GAME CHANGING SYRINGE FOR EPIDURAL ANESTHESIA?
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- Опубліковано 6 гру 2023
- The success and safety of epidural anesthesia depend on accurate identification of the epidural space, which is traditionally done using the loss of resistance technique, based on the operators “feel” of the loss of resistance, but not on objective measuring of that pressure change. Recently, I was introduced to a potentially game-changing epidural syringe that objectively streamlines epidural space localization. Let’s review it in this video! The new syringe system actually monitors the loss of resistance objectively during needle advancement. As the needle tip enters the epidural space, the sudden drop in pressure-known as the "loss of resistance" occurs. With the loss of resistance, a color indicator ring is activated. As you see in the video, this mimics the loss of resistance with a traditional epidural syringe, objectively indicating to the operator that the syringe is in the epidural space, even if the operator is fails to perceive that pressure change manually.
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Is the rate of "false loss of resistance" the same or less than the in the standard technique? The answer to that would greatly impact my decision to adopt this method.
I see this device as a “new toy” on the shelf. Indeed useful for the beginner, technically speaking, but I my own opinion it’s a bit of an overkill. Ok, the beginner got used to it, what next? Once experience is gained (but how?) will this device be still in use? I think there are exceptional technical advances, US, video laryngoscopes etc. but this one…well…I’d go and teach my residents the old way. More sweat on the training camp, less blood on the battlefield.
I think as a teaching tool in simple epidurals it would have a place but in advanced/complicated epidural placement I think it would only distract from the procedure. There is so much more to interpret from the feeling than just 'loss of resistance' like getting a feeling for the location of vertebrae, different ligaments/muscles encountered (depending on how you approach).
Feel as though the Accuro would allow better visualization. I think this syringe can be useful, but does not help the inexperienced learner as much as learning the correct feel for when you pass into the epidural space.
Potentially a useful adjunct. However as others have alluded to, this device detects a pressure change and not exclusively the pressure change associated with entry to the epidural space.
Such a helpful tool, really interested in trying it
I think this would be immensely helpful. It could very well take out the ambiguity in the Epidural.
Helpful tool, especially for the beginner
If there is no need to maintain pressure on the syringe as shown in the video, would this allow for ultrasound guidance?
I would gladly try it. I seems indeed intuitive. I do 20 or more epidurals per month.
Looks amazing
The working principle is similar to the Episure syringe. I hope it will find its place in epidural block education.😊😊
I would definitely like to try this.
Hola a todos. Comparto la idea que este dispositivo podría ser “sólo un nuevo juguete “ pero también pienso que es solo la versión moderna de la técnica de Gutiérrez, conocida como hanging drop, solo que en este caso es el dispositivo que me ayuda a visualizar la pérdida de resistencia teniendo libre las manos para dirigir la aguja con mayor precisión. Por eso estoy de acuerdo que se promuevan estos dispositivos, que sin duda alguna,son de gran ayuda en las situaciones más difíciles y donde se requiere más versatilidad . Saludos
I think this would be great especially for soft ligaments with little feedback
Both future and teaching. Agree, great syringe and intuitive.
Very good video Mr. Hadjik..!
Glad you found it useful!
Happy to test it out.... Where can I get one?
Es interesante el trabajo innovador tecnológico de quienes se preocupan por la enseñanza a nuevas generaciones. Me parece genial !!! En lo personal tuve problemas para aprender la técnica hasta dominarla. Ahora será más sencillo y ante todo objetivo
The innovative technological work of those who care about teaching new generations is interesting. I think it's great!!! Personally, I had trouble learning the technique until I mastered it. Now it will be simpler and above all objective.
Besides analgesia for labour epidural doesn't have good indications according to EBM. This kind of anesthesia due to risk of very severe complications becomes less and less popular nowadays.
Can you reference this data?
@@kodiknott7418 I could recommend PROSPECT papers/ guidelines
Does this work with intermittent pressure (slight pressure every few mm) or only continuous pressure?
Intelligent idea for epidural, it’s flash back to me a “baloon guided epidural” .
