WO2010075997A1 - Vorrichtung und verfahren zur erfolgskontrolle von spinalanästhesien - Google Patents
Vorrichtung und verfahren zur erfolgskontrolle von spinalanästhesien Download PDFInfo
- Publication number
- WO2010075997A1 WO2010075997A1 PCT/EP2009/009238 EP2009009238W WO2010075997A1 WO 2010075997 A1 WO2010075997 A1 WO 2010075997A1 EP 2009009238 W EP2009009238 W EP 2009009238W WO 2010075997 A1 WO2010075997 A1 WO 2010075997A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- skin surface
- temperature sensor
- temperature
- dermatome
- patient
- Prior art date
Links
- 238000002693 spinal anesthesia Methods 0.000 title claims abstract description 17
- 238000000034 method Methods 0.000 title claims description 19
- 238000012544 monitoring process Methods 0.000 title abstract description 5
- 238000005259 measurement Methods 0.000 claims abstract description 10
- 238000011156 evaluation Methods 0.000 claims description 29
- 230000036592 analgesia Effects 0.000 claims description 21
- 238000001514 detection method Methods 0.000 claims 2
- 230000002500 effect on skin Effects 0.000 claims 1
- 230000002889 sympathetic effect Effects 0.000 description 6
- 230000001953 sensory effect Effects 0.000 description 4
- 230000002490 cerebral effect Effects 0.000 description 3
- 230000008030 elimination Effects 0.000 description 3
- 238000003379 elimination reaction Methods 0.000 description 3
- 239000003589 local anesthetic agent Substances 0.000 description 3
- 230000036407 pain Effects 0.000 description 3
- 210000000278 spinal cord Anatomy 0.000 description 3
- 206010002091 Anaesthesia Diseases 0.000 description 2
- 230000037005 anaesthesia Effects 0.000 description 2
- 210000003403 autonomic nervous system Anatomy 0.000 description 2
- 210000001175 cerebrospinal fluid Anatomy 0.000 description 2
- 238000010586 diagram Methods 0.000 description 2
- 239000000835 fiber Substances 0.000 description 2
- 229960005015 local anesthetics Drugs 0.000 description 2
- 210000003666 myelinated nerve fiber Anatomy 0.000 description 2
- 210000005036 nerve Anatomy 0.000 description 2
- 210000001032 spinal nerve Anatomy 0.000 description 2
- 239000007921 spray Substances 0.000 description 2
- 210000002820 sympathetic nervous system Anatomy 0.000 description 2
- 230000003187 abdominal effect Effects 0.000 description 1
- 230000036772 blood pressure Effects 0.000 description 1
- 210000003169 central nervous system Anatomy 0.000 description 1
- 238000006243 chemical reaction Methods 0.000 description 1
- 239000003086 colorant Substances 0.000 description 1
- 238000004040 coloring Methods 0.000 description 1
- 239000003814 drug Substances 0.000 description 1
- 238000002692 epidural anesthesia Methods 0.000 description 1
- 239000006260 foam Substances 0.000 description 1
- 238000002695 general anesthesia Methods 0.000 description 1
- 239000004615 ingredient Substances 0.000 description 1
- 230000030214 innervation Effects 0.000 description 1
- 210000003041 ligament Anatomy 0.000 description 1
- 210000003141 lower extremity Anatomy 0.000 description 1
- 210000004705 lumbosacral region Anatomy 0.000 description 1
- 210000002418 meninge Anatomy 0.000 description 1
- 230000007659 motor function Effects 0.000 description 1
- 210000001002 parasympathetic nervous system Anatomy 0.000 description 1
- 230000008447 perception Effects 0.000 description 1
- 238000012545 processing Methods 0.000 description 1
- 238000002694 regional anesthesia Methods 0.000 description 1
- 230000002441 reversible effect Effects 0.000 description 1
- 238000012552 review Methods 0.000 description 1
- 230000008054 signal transmission Effects 0.000 description 1
- 239000007787 solid Substances 0.000 description 1
- 238000010561 standard procedure Methods 0.000 description 1
- 230000002792 vascular Effects 0.000 description 1
- 230000001755 vocal effect Effects 0.000 description 1
- 238000010792 warming Methods 0.000 description 1
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Substances O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/48—Other medical applications
- A61B5/4821—Determining level or depth of anaesthesia
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/01—Measuring temperature of body parts ; Diagnostic temperature sensing, e.g. for malignant or inflamed tissue
- A61B5/015—By temperature mapping of body part
Definitions
- the invention relates to a device and a method for monitoring the success of spinal anesthesia in medicine.
