Spinal Anesthesia Explained Part 1- Crash course with Dr. Hadzic
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- čas přidán 28. 09. 2021
- 00:48 Anatomy
02:15 Mechanism of action - Onset of analgesia
04:13 Cauda equina
05:24 Mechanism of action of LA - Pharmacology
06:48 LA distribution - Factors affecting block height
11:46 Spinal needles
13:08 Hadzic's spinal level reality check test
13:54 Equipment
15:36 Technique
This is a must-watch video that is sure to become a timeless classic. It's quite well known that spinal anesthesia and lumbar puncture are essential skills for anesthesia practitioners. However, explaining how spinal anesthesia works and describing the technique is challenging when using words and pictures alone. Students and young anesthesia trainees usually find it difficult to understand the nuances and technique details until much later, after they have already performed a number of supervised spinal anesthetics and have a chance to observe their physiologic and anesthetic effects on the human body. This video aims to fill that educational gap. Watch as Dr. Hadzic guides the viewers through the essentials of spinal anesthesia using NYSORA’s reverse ultrasound anatomy illustrations, animations, and clinical videos. This video holds promise to become the single best resource on the internet for learning or teaching spinal anesthesia.
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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 CZcams channel is accurate.
I have taught spinal anesthesia to residents for over 20 years. I only wish I could have taught it this well. Anesthesiologists should be experts at spinal anesthesia in all its iterations. I'm sure in the next videos you will teach the ability to perform the blocks in other positions than sitting (very useful when patients require sedation or when painful conditions such as a hip fracture occur). Use of basicity to control or at least influence laterality is also important. Some days I wish i hadn't retired.
Starting anesthesia residency next year. You may have retired but I'm sure you can get back into it 😁
@@sovereign775 I could, but a.) Thee is still COVID, and b.) I find that I enjoy sleeping in.
PS . You have chosen a wonderful career, and likely won't regret it.
Thank you very much for your kind words, and thanks for sharing!
Sir you are gem 💎 and gems even retired are precious. Huge respect for teachers like you who have passion for teaching.
Thank you for watching. If you found this video useful, make sure you watch this with complimentary information czcams.com/video/cV1xVJQa64g/video.html . And do not forget to SUBSCRIBE and never miss new releases. Greetings from NYSORA!
Mr Hadzic, I think I speak on behalf of many here if I thank you for your generosity sharing all these top quality videos with us. They surely deserve millions of views, which is probably not realistic given that we anesthesiologists are a relatively small niche here on YT. Theyre much appreciated though!
Hey Dave! 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!
@Amit Atwal Thank you for watching. If you found this video useful, make sure you watch this with complimentary information czcams.com/video/cV1xVJQa64g/video.html . And do not forget to SUBSCRIBE and never miss new releases. Greetings from NYSORA!
Very true I really appreciate
I enjoyed listening to this instructional video, I had a total hip replaced last year and everything was perfect got to the hospital at six surgery about 720 at my house by 1:30 PM no pain no narcotics Tylenol ASA 81 and Celebrex and FYI please do not take Celebrex and baby aspirin It’s definitely not a good idea if you’d like to avoid a G.I. complication :-)
My god.. what wonderful videos I was missing until now.. I am glad I found your channel, such wonderful explanation, worth every second... Thankyou Sir❤
Congratulations! Excellent video for all beginners in Regional anesthesia.
Thank you, nice to hear that!
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Fantastic explanation , thanks a lot Dr. Hadzic
Most welcome!
Thank you dr. Hadzic ,
This video was informative and helpful to me .
Glad to hear that!
This is very smart, well explained and detailed yet simple elaboration, even if I haven't gone to a medical school I feel myself being a doctor....God bless you.
Thank you for your comment!
amazing channel !
Thank you
Thankyou so much for this video, I’m currently on my clinical rotation in anaesthesia and this video has saved my time and makes spinal anaesthesia easier to understand. Waiting for the part 2 and 3 🤗
Glad it was helpful! Thanks for watching.
