I'm a med student interested in anesthesiology who loves your videos. I just finished my anesthesia rotation and had an absolute blast! It's such a unique specialty that has so much more freedom and complex decision making than some people realize. Compared to EM especially, it feels both more intellectually stimulating and weirdly creative. I'd love to see you do some higher-level videos if you feel like it for us physiology and pharmacology nerds! A sincere thanks for all of the effort you put into these! 💉
FWIW (not sure if it aligns with your goals for this channel), I, too, would like to see a more “technical” video geared towards Residents or other students of anesthesia, but this is a great primer & well worth the watch.
I am a mom and just now finding out that an epidural isn’t just a shot. I can’t believe I actually had a small tube in my back!! I am pregnant with my 2nd and I wanted to educate myself. Thank you for this video!
I'm not a med student or have anything to do with medicine myself really, but you explain in such a captivating manner that I watched the entire video with my full attention and I have severe ADD lol. Just trying to express how amazing of a job you're doing making educational videos!
Ever since I had a spinal to prep me for the emergency forceps delivery of my son, I’ve had progressively worse arthritic, burning type pain, with unusual numbness. For about 4 months post delivery I had constant, excruciating headache, that was far and away the worst headache of my life. I did what I had to do to deliver my son safely, alhamduillah. I would really appreciate it, Dr. Max, if you could talk about potential complications of spinals/epidurals, and the treatment. Thanks!
This was really cool to watch. I got an epidural after being in labor for 2 days, and in the middle of contractions. Once i was numb, i told the anesthesiologist i loved him. Totally worth it!
I had a spinal for a c-section and had a weird reaction that made me shiver/muscle spasm through the whole procedure. The Anesthesiologist was wonderful about talking me through it and keeping me calm.
Anaesthetics is a fascinating subject. As a teenager, many years ago, I had a 1944 copy of Pye's Surgical Handicraft. In the anaesthesia chapter, only four anaesthetic agents were discussed there was nothing else: ether, chloroform (inhalation) and sodium pentothal and sodium evipan (iv ). The speciality has advanced immesurably!
I’m new to anesthesia and today I assisted a blood patch. 24hr post-partum with a headache. I was in awe to see our patient experience nearly immediate relief 😮 the entire procedure was amazing!
This was such an amazing explanation of how each type of procedure works! I had an epidural when I had my c-section and nobody explained anything to me before delivery day. (I didn't even know they put in a catheter till they said it was time to take it out) I was told to bend over my massive twin belly and hug the nurse and tell them when I couldn't take the pain anymore. I have a high pain threshold so I was so worried that if I told them when it was really, really painful it may have gone too far. I trusted all the doctors, but it was my first surgery, delivery, massive needle in my back...I was really scared. I'd literally never broken a bone or had stitches or even a cavity filled before having my girls so I had no idea what to expect. For people who can handle it, this is what they need to show moms-to-be so they know what's going on back there!
That makes epidural placement sound very frightening. I can't imagine many patients that would not freak if told "now tell me when you can't take the pain anymore"! ???
Well, I don't have a high pain threshold as I have very painful rare nerve pain disorder in my ankle after a terrible injury in 2012. I had to have many surgeries . One was morphine pump n other was nerve stimulator implant to help constant pain. I still need strong painkillers everyday. I even lost my husband to heart attack a month ago n I'm so scared n lost bc he took care of for many yrs. 😔
@@DavidSmith-ki2we Hey buddy. Hope that you are doing ok right now. It’s tough what your going through, and I hope that you have a great support network out there for you. Take care and massive hugs.
I wish the team for my 2nd C-section had your training! 3 residents tried 7 times to get it then gave up and got the attending. They kept doing the lidocaine shot before each try too. So, in all it was 8 lidocaine and 8 tries for the spinal. They made my leg kick (but yelled at me to be still) several shocks in my thighs and toes. Thank goodness for the nurse who told them they were doing all of that. It never did work, I felt almost every and they finally believed me when my legs were moving during the C-section/tubal and my OB told them to give me something through my IV to put me almost under. My whole low back had a huge bruise after. Since then we found out my discs were completely collapsed from degeneration and I've had a couple of fusions. So, I understand it wasn't normal anatomy but I think they should have given up after maybe 5 or 6 tries.
Omg that must have been very traumatic for you. I hope you sued them for not having scanned or X-rayed you beforehand. I had a slipped disc which happened when I was 38 weeks through my pregnancy. A week later in the delivery suite the anaesthetist didn’t believe me as I hadn’t been referred to a consultant for it.(my gp sent me in by ambulance). Mind you, that was 30 years ago. I was so traumatised by what happened that I was given a private room for eight days after our son was born so I couldn’t talk to anyone about it. The anaesthetist tried three times to put an epidural in my lower back and the next time the tube went down my spine and hit something so she pushed very hard which made me pass out in pain. When I came round the anaesthetist had gone from the room and I was left with a very dead, numb right leg and no pain relief in my left side at all. I screamed so much that my husband took himself out and I said they wouldn’t allow a dog to be in the pain I was in so they took me to theatre to have a ventouse delivery. Easy way to deliver! I’m now medically retired because of my back and overall have had 18 episodes of herniated discs.
You Doc. You do a fantastic job on explaining certain anesthesia procedures on UA-cam. By you doing this helps take the stress off of patients minds before going to surgery. The reason I know so much about this is because I used to work in surgery for quite a while. I worked at Wayne Memorial Hospital for 36 years most of those years was spent working in the surgery so I watched and held patients in place for spinal epidurals, spinal blocks for surgery. Not only did I learn so much I miss working in surgery. I also worked in EMS for almost 26 or 27 years. I did 10 and half years as a volunteer EMS, then ,10 years as being a paid for The Goldsboro Fire Department in Goldsboro NC. You have done a great job of explaining what anesthesia actually does. Thank You
I’ve had both a spinal and epidural anaesthetics. I remember having a headache after the epidural. Very grateful for these anaesthetics at the time. Great video.
I had very bad headaches too. In my country we are given pepsi in the first twenty four hours . Since then whenever I get headache Pepsi to the rescue.
Hi Max - - Re: SENIORS, please discuss the benefit of Epidurals over Generals, whenever possible, and the role of Generals in post surgical confusion, cognitive decline and/or dementia.
Max or rather dr. Maxfield I appreciated the subject matter of this video. It helped me appreciate truly the epidural that I had with my gastric resection due to excessive reoccurring tumors in my stomach. My team did a epidural for my gastric resection and I couldn't believe how painless the entire process was. I didn't even realize that I was given shot in the back to be honest let alone the entire procedure of inserting the epidural. It made the entire procedure and healing inside the hospital completely painless.
I really appreciate this video after having a spinal for my hip replacement.it helped give me a clearer picture of what was done. Great video, thank you.
I'm astonished with what I see that I went through during my gastric resection due to excessive tumors and subsequently the paresis. I just discovered your channel and found it extremely beneficial.
I e had several back surgeries and now I have DDD and Osteoporosis. I have injections several times a year. Sometimes I have better relief of pain but then there’s times that I don’t. I’m a 61 yr old lady and it’s getting harder and harder to get any good relief. I really enjoyed your video.
