Slim but Tricky: Axillary Block Challenges in Low BMI Patients!
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- Опубліковано 31 тра 2024
- While one might assume slim patients are easier candidates for an axillary brachial plexus block, the reality is often the opposite. In this video, we explore the challenges associated with performing this procedure on individuals with low BMI. Key points include the role of adipose tissue in nerve identification, the implications of shallow anatomical structures, and the need to adjust needle techniques. We also discuss the increased risk of Local Anesthetic Systemic Toxicity (LAST) in slim patients and the precautions required. The video features a practical demonstration using a ropivacaine-lidocaine mixture for an AV-fistula creation procedure. Join our community, share your experiences, and learn together!
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Disclaimer:
Medicine is an ever-changing science. As new research and clinical experience broaden, changes in treatment and drug therapy are required. The authors and publishers have checked with sources believed to be reliable in efforts to provide accurate information within the available or accepted standards of care. However, given the possibility of human error or changes in medical practice, neither the authors nor the publisher, nor any other party involved in the preparation of this platform warrants that the information contained herein is in every aspect accurate or complete, and they disclaim all responsibility for any errors or omissions for the results obtained from the use of the information contained in this work. Readers are advised to confirm the information contained herein with other sources. For example, readers are advised to check the product information of each drug mentioned, and that any information contained on NYSORA's UA-cam channel is accurate.
Good needle advancing. That group of patients making our skills better!
Renal patients can be the hardest due to oedema and comorbidity. Nice job!
I had 2 done when I had 2 CMC arthroplasty. Done as shown; it paralyzed my arm giving great pain control for almost into next day. Nice post
Why did they stop before showing the MCN injection?
Thank you for watching. We decided to cut the video short - to demonstrate the point of low BMI and difficulty - but indeed - the patient did need the MCT nerve block. Greetings and thank you for watching
Thanks
Nice video!
Will you please discuss mixing LAs? I was always taught that mixing LAs decreases the advantages of each LA; e.g. slower onset
To avoid toxicity an alternative option is to mix the solution with saline.
Indeed. However, this can increase the onset time, and decrease the density of the motor block. Greetings
In skinny patient ( asian patient ) or narrow space , Can we use saline 1-2 cc opening the space before advance the needle to proper position and inject local anesthetic? I always use saline opening space especially in fascial plane block.
Yes! Great suggestion and feasible!
I do the same
My dad died from renal and heart failure.I have general question on something else related to anesthesia do feel that it is unethical for anesthesiologist to sedate patient who is alert but scared and they are telling doctor give them minute but the doctors decide to sedate the patient without their knowledge and the patient wakes of with PTSD. I feel that taking the patients rights away. I reported the doctor because if he had just waited a minute and try to comfort me and told what he was going to do it would of been different out come. What is worse he knew my history and did what wanted anyways regardless of my rights as patient. I was just curious how felt about that? I know you have a lot followers and if you have time to respond thank you.
Why not hydodissection before advance needle?
Good idea/technique - however, there are 2 potential issues: 1) Hydrodissection can decrease the monitoring value of nerve stimulation, which we use routinely 2) It increases the total dose of LA and risk of LAST. While these disadvantages can be eliminated by using saline to hydrodissect - this increases the complexity of the procedure and the equipment setup. Noting wrong with it, just not something we do as a standard at NYSORA. Greetings and thanks for watching!
Nice regular size nibp cuff on a 40kg patient
1% ropivcaine is too concentrated! Even 0.25% bupivacaine with adrenaline will easily result in a good enough surgical block. And 0.25% bupivacaine with adrenaline can be used at 1 ml/kg, so this 40 kg patient could have had upto 40 ml given to him/her! 😮