Hey Michelle! 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!
спасибо большое ! Thank you so much
Incredible!
Doc thanks for your videos, i am med student and your videos intrested me in anestesiology as specialty. Hvala doktore 😄
Most welcome!
Excellent video...another amazing video on this channel
Indeed. Thank you for your comment! Make sure you subscribe to the channel so that you do not miss some super educational upcoming videos!
Very excellent technical points taught sir about sub arachnoid cauda equina block. Thankyou very much.
Very welcome!
Thank you Aduru! 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!
YOU ARE THE BEST TEACHER !!!!!
Thank you for commenting!
thank u dr it s so helpful , I ll be waiting for the next parts
Glad it was helpful!
So well explained👏🏾👏🏾👏🏾
Glad you enjoyed it!
Best as always!
Thank you!
Superb 🔥🔥🔥 very big thanks for your grate informations...🙏🙏🙏
Thanks and welcome!
Very effective and impressive way of teaching. Great contribution to medical students and medical professional community around the world.
Hi Hitesh! Thank you so much for your kind words; we really appreciate your feedback.
excellent presentation.even after doing more than 10000 spinal, ilearn and get good tips. thank you very much Dr.Hadzic
Hi Praful! Glad to hear this! Thanks!
Excellent review thank you 👍
Thanks for watching!
watching this as i performed my 4th succesfull spinal anesthesia for total hip replacement in a 1.6m obese female using 3ml hyperbaric bupivacain 0.5% plus 5ug sufentanyl with the opening towards cranial direction. the level of anesthesia was up to belly button or sligthly below. was efficent to perform the hip replacement on the awake patient. oh what miracle this is. thanks to my senior PD Dr. Seyfried!
Waaaay too much dose don't you think? Less dose, less adverse effects, faster recovery.
Thank you very much for this teaching. It is very helpful and shall watch further videos.
Hi Sipra! 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 have just had spinal anesthesia for prostate surgery,taken without any sedation, absolutely fantastic,,after operation I had something to eat & felt 100% no sickness after What so ever, fantastic,unreal,totally awake & relaxed,you can speak with theatre staff or listen to music on your multimedia device while undergoing your procedure,brilliant
Excellent !!!!
thank you!
Amazing
New subscriber here.Find your video informative & concise... Looking forward to.more videos. Thanks so much doc. I will re-watch ur video for a better understanding of the topic.👍
Hi Angelique! Thank you for watching! A lot more videos are coming very soon. Greetings!
Tq Dr .Hadzic this video is very helpful to me easily understood
Hi Satheesh Yadav! Thank you for your comment! Make sure you subscribe to the channel so that you do not miss some super educational upcoming videos!
Great video , preparing to take off in anaesthesia rotation a couple of weeks to go
You can do it!
@@nysoravideo 🙏🙏🙏
This made me so pumped to continue my journey to becoming a nurse anesthetist. 💉🔥💉
Wow that is cool to hear! Make sure to follow us and maybe subscribe to our newsletter for more content that might be useful and inspirational to you.
Here is the link: www.nysora.com/newsletter/
In Saudi arabia we are using mainly hyperbaric marcaine for spinal anesthesia. 10 years in practice didn't have a single total spinal anesthesia. had couple of C/S which the spinal cause shortness of breath and minor discomfort.
Hi Zemonizer! 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.
thanks
here we have very good explanation of spinal anesthesia
Glad you liked it. Have you subscribed to our newsletter for more educational content? www.nysora.com/newsletter/
This video is very informative..... Waiting for the next part
Hi KD! Thank you for inquiring. We are really happy that you're interested in nudging us to complete the follow-up videos. The videos take quite some time but will promise will get back to this. In the meantime make sure you subscribe and share the channel with your colleagues so that we can all collectively collaborate and learn from each other. Greetings from Nysora!!
You deserve OSCAR
This video is beneficial👏👏
Thank you! Glad that you like it!
Excellent👏
Thanks a lot!
Superb 👌
Thank you! We're glad you're finding our videos interesting and beneficial.
