Continuous Spinal Anesthesia (Spinal Catheter Technique)
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- Опубліковано 23 тра 2024
- In this video we discuss continuous spinal (subarachnoid) anesthesia, a useful technique that provides titratable neuraxial anesthesia without the potential pitfalls of single injection spinal anesthesia or epidural anesthesia
Beautifully done as always, you guys are the best and changing the way people practice regional anesthesia, even for regional fellowship trained physicians. Can you guys make a video on Lumbar Drain placement and management? This has been popping up for anesthesiologists and often at odd hours of the night the call goes to regional-trained anesthesiologist (ex. Heme in the drain, sudden cessation of drainage, etc), yet the education and training on it is inadequate or non-existent during acute pain fellowships. Ironically lumbar drain placement can be tricky and complications seem to occur more often than epidurals, such as catheter shearing off the needle.
I will definitely try this out, thank you
Really love your technique it makes so much sense. Thank you for sharing your experience. ❤❤❤❤
Thank you so much for sharing your experience! Having more techniques we have more weapons!
Tqvm...you all are the best
Thank you for this fantastic video .1. Can we use small titration of hyperbaric bupivacaine without the fear of hypotension - 2. Is the direction of catheter , facing up or down has any significance - 3. What about using this technique in epidural analgesia and anesthesia in case of inadvertent Dural puncture . Thank you for your wonderful videos , please keep going
Why not procure the continuous spinal set instead of using an epidural kit.
Amazing video, love it because i often have so frail patient for knee or hip replacement. I Have some question: 1. can we use isobartic anaropin 0.5% to replace iso bupi? 2. If the anesthesia is not sufficient, how long after the 5mg bolus we top up more 2.5mg to prevent suddenly sympathectomy.? 3. Do you ever try this method with cardiac disease patient.?. 1 more time, thank you so much for great videos.
Wonderful demo, thank you
Glad you liked it, thanks for watching!
Do u guys have vast experience with severe aortic stenosis, hip fracture patients and this technique? Would u add a pre spinal art line?
What is your experience with postpuncture headache after continous spinal anesthesia? Is the risk similiar to failed epidural insertion (wet tap) or smaller?
I used to do that when I was a trainee but stopped it after the continuous spinal catheter (catheter over needle) set is available commercially - which is actually difficult to insert.
Do you take into account a dead space (catheter +filter) when giving a 1ml of bupivacaine ? flashing with normal saline after giving LA or adding additional volume ( dead space ) of LA equal to 1 ml of bupivacaine ?
Very important note to say the least but no answer given over one year time,!!!!!!!!!!!????
From a logical perspective, I'd assume you flush the filter with 0,5%isobaric bupivacaine before attaching it to the catheter, and then add doses of 0,5% isobaric bupivacaine as needed, once attached to the catheter, as stated in the video. That way, the patient recieves exactly the medicine required in the exact dose you apply to the catheter. Well, slightly less, if you take into account the dead space of the catheter itself, but this does not impede safety, so it should be irrelevant. You can also flush the catheter itself with 0,5% isobaric bupivacaine to avoid this minor issue and be precise.
is anyone aware of dedicated SPINAL isobaric bupivacaine.5% marketed anywhere, or is everyone just using available .5%bupivacaine that says "not for spinal" like i do? thanks
I used isobaric ropivacaine 0.75% for continuous spinal n also for segmental spinal anesthesia. With isobaric ropivacaine onset is very slow. Depending upon pts condition, type of surgery n surgical duration we can choose type of the drug n doses.
“Your honor and jury, i didn’t go to the fancy medical school and make all kinds of money, but look at this blown up picture of the vial that says “NOT FOR SPINAL ANESTHESIA”, now i know when something says POISON i don’t drink it, when a sign says 🛑 i stop, but this high falutin doctor says he’s special and he can just ignore “NOT FOR SPINAL ANESTHESIA” while my client is now a vegetable from this high spinal” - plaintiff attorney
What vial of 0.5% Isobaric Bupivacaine are you using? Here at my facility, we have 0.5% Isobaric bupivacaine (Preservative free) but it says not for intrathecal use. Our pharmacy says they cannot find a vial that states "for intrathecal use." Do your vial say the same?
Hi! Yes it’s that same vial-labelled “Not for intrathecal use”. Don’t worry, it’s safe. We use it for nearly ALL of our spinals and have done so for years. The reason it’s labeled that way is bupivacaine was originally approved for epidural and nerve block use, and the only concentration originally approved for spinal use was 0.75%. People still used 0.5%, but the company never bothered to give the FDA a study with that concentration. So the FDA technically can’t say they approve it because they never had a pharma company apply for the expanded indication. And now that it’s off patent and generic, there’s zero incentive for any pharma company to try to get that label approved. Hope that helps! Bottom line is that any preservative free bupivacaine will work, we just like isobaric because it doesn’t travel cephalad and is so forgiving. Thanks for watching!
@@regionalanesthesiology Thank you for the information. It is greatly appreciated.
Question: For your fragile hip fx patients, do you perform your spinal blocks in the sitting position or in the lateral position? What is your preference at your institution and why?
Does it work well if the position of the patient is unilateral?
For the surgery I mean
If spaces r not good or not used to give spinal in lateral position, we can give femoral n block/ PENG/ fascia iliaca block for positoing the pt. So he can sit comfortable.
Devil's advocate here: What's wrong with a combination of lumbar plexus and parasacral ischiadicus blocks?
CSA Dangerous.
Ur note is to the point and much safe
until someone injects they shouldn’t and u get permanent nerve injury or kill someone or raging meningitis. this is super dangerous and borderline malpractice unless yer gonna sleep at the patients bedside to guard them from students, nurses and other providers
Thus the importance of removing the spinal catheter at the end of the case.
Thanks for your comment! This technique is really only used for operative anesthesia. The last tip I talk about references making sure everyone knows this is a SPINAL catheter (to prevent mistaking it for an epidural for example) and also pulling it out at the end of the case. Thanks for watching!
The anaesthetist has to be present in the room throughout any regional Anaesthesia anyway.
So yes, they are literally going to be right there to prevent exactly that.