No experience of using gadolinium in Patients Allergy to Iodine/Contrast. Can any one share experience with gadolinium.
Use of gadolinium in Patients Allergy to Iodine/Contrast
- Thread starter painfre
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It works pretty good, but it is a lot harder to see on fluoro than Isovue. DSA helps.
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Roughly equivalent to omnipaque 100
Forget it though in a very heavy person, maybe you can see a flash to know it is epidural but hard to see any vascular uptake.
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It'll work, but not as well. Hard to see in some patients, particularly heavier ones. Might miss some vascular uptake. May give false sense of security.
No research that I am aware of on this.
No research that I am aware of on this.
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I turn the lights way down low and shoot live with digital subtraction. It's not perfect, but I'd rather do it this way than premedicating the patient with steroids and Benadryl.
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I have used it for all of my so called "contrast allergic" patients (all lumbar) for five years, without any side effects or allergies.
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just be careful in patients with renal failure. Everyone I work around is freaking out about the lawsuits surrounding nephrogenic systemic fibrosis after gad in renal failure patients. I doubt this is really an issue when you're only injecting 1-2cc's though.
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To revisit an old thread, when considering a gadolinium agent for neuraxial procedures, which types are being used (Ominscan, ProHance, etc)? I would assume most try to use non-ionic.
Also for my guys in the game for awhile, what has been your experience with visualizing the gadolinium on TFESIs? Did using DSA help? Certain patients or scenarios you feel it is unrealistic to use (outside of patient with renal impairments)?
Appreciate the insight.
Also for my guys in the game for awhile, what has been your experience with visualizing the gadolinium on TFESIs? Did using DSA help? Certain patients or scenarios you feel it is unrealistic to use (outside of patient with renal impairments)?
Appreciate the insight.
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i use Gad sometimes, sometimes i cannot see it, what worries me about Gad is that one reason for using it is to see if needle tip is intrathecal. if it is, and Gad goes intrathecal, no idea what happens next...
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Encephalopathy may be a big concern of mine in that case.
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does anyone else think using Gad near the IT sac is dumb?
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I guess the question here is what is the least risk. If intrathecal gad is so bad then would it not be better to just not use gadolinium for contrast at all?
(Assuming there is some reason you couldn't just predicate with prednisone and Benadryl and just use regular contrast).
(Assuming there is some reason you couldn't just predicate with prednisone and Benadryl and just use regular contrast).
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100% Agree Bedrock. Always risk:benefit. Elective procedures are elective procedures.
However, I'm compelled to get various opinions from some vets on the topic.
Literature I've read (small and large case reports, mostly from Rads/NeuroRads) "suggests" it as an option. I agree there is risk, but likely less in terms of IT injection if taking a less oblique TFESI approach. Vascular concern always remains, as may be difficult to visualize even if DSA used.
Issue is prior posterior decompressions limits ability to pursue an Interlam ESI. Patient had legitimate anaphylaxis reaction (with in 10 mins) with remote contrast-confirmed ESI by rads prior to her surgeries.
Again, just throwing it out for debate/opinions. Appreciate the thoughts and remarks.
However, I'm compelled to get various opinions from some vets on the topic.
Literature I've read (small and large case reports, mostly from Rads/NeuroRads) "suggests" it as an option. I agree there is risk, but likely less in terms of IT injection if taking a less oblique TFESI approach. Vascular concern always remains, as may be difficult to visualize even if DSA used.
Issue is prior posterior decompressions limits ability to pursue an Interlam ESI. Patient had legitimate anaphylaxis reaction (with in 10 mins) with remote contrast-confirmed ESI by rads prior to her surgeries.
Again, just throwing it out for debate/opinions. Appreciate the thoughts and remarks.
- Joined
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- 42
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- 2
100% Agree Bedrock. Always risk:benefit. Elective procedures are elective procedures.
However, I'm compelled to get various opinions from some vets on the topic.
Literature I've read (small and large case reports, mostly from Rads/NeuroRads) "suggests" it as an option. I agree there is risk, but likely less in terms of IT injection if taking a less oblique TFESI approach. Vascular concern always remains, as may be difficult to visualize even if DSA used.
Issue is prior posterior decompressions limits ability to pursue an Interlam ESI. Patient had legitimate anaphylaxis reaction (with in 10 mins) with remote contrast-confirmed ESI by rads prior to her surgeries.
Again, just throwing it out for debate/opinions. Appreciate the thoughts and remarks.
However, I'm compelled to get various opinions from some vets on the topic.
Literature I've read (small and large case reports, mostly from Rads/NeuroRads) "suggests" it as an option. I agree there is risk, but likely less in terms of IT injection if taking a less oblique TFESI approach. Vascular concern always remains, as may be difficult to visualize even if DSA used.
Issue is prior posterior decompressions limits ability to pursue an Interlam ESI. Patient had legitimate anaphylaxis reaction (with in 10 mins) with remote contrast-confirmed ESI by rads prior to her surgeries.
Again, just throwing it out for debate/opinions. Appreciate the thoughts and remarks.
- Joined
- Sep 26, 2012
- Messages
- 42
- Reaction score
- 2
100% Agree Bedrock. Always risk:benefit. Elective procedures are elective procedures.
However, I'm compelled to get various opinions from some vets on the topic.
Literature I've read (small and large case reports, mostly from Rads/NeuroRads) "suggests" it as an option. I agree there is risk, but likely less in terms of IT injection if taking a less oblique TFESI approach. Vascular concern always remains, as may be difficult to visualize even if DSA used.
