I’ve had the most success in reducing my spinal failure rate by advancing my pencil point needle 1-2 mm after getting free flow CSF (per the guidance in Stoelting’s Basics of Anesthesia text), rotating the needle 360 degrees, aspirating, then injecting carefully. My institution also switched spinal kits from ones containing Whitacres to ones containing Pencan needles, which has a hole that is smaller and closer to the tip of the needle than a Whitacre. The final thing was switching to lower concentration isobaric local anesthetics (0.5% bupivacaine) in most cases, which helped to reduce failure related to inadequate spread.
Very detailed and comprehensive as usual. With the pencil point needles, I find that the needle tip gets displaced from the intrathecal space sometimes while attaching the syringe to the needle hub..this to me is the trickiest step in using pencil point needles. Any tips, Dr Hadzic? Thanking you in advance.
I totally agree with you. For patients over 60 years of age - we often use a 22 G Quincke needle which allows more precise/organized re-direction and no issues of a pencil tip design. Best regards
@@DRBLUESNYC Thank you once again. Sometimes i give my spinal and blood comes out instead of the CSF. Do I need advance more or come out a bit every time I encounter this. It sometimes clears a bit and then gives the drug. Thank you for the video. I have been experiencing a lot of failed blocks and my questions on that note have been answered. Sometimes all the local anaesthetic is given without a drop and the blocks either doesn't take or wears off easily and earlier.
@@kulegodwinkaburuma8008 Glad you like the video! And thanks for watching. Do subscribe to this channel as there's more coming up. And let's share the collective experience so that we all get better in what we do!
Thank you KD! Glad you like the video. Thank you for watching. Share with your colleagues; a lot more videos are coming up - let's share our clinical experience! Cheers!
Check for aspiration half way through, if no aspiration advance another 3-4cms before continuing. Have had many failed aspirations after getting CSF but using this I've never had a failed spinal, anecdotal yes but seems that this method would counteract all three injectate errors mentioned
@@charesepelham7682 Thank you! I would like to be like YOU and never grow up - stay young. ;) Greetings and thank you for watching and commenting. Please feel free to share with your colleagues.
I love Hadgic, as I'm from Bgsria and we speak almost same languages, based on Slavic algabet. So, what I do to prevent-swirl is the most important part. U can have a good drip but believe me, sometimes it might be a drip of your local anesthetic. Or, it could be CSF, but the dure has created a flap, which is covering half of the bevel, and you are screwed. So, swirl should always follow a good drip,don't skip it.
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I go with a combi technique, placing epidural catheter and utilizing that device if needed for failed spinal or insufficient spinal or if the case goes longer than anticipated for spinal drugs.
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Hi there. Thank you. There are a few very good replies already in the thread. Likewise, some techniques of prevention are already in the video. And we will add more to it. Best regards
Great Video as we are used to. My question is: in case of partial block and low level of anesthesia , which dose you use to redo the spinal anesthesia?? Thanks.
So any ideas how to verify the correct position of the needle during subarachnoidal puncture to prevent injcetion into epidural/subdural space? I see that Joe LaFeve recommended trying aspiration while in the subarach space, but isnt there a increased risk of postpuncture headache thus even tho I might prevent SA failure I might on the other hand cause the patient more suffering after the surgery? Would be interested in knowing how often you guys get postpuncture headaches when you aspirate since it is not common practice in our hospital: 🙂
Hi Dharti! Thank you for sharing. Indeed, we all do things differently; in the end - it is what works 4 you. Thank you for watching and do subscribe to the channel - we have a lot more coming up!
Agreed. Indeed, the large gauge needle allows better needle "feel" and re-positioning to reach the intrathecal space. Greetings and thanks for your feedback!
In my experience, one of the best ways to increase the success rate is to rotate the spinal needle 90-180 degrees halfway through the injection and aspirate. If you get the CSF swirl, success is drastically increased.
Greetings! Thank you for sharing. Indeed, we all do things differently; in the end - it is what works for you. Thank you for watching and do subscribe to the channel - we have a lot more coming up!
In recent years, I have seen an increased incidence of less than potent drugs when using weighted Bupivacaine 0.75%. We have validated entry in the subarachnoid space with plenty of good back flow of CSF, sometime up to 1-2 ml, and then less than adequate level for C-Section. We have noticed this in certain kits with medications from Austria, but not so much with Hospira branded/made in USA vials. Wonder if anyone else have had similar experiences?
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Thank you Aashish! Glad you like the video. Thank you for watching. Do subscribe to this channel and share with your colleagues; a lot more videos are coming up - let's share our clinical experience! Cheers!