Thanks from Saudi arabia ,,
Glad you like it!
Nice video..
I would like to see how it is used in LOR to air or saline.
Please post realtime video.
If its of any help to increase safety and accuracy, people will change the practice with good evidence.
Nice video again.
Regards
Interesting. Might be of use for a learner but after that not much benefit. Also- the sense of loss of resistance is removed from the operators finger. Not sure if thats a good thing
I do many epidurals lumbar and thoracic and i really enjoy the feeling of succesful LOR. Therefore i would love to try the new syringe 😊
We test drove the EpiFaith. A cool thing is that it does not interfere with the technique! Definitively interesting! How do you TEACH the LOR - hand feel to others? Thank you for watching!
EpiFaith sounds so cool especially in high thoracic! I don't teach anyone ,I work in private practice and I do everything by myself.@@nysoravideo
Its best used in real time Ultrasound guided epidural anesthesia.. A great game changer.. feel like getting a hand on such a LOR syringe
Amazing!
ems odd though - if the syringe is generating a pressure how is that different from you generating a pressure (whilst scraficing feel)?
I think it is a good idea. Is it necessary? Is it better than current practice? Time will tell. Some people will embrace it enthusiastically, others will reject it. Hopefully some study is done about it.
Thanks for sharing. I won't/can't say there's no place for the new syringe. I think that anyone with good technique for this blind procedure will be able to use this upgrade in technology. Someone with not-so-good technique will have the same outcome
Great point! Potentially, the objective information allows for more objective documentation and perhaps some degree of Medical-legal protection, being more objective than the feel! Thoughts? Greetings and thanks for watching.
@nysoravideo honestly, the technique I use more or less does the same thing such that once I enter the epidural space, the Tuohy needle won't advance unless there's a manufacturer's defect. I'm not certain what conditions brought about the intricacy of this syringe. I also don't want to sound as if I'm an old man stuck in my old ways 😃. In summary, my technique, one hand on Tuohy flange to stabilize deeper progression, so that the Tuohy progresses without turning/rotating. The thumb of my next hand pushes the plunger of the LOR plunger. Note that my other digits of the plunger hand are not involved. The first hand on the Tuohy is NOT pushing. The plunger thumb advances EVERYTHING. So there's no risk of advancement into the intrathecal space by the stabilizing hand.
I tried epidural with regular terumo 5ml syringe (not the loose LOR blue one) once and was surprised that I could feel the pressure difference easily.
Hi there
Can share video of it
May be useful for demonstration while teaching. But for everyday practice I woulg prefer my feeling of sirynge plunger
It looks so efficient! Could you send some of those syringes to a university hospital -for educational purposes- in Turkey 😁
I tried the EpiFaith at the ASA meeting, it's awesome and easy to use.
Great to hear! Thanks for sharing with us.
Are you able to feel BOTH LOR with a thumb on the plunger AND get the visual cue? Also if available, Can you link article(s) regarding its efficacy data? Thanks. Awesome idea though.
Yes and yes
Looks promising (for learners, quick approach or ultrasound guided), needs unbiased trials.
If you try it out, please let us know what you think.
If the cost is the same, I think it could be useful, but if we are going to increase the cost of the epidural just because we are unable to learn the technique it seems a little money-driven.
🙏💯
Safety of the device needs to be objectivated, and I really do wonder if this does bring additional security without a cost in dexterity and feeling in the anaesthesists' hand. It may be handy while teaching, but I doubt a lasting benefit for day-to-day use.
One more thing to cinsider - this does increase the already sickening high pile of waste we chose to accept for medical procedures. And anaesthesists already do have an exceptional bad carbon footprint.
Your nick says it all. One to consider carbon footprint of a possibly useful device...
@@DieWatcher Well, that's your idea about that. I have a different viewing angle, since I know the background of that nick.
Ever heard about ad hominem and when it's mostly used?
@@whocares7215 yeah and whocares. Ever heard of war, poverty and other more important topics than global warming? Eco activists just make me sick with all the hypocrisy.