Thanks for the video! Always enjoy them. Would be cautious about sterility if one were to touch iliac crests during this procedure. While there was a wide prep, the provider's fingers were incredibly close to the non-prepped area as seen from 3:46-3:59. Others who follow your videos may not appreciate the risk of glove contamination when touching landmarks outside the sterile field. Thanks!
This will make a shift in my practice in suspected difficult spinal patients . I will start to use ultrasound for that. I need to read your comments regarding the removal of introducer then further advances of spinal needle without introducer from your experience view of points.
Great video. Always wondered why cannot i use this real time technique. Its hardly mentioned in the literature! I have 2 questions for you Admir!! 1. Why can't the needle be inserted from below the probe with slight cranial angulation in transverse interlaminar or interspinous view so as to get the tip in view closer to the dura? 2. Your opinion on real time needle insertion in Parasagittal oblique view?
Thank you for the excellent video. I would like to know if wearing a sterile gown is no longer deemed necessary before performing a sub arachnoid block. I work at a teaching institute and seem to be the only one insisting on washing of hands, applying sterile fenestrated drapes and wearing sterile gowns. Your own standards of spinal anesthesia mention the same. Are those precautions considered outdated now?
There may be a view by some that what you stated is "unnecessary" and they make the choice to forgo such measures, however your use of increased sterile technique will never cause harm and may still assist in preventing harm to a patient. So I'd continue exactly how you are doing. Being too clean and sterile will never cause a problem for the patient
I did my Training in Germany starting in 2002. While a single course of hand desinfection, wearing a mask, hat and sterile gowns were (and still are) required, we never wore sterile gowns over our scrubs when not introducing a catheter.
No, waste, if you move a needle without a guide from the subcutaneous cellular tissue to the subarachnoid space, you will surely plant that tissue there, it is not at all hypothetical... I think that we must have a little respect for the central nervous system, at least I would never do that...
Hi NYSORA can someone please help me. Is it safe to perform spinal anaesthesia on someone who hasn’t stopped their turmeric for TKR? I’m not finding good evidence
Dear Colleagues, Few thoughts after watching the video: 1. Performing the longitudinal scanning first is preferable in order to define level L3/L4 and the scan this level and one level upper and lower to assess what is the best one for puncture ( qualify of view the posterior and anterior complex) 2. Spinal ultrasound asesses 5 parameters: level of puncture, midline, depth, angle of puncture ( can be caudad needle direction, especially in elderly patients ) and rotation of the spine ( in case of scoliosis) 3. Add maximum 1.5 cm to the depth measurement ( due to the pressure of probe to the soft tissue and difference in angle between needle and probe) 4. We are doing in our hospital pre-procedural spinal ultrasound . We use 27 G needle as standards ( more than 90% of patients) and 25 G for the rest ( mosly if we use long needles for patients above 130 kg). 22G used only in case of lumbar puncture if CSF pressure measurement is necessary 5. M-mode can be used to have midline level on the ultrasound screen 6. Patient position between the scanning and puncture better not to be changed 7. Is the sterile gown not necessary for performer? Best regards V.Firago
It started with the stylet. But sometimes - it is more time efficient to avoid constant stylet in-stylet out maneuvers. Do you agree? Thank you for watching!
@@nysoravideo i totally agree with u..always used stylet for we were taught so..now this has changed my perspective n its easier n visually comprehensive we r in subarachnoid space....i appreciate n practising it :)..thank you so much
No need for the introducer - as this is 22 Gauge, Quincke style needle. Introducer is needed for needles of bullet-style tip and smaller gauge. What gauge and style spinal needle do you use? Thank you for watching!
@@nysoravideo I'm on my 3rd week of OB training and can't remember off the top of my head but I think we use a 25 gauge. I'm at the med center in Houston right now. I haven't seen the ultrasound used for a spinal yet so seeing your video was great. I'm going to bring it up with my attending. Have loved your IV videos! Great tips and confidence builders.
Gotta use a real pt where a spinal can be challenging. This patient you selected does not represent the typical patient population that needs an US guided spinal
Thanks for the video! Always enjoy them. Would be cautious about sterility if one were to touch iliac crests during this procedure. While there was a wide prep, the provider's fingers were incredibly close to the non-prepped area as seen from 3:46-3:59. Others who follow your videos may not appreciate the risk of glove contamination when touching landmarks outside the sterile field. Thanks!
This will make a shift in my practice in suspected difficult spinal patients . I will start to use ultrasound for that.
I need to read your comments regarding the removal of introducer then further advances of spinal needle without introducer from your experience view of points.
Yes - you get 3 important information: 1) Midline 2) Level 3) Depth. Thank you for watching!
Great video. Always wondered why cannot i use this real time technique. Its hardly mentioned in the literature! I have 2 questions for you Admir!!
1. Why can't the needle be inserted from below the probe with slight cranial angulation in transverse interlaminar or interspinous view so as to get the tip in view closer to the dura?
2. Your opinion on real time needle insertion in Parasagittal oblique view?
Thank you for the excellent video.
I would like to know if wearing a sterile gown is no longer deemed necessary before performing a sub arachnoid block. I work at a teaching institute and seem to be the only one insisting on washing of hands, applying sterile fenestrated drapes and wearing sterile gowns. Your own standards of spinal anesthesia mention the same. Are those precautions considered outdated now?