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That is really great. Thank you for sharing. We all get better this way. Make sure you subscribe to this channel; a lot more is coming soon! Greetings!
I’ve had the most success in reducing my spinal failure rate by advancing my pencil point needle 1-2 mm after getting free flow CSF (per the guidance in Stoelting’s Basics of Anesthesia text), rotating the needle 360 degrees, aspirating, then injecting carefully. My institution also switched spinal kits from ones containing Whitacres to ones containing Pencan needles, which has a hole that is smaller and closer to the tip of the needle than a Whitacre. The final thing was switching to lower concentration isobaric local anesthetics (0.5% bupivacaine) in most cases, which helped to reduce failure related to inadequate spread.
Hey Joe! Greetings! And thanks for watching. Do subscribe to this channel as there's more coming up. And let's share the collective experience so that we all get better in what we do!
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I’ve had the most success in reducing my spinal failure rate by advancing my pencil point needle 1-2 mm after getting free flow CSF (per the guidance in Stoelting’s Basics of Anesthesia text), rotating the needle 360 degrees, aspirating, then injecting carefully. My institution also switched spinal kits from ones containing Whitacres to ones containing Pencan needles, which has a hole that is smaller and closer to the tip of the needle than a Whitacre. The final thing was switching to lower concentration isobaric local anesthetics (0.5% bupivacaine) in most cases, which helped to reduce failure related to inadequate spread.
I also rotate the spinal needle in 360 degree ,if still no free flow advance the needle 2_3mm
This is really fascinating. I've had spinal anesthesia 3 times and the Dr did a great job getting it in there considering I am a super obese person.
Outstanding, as always! Three things are vital for first shot success: Position, position, and position.
Agree. Do not forget the patient's position! ;)
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Dragi doktore, velika je čast učiti od Vas, iskreno se nadam da cemo se i upoznati u novembru u Dubaiju!!!
Looking forward to it!
Very detailed and comprehensive as usual. With the pencil point needles, I find that the needle tip gets displaced from the intrathecal space sometimes while attaching the syringe to the needle hub..this to me is the trickiest step in using pencil point needles. Any tips, Dr Hadzic? Thanking you in advance.
I totally agree with you. For patients over 60 years of age - we often use a 22 G Quincke needle which allows more precise/organized re-direction and no issues of a pencil tip design. Best regards
@@DRBLUESNYC thanks a lot, sir
Thank you so much for this elaborate explanation.
Most welcome, feel free to share your views/thougts/advice
@@DRBLUESNYC Thank you once again.
Sometimes i give my spinal and blood comes out instead of the CSF. Do I need advance more or come out a bit every time I encounter this.
It sometimes clears a bit and then gives the drug.
Thank you for the video. I have been experiencing a lot of failed blocks and my questions on that note have been answered. Sometimes all the local anaesthetic is given without a drop and the blocks either doesn't take or wears off easily and earlier.
@@kulegodwinkaburuma8008 Glad you like the video! And thanks for watching. Do subscribe to this channel as there's more coming up. And let's share the collective experience so that we all get better in what we do!
Another great video...Following you from last 3 months and learnt a lot from these YT vidoes.
Thank you KD! Glad you like the video. Thank you for watching. Share with your colleagues; a lot more videos are coming up - let's share our clinical experience! Cheers!
Check for aspiration half way through, if no aspiration advance another 3-4cms before continuing. Have had many failed aspirations after getting CSF but using this I've never had a failed spinal, anecdotal yes but seems that this method would counteract all three injectate errors mentioned
Totally agree. Thank you for your feedback!
Advance another 3 to 4 CENTIMETERS? (3-4cms) Surely you meant MILLIMETERS! Perhaps a typo?
@@charesepelham7682 Good idea/strategy. I am shure that MegaPoliyo meant milimmiters. Thanks for catching this and regards to all!
@@DRBLUESNYC thank you, sir. Very much appreciate your videos. I want to be like you “when I grow up!”
@@charesepelham7682 Thank you! I would like to be like YOU and never grow up - stay young. ;) Greetings and thank you for watching and commenting. Please feel free to share with your colleagues.
I love Hadgic, as I'm from Bgsria and we speak almost same languages, based on Slavic algabet. So, what I do to prevent-swirl is the most important part. U can have a good drip but believe me, sometimes it might be a drip of your local anesthetic. Or, it could be CSF, but the dure has created a flap, which is covering half of the bevel, and you are screwed. So, swirl should always follow a good drip,don't skip it.
Thank you Hali! Glad you like the video. Thank you for watching. Do subscribe to this channel and share with your colleagues; a lot more videos are coming up - let's share our clinical experience!
