lying or sitting

[drmwvr]

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Seems as tho the older (> 45 :0) operators around where I am lie 'em down. CLE/CTE/SAB, doesn't matter. The younger, the more likely sitting. Is this where the training is going? What is your bias?

 

[coprolalia]

I have no f***ing clue what you're talking about.

-copro

 

[Jeff05]

i think:
continuous lumber epi
continuous thoracic epi
subarachnoid block?

i have never heard or seen anyone do a thoracic in lateral decub.

lumber epidurals and spinals - no problem with either lateral decub or sitting.

 

[RabbMD]

I think sitting is easier for lumbars, mainly only in large people however. As the population increases in size I think the trend towards lying down will increase... I am probably a little strange here though and always do my thoracics laying down paramedian(pt can't move as much). Just what I liked to do when training.

I am 3 years out now.

 

[drmwvr]

I have no f***ing clue what you're talking about.

-copro

Ah, Copro. You do have a fetching way about you. Epidurals and spinals, lad. Epidurals and spinals.

 

[proman]

We do thoracic epidurals in our lung transplants POD #1, lateral, intubated, usually on low dose propofol. The ICU bed makes it tricky but I don't think it's any easier or harder than when patients are sitting (obviously not an option with them).

 

[dfk]

my first shot is sitting, unless otherwise contraindicated or preferred such as hip. what procedure are you talking about? for me, age is irrelevant as an outlier.

 

[drmwvr]

my first shot is sitting, unless otherwise contraindicated or preferred such as hip. what procedure are you talking about? for me, age is irrelevant as an outlier.

Perhaps Copro, in his gentle way, had a point. I was referring to the age of the anesthesiologist, not the patient. As to bias, mine is lateral regardless of level of placement, so as to take advantage of the splinting effect of the bed in keeping the spine aligned. This makes the patient less able to twist, lean or squirm and makes me less dependent on my assistant.

 

[dfk]

Perhaps Copro, in his gentle way, had a point. I was referring to the age of the anesthesiologist, not the patient. As to bias, mine is lateral regardless of level of placement, so as to take advantage of the splinting effect of the bed in keeping the spine aligned. This makes the patient less able to twist, lean or squirm and makes me less dependent on my assistant.

eh... depends.

 

[coprolalia]

Ah, Copro. You do have a fetching way about you. Epidurals and spinals, lad. Epidurals and spinals.

Then, why didn't you just say that in your OP? And, who is the "operator"? The surgeon or the anesthetist?

Be clear, man. We have enough cutesy jargon and lingo to deal with on a daily basis in the hospital, a good portion of which is nothing more than someone's made-up acronym or whatnot that no one else can figure out.

(Big pet peeve of mine, in case you couldn't tell.)

-copro

 

[2ndyear]

I sit up just about everyone, except hip/femur fractures and the like. I also use plain bupivacaine for every ortho procedure, so it really doesn't matter what side is up or down.

 

[Impromptu]

I was so tired of not understanding the obscure abbreviations that were used on my rotations by attendings and residents that I purchased a PDA program from Lexi-Comp called MedAbbreviations. I've combined that with a PDA Stedmen's Dictionary and I can now participate in this brave new world of letters and outdated terms.

CLE: Centrilobular emphysema, Congenital lobar emphysema, constant-load exercise, or continuous lumbar epidural

CTE: Chronic traumatic encephalopathy (Continuous thoracic epidural wasn't in there.)

SAB: Serum albumin, sinoatrial block, Spanish-American Black, subarachnoid block, spontaneous abortion, Staphyloccoccus aureus bacteremia, subarachnoid bleed.

 

[periopdoc]

I place my patients in lateral decub for all neuraxial procedures. I find it easier to position the patient after the block goes in, I don't have to worry about them falling over if someone gets carried away with the sedation, 😡 and most importantly people don't feel obligated to stand in front of the patient to "help position them."


And by the way, what the hell is it about me picking up the epidural/ spinal needle that gives every RN, Tech, janitor HA, and attending think they now need to tell the patient to bend further, put chin on chest etc. Thanks, I just spent 5 minutes getting the 400 lb beached whale patient positioned exactly where I want him/her to be and you go and F up all my landmarks by telling them to move. Thanks alot.

- pod