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4. Using LOR Syringe Probes as a Method to Reduce Errors in Epidural Analgesia -- a Robotic Simulation Study

Author

Davidor, Nitsan, Binyamin, Yair, Hayuni, Tamar, and Nisky, Ilana

Subjects
Computer Science - Robotics, Quantitative Biology - Neurons and Cognition
Abstract

Epidural analgesia involves injection of anesthetics into the epidural space, using a Touhy needle to proceed through the layers in the epidural region and a "loss of resistance" (LOR) syringe to sense the environment stiffness. The anesthesiologist's case experience is one of the leading causes of accidental dural puncture and failed epidural - the two most common complications of epidural analgesia. Robotic simulation is an appealing solution to help train novices in this task. Another benefit of it is the ability to record the kinematic information throughout the procedure. In this work, we used a haptic bimanual simulator, that we designed and validated in previous work, to explore the effect LOR probing strategies had on procedure outcomes. Our results indicate that most participants probed more with the LOR syringe in successful trials, compared to unsuccessful trials. Furthermore, this result was more prominent in the three layers preceding the epidural space. Our findings can assist in creating better instructions for training novices in the task of epidural analgesia. We posit that instructing anesthesia residents to use the LOR syringe more extensively and educating them to do so more when they are in proximity to the epidural space can help improve skill acquisition in this task., Comment: 3 pages, 4 figures

Published
2023

5. Design and Assessment of a Bimanual Haptic Epidural Needle Insertion Simulator

Author

Davidor, Nitsan, Binyamin, Yair, Hayuni, Tamar, and Nisky, Ilana

Subjects
Computer Science - Human-Computer Interaction, Computer Science - Robotics
Abstract

The case experience of anesthesiologists is one of the leading causes of accidental dural punctures and failed epidurals - the most common complications of epidural analgesia used for pain relief during delivery. We designed a bimanual haptic simulator to train anesthesiologists and optimize epidural analgesia skill acquisition. We present an assessment study conducted with 22 anesthesiologists of different competency levels from several Israeli hospitals. Our simulator emulates the forces applied to the epidural (Touhy) needle, held by one hand, and those applied to the Loss of Resistance (LOR) syringe, held by the other one. The resistance is calculated based on a model of the epidural region layers parameterized by the weight of the patient. We measured the movements of both haptic devices and quantified the results' rate (success, failed epidurals, and dural punctures), insertion strategies, and the participants' answers to questionnaires about their perception of the simulation realism. We demonstrated good construct validity by showing that the simulator can distinguish between real-life novices and experts. Face and content validity were examined by studying users' impressions regarding the simulator's realism and fulfillment of purpose. We found differences in strategies between different level anesthesiologists, and suggest trainee-based instruction in advanced training stages., Comment: 12 pages, 9 figures

Published
2023

20. Design and Validation of a Bimanual Haptic Epidural Needle Insertion Simulator

Author

Davidor, Nitsan, Binyamin, Yair, Hayuni, Tamar, and Nisky, Ilana

Subjects
FOS: Computer and information sciences, Computer Science - Robotics, Computer Science - Human-Computer Interaction, Robotics (cs.RO), Human-Computer Interaction (cs.HC)
Abstract

The case experience of anesthesiologists is one of the leading causes of accidental dural punctures and failed epidurals - the most common complications of epidural analgesia used for pain relief during delivery. We designed a bimanual haptic simulator to train anesthesiologists and optimize epidural analgesia skill acquisition. We present a validation study conducted with 22 anesthesiologists of different competency levels from several hospitals in Israel. Our simulator emulates the forces applied to the epidural (Touhy) needle, held by one hand, and those applied to the Loss of Resistance (LOR) syringe, held by the other one. The resistance is calculated based on a model of the epidural region layers parameterized by the weight of the patient. We measured the movements of both haptic devices and quantified the results' rate (success, failed epidurals, and dural punctures), insertion strategies, and the participants' answers to questionnaires about their perception of the simulation realism. We demonstrated good construct validity by showing that the simulator can distinguish between real-life novices and experts. Good face and content validity were exhibited in experienced users' perception of the simulator as realistic and well-targeted. We found differences in strategies between different level anesthesiologists, and suggest trainee-based instruction in advanced training stages., Comment: 12 pages, 9 figures

