Failed Spinal Anesthesia Explained #2- Regional anesthesia Crash course with Dr. Hadzic
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- čas přidán 30. 03. 2021
- All of us have experienced this: The patient was slim, had a straight back and the entire spinal anesthesia procedure went straightforward. It took only one attempt to get into the subarachnoid space, there was an obvious dural “click”. A clear CSF flow shows up in the hub of the 27G Sprotte spinal needle, and the injection of the spinal anesthetic dose was a breeze. However, 30 minutes later, in dismay, we diagnose a failed spinal anesthetic. Then comes the question: “Where did the local anesthetic go and why did the spinal fail when it all looked so routine?”. In this video, Dr. Hadzic explains what is the likely reason and how to decrease the chance of failure by implementing one, simple strategic step in your technique that should be routine with every spinal anesthetic.
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The needle has the injection port (opening) on the side of the shaft of the needle. Its rotation with continuous CSF flow at 360 degrees assures that the injection piece is inside the CSF. Important: Upon obtaining the CSF flow at the hub of the needle, the needle should be still advanced 2-3 mm and rotated 360 degrees while monitoring the flow to assure its complete intrathecal location. The thecal sack should be best viewed as a pliable space that can actually collapse partially as the bullet-tipped needle is inserted into it. This is why it is important to advance the needle a bit deeper into the intrathecal space even after obtaining the CSF. In fact - the best is to advance 2-3 mm further and pull back 1-2 mm to assure that the dural sack is not collapsed before injection. Thank you for the comment. Will explain in a video soon.
Thanks for you explanation Dr Hadzic. I’d liked to see these videos when I was resident. I’m fascinated by its content.
I didn't get it why to rotate it 360
The needle has the injection port (opening) on the side of the shaft of the needle. Its rotation with continuous CSF flow at 360 degrees assures that the injection piece is inside the CSF. Important: Upon obtaining the CSF flow at the hub of the needle, the needle should be still advanced 2-3 mm and rotated 360 degrees while monitoring the flow to assure its complete intrathecal location. Will explain in a video soon. The thecal sack should be best viewed as a pliable space that can actually collapse partially as the bullet-tipped needle is inserted into it. This is why it is important to advance the needle a bit deeper into the intrathecal space even after obtaining the CSF. In fact - the best is to advance 2-3 mm further and pull back 1-2 mm to assure that the dural sack is not collapsed before injection. Thank you for the comment.
Thanks for the update
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Hello. I'm a 1st year resident - I didn't understand the purpose of the 360º rotation, how does it help?
Will soon feature a closeup video that explains the need for the rotation. The needle has the injection port (opening) on the side of the shaft of the needle. Its rotation with continuous CSF flow at 360 degrees assures that the injection piece is inside the CSF. Important: Upon obtaining the CSF flow at the hub of the needle, the needle should be still advanced 2-3 mm and rotated 360 degrees while monitoring the flow to assure its complete intrathecal location. Again - will explain in a video soon.
@@DRBLUESNYC Got it, will certainly use this. Already had this exact issue in a failed spinal - even with free flow and clear LOR.
Please do some epidural tips up next. Thanks!
👍👍
Sir Iam a 1st year resident which is best needle for a beginner to learn subarchnoid block
learn with 27G Whitacre needle, everything else will seem easy later
Mine failed 40 minutes after. My baby was born and then I was in horrendous pain. It was absolutely awful. I was put under general anaesthesia as they couldn’t numb me! I didn’t get to hold my baby. I am deeply traumatised and want answers
Do you have any headache ?
@@raheelsharif6316 no
same happened with me 2 month before
I think with Spinocan needle that problem goes to minimum.