- Spinal anesthesia is a spinal cord-like form of regional anesthesia.
- a local anesthetic into the cerebral space at the level of the lumbar spine, the signal transmission in the nerves originating from the spinal cord is inhibited. This achieves a temporary, reversible blockade of the sympathetic nervous system, sensibility and motor function of the lower body.
- spinal anesthesia is now used in a variety of abdominal, pelvic, lower limb and midwifery operations and is an alternative to other regional procedures such as epidural anesthesia and general anesthesia.
- the spine of man consists of 34 vertebrae, which are connected by solid ligaments and surround the spinal cord.
- Spinal nerves emerge between the vertebrae, segmentally innervating the body, thus enabling motor skills and sensibility and, in addition, leading to fibers of the autonomic nervous system (sympathetic / parasympathetic nervous system).
- the spinal cord is surrounded by the meninges, which limit the cerebral space where cerebral water circulates. This cerebrospinal fluid becomes thin during spinal anesthesia Cannula punctured.
- the tip of the needle injects local anesthetics that act on the anterior and posterior roots of the spinal nerves, temporarily eliminating their ability to transmit nerve impulses.
- the level of action of spinal anesthesia depends on the spread of injected CSF ingredients, which may be affected by dose and density of local anesthetics as well as patient storage.
- Analgesia has so far been checked mostly by means of a cold spray by the anesthetist on the body of the patient. The patient had to verbally indicate whether he still feels a corresponding coldness or not.
- the invention has for its object to provide a technique that facilitates the success of spinal anesthesia.
- the object is achieved by a device having the features of claim 1.
- Advantageous embodiments of the device are specified in the subclaims 2 to 12.
- the inventive device for monitoring the success of spinal anesthesia has
- At least one electronic temperature sensor for measuring skin surface temperature within at least one dermatome of a patient
- an electronic evaluation device which is connected to the at least one temperature sensor and is configured to monitor the measurement signal supplied by the at least one temperature sensor for whether the skin surface temperature rises by about 2 to 3 ° C.
- a display device displays the result of the evaluation by the electronic evaluation optically and / or acoustically.
- the device according to the invention is based on the finding that in sympathicolysis (elimination of sympathetic innervation) by spinal anesthesia, the "thinner" non-myelinated nerve fibers are first blocked, and then only the “thicker” myelinated nerve fibers.
- sympathetic blockade is usually two to three segments or dermatomes farther away than sensory blockade.
- the sympathetic block can be up to six segments or dermatomes further away than the sensory blockade.
- the sensory blockage is about two segments or dermatomes farther away than the motor blockade.
- the sympathetic blockade goes with an increase - A - hung the skin temperature by about 2 to 3 0 C in the associated dermatome associated.
- This temperature increase thus indicates that a sensory blockade and thus the analgesia (pain elimination) about 2 to 3 (up to 6) Dermatome caudal occurred.
- analgesia is assumed to be about 2 to 3 (-6) dermatomas caudal to the dermatomes Th4 to Th5 (-Th8).
- the invention takes advantage of this finding by allowing on the basis of the measured temperature rise of about 2 to 3 0 C on at least one dermatome of a patient to identify the 2 to 3 (-6) dermatome caudally arranged dermatome as the one in which the Analgesia has already occurred.
- the physician is the success of spinal anesthesia easier.
- the previous review by means of cold spray and verbal reaction of the patient is replaced by an objective measurement and evaluation of the measurement results.
- a simple embodiment of the device according to the invention shows as a result of the evaluation by the evaluation of the or those dermatomas in which the temperature rise of about 2 to 3 0 C has occurred. Based on this indication, it can be assumed that the analgesia occurred about 2 to 3 (up to 6) caudal dermatomes.
- the electronic evaluation device determines that the analgesia has occurred in a dermatome which is closer to the sacral lumbar vertebrae by about 2 to 6 dermatomes than the dermatome, in which a temperature increase of the skin surface of about 2 to 3 0 C has been determined is.
- the display device displays the dermatome by the analgesia occurred as a result of the evaluation by the electronic evaluation device. Possibly.
