A PIONEERING Irish-led project aimed at both training and assessing medical staff in the area of spinal anaesthesia will be launched today at the College of Anaesthetists in Dublin following over two years of research and development.
The MEDcap project, which was funded by the European Commission’s Leonardo da Vinci Lifelong Learning Programme, involved a research team looking at the performance of spinal anaesthesia to develop a simulated model to examine the area of competence.
Prof George Shorten of the Department of Anaesthesia at Cork University Hospital explained that the project involved developing assessment methods to define the various skills involved in spinal anaesthesia and examining these in a controlled way on a simulator.
“What we did was that we collected common problems into virtual patients where you can change a lot of the parameters that would change in a real patient, so what we’ve created is a simulator on which people learning spinal anaesthesia can train.
“For instance, the anatomy can vary from patient to patient. Normally in spinal anaesthesia, you put a very small needle between two of the vertebrae low down in the spine and then you pass through a number of ligaments before you get really close to the spinal cord.
“In most people, there’s quite a big space, the size of a penny say, between the two vertebrae, but in an older person say or somebody who has had vertebral collapse, that space can be very narrow and you have to find another way in, from the side or from below,” he said.
More than 20 researchers from CUH, University College Cork, the Interaction Design Centre at the University of Limerick, as well as the University of Graz in Austria and the University of Pécs in Hungary, have spent the past 25 months on the project.
Prof Shorten explained that spinal anaesthesia is hugely dependent on sensation and the MEDcap project involves the use of haptic or quantitative tactile technology to assist the trainee so they can judge whether they are carrying out the procedure correctly.
“If a patient is very obese for instance, a couple of things happen – the distance is greater from the point where you puncture the skin to the point where you puncture the dura mater (outermost membrane) which is lining the spinal cord,” he said.
“But as well as that the tissues that you are travelling through have a different feel – for instance, if you are passing through just fat or lipid, it feels as if you’re putting the needle through melted butter, and it really doesn’t give you a lot of information on whether you’re getting close to the spinal cord.
“You’re not really sure if you’re going through the right tissue but then as you get through the three ligaments, the supraspinous, the interspinous and the ligamentum flavum, they have their own special feel and the simulator simulates the sensation you have as you go through each of these.
“Using devices like this, somebody can ascend the learning curve, especially the early part, without being exposed to patients or without patients being exposed to them so they are at a higher level of competence when they first carry out a procedure on a real patient so it’s a very useful device.”