Spinal and muscle relaxation

[icecoldstar]

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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

 

[MirrorTodd]

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!

 

[caligas]

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.

 

[marr65]

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.

To the OP: Just print this post and read it out loud every time!

 

[icecoldstar]

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.

 

[NICMAN]

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).

 

[DocMcCoy]

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.

Anecdotally, this complaint is true if spinal is wearing off or inadequate to begin with. Used to roll my eyes when surgeons said stuff like this then one day had an c section patient start to have some mild discomfort but tolerating procedure. 120 minutes in OB said stomach was tight. Rolled my eyes but decided to look over drape and her abs were squeezing her bowels out of the incision so hard they couldn’t close her up!


But a rock solid spinal, no, in that case they are full of it.

 

[deleted162650]

120 minutes in

Theres’s your problem.

 

[DocMcCoy]

Theres’s your problem.

Slight exaggeration for dramatic effect because it couldn’t be MY fault.

Point is That versed or propofol or whatever can mask a crappy spinal pretty good in a lot of patients.

 

[deleted126335]

Surgical complaints about inadequate muscle relaxation are almost a perfect negative correlation with surgical skill.

 

[deleted162650]

Surgical complaints about inadequate muscle relaxation are almost a perfect negative correlation with surgical skill.

As the saying goes, Good surgeons don’t need muscle relaxation, bad surgeons don’t deserve it.

 

[amyl]

lol - put a rocuronium sticker on a syringe of normal saline and push some every time they say that.... they've gotta have something to blame and you gotta look like you are doing something to "fix" it ;-)

 

[deleted59964]

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.

next they'll ask for hypocalcaemia

 

[coffeebythelake]

next they'll ask for hypocalcaemia

Except that causes tetany..

Hypermagnesemia? Dantrolene?

 

[abolt18]

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).

Not to mention the fact that the tourniquet is on and they want you to redose...

 

[abolt18]

Surgical complaints about inadequate muscle relaxation are almost a perfect negative correlation with surgical skill.

R = -0.99

 

[woopedazz]

next they'll ask for hypocalcaemia

Permissive Asystole

 

[Volatile]

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.

 

[nimbus]

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.

He should have replied, “I’ll call perfusion. You cannulate.”

 

[Airway]

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'?

 

[Mehd School]

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's not holding up his end of the conversation as well as he used to so I'm getting concerned."

 

[deleted59964]

Except that causes tetany..

Hypermagnesemia? Dantrolene?

depends how low you go😉