- the display device displays the dermatomas that have previously occurred to those of the analgesia.
- the electronic evaluation device preferably determines that the analgesia has occurred in a dermatome which is closer to the sacral lumbar vertebrae by about 2 to 3 dermatoms than the dermatome in which an increase in the temperature of the skin surface of about 2 to 3 ° C. has been determined.
- the display device displays the dermatomas in which the main surface temperature is increased by 2 to 3 ° C. and the dermatomas in which the analgesia has occurred (for example in different colors).
- the temperature sensor can be configured differently. For example, it is possible to measure the skin surface temperature of the patient over a large area with a thermal camera and to determine the temperatures in the individual dermoments with an automatic method of image evaluation. According to another embodiment, individual temperature sensors are used. According to a preferred embodiment, the at least one temperature sensor is an NTC resistor.
- At least one temperature sensor is held by spring means on means for fixing the temperature sensor on the body of a patient.
- About the spring means of the temperature sensor is pressed with a constant pressure against the skin surface. Measurement errors are thereby avoided.
- the temperature sensors can be individually fixed on the skin surface of the patient.
- several Temperature sensors arranged at certain distances from each other on a belt which is fastened with means for fastening to the body of a patient.
- the predetermined arrangement of the temperature sensors on a belt facilitates the placement of the temperature sensors on the body of the patient.
- the distance between two adjacent temperature sensors on the belt at a distance corresponds to one or more dermatomes. This configuration facilitates the attachment of the temperature sensors within various dermatomas of the patient.
- the measurement of the distance of adjacent temperature sensors on the tape can be based on a patient of average size. Further, it is possible to provide multiple bands of temperature sensors at different distances for patients of different sizes.
- the temperature sensor is connected to a tape for fastening to the body of a patient.
- the electronic evaluation device can work analog or digital. It may be a program-controlled electronic data processing device or a pure hardware. Preferably, a programmable, digital evaluation device is used. In particular, a PC can be used as the evaluation device.
- an analog temperature sensor is connected to a digital evaluation device via at least one analog-to-digital converter.
- the analog-to-digital converter is connected to a USB socket of the PC.
- the display device is, for example, a screen of a PC.
- the display device displays a graphic of a human body in which the dermatomas in which the analgesia has entered and / or the dermatomes in which the skin surface temperature has risen by about 2 to 3 ° C. are graphically highlighted.
- the graphic highlighting can be done, for example, by a contrasting coloring of the relevant dermatomes that differs from the rest of the graphic.
- FIG. 1 shows a device according to the invention for checking the success of spinal anesthesia on a patient's body in a rough schematic block diagram
- FIG. 2 shows a section of a strip with temperature sensors in plan view
- Fig. 3 is an enlarged detail of the belt of Fig. 2 in a vertical section.
- the skin surface of a patient 1 is segmented into various dermatomes, which are labeled with such.
- dermatomes which are labeled with such.
- L3 and C4 are designated.
- temperature sensors are 2 appropriate.
- the temperature sensors 2 are connected via an amplifier 3 with at least 8 channels to an analog-to-digital converter 4.
- the analog-to-digital converter 4 samples the output channels of the amplifier 3 and converts the amplified, analog measurement signal into a digital signal.
- the analog-to-digital converter 4 is connected to a PC 5.
- the PC 5 determines whether the skin temperature measured by the temperature sensors 2 increases by about 2 to 3 0 C, as shown in the temperature-time diagram 6.
- the PC 5 detects an increase of 2 to 3 ° C, it calculates that analgesia has occurred in about 2 to 3 (-6) dermatomes of the caudally arranged dermatome.
- the dermatomes in which the analgesia was detected are displayed on a screen 7 with a graphic 8 of a human body.
- a plurality of temperature sensors 2 are fastened on a band 9 with the interposition of a foam pad.
- the distances between adjacent temperature sensors 2 correspond to the distances between certain dermatomes.
- the tape 9 is fastened to the body 1 by means of tapes which are mounted transversely on the tape 9.