I am first year anesthesia resident in India your vedios are very helpful.
Hi Tilak! Glad to hear that. Do subscribe to this channel and share with your colleagues; a lot more videos are coming up. Cheers!
I go with a combi technique, placing epidural catheter and utilizing that device if needed for failed spinal or insufficient spinal or if the case goes longer than anticipated for spinal drugs.
Thank you Richard! Thank you for watching. Do subscribe to this channel and share with your colleagues; a lot more videos are coming up - let's share our clinical experience!
Amazing lecture doctor. Nicely explained as usual.
And how to solve these issues?
Hi there. Thank you. There are a few very good replies already in the thread. Likewise, some techniques of prevention are already in the video. And we will add more to it. Best regards
Excellent presentation, but you forgot to advice about turning the inserted needle 180 degrees.
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Great Video as we are used to. My question is: in case of partial block and low level of anesthesia , which dose you use to redo the spinal anesthesia?? Thanks.
Another great video 👏👏
Thank you !
Indeed. Thank you for your comment! Make sure you subscribe to the channel so that you do not miss some super educational upcoming videos!
So any ideas how to verify the correct position of the needle during subarachnoidal puncture to prevent injcetion into epidural/subdural space?
I see that Joe LaFeve recommended trying aspiration while in the subarach space, but isnt there a increased risk of postpuncture headache thus even tho I might prevent SA failure I might on the other hand cause the patient more suffering after the surgery? Would be interested in knowing how often you guys get postpuncture headaches when you aspirate since it is not common practice in our hospital: 🙂
Great insight. Thank you
Glad it was helpful!
Sometimes I got very good free flow of CSF but no effect with bupivacaine heavy...I change the drug xylocaine nd it shows effect
Hi Dharti! Thank you for sharing. Indeed, we all do things differently; in the end - it is what works 4 you. Thank you for watching and do subscribe to the channel - we have a lot more coming up!
I use 23 g quinke for difficult cases .
I feel the give way of ligamentum flavum first and then dura
Aspirate gently for 3 times
Inject
Agreed. Indeed, the large gauge needle allows better needle "feel" and re-positioning to reach the intrathecal space. Greetings and thanks for your feedback!
Very interesting.
Thank you
Indeed. Thank you for your comment! Make sure you subscribe to the channel so that you do not miss some super educational upcoming videos!
In my experience, one of the best ways to increase the success rate is to rotate the spinal needle 90-180 degrees halfway through the injection and aspirate. If you get the CSF swirl, success is drastically increased.
Best way to dislocate
Displace chance is there !
Greetings! Thank you for sharing. Indeed, we all do things differently; in the end - it is what works for you. Thank you for watching and do subscribe to the channel - we have a lot more coming up!
another great video....!!!!!
Indeed. Thank you for your comment! Make sure you subscribe to the channel so that you do not miss some super educational upcoming videos!
In recent years, I have seen an increased incidence of less than potent drugs when using weighted Bupivacaine 0.75%. We have validated entry in the subarachnoid space with plenty of good back flow of CSF, sometime up to 1-2 ml, and then less than adequate level for C-Section. We have noticed this in certain kits with medications from Austria, but not so much with Hospira branded/made in USA vials. Wonder if anyone else have had similar experiences?
Thankyou ❤️
Most welcome. Feel free to share you experience!
Very well explained...Thank you
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This video is really informative to me.. Thank you Dr
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Love it so much thank you.
Excellent
Thank you! Cheers!
Please I had hysteroscopy to view my uterus and I was given spinal anaethesic but now I can't control my urine, is it normal for back anaesthesic
Will it go away
Thank you sir
Well explained
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To avoid failed spinal anaesthesia i practice reaspiration after half of the drug is injected...
That is really great. Thank you for sharing. We all get better this way. Make sure you subscribe to this channel; a lot more is coming soon! Greetings!
is this what happened to me during my birth?
i felt the legs
thanks alot
Thank you for your comment!
I’ve had the most success in reducing my spinal failure rate by advancing my pencil point needle 1-2 mm after getting free flow CSF (per the guidance in Stoelting’s Basics of Anesthesia text), rotating the needle 360 degrees, aspirating, then injecting carefully. My institution also switched spinal kits from ones containing Whitacres to ones containing Pencan needles, which has a hole that is smaller and closer to the tip of the needle than a Whitacre. The final thing was switching to lower concentration isobaric local anesthetics (0.5% bupivacaine) in most cases, which helped to reduce failure related to inadequate spread.
Hey Joe! Greetings! And thanks for watching. Do subscribe to this channel as there's more coming up. And let's share the collective experience so that we all get better in what we do!