now a decade by using ultrasound guidance (USG).
Ultrasound-guided regional anesthesia (USGRA) has allowed reaching the safety standards and reducing complications as never before (4). When using US-guidance the anesthesiologist is able to identify the various anatomical structures and thus adapt the procedure to inter-individual anatomy. Furthermore, US-guidance allows real-time needle guidance and assessment of local anesthetic spread around neural structures. Visualizing the spread of local anesthetic allows a rapid and early diagnosis of intravascular or intraneural injection too. There is now also scientific evidence that US-guidance decreases the number of vascular punctures, as well as reduces the injected volumes of local anesthetics, while increasing the overall success rate of PNBs. Moreover, USGRA improves the patient comfort (5).
Ultrasonography is now part of the everyday tools for the anesthesiologist. This bedside technology is useful not only for regional anesthesia, but also for placing peripheral and central venous access with a reduced risk of complications, for bedside assessment of gastric emptiness before the induction of a general anesthesia, or for an early assessment of severe trauma patients (i.e. FAST protocols) (6). Ultrasonography is also a major tool in intensive care units (i.e. cardiac and thoracic ultrasonography). Putting all this together, it is no longer possible to imagine working as an anesthesiologist without having an immediate access to bedside high quality ultrasonography.
Ultrasound devices designed for the operating theatre must provide high quality of images, as well as the usual US modes (i.e. B, PW, CFM,
MUSICA image processing software
, /in Featured Articles /by 3wmediaA focus on Intraoperative Awareness
, /in Featured Articles /by 3wmediaWith the release of the Bollywood film
Image-guided surgery
, /in Featured Articles /by 3wmediaImage-guided surgery (IGS) involves correlating pre-surgical images of an operative area and its adjacent anatomic structures to a surgical instrument, and achieving this with a high degree of precision, in real time.
IGS, in some senses, can be considered as an enhancement of minimally invasive surgery (MIS), which became widespread during the 1980s and early 1990s. Like IGS, MIS too had the goal of providing precise access and reducing collateral damage to nearby tissue during a surgical procedure.
IGS and Computer Assisted Surgery
IGS is now seen as a key component of computer assisted surgery (CAS), a methodology to use computers in the surgical process, all the way from pre-operative planning to intervention and post-surgery assessments. The two terms were often used interchangeably in the past, and still overlap in several features and applications, such as the use of virtual or augmented reality.
However, given the emergence in its own right of another specialty application, robotic surgery, CAS is now differentiating itself from IGS.
Graphic processor capabilities drive IGS
Both CAS and IGS were driven by the explosive growth of computing power in the late 1990s and the consequent availability of structured patient information in the operating theatre.
IGS, however, has a more targeted heritage in the field of graphic processor units (GPUs). Aided by advanced algorithms in areas such as dynamic texture binding, texture sampling, rendering and image compositing, these have enabled
Healthcare and the cloud: towards a hCloud ?
, /in Featured Articles /by 3wmediaCloud computing is rapidly emerging as a preferred solution for the challenges of Big Data, mobility and access to information on demand, any time, from anywhere. Although a late arrival to the scene, healthcare has been making up for lost time in terms of embracing the Cloud.
Healthcare and Big Data
In reality, there is little choice. Healthcare is among the largest contributors to Big Data, not least because of the explosion in massive graphic files which constitute Picture Archiving and Communication Systems (PACS). Coping with exabytes of information, growing by the second, has made traditional physical storage a relic. Data storage has become virtual, with the computing process moving to the data rather than the other way round.
In the healthcare context, this is pertinent given that physician interaction with PACS and other clinical information systems is what gives the data meaning. With 75% of physicians using a smartphone and more than 10,000 mobile health applications already in use, healthcare carries some of the biggest and most exacting requirements for mobility, scalability and security.
The above scenarios are central to the Cloud computing offer, and they have guided its development and refinement from the outset.
The Cloud: enhancing healthcare quality and cost-effectiveness
Cloud computing technologies can assist healthcare providers
Sharing images across 11 UK trusts
, /in Featured Articles /by 3wmediaThe Cheshire and Merseyside Consortium is made up of eleven trusts in the area, including Aintree University Hospitals, Clatterbridge Centre for Oncology, Liverpool Community Health, Liverpool Heart and Chest Hospital, Liverpool Women
Anesthesia and mortality – concerns re-emerge
, /in Featured Articles /by 3wmediaGeneral anesthesia remains a major challenge for patients entering an operating room. In spite of an apparent fall in fatalities accompanying anesthesia use since the late 1940s, worries about
New frontiers in anesthesiology
, /in Featured Articles /by 3wmediaAnesthesiologists face a daunting task keeping up and adapting their practice to cope with the incessant advances in surgery, and to innovations within their own discipline.
