Abstract Details

Title A Novel Method for Targeting Intramuscular Diaphragm Injections Using Ultrasound and Electromyography

Topic Clinical Neurophysiology

Presentation(s) P02 - (-)

Poster/Presentation
Number 220

Objective

Background BACKGROUND: Needle electromyography of the diaphragm is usually done blind using technique guided only by anatomic landmarks. The possible complications include pneumothorax caused by inadvertent lung puncture or liver hematoma.

Design/Methods DESIGN/METHODS: Animal care and use committee approved all procedures in live animals. Ultrasound was used to visualize the diaphragm on each side of spontaneously breathing, anesthetized beagles (n=3) or vervets (n=3) using the B mode with a 15 MHz linear probe. Probe was placed on the lowest intercostal space in the mid-axillary line and directed towards the midline through the liver or spleen window. The beagles were anesthetized and EMG guided injections were planned to be performed a part of a separate independent study. Ultrasound guidance was used to target four separate methylene blue injections into the diaphragm. EMG needle was introduced directed by ultrasound to confirm that the visualized image was the muscular portion of the diaphragm. The site of injections was confirmed upon necropsy by tracking spread of injected methylene blue.

Results RESULTS: The diaphragm was easily identifiable with the intercostal approach. All methylene blue injections were confirmed upon necropsy to have been appropriately placed into the diaphragm.

Conclusions CONCLUSIONS: This study demonstrates the feasibility and practicality of using ultrasound to guide injections and needle EMG in animal models in an effort to reduce complications associated with conventional blind technique. Further, this new method demonstrates the feasibility of targeted diaphragm injections with gene replacement therapy in muscle diseases.

Authors/Disclosures
Aarti Sarwal, MD, FAAN PRESENTER	Dr. Sarwal has received personal compensation in the range of $0-$499 for serving as a Consultant for Stimdia, Inc. Dr. Sarwal has received personal compensation in the range of $0-$499 for serving as a Consultant for Sheinkei. Dr. Sarwal has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Society of Critical Care Medicine . Dr. Sarwal has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Society of Neuroimaging . The institution of Dr. Sarwal has received research support from Butterfly, Inc. The institution of Dr. Sarwal has received research support from Bard. The institution of Dr. Sarwal has received research support from Biogen. The institution of Dr. Sarwal has received research support from Novartis. The institution of Dr. Sarwal has received research support from CVR Global. The institution of Dr. Sarwal has received research support from NIH/NIA R01 AG066910-01 . The institution of Dr. Sarwal has received research support from Image Monitoring. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker/Faculty, CME courses with Society of Critical Care Medicine . Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker at annual congress with Intensive Care Society. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker at annual congress with Indian Society of Critical Care. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a speaker/Faculty for Annual meeting, travel compensation with European Society of Intensive Care Medicine. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker with ISICEM. Dr. Sarwal has a non-compensated relationship as a Social Media Editor with Neurocritical Care that is relevant to AAN interests or activities. Dr. Sarwal has a non-compensated relationship as a Secretary with American Society of Neuroimaging that is relevant to AAN interests or activities. Dr. Sarwal has a non-compensated relationship as a President with Association of Indian Neurologists in America that is relevant to AAN interests or activities. Dr. Sarwal has a non-compensated relationship as a Member, Board of Directors with Neurocritical Care Society that is relevant to AAN interests or activities. Dr. Sarwal has a non-compensated relationship as a Section Chair, Neurosciences Section with Society of Critical Care Medicine that is relevant to AAN interests or activities.
	No disclosure on file
	No disclosure on file
Michael Cartwright, MD (Wake Forest School of Medicine)	Dr. Cartwright has received publishing royalties from a publication relating to health care.
	No disclosure on file
	No disclosure on file
Bernd C. Kieseier, MD (Novartis)	Dr. Kieseier has received personal compensation for serving as an employee of Novartis. Dr. Kieseier has stock in Novartis.
Martin K. Childers, DO, PhD (Wake Forest University School of Med)	No disclosure on file

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