Published
2023
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23. Incidence of conversion to general anaesthesia and need for intravenous supplementation in parturients undergoing caesarean section under spinal anaesthesia: A retrospective observational study

Author

Stav, Michael, primary, Matatov, Yuri, additional, Hoffmann, Dana, additional, Heesen, Philip, additional, Gliesche, Vincent, additional, Binyamin, Yair, additional, Ioscovich, Alexander, additional, Eidelman, Leonid A., additional, and Orbach‐Zinger, Sharon, additional

Published
2022
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27. Intraoperative pain during caesarean delivery: Incidence, risk factors and physician perception

Author

Keltz, Amir, Heesen, Philip, Katz, Daniel, Neuman, Ido, Morgenshtein, Anna, Azem, Karam, Binyamin, Yair, Hadar, Eran, Eidelman, Leonid A, Orbach‐Zinger, Sharon, University of Zurich, and Heesen, Philip

Subjects
Anesthesiology and Pain Medicine, 10216 Institute of Anesthesiology, 610 Medicine & health, 2703 Anesthesiology and Pain Medicine, 10044 Clinic for Radiation Oncology
Published
2022
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31. Incidence of conversion to general anaesthesia and need for intravenous supplementation in parturients undergoing caesarean section under spinal anaesthesia: A retrospective observational study.

Author

Stav, Michael, Matatov, Yuri, Hoffmann, Dana, Heesen, Philip, Gliesche, Vincent, Binyamin, Yair, Ioscovich, Alexander, Eidelman, Leonid A., and Orbach‐Zinger, Sharon

Subjects
CESAREAN section, PREGNANT women, ANESTHESIA, SPINAL injections, POSTPARTUM hemorrhage
Abstract

Background: Conversion from spinal anaesthesia to general anaesthesia (GA) was shown to be associated with more complications. It has been postulated that spinal injection of a low dose of local anaesthetic is a risk factor. We aimed to discover the rate of conversion from spinal anaesthesia to GA in women who received at least 10 mg heavy bupivacaine and opioids and assess its risk factors. Methods: All women that underwent spinal anaesthesia for caesarean section from 1 January 2017 to 31 December 2020 were included in this analysis. Spinal anaesthesia was performed according to department protocol using heavy bupivacaine 0.5% 10–13 mg, fentanyl 20 μg, and morphine 0.1 mg. We examined rate of conversion from spinal anaesthesia to GA and rate of need for analgesia/sedation. Results: There were 1.7% of women that required conversion to GA. Bupivacaine dose (OR 0.54 [95% CI 0.38 to 0.75], p < 0.001), surgery time (OR 1.03 [95% CI 1.02 to 1.04], p < 0.001), emergency caesarean section (OR 1.06 [95% CI 1.16 to 3.76], p = 0.015), and postpartum haemorrhage (OR 5.96 [95% CI 1.09 to 25.18], p = 0.025) were independent predictors of need for conversion to GA. Of the women who had CS under spinal anaesthesia, 4.1% of parturients required intraoperative analgesics/sedatives and 9.1% required anxiolysis. Conclusions: A small proportion of women required conversion to GA. This conversion occurred especially with emergency caesarean section and when low spinal bupivacaine doses were used. [ABSTRACT FROM AUTHOR]

Published
2023
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32. Anesthesiologists’ perspectives on why dural punctures occur: a multicenter international survey

Author

Orbach-Zinger, Sharon, primary, Heesen, Michael, additional, Ioscovich, Alexander, additional, Shatalin, Daniel, additional, Aptekman, Boris, additional, Weiniger, Carolyn F, additional, Eidelman, Leonid A, additional, Frenkel, Amit, additional, Beilin, Yaakov, additional, Katz, Daniel J, additional, Schlosberg, Ira, additional, and Binyamin, Yair, additional

Published
2021
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38. Ból śródoperacyjny w czasie cięcia cesarskiego: częstość występowania, czynniki ryzyka, ocena bólu przez lekarzy.

