Epidural Stimulation Test Criteria
Bibliographic record
Abstract
In Response: We would like to thank Dr. Tsui (1) for his interest in our work (2) and his insightful comments. We agree that the upper current limit used for a positive epidural stimulation test should be increased to at least 15 mA, with an appropriate elicited motor response. We do not agree with the assertion that “when a catheter is situated properly within the epidural space, muscle twitches are typically elicited with a current much greater than 1 mA.” In our study (2), of the 167 patients with a positive epidural stimulation test, 9 had unilateral motor response with current less than or equal to 1 mA and 19 had positive unilateral motor response at current less than or equal to 1.5 mA. All of these patients had adequate postoperative analgesia. None had evidence of subdural or intrathecal catheter placement. Hogan (3) demonstrated that epidural catheter tips were more often found lateral in the epidural space than in the intervertebral foramen. With increasing volume of injectate, the epidural spread becomes more symmetric. We believe that as long as the motor response is unilateral and segmental, the catheter tip is most likely in close proximity to a nerve root, probably in the intervertebral foramen. Bilateral or multi-segmental motor response at low current should warn the clinician of possible intrathecal or subdural catheter placement. Radiological confirmation remains the “gold standard” for assessing adequate epidural catheter placement and localization. As such confirmation was not feasible in our institution, our “gold standard” was our studied population's appropriate postoperative analgesic response, the ultimate reason we insert epidural catheters in surgical patients. The lidocaine test was our usual presurgical test for epidural localization before the introduction of the epidural stimulation test and epidural pressure waveform analysis. Dr. Tsui should be commended for his work with the epidural stimulation test, a method that improves the success of epidural placement, confirms adequate dermatomal level, and increases the efficacy of epidural anesthesia and/or analgesia. Etienne de Medicis, MD, MSC, FRCP(C) Rene Martin, MD, FRCP(C) Jean-Pierre Tetrault, MD, MSC, FRCP(C) Departement d'Anesthesiologie Centre Hospitalier Universitaire de Sherbrooke Sherbrooke, Quebec, Canada [email protected]
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.012 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.061 | 0.022 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".