CSEs are a cornerstone of my ortho days. It still blows my just how much anesthesia can be provided with a 9 cm needle and a couple milliliters of local anesthetic. Great explanation, technique, and visuals, Dr. Feinstein. I also find it helpful to mark the apex of the interspace of with my thumbnail.
I saw this done on my wife when she was in labour for my son. I have never been more in awe of a medical procedure than watching the anesthesiologist perform this.
Thank you for the wonderfully informative and fascinating video. I had an epidural during my first labour, which worked for about 45min and then stopped providing the necessary pain relief. After several top-ups, they had to stop giving medication as i was becoming numb up to chest level, despite not getting pain relief. When finally i was taken for a c-section, i was terrified that a spinal would likewise not provide pain relief, but fortunately it worked almost instantly. I had 3 subsequent c-sections and each time the spinal anasthesia was the longest and most complicated (and most painful) part, taking almost an hour with my second csection. Besides from severe swelling due to weight etc, they believed that anatomical issues with my spine may have complicated the siting of the needle (perhaps related to the problems with the epidual from my first labour??) In any case, i have had 4 spinals for 4 csections, rather traumatic experiences. Watching this video, although really interesting, was a bit of an uncomfortable reminder of what i was experiencing each of those times. All that aside, many thanks again!
I am an anesthesia technology intern, and these videos are very helpful !! So thanks for that. Also, I would really like to see caudal anesthesia as I didn’t get the chance to see it yet
I’ve had two gynae ops, 2 ankle arthroscopies and one ankle replacement all by spinal - they are the best! You don’t get the general anaesthetic hangover and you can talk to the Drs and Nurses! If they get sick of you they madazolam you into oblivion😅 The OR has been my work place for years and I feel comfortable with the technology and going’s on! Thanks Dr Max love your educational videos.
Thank you so so much for your effort in making this video (and also the others). I learnt so much and actually understood the concept behind each steps. - Anaesthesiology resident from Malaysia. 🇲🇾
"Stinging" was not what I felt during the insertion of the local. It was as if a flame was relentlessly applied to the skin on my back (pain level 10/10)! I'm glad to read that my experience was likely the exception. As others have stated, no explanation was offered for anything. I was told to lie on my side, curl up, and hold still. Thankfully I had the sense to do a bit of research prior. I'm not sure what they hit but my top leg involuntarily twitched rather dramatically. I was again told to lie still, but I stated that the leg twitch was their fault, not mine. After finishing the mysterious (at the time) activities, I was told to roll onto my back and observe the progress of the numbness as it rose from my toes on up. Meanwhile, I watched my obgyn scrub, gave him a thumbs-up through the window, and the C-section proceeded. Nobody explained that there'd be a urinary catheter inserted, resulting in more pain once sensation returned. After my son was properly extracted, he was hauled away and I was knocked out as per my prior request. I awoke hours later, was handed my son, and instantly realized why no one in their right mind would opt for a C-section if it can possibly be avoided (mine couldn't as the lad's head was too large to fit through). I literally patted down the sheets next to me (I'd been lying on my side in bed), fully expecting to find my reproductive system lying there based on what I felt. As bad as that pain was, it wasn't as bad as the burning that I felt when the local was administered.
Please help answer this question. You are such a fine teacher! and I am so very grateful the Mt. Sinai Hospital provides such wonderful support that allows this very informative program. QUESTION: I watched a PA do an epidural! I was absolutely floored because I thought that it was something strictly for a physician . Can a PA do this?
I remember that headache very well. It was the headache from hell. They were doing a epidural for child birth, and went to far and wound up giving me spinal. Child birth had nothing on that headache. After 3days of caffeine loading to try to get it to stop or ease the pain. The cure ironically enough is another epidural.
Maybe it's a spinal they said I would have while having my knees replaced. And what you just said about where the spinal is placed makes me feel a lot better about possibly having a spinal. I've never known that before! Thanks 😊
Thank you for your videos Max they're filmed very professionally and very informative. As an MS3 who wants to match anesthesiology, and currently on my OB anes rotation, your videos help refresh my anatomy knowledge and help prep for procedures! Your attention to detail and thorough-ness are what id expect from an anesthesiologist! One thing I noticed was that during the spinal demo at 9:09, you mentioned that after you punctured the ligamentum flavum, you'd expect to see CSF. I believe you'd need to advance to also puncture dura to achieve a spinal and get CSF, correct?
This is super cool to watch. I'm starting clerkship soon and with only 2 weeks of anesthesia core rotation, your videos will really help make the most of it!! 😅😅😅
It's good to know where the spinal cord ends and where the injections are done. I'd always wondered about that and if offered a spinal or epidural I would have been hesitant to say "yes". Although I assume the person doing the procedure would explain that to me when I showed hesitancy it's nice to know in advance.
I wish I had had an explanation before having my son. I had a c-section and the epidural fell out and I had a window where I felt the pain and lots of gas was given to ease the pain. That didn't work too well. You seem so intelligent in your area of expertise.
Hi Dr Max! Great video! I love to learn from you! I have had about 20 epidurals due to 3 bulged disks and degeneration. I have always had a general anesthetic. I once asked about going without the general (because you are limited for 24 hours afterward) and they told me they could but it was very painful. So I didn’t try it. I now have a spinal cord stimulator but I still get an occasional set of epidurals. I don’t think the stimulator is that great. My doctor pushes them but I know some doctors won’t see you if you have one. Also you can’t get an MRI in Texas if you have a stimulator. Thanks for being so detailed in this video! See you on the next one!
Great video! It’s not a matter of if but when I’ll eventually need a knee replacement for my bad knee (bad joints run in both sides of my family and there has been/will be roughly 8-9 knee replacements between six different family members from both sides) so this was very helpful info as I’ve never had surgery before unless you count the stitches I had when I was two to reattach my nose that I cut on a stamp box I was playing with when I tripped and fell. (I might eventually have skin removal surgery from my 85 Lb. weight loss four years ago but building my house comes first so that doesn’t count right now).
Great video!! Dr Max, I had a lumbar tap done but afterwards, I developed severe headache and it was found I had a CSF leak. I had to get a "blood patch" done to "plug the hole." It worked. Can you please explain why this would happen, and how does a "blood patch" work? Thank you!
Great video man! I really enjoyed it! I always learn a lot from your videos! You rock!! I’m gonna start Donating to the Anesthesiologist Foundation in June since It was hard for me to go to college to be a Anesthesiologist after I graduated high school in 08 because of my cerebral palsy! I have had 14 surgeries because of my cerebral palsy! Those needles 💉 are very cool
Dr. Max thank u so much for this video! When u inject the lidocaine, do u think its necessary to wait a few minutes to let the lidocaine work before taking the next steps? Im curious to know ur thoughts😊
I had a total hysterectomy at Christmas 21. My uterus was so large I had to have a vertical abdominal cut. I had full anesthesia and I asked for an epidural. My surgeon had the anesthesiologist put one in and after my surgery the epidural was kept in place 24 hrs. The day after my surgery and the 6 days I was in the hospital I had a pain level around a 2 and only had tylenol. I was so happy how smooth it went together with the full anesthesia. I enjoy your videos very much. I had 2 epidurals with my c sections and was great to be awake for the birth of my children. That must be so challenging with women in labor and can't bend forward well due to the baby. Have you ever had one of these procedures?
