Difficult spinal, needle as the examining tool - Regional anesthesia Crash course with Dr. Hadzic
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- Опубліковано 9 бер 2021
- Difficult spinal anesthesia, needle as the examining tool explained
Spinal anesthesia is an essential procedure skill for a practicing anesthesiologist. The technique is featured in every anesthesia textbook. It is sufficiently simple and straightforward so that most practitioners and “occasional regionalists” can use it in daily practice with adequate success. Observing a spinal anesthetic being administered by practitioners can give an impression of substantial skills when the procedure is straightforward and successful on the first couple of attempts.
However, when an attempt is not successful after a few attempts, and the anatomy is not clear, this is where the expert approach makes a difference between success and failure. In this video, Dr. Hadzic discusses crucial tips he teaches residents and fellows on how to trouble-shoot spinal anesthesia when the needle constantly encounters osseous structures and makes access to the intrathecal space difficult.
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Disclaimer:
Medicine is an ever-changing science. As new research and clinical experience broaden, changes in treatment and drug therapy are required. The authors and publishers have checked with sources believed to be reliable in efforts to provide accurate information within the available or accepted standards of care. However, given the possibility of human error or changes in medical practice, neither the authors nor the publisher, nor any other party involved in the preparation of this platform warrants that the information contained herein is in every aspect accurate or complete, and they disclaim all responsibility for any errors or omissions for the results obtained from the use of the information contained in this work. Readers are advised to confirm the information contained herein with other sources. For example, readers are advised to check the product information of each drug mentioned, and that any information contained on NYSORA's UA-cam channel is accurate.
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This is the most common problem we face ,facing the bone.Thank you
All this is true.
There is also another scenario : the needle is between the spinous processes but it touches the superior or the inferior one.
In this case the solution is the paramedian approach.
Very helpful tips 👍👍
I really love tips and tricks for troubleshooting! Thank you sir!
We are glad you like it, thank you!
This was very helpful. Thank you!
Glad it was helpful!
Huge help for an anesthesia resident!!
Thank you very much, glad it's helpful!
Well explained, Thank YOU.
Hey Maxamed Abdi! Glad it was helpful! Stay Connected!
I'm matching in Anesthesia in ~1 week. Awesome vids! Thank you.
Good luck!!
Congratulations. Good luck!
Such a neat reminder for daily practice even for a ln experienced anesthesiologist
We are glad it is helpful!
Thank you very much sir
It Cleared my concept.. thank you a lot sir
You are welcome!
Thank you very much ! But could you please do this video with the subtitles 🙏🙏🙏
Thank you
You're welcome
Nice video .. thank u
Thank you too!
Nice 👏🏼👍🏼
Thanks 👍
Hello sir can u discuss abt the troubleshooting in paediatric ( especially infants ) femoral central venous catheterisation…
Sir
Do you have any needle preference to overcome difficult spinal in between quincke and sprotte ?
If it is , would you tell me why ?
Tq
Dr. Hodzic, I love how simply you explain this stuff - I’m not even an anesthesiologist, but now I’d want to be one!😂😎👍
❤️
I love your videos btw. Thanks for making these. I find that when I teach novices to withdraw the needle to subQ tissues first and then redirect, they tend to make too big of an adjustment to the angle. I constantly have to correct that tendency. Having said this, I admit I don’t know the skill level of your intended audience for this video. Ideally, I’d like to be able to send all my learners to your channel, so I hope you’ll consider making a video that breaks down the steps further. Thanks for what you do!
Thank you, we will take your suggestion into account when creating new videos, and you can expect more videos on our channel in the future. For your students we can recommend the NYSORA Nerve Blocks app with over 40 nerve blocks and lots of tips and tricks, a rich image gallery, illustrations and a lot of videos.
Best regards,
NYSORA Team
Nice vid tq!!
Hey Zulfalhie Mohmad! Indeed. Thank you for your comment! Make sure you subscribe to the channel so that you do not miss some super educational upcoming videos!
I just had a surgery where they used an Epidural on me to help control the pain after surgery well I woke up from surgery my legs was pale and I couldn't move them or my toes so they pulled the Epidural out well I got a very bad headache for a few days but the day I was to go home it wasn't as bad well at home I was given shots to give myself a blood thinner soon as I started taking them by the second day my headache was back.. they tried to do a blood patch on me but had a hard time getting between the bone they tried 5 times the pain of him digging hurt so bad I passed out from it but they got it on the fifth try.. I have 6 big holes in my back where they tried , never again will I let any Dr put a needle any where near my back.. I had 2 kids with out a Epidural and I'm glad I did not.. was so sick from the pain they put me through and the digging of the bone trying to get that big needle in .. should of given me something to relax be before hand because I am good with pain but I never felt anything as bad as that pain in my life time...
Where did you feel the pain ? Actually I am going through the same thing
@khaulaal3089 in my neck up into my head I still have headaches I'm on a bunch of meds for them now and now I am dealing with other problems I was to have a biopsy done but I didn't let them do it because they don't put you to sleep to do it I had a MRI done and it shows a small spot of Multiple Myeloma and they said its in a hard spot to get to so I said no to the biopsy so I just have to go for more MRI to keep an eye on it. I do go for nerve blocks now too because of that surgery they put them in the back of my head and down my neck.. it only helps me for about a week. And now I'm having jerking of my neck it jerks to the right and my muscles in my jaw gets all tight.. the longer I sit up the worse it gets..
Thank you sir... Very useful tips... Which is ur preferred route median or paramedian?
Younger patients, good anatomy/position = medline. Older patients, lateral position = paramedial.
Waiting
Thank you!
What about the positioning sir ? Does these piece of advice work , even there is no proper position of the patient?
I have another one for you! It happened to me now 3 times, I'm fully inserted with the needle and have checked every 0.3 cm or so presence of CSF but sometimes even fully inserted I cannot tap anything. Where am I ? How can this be that starting on the midline and being fully inserted I don't reach CSF ? Thanks a lot !
Can I use 25G pencan without introducer. My success rate is significantly reduced since I have started using introducer.
Previously i was using quincke without introducer. 25G
Please add english subtitles for these videos 🙏🙏🙏. Thank u so much
😍
How do you know when you are in the Wright place. Ie. The space. Without hitting and damaging the nerves.. I am not talking about the spinal nerves but the nerves below. Where you inject the anesthetic. You don't use ultrasound to guide you. I will have a knee replacement. So I'm wondering how safe is it.
Experience sometimes betrays yo
I’m a spinal surgeon with over 30years of operating experience. You would do well to assist a surgeon and understand the patho- anatomy of the degenerate spine. By the way it is not a good idea to go through the Supra and inter-spinous ligaments. We usually remain lateral to the above mentioned ligaments. Use a thicker more stable needle, if you hit the lamina , angle the needle parallel to the lamina aiming centrally. One can feel the lig. Flavum easily and according place an epidural or Intra-thecal catheter. Hypertrophic facet or zygapophyseal joints may leave but a millimeter gap. In such cases it is essential to place the needle at the point where both left and right laminate meet and to angle it so that it points cephalad . Here there is always a larger gap.
Thicker needle means higher incidence of PDPH. And you are desciring alternative, already well known technique. Maybe a surgeon should assist anesthesiologist so he would know some basics before being impertinent towards such respected and knowledgeable physician as Doctor Hadzic
I will never have another spinal! Too fucking painful! And they fucked up my spine! The asshole anesthesiologist poked
Me 7times and still couldn't get it right !!!!!!!
Now imagine a 135kg woman with almost 2 inches depth subcutaneous tissue 😂😂😂