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Biophysics (AREA)
- Pathology (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Veterinary Medicine (AREA)
- Physics & Mathematics (AREA)
- Molecular Biology (AREA)
- Surgery (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Anesthesiology (AREA)
- Measuring And Recording Apparatus For Diagnosis (AREA)
- Measuring Pulse, Heart Rate, Blood Pressure Or Blood Flow (AREA)
Abstract
Description
Claims
Priority Applications (7)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
RU2011130250/14A RU2503403C2 (ru) | 2009-01-03 | 2009-12-23 | Устройство и способ контроля результата спинальной анестезии |
JP2011543988A JP5520314B2 (ja) | 2009-01-03 | 2009-12-23 | 脊椎麻酔の成功をモニタリングする装置および方法 |
BRPI0923927A BRPI0923927A2 (pt) | 2009-01-03 | 2009-12-23 | dispositivo e método para monitoramento do sucesso da anestesia espinhal |
EP09796972.9A EP2373210B1 (de) | 2009-01-03 | 2009-12-23 | Vorrichtung und verfahren zur erfolgskontrolle von spinalanästhesien |
CA2748730A CA2748730C (en) | 2009-01-03 | 2009-12-23 | Device and method for monitoring the success of spinal anesthesia |
US13/142,762 US20120265091A1 (en) | 2009-01-03 | 2009-12-23 | Device and method for monitoring the success of spinal anesthesia |
CN200980155992.2A CN102307515B (zh) | 2009-01-03 | 2009-12-23 | 用于脊髓麻痹效果检验的设备和方法 |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
DE102009003897.3 | 2009-01-03 | ||
DE102009003897A DE102009003897A1 (de) | 2009-01-03 | 2009-01-03 | Vorrichtung und Verfahren zur Erfolgskontrolle von Spinalanästhesien |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2010075997A1 true WO2010075997A1 (de) | 2010-07-08 |
Family
ID=41818395
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/EP2009/009238 WO2010075997A1 (de) | 2009-01-03 | 2009-12-23 | Vorrichtung und verfahren zur erfolgskontrolle von spinalanästhesien |
Country Status (9)
Country | Link |
---|---|
US (1) | US20120265091A1 (de) |
EP (1) | EP2373210B1 (de) |
JP (1) | JP5520314B2 (de) |
CN (1) | CN102307515B (de) |
BR (1) | BRPI0923927A2 (de) |
CA (1) | CA2748730C (de) |
DE (1) | DE102009003897A1 (de) |
RU (1) | RU2503403C2 (de) |
WO (1) | WO2010075997A1 (de) |
Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2013045119A1 (en) | 2011-09-30 | 2013-04-04 | Latvijas Universitate | Device for the determination of peripheral regional anaesthesia using contactless photoplethysmography |
Families Citing this family (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CN107510435B (zh) * | 2017-07-07 | 2020-05-12 | 中国人民解放军第三军医大学第一附属医院 | 椎管内麻醉阻滞平面连续监测装置 |
CN111354474A (zh) * | 2018-12-24 | 2020-06-30 | 景立科技有限公司 | 神经节人体图麻醉纪录系统 |
CN113729644A (zh) * | 2021-09-06 | 2021-12-03 | 中山大学 | 一种利用温度传感阵列检测区域神经阻滞麻醉效果的方法 |
Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
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EP0236513A1 (de) * | 1986-02-13 | 1987-09-16 | John E. Barsa | Gerät und Verfahren zur Überwachung sensorischer Fähigkeiten |
US6002960A (en) * | 1996-08-27 | 1999-12-14 | The Johns Hopkins University | Passive, non-invasive method to quantify objectively the level and density of a neural blockade |
Family Cites Families (7)
Publication number | Priority date | Publication date | Assignee | Title |
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EP1009279A4 (de) * | 1997-08-26 | 2004-05-12 | Univ Johns Hopkins | Passives nicht-invasives verfahren zur objektiven quantifizierung des ausmasses von neuralen blockaden |
JP2000051153A (ja) * | 1998-08-11 | 2000-02-22 | Kanebo Ltd | 皮膚状態評価方法およびそれに用いる装置 |
US7938783B2 (en) * | 2003-08-19 | 2011-05-10 | Advanced Monitors Corporation | Medical body core thermometer |