Just had a scheduled C-section and this gave me the chills. They tried 3 different times to get the block in place...4th times the charm. I was crying by the time they finally got the spinal block 😭😭
I have a permanent Epidural with 2 lines feeding the Fentanyl and Bupivacaine from a pump located inside me called a Medtronics intrathecal pain pump. I have a constant flow of medication and a remote bolus device that I can use to give me more medication at set intervals for pain relief. It gets refilled about every 30 days. It is about the size of a small hamburger, located in the right side of my abdomen. This has been a great help for chronic pain due to a spinal injury. I have a 5 level fusion at my lower lumbar with discs removed Anterior posterior interbody fusion 360. I have permanent nerve damage, but can walk now. Fusion was done by Dr, Tiffany Perry at Cedars Sinai and pump was implanted by Dr. Leo Langlois in Bakersfield, Ca.
I'm wondering as a curious nurse. Is it a possible occurence to miss a combined spinal/epidural and deliver the epidural through the arachnoidian space by mistake? Thanks for your videos :) love them!
Hi Nina, while that is technically possible, the "test dose" which is delivered before the epidural is hooked up should be able to detect if that happened. Thanks for the nice feedback!
I think what Nina meant was that after performing the spinal with hyperbaric bupivacaine for instance, then pushing the catheter through the Tuohy needle and it accidentally ending up in the subarachnoid space. In that case, the testing dose given through the catheter wouldn’t be effective to detect the catheter mispositioning, since spinal anesthesia would already have been installed. That’s why before injecting the larger volume of local anesthetic needed for the epidural we should also give some time to observe if there’s any CSF reflux through the catheter.
@@henriquelaydner4080 i have never heard of that happening with a cse. In the cse needles that I have always seen/used, there are different openings for the epidural catheter and the spinal needle that comes in the kit so the catheter is directed up and away from the hole where the spinal was done . The hole that the spinal needle makes is also very small. I doubt the epidural catheter would fit through it. CSE is not very common compared to spinal and epidural alone. Most people just do one or the other depending on what you need it for.
Thank you for the information. The epidural was one of the worst parts of my after birth issues. I felt pain regularly and could tell you exactly where they placed the epidural. In fact, I had pain at the point of the epidural for at least 5 years. I wish you had been the individual who had given me my epidural. The woman I had no bedside manner and seemed angry at me for wanting to get one after all.
Dr.Max Feinstein, I’ve watched quit a few of your videos and it has helped me to understand the way things happen so people other than Dr.’s can understand what happens. You do such an amazing and clear job of explaining all the different steps that a patient can expect to have happen. You also say if anyone has any questions to drop you a line. So first let me say I live in Ontario, Canada and I don’t know how different the steps and or medication’s used to put me under will differ between the USA and Ontario, Canada. So first let me say I have ABSOLUTELY 0% of having any kind of French in my DNA or bloodline going back generations on either side of my parents and their ancestors. So I’m 38 years old and I have a condition that is an Anesthesiologist Nightmare called Malignant Hyperthermia or M.H for short. I of course wear a medic alert necklace. I only mention the French bloodline because I’ve been told from several different Anesthesiologist that typically it is found in people that have French in their bloodline. However I was wondering if you could explain the different processes of putting a regular patient to sleep versus putting a patient to sleep who has Malignant Hyperthermia. I’m looking to know the steps and procedures and the process from the Anesthesiologist point of view from the time that they come and introduce themselves to the patient on the day of surgery prior to going in the Operating Room to how they are put to sleep and during the operation to waking the patient up. I know the response will not be super down to the exact way of things as you don’t know my current medication or height and weight and overall information about me that you would need to know. I’ve tried to ask questions from each time that I’ve had surgery but any of the Anesthesiologist that I’ve had are always to much in a hurry to answer my questions. The only thing I know about having Malignant Hyperthermia is that I have to be the first patient of the day that’s operated on with that specific Dr that the Anesthesiologist is working with that day and right after they put the oxygen mask over my face just seconds before they put whatever drugs in the IV to put me to sleep is that they roll the crash cart right beside my head and turn it on. They do all that while I’m still awake and that’s the last thing I see before they put me under, as if having surgery isn’t already scary enough knowing I have a condition that is scary when being put to sleep but to have to view that crash cart being rolled right beside me and then turned on as the last thing I witness is way more frightening and they wonder why my heart beat increases as their doing that. I don’t even know what Malignant Hyperthermia is as to how it affects a patient or the definition. I don’t know if I’m allowed to leave my email address or not but I’m going to try that way hopefully I get a response. elvis0310@hotmail.com
Hi Max! Can you briefly touch on your typical contraindications for lumbar puncture? How frequently do you observe the optic disc with an ophthalmoscope for instance?
Giving SAB before epidural can cause sadle/partial block in sitting position as you have to keep the pt in sitting position for catheter placement. What i do i give epidural 1st then i give spinal one space bellow. Pt gets two prick but its good for long run.
I’m getting knee replacement surgery soon & been told I will be having a spinal anaesthetic plus sedation. This video has been very helpful. This video h
Very instructive. When puncturing the dura, I think you said "bevel up". Since the longitudinal fibers of the dura would then more likely be severed by the needle, are you concerned that post-spinal headache might be more likely than if the needle were placed with the bevel vertical? I assume that the specific gravity of the anesthetic may determine the level of spinal anesthesia. If so, how then do you control this should the pt. have to be positioned unexpectedly in a position unfavorable for anesthetic agent drift?
Since doing anesthesia and completing my OB rotation, I've wondered why the needles aren't color-coded to the same gauge as peripheral IV catheters. For example, the 27g needle for the lidocaine is blue, while a 22g PIV is blue. Or in the Braun spinal kit I use, the 25g needle is orange, while a 14g PIV is orange. This was very confusing the first time I opened up a spinal tray.
That would be something you might need to talk to your doctor i get them done quite often and I never had a headache after the fact , so its might be a reaction to the steroid, i thing you should mention that to your pain management doctor.
Gosh your center should send u to places to teach the method. So why does the pt have to be awake for this?if the pt developed a spinal headache and needs a blood patch. Does it mean placemats was wrong or thhat the little hole didn't seal ?
So with that special one that the catheter points up. Is that what the doctor means when he does a caudal block and says the meds will go upwards? These videos are fascinating 👌 👏 thank u.
Thank you for the clarity. It's important to know, but I'm sure most of us don't. When I had my babies, we had something called a "Saddle Block." How is that different. Thanks for a great channel.
I have had both for 3 c sections. On one of them it took a couple of times to get the needle in the right place. I ended up screaming as the medication was not working anymore. I think some of the medication got wasted in the prior attempts. It was long time ago and surely better now.
Absolutely exceptional video! This describes those procedures perfectly and is very easy to understand, thank you! If possible, could you share what you are looking for on a test dose? I know a common side effect of an epidural is hypotension, so I'm guessing you are looking for something else?
