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Does spinal provide muscle relaxation for lower extremity tendon repair surgeries? Our surgeons want "0 twitch" for those and struggle is real. Thanks
Lol they gotta be ****ing with you!Does spinal provide muscle relaxation for lower extremity tendon repair surgeries? Our surgeons want "0 twitch" for those and struggle is real. Thanks
Spinal: prevents active/intentional muscle movement and movement initiated by spinal cord reflex.
NMB: at adequate dosage prevents movement as above AND movement triggered by electrocautery stimulation of peripheral nerves.
NOTHING prevents localized muscle twitching triggered by electrocautery stimulation of motor end plates.
I'm not talking about electrocautery stuff. Sometimes when they start pulling and tugging on the muscles/fascia, they complain that it's too tight, and want roc. This pretty much force us to tube all those patients instead of a spinal. My question is, does giving high dose NMB to the point of 1-2 twitches provide the same degree of relaxation compared to a spinal? My thought is yes and make sense physiologically, but I can't really find any literature to support that statement.Spinal: prevents active/intentional muscle movement and movement initiated by spinal cord reflex.
NMB: at adequate dosage prevents movement as above AND movement triggered by electrocautery stimulation of peripheral nerves.
NOTHING prevents localized muscle twitching triggered by electrocautery stimulation of motor end plates.
I'm not talking about electrocautery stuff. Sometimes when they start pulling and tugging on the muscles/fascia, they complain that it's too tight, and want roc. This pretty much force us to tube all those patients instead of a spinal. My question is, does giving high dose NMB to the point of 1-2 twitches provide the same degree of relaxation compared to a spinal? My thought is yes and make sense physiologically, but I can't really find any literature to support that statement.
120 minutes in
Theres’s your problem.
Surgical complaints about inadequate muscle relaxation are almost a perfect negative correlation with surgical skill.
next they'll ask for hypocalcaemiaSpinal: prevents active/intentional muscle movement and movement initiated by spinal cord reflex.
NMB: at adequate dosage prevents movement as above AND movement triggered by electrocautery stimulation of peripheral nerves.
NOTHING prevents localized muscle twitching triggered by electrocautery stimulation of motor end plates.
next they'll ask for hypocalcaemia
Not to mention the fact that the tourniquet is on and they want you to redose...The stretch reflex is a spinal reflex. Some people may have increased tone (eg, parkinson's).
Most of the time the "relaxation" they are seeking is due to scar tissue or contractures. Sometimes I just tell them "It is completely flat.....I can't paralyze scar tissue. (if it is 1/4 then basically >90% of receptors are occupied--which is functionally complete relaxation).
R = -0.99Surgical complaints about inadequate muscle relaxation are almost a perfect negative correlation with surgical skill.
Permissive Asystolenext they'll ask for hypocalcaemia
Permissive Asystole
Sadly, in residency one of my co-residents was asked by an oncology surgeon to stop the iliac artery pulsations because they were interfering with his procedure you can’t make this s$*t up. He was a terrible surgeon.
I had a transplant surgeon (CT and urology involved as well) during a circ arrest case ask me repeatedly 'how is the patient doing'?He should have replied, “I’ll call perfusion. You cannulate.”
I had a transplant surgeon (CT and urology involved as well) during a circ arrest case ask me repeatedly 'how is the patient doing'?
depends how low you goExcept that causes tetany..
Hypermagnesemia? Dantrolene?