I wish I had understood this 20 years ago when I started placing spinals😂 some of these techniques I was doing unconsciously, but now to hear the details explained and the reasons why, my practice will be very different now. Concise information, great camera work, a very good voice for instruction, this is an excellent video.👍
Superb as usual KJC. The incremental gains from optimising each small step add up to a significant overall improvement in performance success. Kudos for these excellent videos
Thank you for the astute comment - it's the small nuances that become more and more important to continual progress as one ascends up the ladder of experience and expertise.
On the more corpulent population, I found it very helpful to use aTuohy epidural needle as an introducer. It's blunt tip makes it much easier to feel and identify the different anatomy and it's stiffness, made it much less likely to bend or deviate.
In NON-OBSTETRIC OLDER populations, and where we are performing spinal anesthesia (not LP with extraction of a significant volume of CSF) the impact of a 22G on PDPH appears clinically insignificant. The group from Duke university presented a poster with retrospective data that showed a very low incidence of PDPH with a 22G needle in this specific population for this specific indication. I will link to it in the description if I find it. Echoing this experience, as far as I am aware we have never had a PDPH in our ortho population in the 15+ years I have worked in my hospital, despite using 22G needles fairly often. However - note that (1) I am not advocating it as a first-line, but rather I am offering it up as an consideration in DIFFICULT patients and (2) ultimately it is an individual judgment as to whether you want to maximize your chances of a successful spinal vs the possible increase in any side-effects (and the other effects if one doesn't use the optimal equipment, e.g. trauma from multiple passes, etc).
I wish I had understood this 20 years ago when I started placing spinals😂 some of these techniques I was doing unconsciously, but now to hear the details explained and the reasons why, my practice will be very different now. Concise information, great camera work, a very good voice for instruction, this is an excellent video.👍
Superb as usual KJC. The incremental gains from optimising each small step add up to a significant overall improvement in performance success. Kudos for these excellent videos
Thank you for the astute comment - it's the small nuances that become more and more important to continual progress as one ascends up the ladder of experience and expertise.
Very useful tips. Thank you.
Thank you
Thank you, Sir
On the more corpulent population, I found it very helpful to use aTuohy epidural needle as an introducer. It's blunt tip makes it much easier to feel and identify the different anatomy and it's stiffness, made it much less likely to bend or deviate.
Thnks
22 g ? What about PDPH ?
It's a greater possibility for sure.
In NON-OBSTETRIC OLDER populations, and where we are performing spinal anesthesia (not LP with extraction of a significant volume of CSF) the impact of a 22G on PDPH appears clinically insignificant. The group from Duke university presented a poster with retrospective data that showed a very low incidence of PDPH with a 22G needle in this specific population for this specific indication. I will link to it in the description if I find it. Echoing this experience, as far as I am aware we have never had a PDPH in our ortho population in the 15+ years I have worked in my hospital, despite using 22G needles fairly often.
However - note that (1) I am not advocating it as a first-line, but rather I am offering it up as an consideration in DIFFICULT patients and (2) ultimately it is an individual judgment as to whether you want to maximize your chances of a successful spinal vs the possible increase in any side-effects (and the other effects if one doesn't use the optimal equipment, e.g. trauma from multiple passes, etc).
@@KiJinnChin Thanks for the answer. Best regards
So your unsterile glove on the shaft of the needle is safe?
We always handle all our equipment for spinal anesthesia and other regional blocks with sterile gloves on; so the answer to your comment is - no.
Urgent cs, not npo severe fat mp 3 the nightmare of anesthesiologist