Thanks for this video
Welcome-Keep watching, a lot more is coming soon!
thanks a lot Dr hadzic for this amazing explanation and l am very excited to the next parts l am student CAA from Yemen.I wish if there is also vedio like this for epidural
Glad to hear that! Thank you for your suggestions! Greetings!
Good 😊❤ I student form Iraq
Very much useful. Thank you sir😊
So nice of you! Keep watching!
beautifu video! rotating under anesthesia
Thank you!
I had to undergo through it 3 times, as i got 3 spinal anesthesia for 1 surgery because of 2 spinal failure, even third one didn't work on me .At last they gave me general anesthesia.And now suffering from severe back pain 😢😢
Thank you, I have experience in having CSF flow through the introducer in thin pregnant patient , I inject the heavy bupivacaine immediately through the introducer and spinal block act for CS , fortunately patient did not develop postspinal headache . (This is just comment on the video tip at min 18: 30)
Very nice explanation with rich illustrations and also the big screen behind you make it easy to follow you plus the diagrams pop up while you continue explain. Thank you doctor I enjoyed watching all of the video. Did not get the chance to see the titles of the books in the video only pediatrics title and solar , I don't know what were the rest and were they important or not for anesthetics!
Thank you! You can view the full asortment of eBooks currently available on PocketEdu at the following link:
www.pocketedu.com/e-books
@@nysoravideo ty so much , i will check the link now.
Very best
Hi Hirbayyee Uddessaa! Indeed. Thank you for your comment! Make sure you subscribe to the channel so that you do not miss some super educational upcoming videos!
Damn watching it hurts my spine XD
I felt the pain once
For the hadzic technique. Is there an error? You mention the bottom third but on the illustration the bottom third is the sacrum. Do you mean to say bottom third of the spinal column (not including the sacrum)? Thank you. Thank you very much for these videos. I appreciate you sharing your knowledge and time and commitment in making these vids.
No error that the sacrum is included. The goal is to use precise anatomical landmarks to locate the exact L2-3, L3-4, or L4-5 space. However, what he is suggesting is to simply incorporate a “does this make sense test” - a check before inserting a needle into the cord and causing injury at the level of L1-2 or above. If you think you found L2-3 but it’s more than a third of the way up the back on a sitting patient - you’re wrong and need to reassess. Hope this helps.
Thank you for the video. Is it normal to reintroduce the introducer or stylet of the Anesthesia needle several times? I see that it is only done once by determining the correct place, but I am not sure if it is normal to take it out and re-insert it until you find it.
is it possible to perform open cholecystectomy by spinal anaesthesia? plz reply Sir
ممتاز
thanks dear Hadzic
I wonder if you use a cutting spinal needle G25 ( Quincke) , do you prefers to inter in a bevel up or bevel lateral?
Is there any possibility in a very thin patient that the introducer needle, when hubbed, can actually enter SA space? Do you recommend the introducer needle be hubbed by habit or stopped when 'engaged'.
Dear Thank YOU VERY MUCH ❤❤❤❤🙏🙏🙏🙏🙏🌹🌹🌹🌹
Most welcome 😊
I had spinal anaesthesia when I had major foot reconstruction surgery last year. I was worried that during and post operation, I would struggle with the immobility and feel trapped. But I didn't. While lying down I was barely aware I had been anaesthetised and was shocked when I looked down and saw the nurse lifting my leg! I didn't feel 'numb', I felt I was lying normally, and what I was seeing conflicted with what I felt. Post operation, I never felt trapped, just relaxed. Is this normal patient experience?
I think it's normal
Very much so. I once had a young patient have the exact same experience. She wanted to watch and she couldn't stop laughing during the surgery because of the disconnect between what she saw and what she felt.
Hello Dear! Thank you for watching our channel. However it is difficult to give medical recommendation based on them short information you have provided. We are unable to do this in this on this platform. We would strongly recommend you contact your doctor for further management. Wishing you best for your recovery. Nysora Team!
