Can a Head-mounted Display Interface Alleviate Ergonomic Challenges in Ultrasound-guided Regional Anesthesia?

Ankeet Deepak Udani* T. Kyle Harrison*
David M. Gaba*
Ankeet Deepak Udani*, Stanford University, Stanford, United States
T. Kyle Harrison*, VA Palo Alto, Palo Alto, United States
Steven K. Howard, VA Palo Alto, Palo Alto, United States
T. Edward Kim, VA Palo Alto, Palo Alto, United States
John G. Brock-utne, Stanford University, Stanford, United States
David M. Gaba*, VA Palo Alto, Palo Alto, United States
Edward R. Mariano, VA Palo Alto, Palo Alto, United States

Track: Research
Presentation Topic: Human-Computer Interface (HCI) Design
Presentation Type: Poster presentation
Submission Type: Single Presentation

Building: LKSC Conference Center Stanford
Room: Lower Lobby
Date: 2011-09-17 12:30 PM – 01:30 PM
Last modified: 2011-08-12

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The use of a head-mounted display (HMD) for the real-time transmission of vital signs to the anesthesiologist’s visual field in clinical anesthesia has been described. The practice of ultrasound-guided regional anesthesia (USRA) requires positioning the ultrasound machine so that the operator can visualize the monitor display often in ergonomically-challenging environments. A HMD may provide a more functional human-computer interface with continuous, real-time, ultrasound imaging within the practioner’s visual field. We tested the feasibility of using HMD technology to alleviate the ergonomic challenges of USRA.
In this pilot study, the clinical scenario of performing preoperative USRA with limited workspace was simulated using a pig hind-quarter with intact popliteal fossa and sciatic nerve on a gurney in an actual block room. A HMD (MicroOptical CV-3, MyVu, Wellesley, MA, USA) was connected to the S-video output of an ultrasound machine (MicroMaxx, Sonosite, Bothell, WA, USA) and the machine’s monitor display was then positioned out of the practioner’s procedural field. Two anesthesiologists (one expert and one novice in USRA) performed a total of 10 ultrasound-guided popliteal-sciatic nerve blocks. For each procedure, the sciatic nerve was visualized in short-axis with a 13-6 MHz linear transducer transmitted via HMD to the left eye piece, an 18 gauge Tuohy-tip epidural needle (B. Braun, Bethlehem, PA, USA) was directed in-plane from lateral to medial toward the target nerve, and injectate deposited around the nerve. An independent observer measured the number of times the practitioner’s attention was directed away from the procedural field and overall block quality for each USRA procedural attempt.
All 10 USRA procedures were successfully completed based on proper needle control and visualization and circumferential injectate spread around the sciatic nerve. Neither practitioner redirected his attention away from the procedural field to directly view the ultrasound monitor while performing any of the USRA procedures.
The use of HMD technology for real-time, ultrasound image transmission to the practioner’s procedural field independent of ultrasound machine placement is feasible. Within the constraints of a limited workspace and its challenging ergonomics, the functionality of an easy set-up and block performance may outweigh the additional cost and tethered nature of the HMD. The HMD interface merges ultrasound imaging with the practitioner’s hand-eye coordination during ultrasound-guided procedures. Potentially, this technology may assist the novice practioner in proper needle and probe alignment which is often a difficult technical skill to acquire. Larger, prospective, controlled studies are needed to quantify the ergonomic effects and potential educational benefits of HMD technology in USRA.

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