Testing dose is meant to detect both inadvertently inserted catheter into a blood vessel and the subarachnoid space, which is where lies the CSF (cerebral spinal fluid). For that we give a small volume of a less toxic, faster and shorter acting local anesthetic (usually lidocaine) with a very diluted dose of epinephrine. Since epidural blocks are meant to install slower than spinals, if the blockade starts too fast we will probably be facing an inadvertent spinal anesthesia. Alternatively, if the injection is given to a blood vessel, then there will be an almost immediate rise in the cardiac frequency and maybe some tinnitus and numbing to the tongue, due to the local anesthetic effect. It’s important to notice that the test dose is the ultimate resource to detect a misplaced epidural catheter, but the feeling of an experienced anesthesiologist during the process plays a major role, as well looking for CSF or blood reflux before injecting anything.
@@henriquelaydner4080 Thanks for the supplementing Dr. Max's excellent video on the subject which is most relevant to healthcare persons and if it had been incorporated by Dr. Max , would have of more benefit to the viewers. Mentioning of dosage, volumes and top up procedure could make it a masterpiece.
I had a spinal with my c section...horrible experience...they hit a nerve and it hurt so bad i passed out...i think they injected something into my nerve if this is possible because part of my right thigh is numb to this day...they had to do my spinal at L1 L2 because i have a bulging disk at L3 L4... After a few tries and having to lay on my side they finally got it...im not looking forward to another c section..i don't think I can go through that again...
Dr. Feinstein: I had an epidural for my daughter’s birth 3 months ago and it actually stopped working 2 hours in and the anesthesiologist had to come back and give me a second epidural (which worked, thank goodness and made me SUPER numb). Can you explain what you think may have happened as to why the first one stopped working?
Hi there, it's possible the epidural catheter moved out of place despite being (presumably) taped down very well. Without being there, I really couldn't say.
I had this happen too. The first didn't respond the way they thought it should. Then ultimately after hours when I 'failed to progress past 7cm' it was an urgent rush to replace the epidurals with a block and immediate c-section. Whatever it took- I have a beautiful 10 year old. (Just holding off on her full birth story until she's a bit older!)
Why isn't done under Fluoroscopy? Epidurals have always freaked me out, so I've never had one. They say that they're really good to have something like that if you're having your knees replaced which I need to have one of these days. And today I actually had knee injections under Fluoroscopy.
Fluoroscopy is cumbersome, can take a lot of time (which is limited when a laboring patient is in significant pain), and also introduces a considerable amount of radiation. Fluoroscopy can be used for certain procedures (like injections as you mentioned) when the benefits outweigh the risks.
My neurologist does lumbar punctures in his office in a regular patient exam room lol. I was quite horrified when I found out mine would be in the office.
Great video. Other content ideas that I would love to see.. tutorials for: double-lumen, fiberoptic intubations, central line, nasal intubations, (I could really make this list go on for a while lol but I think those are the most ideal).
Great info Max. I’m going in for hip replacement surgery, March 2nd/2022. I’ve had 5 - L4/5 fusions, and a final Inner-body fusion. They’ve advised me they’re going to perform a spinal/epidural. With my previous L4/5 surgeries, what level would you say they would enter at? Thank you sir.
i had a epidural after my scoliosis surgery no clue where abouts on my back it was tho lol but it was really cool to see how they did it as i was under general anesthesia at the time
This was a great video! I feel like I probably should have had the combined epidural and spinal during my 3rd and last c-section, but I was given a spinal. I was having my tubes tied as well. They show me my baby briefly and then they whisked her off to do her examination... all of a sudden, I am in so much pain... The anesthesiologist and my OBGYN start arguing, I hear someone say that I'm losing a lot of blood, and I start crying because this just does not feel right... then my anesthesiologist says to me, "don't worry, I'm going to stop the pain..." and I'm out like a light. I wake up in recovery and find out that I had the most adhesions my OBGYN had ever seen and had to slice through my bladder to get to my baby. My uterus was also super thin and kept ripping back open when he was stitching it up... he said it was a good thing I got my tubes tied because he would not recommend me having any more children. I spent 6 days in the hospital getting bladder scans and I had a jp drain in my abdomen and a catheter for days. Luckily, my bladder healed nicely.
I have a condition called adhesive arachnoiditis, which was possibly caused by epidural injections and the inadvertent puncture of the dura during the procedure. How do you prevent or lessen the possibility of this happening?
Hi...thank you for this interesting vidéo. Can you please share with us how to calculate the depth of the catheter we have to advence depending of patients tall ..(sorry for my English..I hope you understand my question)
I'm a med student interested in anesthesiology who loves your videos. I just finished my anesthesia rotation and had an absolute blast! It's such a unique specialty that has so much more freedom and complex decision making than some people realize. Compared to EM especially, it feels both more intellectually stimulating and weirdly creative. I'd love to see you do some higher-level videos if you feel like it for us physiology and pharmacology nerds! A sincere thanks for all of the effort you put into these! 💉
Glad you enjoyed! Yes I think there is really a science as well as an art to anesthesiology. It's such an enjoyable specialty.
FWIW (not sure if it aligns with your goals for this channel), I, too, would like to see a more “technical” video geared towards Residents or other students of anesthesia, but this is a great primer & well worth the watch.
Good luck to you promise me you will be top of your class . 🌹💉🔬You will 💯
Im a med student in Scotland and we don't get an anaesthesia rotation ☹️
@@MaxFeinsteinMDI am a nurse and looking forward to do my bachelors in anaesthesia I am kindly looking for scholarships.
Thanks
I am a mom and just now finding out that an epidural isn’t just a shot. I can’t believe I actually had a small tube in my back!! I am pregnant with my 2nd and I wanted to educate myself. Thank you for this video!
I'm not a med student or have anything to do with medicine myself really, but you explain in such a captivating manner that I watched the entire video with my full attention and I have severe ADD lol. Just trying to express how amazing of a job you're doing making educational videos!
I love your sense of humor. Also I'd like to mention if you're getting one, as I did for a c-section, DON'T MOVE. Don't so much as BLINK.
glad to meet you
Ever since I had a spinal to prep me for the emergency forceps delivery of my son, I’ve had progressively worse arthritic, burning type pain, with unusual numbness. For about 4 months post delivery I had constant, excruciating headache, that was far and away the worst headache of my life. I did what I had to do to deliver my son safely, alhamduillah. I would really appreciate it, Dr. Max, if you could talk about potential complications of spinals/epidurals, and the treatment. Thanks!
This was really cool to watch. I got an epidural after being in labor for 2 days, and in the middle of contractions. Once i was numb, i told the anesthesiologist i loved him. Totally worth it!
I had a csf leak repair in my skull and then a lumbar drain placed for about a week while I healed. Fascinating to see more about this! :)
I had a spinal for a c-section and had a weird reaction that made me shiver/muscle spasm through the whole procedure. The Anesthesiologist was wonderful about talking me through it and keeping me calm.
I experienced the same.
I think it's actually a common reaction
@@lorih6603 weird to me, not to the anesthesiologist.
Anaesthetics is a fascinating subject. As a teenager, many years ago, I had a 1944 copy of Pye's Surgical Handicraft. In the anaesthesia chapter, only four anaesthetic agents were discussed there was nothing else: ether, chloroform (inhalation) and sodium pentothal and sodium evipan (iv ). The speciality has advanced immesurably!