There may be a view by some that what you stated is "unnecessary" and they make the choice to forgo such measures, however your use of increased sterile technique will never cause harm and may still assist in preventing harm to a patient. So I'd continue exactly how you are doing. Being too clean and sterile will never cause a problem for the patient
I did my Training in Germany starting in 2002. While a single course of hand desinfection, wearing a mask, hat and sterile gowns were (and still are) required, we never wore sterile gowns over our scrubs when not introducing a catheter.
Where is Nysora, and where was this video done at...
Great video as always! Usg isnt used for difficult spinal in our institute. Looking forward to using your techniques next time
Actually Presently what I feel is Transverse Obluque view of lumbar spinal is much helpful for realtime Ultrasound Guided Spinal Anesthesia
Thank you so much for the super explanation. It is much appreciated!👌🏼
Which part of the video is most useful? Thank you for watching!
Isn’t she move all the debris to the intrathecal area ?
Hypothethical. Have you ever seen the problem related to it? Thank you for watching!
No, waste, if you move a needle without a guide from the subcutaneous cellular tissue to the subarachnoid space, you will surely plant that tissue there, it is not at all hypothetical... I think that we must have a little respect for the central nervous system, at least I would never do that...
I am concerned about the transducer gel migrating into the intrathecal space via the needle.
Would love to see reverse ultrasound anatomy animation that you guys do so well!
I appreciate this explanation. Thank you.
More informative.Thanks for the vedio
Hi NYSORA can someone please help me. Is it safe to perform spinal anaesthesia on someone who hasn’t stopped their turmeric for TKR? I’m not finding good evidence
I always enjoy and I have learned a lot from you and your videos, but this one. Has a lot of ... Safety issues moreover to choose a 23 g is too much.
Thanks for sharing
Sir please explain how to calculate epidural depth 🙏 thank you very much for very good demo 🙏🙏
You can take a look at the right part of US image, there will be some lines and numbers like a ruler
Indeed! @user-uz explains it correctly!! Thank you for watching!
Dear Colleagues,
Few thoughts after watching the video:
1. Performing the longitudinal scanning first is preferable in order to define level L3/L4 and the scan this level and one level upper and lower to assess what is the best one for puncture ( qualify of view the posterior and anterior complex)
2. Spinal ultrasound asesses 5 parameters: level of puncture, midline, depth, angle of puncture ( can be caudad needle direction, especially in elderly patients ) and rotation of the spine ( in case of scoliosis)
3. Add maximum 1.5 cm to the depth measurement ( due to the pressure of probe to the soft tissue and difference in angle between needle and probe)
4. We are doing in our hospital pre-procedural spinal ultrasound . We use 27 G needle as standards ( more than 90% of patients) and 25 G for the rest ( mosly if we use long needles for patients above 130 kg). 22G used only in case of lumbar puncture if CSF pressure measurement is necessary
5. M-mode can be used to have midline level on the ultrasound screen
6. Patient position between the scanning and puncture better not to be changed
7. Is the sterile gown not necessary for performer?
Best regards
V.Firago
El uso de xilocaina en gel en lugar del gel
suggestion : use "screen in screen" for those videos. i am more intrested in USG image and in the corner we would then see a marker action.
Great recommendation! WIll do. Thank you for watching!
Is it a 22g?
Why is entry without stylet?
Because it is a 22.
It started with the stylet. But sometimes - it is more time efficient to avoid constant stylet in-stylet out maneuvers. Do you agree? Thank you for watching!
Not sure if we are discussing a Stylets or Introducer? Thank you for watching!
@@nysoravideo i totally agree with u..always used stylet for we were taught so..now this has changed my perspective n its easier n visually comprehensive we r in subarachnoid space....i appreciate n practising it :)..thank you so much
No introducer? Thanks for the content!
No need for the introducer - as this is 22 Gauge, Quincke style needle. Introducer is needed for needles of bullet-style tip and smaller gauge. What gauge and style spinal needle do you use? Thank you for watching!
@@nysoravideo I'm on my 3rd week of OB training and can't remember off the top of my head but I think we use a 25 gauge. I'm at the med center in Houston right now. I haven't seen the ultrasound used for a spinal yet so seeing your video was great. I'm going to bring it up with my attending. Have loved your IV videos! Great tips and confidence builders.
I would never advance a needle without the guide, there is a risk of sowing foreign tissue into the subaranoid space.
Good thinking
Gotta use a real pt where a spinal can be challenging. This patient you selected does not represent the typical patient population that needs an US guided spinal
Oh boy the amount of CSF just flowing after the insertion :s
🙌🏾
Sterile aseptic technique has gone for a toss.
Sorry very confusing video totally unsterile technique not happy 😮
Which part?
Inserting the entire needle and not appreciating the appearance of spinal fluid increases the risk of spinal cord puncture!!!
Should not be the case since we have determined the LEVEL of needle insertion as L3/L4. Do you agree? Thank you for watching!
They are in the save zone below L2 remember
I am concerned about the transducer gel migrating into the intrathecal space via the needle.
I am concerned about the transducer gel migrating into the intrathecal space via the needle.
I am concerned about the transducer gel migrating into the intrathecal space via the needle.