Patients with Spinal Muscular Atrophy (SMA) may have scoliosis requiring spinal hardware for spinal fixation. The scoliosis in addition to the spinal hardware makes intrathecal access difficult with conventional approaches. With recent FDA approval of nusinersen (SpinrazaÒ) for SMA, intrathecal access is required for administration of this meditation. We describe our experience in these patients using a variety of lumbar puncture approaches (intra-spinous process, trans-pedicle, and trans-foraminal) utilizing conventional fluoroscopy, cone-beam CT (CBCT) with fluoroscopy overlay and/or conventional CT with CT fluoroscopy. Approach to the type of access and image guidance is based on the presence of spinal hardware and degree of scoliosis and spinal fusion. Read More

Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018

Authors: Patel Manish, Weiss Judith, Kandil Ali, Johnson Neil

Keywords: Spinal Muscular Atrophy, Lumbar Puncture, Spinraza

Administering oral contrast less than two hours before sedation/anesthesia is often needed for computed tomography (CT) studies of the abdomen in children, but violates the American Society of Anesthesiologists (ASA) nothing-by-mouth guidelines and may increase the risk of aspiration pneumonia.<b> </b>ASA guidelines are based on gastric aspiration.<b> </b>Oral contrast is best administered 1 hour prior to imaging for optimal abdominal CT evaluation. The aim of our study was to measure residual gastric fluid volume (RGV) by CT and with manual aspiration in subjects undergoing general anesthesia (GA) less than 2 hours after oral contrast. Read More

Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020

Authors: Afonya Boma, Kandil Ali, Mahmoud Mohamed, Das Bobby, Fleck Robert

Keywords: Anesthesia, Enteric Contrast, Safety