As a pharmacist I enjoyed both technical and pharmacologic aspects you provided in your videos 👌👌
I’m new to anesthesia and today I assisted a blood patch. 24hr post-partum with a headache. I was in awe to see our patient experience nearly immediate relief 😮 the entire procedure was amazing!
It is one of the best demonstrations of spinal & epidural anaesthesia I've seen. Thanks a lot.
This was such an amazing explanation of how each type of procedure works! I had an epidural when I had my c-section and nobody explained anything to me before delivery day. (I didn't even know they put in a catheter till they said it was time to take it out) I was told to bend over my massive twin belly and hug the nurse and tell them when I couldn't take the pain anymore. I have a high pain threshold so I was so worried that if I told them when it was really, really painful it may have gone too far. I trusted all the doctors, but it was my first surgery, delivery, massive needle in my back...I was really scared. I'd literally never broken a bone or had stitches or even a cavity filled before having my girls so I had no idea what to expect. For people who can handle it, this is what they need to show moms-to-be so they know what's going on back there!
That makes epidural placement sound very frightening. I can't imagine many patients that would not freak if told "now tell me when you can't take the pain anymore"! ???
Well, I don't have a high pain threshold as I have very painful rare nerve pain disorder in my ankle after a terrible injury in 2012. I had to have many surgeries . One was morphine pump n other was nerve stimulator implant to help constant pain. I still need strong painkillers everyday. I even lost my husband to heart attack a month ago n I'm so scared n lost bc he took care of for many yrs. 😔
@@DavidSmith-ki2we Hey buddy. Hope that you are doing ok right now. It’s tough what your going through, and I hope that you have a great support network out there for you.
Take care and massive hugs.
Ppl
Had a spinal for my C-section, birth, and tubal ligation. Blessed are the anesthesiologists!
I’m a CCRN and I still can’t wrap
my head around regional anesthesia so videos like these are good for keeping updated.
I wish the team for my 2nd C-section had your training! 3 residents tried 7 times to get it then gave up and got the attending. They kept doing the lidocaine shot before each try too. So, in all it was 8 lidocaine and 8 tries for the spinal. They made my leg kick (but yelled at me to be still) several shocks in my thighs and toes. Thank goodness for the nurse who told them they were doing all of that. It never did work, I felt almost every and they finally believed me when my legs were moving during the C-section/tubal and my OB told them to give me something through my IV to put me almost under. My whole low back had a huge bruise after. Since then we found out my discs were completely collapsed from degeneration and I've had a couple of fusions. So, I understand it wasn't normal anatomy but I think they should have given up after maybe 5 or 6 tries.
Omg that must have been very traumatic for you. I hope you sued them for not having scanned or X-rayed you beforehand. I had a slipped disc which happened when I was 38 weeks through my pregnancy. A week later in the delivery suite the anaesthetist didn’t believe me as I hadn’t been referred to a consultant for it.(my gp sent me in by ambulance). Mind you, that was 30 years ago. I was so traumatised by what happened that I was given a private room for eight days after our son was born so I couldn’t talk to anyone about it. The anaesthetist tried three times to put an epidural in my lower back and the next time the tube went down my spine and hit something so she pushed very hard which made me pass out in pain. When I came round the anaesthetist had gone from the room and I was left with a very dead, numb right leg and no pain relief in my left side at all. I screamed so much that my husband took himself out and I said they wouldn’t allow a dog to be in the pain I was in so they took me to theatre to have a ventouse delivery. Easy way to deliver! I’m now medically retired because of my back and overall have had 18 episodes of herniated discs.
You Doc. You do a fantastic job on explaining certain anesthesia procedures on UA-cam. By you doing this helps take the stress off of patients minds before going to surgery. The reason I know so much about this is because I used to work in surgery for quite a while. I worked at Wayne Memorial Hospital for 36 years most of those years was spent working in the surgery so I watched and held patients in place for spinal epidurals, spinal blocks for surgery. Not only did I learn so much I miss working in surgery. I also worked in EMS for almost 26 or 27 years. I did 10 and half years as a volunteer EMS, then ,10 years as being a paid for The Goldsboro Fire Department in Goldsboro NC. You have done a great job of explaining what anesthesia actually does. Thank You
WOW !!!...much , much respect to all of you doctors who help us when much needed, THANK-YOU SO VERY MUCH DR. FEINSTEIN , BLESSINGS TO YOU ALL !!
I’ve had both a spinal and epidural anaesthetics. I remember having a headache after the epidural. Very grateful for these anaesthetics at the time.
Great video.
I had very bad headaches too.
In my country we are given pepsi in the first twenty four hours . Since then whenever I get headache Pepsi to the rescue.
@@rosebertram9932 what country are you in? And that's clever to have a Pepsi. I'll keep that in mind
Very interesting thanks for teaching about epidurals.
I had epidurals. And allowed students to do them
Coming back to this 2 years later - just matched to Anesthesiology myself!! Hopefully our paths will cross somehow. Huge fan! 🤩
Hi Max - - Re: SENIORS, please discuss the benefit of Epidurals over Generals, whenever possible, and the role of Generals in post surgical confusion, cognitive decline and/or dementia.
Max or rather dr. Maxfield I appreciated the subject matter of this video. It helped me appreciate truly the epidural that I had with my gastric resection due to excessive reoccurring tumors in my stomach. My team did a epidural for my gastric resection and I couldn't believe how painless the entire process was. I didn't even realize that I was given shot in the back to be honest let alone the entire procedure of inserting the epidural. It made the entire procedure and healing inside the hospital completely painless.
I really appreciate this video after having a spinal for my hip replacement.it helped give me a clearer picture of what was done. Great video, thank you.
I'm astonished with what I see that I went through during my gastric resection due to excessive tumors and subsequently the paresis. I just discovered your channel and found it extremely beneficial.
I e had several back surgeries and now I have DDD and Osteoporosis. I have injections several times a year. Sometimes I have better relief of pain but then there’s times that I don’t. I’m a 61 yr old lady and it’s getting harder and harder to get any good relief. I really enjoyed your video.
Having had 3 epidurals I found this very interesting to watch, thanks Dr. Feinstein
CSEs are a cornerstone of my ortho days. It still blows my just how much anesthesia can be provided with a 9 cm needle and a couple milliliters of local anesthetic. Great explanation, technique, and visuals, Dr. Feinstein. I also find it helpful to mark the apex of the interspace of with my thumbnail.
I saw this done on my wife when she was in labour for my son. I have never been more in awe of a medical procedure than watching the anesthesiologist perform this.
Thank you for the wonderfully informative and fascinating video. I had an epidural during my first labour, which worked for about 45min and then stopped providing the necessary pain relief. After several top-ups, they had to stop giving medication as i was becoming numb up to chest level, despite not getting pain relief. When finally i was taken for a c-section, i was terrified that a spinal would likewise not provide pain relief, but fortunately it worked almost instantly.