Author

Keltz, Amir, Heesen, Philip, Katz, Daniel, Neuman, Ido, Morgenshtein, Anna, Azem, Karam, Binyamin, Yair, Hadar, Eran, Eidelman, Leonid A., and Orbach-Zinger, Sharon

Subjects
SURGICAL therapeutics, STATE-Trait Anxiety Inventory, PAIN, ANESTHESIA, ANESTHESIOLOGISTS, PHYSICIANS' attitudes, DISEASE incidence, OBSTETRICS, CESAREAN section, ANXIETY, PREDICTION models, POSTOPERATIVE pain
Abstract

Copyright of Pain Research / Ból is the property of Index Copernicus International and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2022
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43. A Nearly Lethal Screw: An Unusual Cause of Recurrent Bradycardia and Asystole Episodes after Fixation of the Cervical Spine

Author

Frenkel, Amit, Binyamin, Yair, Brotfain, Evgeni, Koyfman, Leonid, Roy-Shapira, Aviel, Shelef, Ilan, and Klein, Moti

Subjects
Article Subject
Abstract

We present a case of a 51-year-old man who was injured in a bicycle accident. His main injury was an unstable fracture of the cervical and thoracic vertebral column. Several hours after his arrival to the hospital the patient underwent open reduction and internal fixation (ORIF) of the cervical and thoracic spine. The patient was hospitalized in our critical care unit for 99 days. During this time patient had several episodes of severe bradycardia and asystole; some were short with spontaneous return to sinus and some required pharmacological treatment and even Cardiopulmonary Resuscitation (CPR). Initially, these episodes were attributed to the high cervical spine injury, but, later on, CT scan suggested that a fixation screw abutted on the esophagus and activated the vagus nerve by direct pressure. After repositioning of the cervical fixation, the bradycardia and asystole episodes were no longer observed and the patient was released to a rehabilitation ward. This case is presented in order to alert practitioners to the possibility that, after operative fixation of cervical spine injuries, recurrent episodes of bradyarrhythmia can be caused by incorrect placement of the fixation screws and might be confused with the natural history of the high cervical cord injury.

Published
2017
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44. Development Of A Novel Model To Assess Cognitive And Memory Impairment In Rats After Stroke

Author

Binyamin, Yair

Abstract

Development of a novel model to assess cognitive and memory impairment in rats after strokeIntroduction: Stroke is a leading cause of mortality and morbidity worldwide. Survivors of stroke frequently suffer from motor deficits, cognitive impairments, and neuropsychiatric complications that can result in disturbances in learning and special memory, impairing quality of life. Cerebrovascular disease and dementia are closely linked. Dementia has been described in about 30% of those with a history of stroke with a relative risk ranging from 3.6 to 5.8. The risk of dementia after stroke is high immediately after the insult and remains high even 25 years later. Interesting, elderly patients without a history of stroke but with cognitive decline have a higher risk of stroke. The pathophysiology of post-stroke dementia remains elusive and appears to be multifactorial rather than purely biological or psychosocial. Thus, valid animal models would contribute to the study its etiology and treatment. This study describes a novel rat model for post-stroke dementia using middle cerebral artery occlusion (MCAO).Methods: 40 Sprague Dawley rats (weight 350u2013450 g) were randomly assigned to receive MCAO using an uncoated 4-0 monofilament, or as a sham-control. An MRI was performed 24hrs post-surgery to evaluate the severity of brain injury by measuring brain edema, infarct zone and blood brain barrier breakdown. On day 30 post-surgery the rats were introduced to the Barnes maze, an experimental tool to measure spatial learning and memory. After three days of training, time spent finding the escape box and the number of errors before finding the escape box was measured during two trails. Results: On day 4 of the Barnes maze, there was a significant increase in the time spent finding the escape box and the number of errors before finding the escape box, during both trials in the post-stroke rats (p

Published
2017

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