Issue is prior posterior decompressions limits ability to pursue an Interlam ESI. Patient had legitimate anaphylaxis reaction (with in 10 mins) with remote contrast-confirmed ESI by rads prior to her surgeries.
Again, just throwing it out for debate/opinions. Appreciate the thoughts and remarks.
However, I'm compelled to get various opinions from some vets on the topic.
Literature I've read (small and large case reports, mostly from Rads/NeuroRads) "suggests" it as an option. I agree there is risk, but likely less in terms of IT injection if taking a less oblique TFESI approach. Vascular concern always remains, as may be difficult to visualize even if DSA used.
Issue is prior posterior decompressions limits ability to pursue an Interlam ESI. Patient had legitimate anaphylaxis reaction (with in 10 mins) with remote contrast-confirmed ESI by rads prior to her surgeries.
Again, just throwing it out for debate/opinions. Appreciate the thoughts and remarks.
- Joined
- Sep 26, 2012
- Messages
- 42
- Reaction score
- 2
100% Agree Bedrock. Always risk:benefit. Elective procedures are elective procedures.
However, I'm compelled to get various opinions from some vets on the topic.
Literature I've read (small and large case reports, mostly from Rads/NeuroRads) "suggests" it as an option. I agree there is risk, but likely less in terms of IT injection if taking a less oblique TFESI approach. Vascular concern always remains, as may be difficult to visualize even if DSA used.
Issue is prior posterior decompressions limits ability to pursue an Interlam ESI. Patient had legitimate anaphylaxis reaction (with in 10 mins) with remote contrast-confirmed ESI by rads prior to her surgeries.
Again, just throwing it out for debate/opinions. Appreciate the thoughts and remarks.
However, I'm compelled to get various opinions from some vets on the topic.
Literature I've read (small and large case reports, mostly from Rads/NeuroRads) "suggests" it as an option. I agree there is risk, but likely less in terms of IT injection if taking a less oblique TFESI approach. Vascular concern always remains, as may be difficult to visualize even if DSA used.
Issue is prior posterior decompressions limits ability to pursue an Interlam ESI. Patient had legitimate anaphylaxis reaction (with in 10 mins) with remote contrast-confirmed ESI by rads prior to her surgeries.
Again, just throwing it out for debate/opinions. Appreciate the thoughts and remarks.
- Joined
- Sep 26, 2012
- Messages
- 42
- Reaction score
- 2
100% Agree Bedrock. Always risk:benefit. Elective procedures are elective procedures.
However, I'm compelled to get various opinions from some vets on the topic.
Literature I've read (small and large case reports, mostly from Rads/NeuroRads) "suggests" it as an option. I agree there is risk, but likely less in terms of IT injection if taking a less oblique TFESI approach. Vascular concern always remains, as may be difficult to visualize even if DSA used.
Issue is prior posterior decompressions limits ability to pursue an Interlam ESI. Patient had legitimate anaphylaxis reaction (with in 10 mins) with remote contrast-confirmed ESI by rads prior to her surgeries.
Again, just throwing it out for debate/opinions. Appreciate the thoughts and remarks.
However, I'm compelled to get various opinions from some vets on the topic.
Literature I've read (small and large case reports, mostly from Rads/NeuroRads) "suggests" it as an option. I agree there is risk, but likely less in terms of IT injection if taking a less oblique TFESI approach. Vascular concern always remains, as may be difficult to visualize even if DSA used.
Issue is prior posterior decompressions limits ability to pursue an Interlam ESI. Patient had legitimate anaphylaxis reaction (with in 10 mins) with remote contrast-confirmed ESI by rads prior to her surgeries.
Again, just throwing it out for debate/opinions. Appreciate the thoughts and remarks.
- Joined
- Sep 26, 2012
- Messages
- 42
- Reaction score
- 2
100% Agree Bedrock. Always risk:benefit. Elective procedures are elective procedures.
However, I'm compelled to get various opinions from some vets on the topic.
Literature I've read (small and large case reports, mostly from Rads/NeuroRads) "suggests" it as an option. I agree there is risk, but likely less in terms of IT injection if taking a less oblique TFESI approach. Vascular concern always remains, as may be difficult to visualize even if DSA used.
Issue is prior posterior decompressions limits ability to pursue an Interlam ESI. Patient had legitimate anaphylaxis reaction (with in 10 mins) with remote contrast-confirmed ESI by rads prior to her surgeries.
Again, just throwing it out for debate/opinions. Appreciate the thoughts and remarks.
However, I'm compelled to get various opinions from some vets on the topic.
Literature I've read (small and large case reports, mostly from Rads/NeuroRads) "suggests" it as an option. I agree there is risk, but likely less in terms of IT injection if taking a less oblique TFESI approach. Vascular concern always remains, as may be difficult to visualize even if DSA used.
Issue is prior posterior decompressions limits ability to pursue an Interlam ESI. Patient had legitimate anaphylaxis reaction (with in 10 mins) with remote contrast-confirmed ESI by rads prior to her surgeries.
Again, just throwing it out for debate/opinions. Appreciate the thoughts and remarks.
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HaHaHa apologizes on the reposts. I don't like gadolinium that much.
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These guys like Gad-
Gadolinium use in spine procedures for patients with allergy to iodinated contrast--experience of 127 procedures.
"Gadolinium seems to be a safe alternative..."
http://www.researchgate.net/publica...inated_contrast--experience_of_127_procedures
Gadolinium use in spine procedures for patients with allergy to iodinated contrast--experience of 127 procedures.
"Gadolinium seems to be a safe alternative..."
http://www.researchgate.net/publica...inated_contrast--experience_of_127_procedures
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That was one of the main large case studies I was referring to yes. "seems".....have to love it.
