New research presented at Euroanaesthesia, the annual meeting of the European Society of Anesthesiology and Critical Care (ESAIC), held online this year, suggests that the use of 3D printing and virtual reality may improve care to patients and reduce anesthesiologist stress and wasted equipment.

An anesthesia team from Tel Aviv Sourasky Medical Center in Israel reports the use of 3D technology to prepare for operations in 20 patients, including a 35-week-old fetus that required a cesarean delivery and an 83-year-old woman requiring surgery. open heart surgery.

The majority of cases reported in the study are in children undergoing lung surgery, but the technology has also been used to design personalized plans for patients with large mediastinal masses (MM) in the chest that compress the heart and lungs. , including a pregnant woman.

“Using imaging scans, our anesthesia team were able to print very accurate models of patients’ airways on which to plan and perform their procedures,” says Dr. Ruth Shaylor, lead author of the report. “This is especially important in children because they are smaller, as is our margin for error. Being able to see, hold and rotate an accurate replica of their patient’s airways gives a new angle to their cases, providing information on the most appropriate airway equipment that might be invisible on a flatbed scanner.

A 3D model can be made in 30 minutes, and a single print can be shot in 3-4 hours on entry-level 3D printers. Although the technology is widely used in other medical specialties like orthopedic surgery, pediatric cardiology, and dentistry, the use of 3D printing and virtual reality in anesthesia has primarily been aimed at education and Training.

In 2019, the Anesthesia Department at Tel Aviv Medical Center began using 3D printing and virtual reality modeling to systematically assess pre-surgery patients who had potentially difficult airways due to narrowing. or large MM, as well as children requiring unipulmonary ventilation for surgery. could be performed on the other lung.

To examine the potential benefits of these technologies for anesthesia management, Shaylor and colleagues retrospectively examined the 20 patients referred for 3D modeling as part of their anesthesia plan between July 2019 and July 2021. In general, 3D printing was used for the respiratory tract cases (15 patients) with virtual reality for the large MM cases (3 patients).

The results showed that when 3D printing was used, the airway plane made on the model was the last airway plane in 13 of 15 (87%) patients. This reduced the risk of trial and error during the surgery. There were two cases where the model plan was either more conservative (the equipment used was larger than the suggested model), and one case in which a model could not be made due to poor air sweeps. initial imagery.

After reviewing the virtual reality images, none of the MM patients had to undergo any invasive procedures before being anesthetized. In addition, no anesthetic complications were reported in the patients referred for 3D modeling.

“3D printing is still underutilized for patient-specific preoperative anesthesia planning,” explains Dr. Shaylor. “Our 2-year experience shows that with a specific plan in place, trial and error is reduced, and there is less patient trauma and wasted equipment. The anesthesiologists involved in these cases reported less stress, and by reviewing them with the surgeons, there was a better understanding of the challenges involved for each patient. We also found that sharing these models with patients gave them a better understanding of their upcoming surgery and helped improve communication. “

7-year-old patient with Ewing’s sarcoma

A A 7-year-old girl with Ewing’s sarcoma (a cancer of the bones and soft tissues) had to have an operation to remove part of her right lung. Anesthesiologists were concerned that the standard tubing and devices used for pulmonary operations in elderly patients were not appropriate. Thus, CT scans were used to create a virtual reality program of his airways and lungs and a 3D printed plastic model so that they could formulate a personalized airway plan and familiarize themselves with the anatomy of the airways. respiratory tract of the patient. The final airway plan was significantly different from the plan developed using standard imaging techniques. This reduced the number of lung isolation attempts that might otherwise have been made on the patient, and she recovered well.

35 week fetus with a mass pressing on the trachea

In order for the baby to deliver safely, it had to be done by cesarean section and the team had to put on a breathing tube before cutting the umbilical cord. The team made a 3D model from an MRI, which is no easy task when your patient is standing on his head and sucking his thumb. The team then imprinted the windpipe, tongue, jaw, and mass, and practiced the intubation technique before the operation.

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