US20080214951A1 (en) * | 2004-02-03 | 2008-09-04 | Neuro Diagnostic Devices, Inc. | Cerebrospinal Fluid Evaluation Systems |
EP1734858B1 (de) * | 2004-03-22 | 2014-07-09 | BodyMedia, Inc. | Nichtinvasive temperaturüberwachungsvorrichtung |
US20070055166A1 (en) * | 2005-09-02 | 2007-03-08 | Chandrashekhar Patil | Method and system for recording and transmitting data from biometric sensors |
RU2317815C1 (ru) * | 2006-05-15 | 2008-02-27 | Государственное образовательное учреждение высшего профессионального образования "Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова Федерального агентства по здравоохранению и социальному развитию" | Способ сочетанной комбинированной спинномозговой и эпидуральной анестезии |
-
2009
- 2009-01-03 DE DE102009003897A patent/DE102009003897A1/de not_active Withdrawn
- 2009-12-23 BR BRPI0923927A patent/BRPI0923927A2/pt not_active Application Discontinuation
- 2009-12-23 WO PCT/EP2009/009238 patent/WO2010075997A1/de active Application Filing
- 2009-12-23 US US13/142,762 patent/US20120265091A1/en not_active Abandoned
- 2009-12-23 RU RU2011130250/14A patent/RU2503403C2/ru active
- 2009-12-23 EP EP09796972.9A patent/EP2373210B1/de not_active Not-in-force
- 2009-12-23 JP JP2011543988A patent/JP5520314B2/ja not_active Expired - Fee Related
- 2009-12-23 CA CA2748730A patent/CA2748730C/en not_active Expired - Fee Related
- 2009-12-23 CN CN200980155992.2A patent/CN102307515B/zh not_active Expired - Fee Related
Patent Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
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EP0236513A1 (de) * | 1986-02-13 | 1987-09-16 | John E. Barsa | Gerät und Verfahren zur Überwachung sensorischer Fähigkeiten |
US6002960A (en) * | 1996-08-27 | 1999-12-14 | The Johns Hopkins University | Passive, non-invasive method to quantify objectively the level and density of a neural blockade |
Non-Patent Citations (4)
Title |
---|
CHAMBERLAIN D ET AL: "Changes in the skin temperature of the trunk and their relationship to sympathetic blockade during spinal anesthesia", ANESTHESIOLOGY, AMERICAN SOCIETY OF ANESTHESIOLOGISTS, PHILADELPHIA, PA, US, vol. 65, no. 2, 1 August 1986 (1986-08-01), pages 139 - 143, XP007912248, ISSN: 0003-3022 * |
GREENE N M: "Area of differential block in spinal anesthesia with hyperbaric tetracaine", ANESTHESIOLOGY, vol. 19, 1 January 1958 (1958-01-01), pages 45 - 50, XP002574069 * |
JETZEK-ZADER ET AL: "Increase in Skin Temperature After Spinal Anesthesia in Infants", REGIONAL ANESTHESIA AND PAIN MEDICINE, CHURCHILL LIVINGSTONE, SECAUCUS, NJ, US, vol. 31, no. 6, 28 November 2006 (2006-11-28), pages 519 - 522, XP005743835, ISSN: 1098-7339 * |
SAITO T ET AL: "A single-injection, multi-segmental paravertebral bloc extension of somatosensory and sympathetic block in volunteers", ACTA ANAESTHESIOLOGICA SCANDINAVICA, WILEY-BLACKWELL MUNKSGAARD, DK, vol. 45, 1 January 2001 (2001-01-01), pages 30 - 33, XP007912285, ISSN: 0001-5172 * |
Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2013045119A1 (en) | 2011-09-30 | 2013-04-04 | Latvijas Universitate | Device for the determination of peripheral regional anaesthesia using contactless photoplethysmography |
Also Published As
Publication number | Publication date |
---|---|
DE102009003897A1 (de) | 2010-07-15 |
BRPI0923927A2 (pt) | 2016-01-12 |
EP2373210B1 (de) | 2013-06-26 |
JP2012514480A (ja) | 2012-06-28 |
EP2373210A1 (de) | 2011-10-12 |
JP5520314B2 (ja) | 2014-06-11 |
US20120265091A1 (en) | 2012-10-18 |
RU2011130250A (ru) | 2013-02-10 |
RU2503403C2 (ru) | 2014-01-10 |
CA2748730C (en) | 2014-09-16 |
CN102307515A (zh) | 2012-01-04 |
CN102307515B (zh) | 2014-04-02 |
CA2748730A1 (en) | 2010-07-08 |
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