I’m preparing for total knee revision I don’t want to see anything and am a bit apprehensive about this spinal anesthesia due to issues with L 4 and L 5 already will see what occurs on 10/9/23 one thing for certain and two is for sure I definitely need this knee revision surgery desperately 😮🙏🏽
So if a pt has a pump with meds going into the intrathecal space. Then should this not be done?
I had a kidney stone operation six days ago, and on the third day I had vomiting. I still have a lot of headaches and should not get up. What to do now ....
Give me suggestions plz
Can lapro cholecystomy perform under spinal anesthesia safely llease suggest its urgent.
Only one question. According the video is it nessesary to define the points of a possible injection wearing the same sterile gloves that you would later use to perform the spinal anesthesia?
Why is the introducer made so long?
I inserted the introducer 3/4 of the way in, unintentionally punctured the dura mater, the anesthesia was ruined, post-puncture headache is guaranteed, if not worse, since the introducer is quite thick.
All that was needed was to make the introducer 1-0.5 cm shorter.
Hi! Is this column division in three equal parts from the transition from head/neck to the end of the sacrum, including the cervical part of it? The image showed gave me the impression that only thoracic/lumbar/sacral spine was being considered. Thanks, and one more wonderful video by NYSORA, congratulations to you all!
Thank you Lucas! 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!
Is there possibility of damaging the nerves with the needle?
Where is part 2 and part 3 as told in video?
Can any one share the link of video 2&3
Eracs with low dose hiperbaric with position lateral decubitus SAB and adjuvan opioid morphin fenthanyl , head down, fine neddle 27, with no skin infiltration lokal anesthesia, no introducer needle, one shoot. Short motoric block with prolonged sensoris post operative pain control with early mobilitation
Hi Evelyn! Thank you for sharing. It will be great to see a video of the procedure as you describe it. In our experienced 27 gauge needle is without introducer are extremely difficult to direct towards the desired target. Greetings and Thank you for sharing!!
Usually our anaesthesiologists used 22G for spinal anesthesia , hyperbaric marcain with 25mcq of fentanyl.
Thanks for sharing. Where are you writing us from?
@@nysoravideo King Abdulaziz Hospital, Makkah, Saudi Arabia
i had a surgery 3 days ago and i was injected in spine with rahianestezia,affter the first day i started having pain in my upper spine ,cant move my head without big pain ,even now affter 3 days .is it normal ,does anyone know when will it pass?
Dear Octavian! Thank you for watching our channel. However it is difficult to give medical recommendation based on them short information you have provided. We are unable to do this in this on this platform. We would strongly recommend you contact your doctor for further management. Wishing you best for your recovery. Nysora Team!
how do you do doctor?
Pregnant first time mum highly anxious abt the spinal for c section here. I am sooooooo scared
Year 2019 I gave birth thru CS. Why my spine the part that they injected is still hurt. Really hurt i cant even press it because it is really hurt
I just had hip replacement surgery 4 weeks ago. I requested spinal anesthesia. I’m both glad and regretful about that decision. Yeah, ya wake up pain free. The first thing that you do is try and dorsi flex your feet. OMG, I’m paralyzed! Felt great! Then the anesthetics wore off. Let the ouch begin. Ooh we! Level 10 pain! A patient self administered narcotic pump wasn’t working for me. Then the shakes came as my body slowly awakened to reality. What they don’t tell ya is that your bladder pressure nerves are some of the last ones to awaken. Hence, I had severe urinary incontinence. I warned them to NOT take my catheter out yet. But no. Therefore I pissed all over my bed, numerous times. They couldn’t get to me in time. Thankfully I had pee pads underneath me. During my first 24 hours in hospital I peed out 4 liters. Because they do measure output. Why oh why would they remove my catheter when I was staying another night!? And, They gave me a nasty case of phlebitis bc of poor IV cannula placement. I told them to take it out once I noticed my arm starting to swell. But no. Left it in, even tho I wasn’t being infused with anything at that point. Now I have pain from those superficial thromboses in my veins. It’s painful and you can feel the hardened veins along my forearm. Freaking hospitals! I would rather go it alone at home compared to their patient non care. Doctors these days have no patience for patients. Practically a drive thru procedure regarding hp replacement. Surprised they don’t guide you thru the operation over the phone. Or, televisits. The new covid free way to treat patients. Over the phone. Wow
Prayers 🙏🏽you’re doing much better now I am heading for total knee revision 😮
The hadzic divides the spine into 4 equal parts or 3 parts. The video seems to show 4 . Hadzic says 3
When I draw CSF to confirm the correct location of the needle tip, what am I supposed to see in the syringe? My attending tutor says I should see a sort of white floating "fog" in the fluid (she calls it barbotage), that'd be the result of the different viscosity between the csf and the anesthetic. After watching her do this procedure many times, and even after doing it myself a few times now, I still can't see it. I always need her to confirm that said "barbotage" is or isn't there, and she's starting to get impatient at me for not being able to do it on my own. Am I blind or what? Any tip would be appreciated...
