Disposable Spinal Kits

[anesthesia11230]

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Currently doing an OB rotation.

The other day we did a spinal for an elective C section (repeat)
Relatively easy no issue spinal (good landmarks)
spinal needle goes in...CSF comes back
aspirate alil...see the beautiful turbidity and w/o a doubt know its CSF
inject about 10mg bupivicain 0.75% along with about 30 ug fentanyl
towards the end of injection...aspirate again...nice turbidity

Patient states legs getting heavy etc etc
patient prepped...OB attending test..."OUCH"

somehwat pissed for looking like an azz,
my attending comes back to the room...assured the spinal was good but to get a move on things...give some ketamine...

The time from the injection of bupivicaine to the OB pinch test was about 15 mins...why the heck this spinal onset is SO LONGGGGG?

at the end of the case...spinal was perfect...couldnt move legs at all along with perfect postop analgesia

Then up on the floor...same day...resident tells me she had a perfect spinal...CSF, turbidity etc etc...and the spinal had no effect...

POINT IS: im thinking it could be the actual batch/stock of disposable spinal trays (defective or ineffective local anesthetics)

QUESTION: How common is this?
other people have similar experiences?

Reason im asking...could actually get really screwed in an emergent situation (ex. STAT C section...do a one shot spinal...think its good)
rush rush rush...OUCH
convert to GA...aspiration ....downward spiral
would be a shame

perhaps this needs to be looked more into
any thoughts?

thanks
MP

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http://www.02demand.com
online community of clinical excellence in anesthesia

 

[bostonblaz]

we actually had three of these in a one month peroid a half year ago, one on ob and two in the or. all same story. department decided to get rid of the rest of that specfic shipment of spinal marcaine. sent some for analysis and all came back fine. have not had a problem since. company never told us why.

 

[anesthesia11230]

thanks for the reply.

Think this is something we should all keep our "collective eye" on and make sure this occurence becomes nonexistent.

You take the chance in putting a needle in someone's back with the related associated risks (hematoma, abcess, neuropathy) for what...no effect. Seems like a terrible offense esp if dealing with someone with difficult airway and reactive aiways and you try to avoid ETT GA at all cost.

Has only happened to me once...hope never again and hope even more that I dont accept it as ..."its happens"

http://www.02demand.com
online community of clinical excellence in anesthesia

 

[militarymd]

It happens....

 

[numbmd]

I've done OB anesthesia for over 10 years at a busy (6-7K deliveries) a year. This is a uncommon, but unfortunately too uncommon occurence upstairs. And many times there is absolutely no rhyme or reason to it. So, like Forest says, "It happens."