I had 3 subsequent c-sections and each time the spinal anasthesia was the longest and most complicated (and most painful) part, taking almost an hour with my second csection. Besides from severe swelling due to weight etc, they believed that anatomical issues with my spine may have complicated the siting of the needle (perhaps related to the problems with the epidual from my first labour??) In any case, i have had 4 spinals for 4 csections, rather traumatic experiences. Watching this video, although really interesting, was a bit of an uncomfortable reminder of what i was experiencing each of those times. All that aside, many thanks again!
I am an anesthesia technology intern, and these videos are very helpful !! So thanks for that. Also, I would really like to see caudal anesthesia as I didn’t get the chance to see it yet
I’ve had two gynae ops, 2 ankle arthroscopies and one ankle replacement all by spinal - they are the best! You don’t get the general anaesthetic hangover and you can talk to the Drs and Nurses! If they get sick of you they madazolam you into oblivion😅 The OR has been my work place for years and I feel comfortable with the technology and going’s on! Thanks Dr Max love your educational videos.
At this point, you're probably the only MD I would allow to medicate me via spinal or epidural. Great video and awesome technique!
Your gonna be in a LOT of pain when you refuse your actual doctor…..
I was thinking same thing I wouldn’t have a issue with him being the doctor that does it. I like his confidence and patience he displays
Definitely, I trul appreciate your brand of subjects and topics presented in your videos.
Thank you so so much for your effort in making this video (and also the others). I learnt so much and actually understood the concept behind each steps. - Anaesthesiology resident from Malaysia. 🇲🇾
I'm doing Bachelor in Anesthesia Technology, Max your video creation and anesthesia related techniques are so impressive 😍
Dr. Feinstein, Thanks for another great video! Always learning something and you explain it so well.
"Stinging" was not what I felt during the insertion of the local. It was as if a flame was relentlessly applied to the skin on my back (pain level 10/10)! I'm glad to read that my experience was likely the exception. As others have stated, no explanation was offered for anything. I was told to lie on my side, curl up, and hold still. Thankfully I had the sense to do a bit of research prior.
I'm not sure what they hit but my top leg involuntarily twitched rather dramatically. I was again told to lie still, but I stated that the leg twitch was their fault, not mine.
After finishing the mysterious (at the time) activities, I was told to roll onto my back and observe the progress of the numbness as it rose from my toes on up. Meanwhile, I watched my obgyn scrub, gave him a thumbs-up through the window, and the C-section proceeded.
Nobody explained that there'd be a urinary catheter inserted, resulting in more pain once sensation returned.
After my son was properly extracted, he was hauled away and I was knocked out as per my prior request. I awoke hours later, was handed my son, and instantly realized why no one in their right mind would opt for a C-section if it can possibly be avoided (mine couldn't as the lad's head was too large to fit through). I literally patted down the sheets next to me (I'd been lying on my side in bed), fully expecting to find my reproductive system lying there based on what I felt. As bad as that pain was, it wasn't as bad as the burning that I felt when the local was administered.
Please help answer this question. You are such a fine teacher! and I am so very grateful the Mt. Sinai Hospital provides such wonderful support that allows this very informative program. QUESTION: I watched a PA do an epidural! I was absolutely floored because I thought that it was something strictly for a physician . Can a PA do this?
I remember that headache very well. It was the headache from hell. They were doing a epidural for child birth, and went to far and wound up giving me spinal. Child birth had nothing on that headache. After 3days of caffeine loading to try to get it to stop or ease the pain. The cure ironically enough is another epidural.
Maybe it's a spinal they said I would have while having my knees replaced. And what you just said about where the spinal is placed makes me feel a lot better about possibly having a spinal. I've never known that before! Thanks 😊
it's usually spinal anesthesia with propofol sedation. Some places will also do a nerve block in the leg to decrease pain once the spinal wears off.
The work that you are doing is excellent, teaching wise and surely it must be a reflection of how effectively you practice medicine.
Thanks doc 👍🏼
I appreciate this video so much. I hate needles with a burning passion and this kind of helps
Thank you for taking the mystery out of my pain treatments!
Thank you for your videos Max they're filmed very professionally and very informative. As an MS3 who wants to match anesthesiology, and currently on my OB anes rotation, your videos help refresh my anatomy knowledge and help prep for procedures! Your attention to detail and thorough-ness are what id expect from an anesthesiologist! One thing I noticed was that during the spinal demo at 9:09, you mentioned that after you punctured the ligamentum flavum, you'd expect to see CSF. I believe you'd need to advance to also puncture dura to achieve a spinal and get CSF, correct?
This is super cool to watch. I'm starting clerkship soon and with only 2 weeks of anesthesia core rotation, your videos will really help make the most of it!! 😅😅😅
I hope you have a great experience on your anesthesia rotation!
@@MaxFeinsteinMD thank you so much!! 🤩🤩
this was so comprehensive and detailed... i feel like i could give an epidural or a spinal right now!
It's good to know where the spinal cord ends and where the injections are done. I'd always wondered about that and if offered a spinal or epidural I would have been hesitant to say "yes". Although I assume the person doing the procedure would explain that to me when I showed hesitancy it's nice to know in advance.
I love this Man so much. He is the person I want in my corner.
I almost cried while watching this. It's beautiful 🥺. Can't wait to be an anesthesiologist
I wish I had had an explanation before having my son. I had a c-section and the epidural fell out and I had a window where I felt the pain and lots of gas was given to ease the pain. That didn't work too well. You seem so intelligent in your area of expertise.
Heading into a TKR soon. This great video really helps me understand what will happen during the procedure. Thanks! 👍🏼
Please do a video on art lines.
Your content is amazingly well explained you definitely inspire me to persevere. thank you.
This was an educational how it works with details. Thanks!
Fascinating video and walk through dr Feinstein. I appreciate time you take to make these videos for us love and appreciation you sir.
Hi Dr Max! Great video! I love to learn from you! I have had about 20 epidurals due to 3 bulged disks and degeneration. I have always had a general anesthetic. I once asked about going without the general (because you are limited for 24 hours afterward) and they told me they could but it was very painful. So I didn’t try it. I now have a spinal cord stimulator but I still get an occasional set of epidurals. I don’t think the stimulator is that great. My doctor pushes them but I know some doctors won’t see you if you have one. Also you can’t get an MRI in Texas if you have a stimulator. Thanks for being so detailed in this video! See you on the next one!
Great video! It’s not a matter of if but when I’ll eventually need a knee replacement for my bad knee (bad joints run in both sides of my family and there has been/will be roughly 8-9 knee replacements between six different family members from both sides) so this was very helpful info as I’ve never had surgery before unless you count the stitches I had when I was two to reattach my nose that I cut on a stamp box I was playing with when I tripped and fell. (I might eventually have skin removal surgery from my 85 Lb. weight loss four years ago but building my house comes first so that doesn’t count right now).
What’s the highest opening pressure you’ve had from an LP? Great video Dr Feinstein.
thank you so much for these videos. production quality is insane and j think you’ve convinced me to pursue medicine.
Great video!! Dr Max, I had a lumbar tap done but afterwards, I developed severe headache and it was found I had a CSF leak. I had to get a "blood patch" done to "plug the hole." It worked. Can you please explain why this would happen, and how does a "blood patch" work?
Thank you!