Hi and thanks for the question! You can never see any difference in color or viscosity between local anesthetic and CSF by the naked eye. If you wanted to make sure that the fluid is CSF and not Local Anesthetic - you can do a glucose test - obviously, it would be positive for CSF and negative for LA. However, this is not practical in most circumstances. Therefore, clinically - it is sufficient to aspirate at the beginning and at the end of the injection. Free aspiration = CSF. You will NEVER see the difference. And any other testing is impractical. We hope this helps. Greetings from NYSORA!
Can a patient lie on his back for surgery of HoLEP? For prostate surgery?
Motor block
Sensory block
Autonomic block ,
Doubt is both sympathetic & Parasympathetic block occurs ?
Hi Preety! Thank you for showing your interest in this topic. For more information, We strongly recommend this source for the clinically proven standardized nerve block techniques: www.nysora.com/nysora-product-nerve-block-app/ This is the source used by NYSORA's students, fellows, and over 10,000 clinicians worldwide".
Spinal anesthesia are required for before all operation surgery.
Wut
part 2🤔😭😭??
Waiting for part 2 & 3🙏🏻
Hi Banzeedoc! Thank you for inquiring. We are really happy that you're interested in nudging us to complete the follow-up videos. The videos take quite some time but will promise will get back to this. In the meantime make sure you subscribe and share the channel with your colleagues so that we can all collectively collaborate and learn from each other. Greetings from Nysora!!
I want epidural video from your channel
Hi Habib Farooq! Thank you for your suggestion. We will definitely put this on our list. Greetings to you and all your colleagues and make sure you subscribe to our channel so you don't miss these upcoming videos. Best Regards from NYSORA!!
Part 2?
Hi there! thank you for inquiring. We really happy that you're interested in nudging us to complete the follow-up videos. The videos take quite some time but will promise will get back to this. In the meantime make sure you subscribe and share the channel with your colleagues so that we can all collectively collaborate and learn from each other. Greetings from NYSORA!!
للاسف الترجمة العربية سيئة جدا لكن شرحه رائع بالفعل
Is part 2 and three out ?
Hi David, Thank you for inquiring. We really happy that you're interested in nudging us to complete the follow-up videos. The videos take quite some time but will promise will get back to this. In the meantime make sure you subscribe and share the channel with your colleagues so that we can all collectively collaborate and learn from each other. Greetings from NYSORA!!
@@nysoravideo thank you so much! I love your contents and just today showed my supervisor your videos! Appreciate the amazing work! All the best from Germany
@@davidscb3632 That is great. Thank you for sharing! B-Safe!
Does this hurt?? :S
In Indian they use spinal anesthesia T6 t7
Je suis pro
Help me doctor my canty Bangladesh I am poor men
Jesus christ just knock me out.
V
L
Its so painful and for a second i felt just like electric shock before cerean delivery...
Thanks for this video
Thank you for watching. Which part of it did you find the most useful?
V