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Vital Signs

Ultrasound invention is out-stand-ing

By Danielle Thomas

When Dr. Brian Sites, a DHMC anesthesiologist, began offering ultrasound-guided nerve blocks four years ago, he anticipated that patients would choose it over general anesthesia whenever possible. Many people did. But Sites did not anticipate two problems.

First, one person can't do the procedure alone—someone has to hold the ultrasound probe, while someone else injects the anesthetic. And it can be tiring to hold the probe steady, so the images are often unclear.

"Ultrasound exams are ergonomically challenging, and the operators get fatigued," explains Sites, who is now the director of DHMC's Center for Ultrasound Guided Regional Anesthesia (UGRA). "This fatigue results in movement of the ultrasound probe, causing degradation of the ultrasound image," which makes it difficult to know where to insert the needle.

Undaunted, Sites and Dr. Brian Spence, a fellow anesthesiologist who is also a graduate of Dartmouth's Thayer School of Engineering, collaborated with the Dartmouth Entrepreneurial Network; Katherine Hickey, another Thayer alum; and a local consulting company to come up with a solution: the Ultra-Stand, a probe-stabilizing device.

Steady: Now, a clinician can administer UGRA without help because the Ultra-Stand holds the probe steady. The anesthesiologist sees a precise image of where to inject the medication. "One of the benefits of using UGRA," says Spence, "is that you can actually see where you're placing the local anesthesia, where with other traditional techniques you can't."

Brian Sites—pictured performing an ultrasound-guided regional anesthesia several years ago—has invented a device that makes the procedure easier and safer.

Before the invention of UGRA, anesthesiologists relied on anatomical "landmarks" to determine the location of the nerve to be numbed. But that technique is limited because anatomical variations among patients make finding the nerves difficult and potentially dangerous. The anesthesiologist might have to insert the needle more than once, causing significant discomfort for the patient. "If you can see where your target area is, you don't have to use as much local anesthetic, because you don't have to saturate the area," says Spence.

Aaron Gjerde, a consultant who is working on a business plan for the device, calls it "a simple solution that just worked. It isn't complicated, doesn't need training, and doesn't need expertise."

The Ultra-Stand has gone through numerous iterations in the past year, says

Hickey. Several patents are pending for the device, and several major distributors and companies are interested in carrying the product, according to Gjerde. Gjerde and Hickey have also received an enthusiastic response from physicians in the American Society of Anesthesiologists.

Psyched: And now Thayer engineering students may be helping to improve the Ultra-Stand. "It's really the collaborative thing all over again," says Hickey. "We're going back and both using Dartmouth resources and adding to some student experiences. . . . We're pretty psyched about that."

But the bottom line, explains Spence, "was developing a device that would make our lives easier and make the lives of other regional anesthesiologists easier, such that we can improve patient care."

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