Pam! WTF are you talking about! CSF? you really mean OPP! or KFC? Are you still sober hun?
Great video man! I really enjoyed it! I always learn a lot from your videos! You rock!! I’m gonna start Donating to the Anesthesiologist Foundation in June since It was hard for me to go to college to be a Anesthesiologist after I graduated high school in 08 because of my cerebral palsy! I have had 14 surgeries because of my cerebral palsy! Those needles 💉 are very cool
I appreciate the amazing detail, easiness to follow, and great editing. Thank you!
I had this done ended up with a headache, also couldn’t move my legs or feel them for 3 days thank you so mad thought I was going mad
Dr. Max thank u so much for this video! When u inject the lidocaine, do u think its necessary to wait a few minutes to let the lidocaine work before taking the next steps? Im curious to know ur thoughts😊
I had a total hysterectomy at Christmas 21. My uterus was so large I had to have a vertical abdominal cut. I had full anesthesia and I asked for an epidural. My surgeon had the anesthesiologist put one in and after my surgery the epidural was kept in place 24 hrs. The day after my surgery and the 6 days I was in the hospital I had a pain level around a 2 and only had tylenol. I was so happy how smooth it went together with the full anesthesia. I enjoy your videos very much. I had 2 epidurals with my c sections and was great to be awake for the birth of my children. That must be so challenging with women in labor and can't bend forward well due to the baby. Have you ever had one of these procedures?
Just had a scheduled C-section and this gave me the chills. They tried 3 different times to get the block in place...4th times the charm. I was crying by the time they finally got the spinal block 😭😭
I have a permanent Epidural with 2 lines feeding the Fentanyl and Bupivacaine from a pump located inside me called a Medtronics intrathecal pain pump. I have a constant flow of medication and a remote bolus device that I can use to give me more medication at set intervals for pain relief. It gets refilled about every 30 days. It is about the size of a small hamburger, located in the right side of my abdomen. This has been a great help for chronic pain due to a spinal injury. I have a 5 level fusion at my lower lumbar with discs removed Anterior posterior interbody fusion 360. I have permanent nerve damage, but can walk now. Fusion was done by Dr, Tiffany Perry at Cedars Sinai and pump was implanted by Dr. Leo Langlois in Bakersfield, Ca.
I always thought that these were all the same thing! Thanks for clarification!
I'm wondering as a curious nurse. Is it a possible occurence to miss a combined spinal/epidural and deliver the epidural through the arachnoidian space by mistake? Thanks for your videos :) love them!
Hi Nina, while that is technically possible, the "test dose" which is delivered before the epidural is hooked up should be able to detect if that happened. Thanks for the nice feedback!
I think what Nina meant was that after performing the spinal with hyperbaric bupivacaine for instance, then pushing the catheter through the Tuohy needle and it accidentally ending up in the subarachnoid space. In that case, the testing dose given through the catheter wouldn’t be effective to detect the catheter mispositioning, since spinal anesthesia would already have been installed. That’s why before injecting the larger volume of local anesthetic needed for the epidural we should also give some time to observe if there’s any CSF reflux through the catheter.
@@MaxFeinsteinMD thanks for your reply :D I look forward to your next videos!
@@henriquelaydner4080 i have never heard of that happening with a cse. In the cse needles that I have always seen/used, there are different openings for the epidural catheter and the spinal needle that comes in the kit so the catheter is directed up and away from the hole where the spinal was done . The hole that the spinal needle makes is also very small. I doubt the epidural catheter would fit through it. CSE is not very common compared to spinal and epidural alone. Most people just do one or the other depending on what you need it for.
Thank you for the information. The epidural was one of the worst parts of my after birth issues. I felt pain regularly and could tell you exactly where they placed the epidural. In fact, I had pain at the point of the epidural for at least 5 years. I wish you had been the individual who had given me my epidural. The woman I had no bedside manner and seemed angry at me for wanting to get one after all.
Dr.Max Feinstein,
I’ve watched quit a few of your videos and it has helped me to understand the way things happen so people other than Dr.’s can understand what happens.
You do such an amazing and clear job of explaining all the different steps that a patient can expect to have happen.
You also say if anyone has any questions to drop you a line. So first let me say I live in Ontario, Canada and I don’t know how different the steps and or medication’s used to put me under will differ between the USA and Ontario, Canada.
So first let me say I have ABSOLUTELY 0% of having any kind of French in my DNA or bloodline going back generations on either side of my parents and their ancestors.
So I’m 38 years old and I have a condition that is an Anesthesiologist Nightmare called Malignant Hyperthermia or M.H for short. I of course wear a medic alert necklace. I only mention the French bloodline because I’ve been told from several different Anesthesiologist that typically it is found in people that have French in their bloodline.
However I was wondering if you could explain the different processes of putting a regular patient to sleep versus putting a patient to sleep who has Malignant Hyperthermia.
I’m looking to know the steps and procedures and the process from the Anesthesiologist point of view from the time that they come and introduce themselves to the patient on the day of surgery prior to going in the Operating Room to how they are put to sleep and during the operation to waking the patient up.
I know the response will not be super down to the exact way of things as you don’t know my current medication or height and weight and overall information about me that you would need to know.
I’ve tried to ask questions from each time that I’ve had surgery but any of the Anesthesiologist that I’ve had are always to much in a hurry to answer my questions. The only thing I know about having Malignant Hyperthermia is that I have to be the first patient of the day that’s operated on with that specific Dr that the Anesthesiologist is working with that day and right after they put the oxygen mask over my face just seconds before they put whatever drugs in the IV to put me to sleep is that they roll the crash cart right beside my head and turn it on.
They do all that while I’m still awake and that’s the last thing I see before they put me under, as if having surgery isn’t already scary enough knowing I have a condition that is scary when being put to sleep but to have to view that crash cart being rolled right beside me and then turned on as the last thing I witness is way more frightening and they wonder why my heart beat increases as their doing that.
I don’t even know what Malignant Hyperthermia is as to how it affects a patient or the definition. I don’t know if I’m allowed to leave my email address or not but I’m going to try that way hopefully I get a response. elvis0310@hotmail.com
Great videos, always loved working with anesthesiologist
I have often wondered how tge anaestiologist would know how far to go for an epidural. So this explanation was rwally interesting. Thanks
Hi Max! Can you briefly touch on your typical contraindications for lumbar puncture? How frequently do you observe the optic disc with an ophthalmoscope for instance?
Dr. Max, Your videos are so incredibly interesting. Thank you for sharing some of your knowledge with us!
Thank you for this! I had one of these done last month in the UK, this video was very interesting.
Giving SAB before epidural can cause sadle/partial block in sitting position as you have to keep the pt in sitting position for catheter placement. What i do i give epidural 1st then i give spinal one space bellow. Pt gets two prick but its good for long run.
I’m getting knee replacement surgery soon & been told I will be having a spinal anaesthetic plus sedation. This video has been very helpful.
This video h
Very instructive. When puncturing the dura, I think you said "bevel up". Since the longitudinal fibers of the dura would then more likely be severed by the needle, are you concerned that post-spinal headache might be more likely than if the needle were placed with the bevel vertical? I assume that the specific gravity of the anesthetic may determine the level of spinal anesthesia. If so, how then do you control this should the pt. have to be positioned unexpectedly in a position unfavorable for anesthetic agent drift?
