Biomedical subjects

G Holmaas

Publications and source records attributed to G Holmaas.

3 recordsLinked to original sources

PubMed2006

Identification of thoracic intervertebral spaces by means of surface anatomy: a magnetic resonance imaging study.

BACKGROUND: Successful thoracic epidural analgesia depends on the sensory blockage of specific dermatomes following appropriate placement of the epidural catheter. This study aimed to ascertain how accurately anaesthesiologists identify thoracic intervertebral spaces, and whether counting from the prominent vertebra is easier than using the iliac crest as an anatomical landmark. METHODS: Five anaesthesiologists attempted to locate one out of five consecutive intervertebral spaces (Th7-Th8 to Th11-Th12) on patients referred for magnetic resonance imaging of the vertebral column. The intended thoracic interspace and the counting reference point (C7-Th1 or L3-L4) were marked with oil capsules. The body mass index, gender and position of the patient were recorded. The exact capsule positions were determined by a radiologist after the study. RESULTS: In 92 patients, 26.7% of the thoracic interspaces were correctly identified. The counting reference point was the only variable studied with a significant influence on error. The accuracy increased when the iliac crest was used as an anatomical landmark rather than the prominent vertebra (odds ratio, 0.29). The majority (76.4%) of all the incorrectly placed capsules were found cephalad to the intended level. CONCLUSION: We recommend that the caudal of two to three possible interspaces should be used when placing an epidural catheter in the thoracic spine. Because of the inaccurate localization of the thoracic intervertebral spaces, documentation should state the site of puncture as being in the upper or lower thoracic spine instead of claiming to be in an exact interspace.

Adolescent↗

PubMed1999

Effect of experience with spinal anaesthesia on the development of post-dural puncture complications.

BACKGROUND: This clinical study was conducted in order to investigate the effect of operator experience with spinal anaesthesia (SA) on development of postural post-dural puncture headache (PPDPH) and postoperative backache. METHODS: The study was a cohort study of the first 100 SA performed by each of 5 trainees in anaesthesiology at the very beginning of their training period. SA was conducted with assistance and guidance according to usual departmental practice. In each SA, data regarding level of puncture, needle size, number of punctures, use of introducer and infiltration anaesthesia were recorded. In addition, usual problems and complications connected with dural puncture were registered. A visual analogue scale was used to record how difficult the procedure was experienced by the trainees. Postoperatively, the patients were contacted by the same trainee, usually by telephone. A semi-structured interview was conducted where occurrence and duration of headache, backache and other complaints were recorded. Headache was classified as PPDPH or non-PPDPH, and intensity of the headache was registered using a numerical rating scale (NRS) from 0 to 10. RESULTS: Five hundred SA in 495 patients with a mean age of 61.3 years were included in the study. Of these, 394 patients were completely followed-up postoperatively; the main reason for the drop-out was patient-related factors such as advanced age and dementia. Headache occurred in 56 patients postoperatively. PPDPH was diagnosed in 33 and non-PPDPH occurred in 23 patients. Postoperative backache was experienced by 27 patients. No significant effect experience with SA could be found regarding the occurrence of postoperative complications; 16 compared to 17 patients with PPDPH were found in the first and the last half of patients. A marked inter-individual difference in the occurrence of PPDPH was found in the patients treated by the 5 trainees. CONCLUSIONS: We could not demonstrate an effect of experience and training on development of complications after SA with regard to PPDPH and backache.

Aged↗

PubMed1998

[Wound botulism in heroin addiction].

Botulism is a rare disease which usually is caused by preformed botulinum toxin in food. However, this article describes a case of wound botulism in a 29-year-old male heroin addict who developed progressive diplopia, dysphagia and proximal weakness of skeletal limb muscles. He needed mechanical ventilation for two weeks. The clinical diagnosis of botulism was supported by neurophysiological tests. Assays for detection of botulinum toxin and Clostridium botulinum were negative. The patient had not eaten any contaminated food the last two weeks before symptoms appeared, but he had multiple contaminated skin wounds. After treatment with botulinum antitoxins and antibiotics he gradually recovered, and six weeks later he was discharged from hospital in good condition. To the best of our knowledge this is the first case of wound botulism reported in Norway.

Adult↗