Utilizing patient-specific 3D or virtual reality (VR) models for preoperative evaluation can help anesthesiologists plan for procedures that involve patients with suspected difficulty breathing, according to an abstract that was presented at the Euroanaesthesia 2021 meeting in Munich, Germany.
The authors claim that an effective plan is better than trial and error, equipment squander and the trauma that patients suffer.
While these technologies have been used to teach residents how to intubate, they are not as commonly used in clinical anesthesia, said lead author Ruth Shaylor, BMBS, an anesthesiologist at Tel Aviv Medical Center in Israel. “Until now, we hadn’t realized how it can be useful for us,” she told Medscape Medical News.
Dr Ruth Shaylor
All that changed when the new thoracic surgeon came to the hospital and brought children, a patient group with whom Shaylor and her colleagues had never previously worked. “Suddenly, we were presented to a patient for whom in theory we knew what to do, but in reality we hadn’t previously done it,” she explained. Since she had already used 3D-printing to train residents, she made the next step logically: “If I print off tracheas in order to teach residents how to intubate, then why don’t I print a trachea for a specific patient to learn myself?” She remembered.
Using medical imaging from one patient she printed a 3D-model of the patient’s trachea that allowed her to select the appropriate equipment and practice the procedure. Soon after, she used 3D-printing again to help plan the intubation procedure for an adult patient who has severe narrowing of the trachea. Shaylor stated that the entire service was able to take off after these two instances.
The team at Tel Aviv Medical Center, Israel began with an CT scan of the main bronchial artery and trachea.
3D-modeling is now used by the department to treat pediatric patients who need surgery to the thorax and those who have breathing problems or have lung or mediastinal mass. To determine the potential benefits of the program, Shaylor and colleagues conducted an examination of all cases referred to 3D-modeling during the first 2 years of the program, which ran from July 2019 through July 2021. In the two-year period 10 fetal, two pediatric and eight adult cases were admitted to the program. Seventeen patients presented with suspected difficult airways, and three had anterior mediastinal masses.
For 3D printed airway models, the team began with a CT of the trachea, main bronchi and lobar bronchi. These images were then transferred into post-processing software. The 3D model was printed using clear plastic, building outward to keep the model’s internal diameter. The model would then be utilized by the anesthesiologist treating the patient to determine the best airway plan. The virtual reality models were created from volume-rendered medical images- either CT or MRI — and were viewed on Oculus VR headsets. The cardiothoracic surgeons responsible for extracorporeal membrane oxygenation (ECMO) and treating anesthesiologists consulted on the VR model, and the anesthesia and induction plans were developed together.
In the course of the study the team developed five VR reconstructions and printed 15 3D models. The final airway plan was utilized in 13 of the 15 cases that were printed 3D models. The additional two cases had poor initial imaging and the plan that was devised on the model was more conservative than the final airway plan. After going through the VR images, it was evident that none of the three patients with mediastinal mass were preinducible. ECMO or wires.
Dr Ian Chao
“Although it is a tiny observational study with only 20 cases, it’s the first attempt I have seen of a research center which is actively developing a process to make routine use of this technology in clinical decision-making,” said Ian Chao, MBBS, a specialist anesthetist in Melbourne, Australia, in an interview via email with Medscape. His research is focused on 3D printing anesthesia. He was not involved in the work. “Although we are still in the very early stages of research in this field, hopefully this abstract helps to keep the momentum going and encourage other physicians to think about this innovative technology as feasible options for anesthesia.”
Seth Friedman, PhD, the director of Innovation Imaging and Simulation Modeling at Seattle Children’s in Washington, who was not associated with the research was in agreement with Chao and said that the abstract suggests that communication -between providers and between the provider and patient improved through the use of 3D modeling. The next step, he said is to measure the outcomes of the procedures that utilized 3D modeling tools versus those that did not.
Friedman stated that although the authors claim that the models improve care by reducing trauma, trial and error, Friedman said that more data is needed to back these claims. Friedman said that if you could print a 3D model or VR for every complex airway patient , and have regular, less frequent complications and better outcomes, that could spur an increase in investment in these modeling technologies in anesthesia.
Friedman was part of the beta-testing program for Stratasys digital anatomy creator software. While the software was not used for research however, the team did utilize the Stratasys 3-D printer. Shaylor and Chao have disclosed no financial connections that could be relevant to the research.
Euroanaesthesia 2021. Abstract Virtual reality and 3D printing in clinical anesthesia; 18 months of experience in a large, single medical center. December 18 2021.
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