Since doing anesthesia and completing my OB rotation, I've wondered why the needles aren't color-coded to the same gauge as peripheral IV catheters. For example, the 27g needle for the lidocaine is blue, while a 22g PIV is blue. Or in the Braun spinal kit I use, the 25g needle is orange, while a 14g PIV is orange. This was very confusing the first time I opened up a spinal tray.
Hi Dr. Feinstein, Could you please explain why people get a post spinal headache with certain needles and how a blood patch works?
That would be something you might need to talk to your doctor i get them done quite often and I never had a headache after the fact , so its might be a reaction to the steroid, i thing you should mention that to your pain management doctor.
I find your videos very interesting and educational. The blue skin needle is a 25 gauge though I believe. A 27 should be gray.
This is very helpful. I'm due to have one of these on Tuesday, and it's nice to know what it actually entails.
Fascinating video. You explained everything so well. Thank you.
Hey max, how many epidurals did it take for you to get comfortable doing it? is the tecnique hard to learn? cheers
Hi Ribbot, I felt somewhat comfortable after 10, quite comfortable after 50, and very comfortable after 100. Very roughly speaking.
@@MaxFeinsteinMD Nice! Im starting my anesthesiology residency (in barcelona, spain) this may. Youre a huge inspiration!
Gosh your center should send u to places to teach the method. So why does the pt have to be awake for this?if the pt developed a spinal headache and needs a blood patch. Does it mean placemats was wrong or thhat the little hole didn't seal ?
So with that special one that the catheter points up. Is that what the doctor means when he does a caudal block and says the meds will go upwards? These videos are fascinating 👌 👏 thank u.
Thank you for the clarity. It's important to know, but I'm sure most of us don't. When I had my babies, we had something called a "Saddle Block." How is that different. Thanks for a great channel.
I have had both for 3 c sections. On one of them it took a couple of times to get the needle in the right place. I ended up screaming as the medication was not working anymore. I think some of the medication got wasted in the prior attempts. It was long time ago and surely better now.
Absolutely exceptional video! This describes those procedures perfectly and is very easy to understand, thank you! If possible, could you share what you are looking for on a test dose? I know a common side effect of an epidural is hypotension, so I'm guessing you are looking for something else?
Testing dose is meant to detect both inadvertently inserted catheter into a blood vessel and the subarachnoid space, which is where lies the CSF (cerebral spinal fluid). For that we give a small volume of a less toxic, faster and shorter acting local anesthetic (usually lidocaine) with a very diluted dose of epinephrine. Since epidural blocks are meant to install slower than spinals, if the blockade starts too fast we will probably be facing an inadvertent spinal anesthesia. Alternatively, if the injection is given to a blood vessel, then there will be an almost immediate rise in the cardiac frequency and maybe some tinnitus and numbing to the tongue, due to the local anesthetic effect. It’s important to notice that the test dose is the ultimate resource to detect a misplaced epidural catheter, but the feeling of an experienced anesthesiologist during the process plays a major role, as well looking for CSF or blood reflux before injecting anything.
@@henriquelaydner4080 wow you explain very well :)
@@henriquelaydner4080 Thanks for the supplementing Dr. Max's excellent video on the subject which is most relevant to healthcare persons and if it had been incorporated by Dr. Max , would have of more benefit to the viewers. Mentioning of dosage, volumes and top up procedure could make it a masterpiece.
I had a spinal with my c section...horrible experience...they hit a nerve and it hurt so bad i passed out...i think they injected something into my nerve if this is possible because part of my right thigh is numb to this day...they had to do my spinal at L1 L2 because i have a bulging disk at L3 L4... After a few tries and having to lay on my side they finally got it...im not looking forward to another c section..i don't think I can go through that again...
Dr. Feinstein: I had an epidural for my daughter’s birth 3 months ago and it actually stopped working 2 hours in and the anesthesiologist had to come back and give me a second epidural (which worked, thank goodness and made me SUPER numb). Can you explain what you think may have happened as to why the first one stopped working?
Hi there, it's possible the epidural catheter moved out of place despite being (presumably) taped down very well. Without being there, I really couldn't say.
I had this happen too. The first didn't respond the way they thought it should. Then ultimately after hours when I 'failed to progress past 7cm' it was an urgent rush to replace the epidurals with a block and immediate c-section. Whatever it took- I have a beautiful 10 year old. (Just holding off on her full birth story until she's a bit older!)
Why isn't done under Fluoroscopy? Epidurals have always freaked me out, so I've never had one. They say that they're really good to have something like that if you're having your knees replaced which I need to have one of these days.
And today I actually had knee injections under Fluoroscopy.
Fluoroscopy is cumbersome, can take a lot of time (which is limited when a laboring patient is in significant pain), and also introduces a considerable amount of radiation. Fluoroscopy can be used for certain procedures (like injections as you mentioned) when the benefits outweigh the risks.
My neurologist does lumbar punctures in his office in a regular patient exam room lol. I was quite horrified when I found out mine would be in the office.
Great video. Other content ideas that I would love to see.. tutorials for: double-lumen, fiberoptic intubations, central line, nasal intubations, (I could really make this list go on for a while lol but I think those are the most ideal).
Great info Max. I’m going in for hip replacement surgery, March 2nd/2022. I’ve had 5 - L4/5 fusions, and a final Inner-body fusion. They’ve advised me they’re going to perform a spinal/epidural. With my previous L4/5 surgeries, what level would you say they would enter at?
Thank you sir.
Hope that your surgery went well buddy 👍🏻
i had a epidural after my scoliosis surgery no clue where abouts on my back it was tho lol but it was really cool to see how they did it as i was under general anesthesia at the time
Great video. How about a video on ventilators and ventilator settings?
I frequently pause the video to find out the meaning of any terms I am unfamiliar with. I really enjoyed reading about Gertie Marx's life
This was a great video! I feel like I probably should have had the combined epidural and spinal during my 3rd and last c-section, but I was given a spinal. I was having my tubes tied as well. They show me my baby briefly and then they whisked her off to do her examination... all of a sudden, I am in so much pain... The anesthesiologist and my OBGYN start arguing, I hear someone say that I'm losing a lot of blood, and I start crying because this just does not feel right... then my anesthesiologist says to me, "don't worry, I'm going to stop the pain..." and I'm out like a light. I wake up in recovery and find out that I had the most adhesions my OBGYN had ever seen and had to slice through my bladder to get to my baby. My uterus was also super thin and kept ripping back open when he was stitching it up... he said it was a good thing I got my tubes tied because he would not recommend me having any more children. I spent 6 days in the hospital getting bladder scans and I had a jp drain in my abdomen and a catheter for days. Luckily, my bladder healed nicely.
I have a condition called adhesive arachnoiditis, which was possibly caused by epidural injections and the inadvertent puncture of the dura during the procedure. How do you prevent or lessen the possibility of this happening?
Hi...thank you for this interesting vidéo. Can you please share with us how to calculate the depth of the catheter we have to advence depending of patients tall ..(sorry for my English..I hope you understand my question)