Today
Regional anesthesia and ultrasound-guidance
, /in Featured Articles /by 3wmediaAmong various techniques of regional anesthesia, peripheral nerve blocks (PNB) consist in anesthetizing only one single limb or one specific anatomical area. A huge body of scientific evidence now demonstrates that PNBs are of major interest during perioperative patient care in many surgical specialties. As a matter of fact, PNBs are even frequently superior to general anesthesia. The most important benefits of PNBs are found in outpatient surgery (1), in orthopedic surgery (2), but also in improving the overall quality of postoperative analgesia (3), at rest but especially during mobilization (i.e. long lasting blocks, perineural catheters).
However, the PNB techniques require expertise and technical skills, since it is necessary to inject the local anesthetic in close vicinity of nerve trunks or nerve roots in order to interrupt the nerve impulses.
The overall safety of these techniques requires mastering all potential complications, which, although exceptional, can be major when they occur (i.e. nerve lesion, seizure, cardiac arrest, to name only the most serious). These complications may be caused either by a mechanical trauma (nerve damage by the needle), or by toxicity of the administered local anesthetic (all local anesthetics show neurological toxicity, and some also cardiac toxicity). To summarize, safety in regional anesthesia requires the ability to avoid injecting local anesthetic intraneurally as well as intravascularly, and in reducing the injected doses.
Historically speaking, PNBs were initially performed using a blind technique (seeking paresthesias), then more recently using nerve stimulation, and since now a decade by using ultrasound guidance (USG).
Ultrasound-guided regional anesthesia (USGRA) has allowed reaching the safety standards and reducing complications as never before (4). When using US-guidance the anesthesiologist is able to identify the various anatomical structures and thus adapt the procedure to inter-individual anatomy. Furthermore, US-guidance allows real-time needle guidance and assessment of local anesthetic spread around neural structures. Visualizing the spread of local anesthetic allows a rapid and early diagnosis of intravascular or intraneural injection too. There is now also scientific evidence that US-guidance decreases the number of vascular punctures, as well as reduces the injected volumes of local anesthetics, while increasing the overall success rate of PNBs. Moreover, USGRA improves the patient comfort (5).
Ultrasonography is now part of the everyday tools for the anesthesiologist. This bedside technology is useful not only for regional anesthesia, but also for placing peripheral and central venous access with a reduced risk of complications, for bedside assessment of gastric emptiness before the induction of a general anesthesia, or for an early assessment of severe trauma patients (i.e. FAST protocols) (6). Ultrasonography is also a major tool in intensive care units (i.e. cardiac and thoracic ultrasonography). Putting all this together, it is no longer possible to imagine working as an anesthesiologist without having an immediate access to bedside high quality ultrasonography.
Ultrasound devices designed for the operating theatre must provide high quality of images, as well as the usual US modes (i.e. B, PW, CFM,
Interdisciplinary cooperation between radiology and surgery: what can International Hospital (or the media generally) do to make this possible?
, /in Featured Articles /by 3wmediaThe origin of disciplines
If neither the knife nor the X-ray machine had been invented, there would be no disciplines of surgery or radiology as we understand them today. In short, tools themselves can lead to the creation of complex disciplines, be they medical or otherwise.
Many scientific and medical disciplines are, in principle, defined by tools or tool sets and the ability of certain humans to use them effectively and efficiently. Tools may be material artefacts or tools of thought and may indirectly lead to ethnocentric thinking and mesa-communication*.
For example in the case of Surgery, tool sets, such as knives and saws, and the art of using them, were developed over thousands of years by those devoted to healing. In modern times, the disciplines which were originally associated with these basic tools have evolved into a multitude of different surgical and interventional subspecialties, each with its own refined set of tools and instruments.
A similar situation can be observed for the discipline of Radiology. Since the discovery of the X-ray by Roentgen in 1895, radiology has evolved into a multitude of different diagnostic and therapeutic subspecialties that may be identified by their specialized sets of imaging tools and devices.
Finally, the discipline of Computer Science or informatics has managed over a period of only about 70-80 years to factor itself into some 40 specialities; a few of them are hardware tools but most are software tool-oriented.
It is interesting to note that some tool sets of these disciplines are in the process of being merged towards potentially creating a speciality defined as
Healthcare providers and social media
, /in Featured Articles /by 3wmediaIf the Internet and the Web were stepping stones to the Information Age at the end of the 20th century, social media seems to be opening the floodgates to the Connected World in the 21st.
Nearly everyone agrees that the impact of social media in the years to come is likely to be sweeping. A study by the University of California at San Diego found that rather than being a parallel world, Facebook is becoming an extension, even an