spinal for scrotal surgery

[Idiopathic]

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never done caudal on adult outside of the fluoro suite. plan on doing intrathecal injection 15mg heavy marcaine, 25mcg fentanyl and +/- morphine. would you have him stay seated for a little bit longer than say a gravid female, in order to ensure good coverage of the sacral roots (especially since i dont really need anything above T10) and a high block could be devastating (known difficult airway) or maybe a little reverse T?

 

[Planktonmd]

never done caudal on adult outside of the fluoro suite. plan on doing intrathecal injection 15mg heavy marcaine, 25mcg fentanyl and +/- morphine. would you have him stay seated for a little bit longer than say a gravid female, in order to ensure good coverage of the sacral roots (especially since i dont really need anything above T10) and a high block could be devastating (known difficult airway) or maybe a little reverse T?

I am assuming that the surgery is on the scrotum as well as the testicles, so a saddle block alone might not be enough.
Just do the spinal with 10mg hyperbaric Marcaine in the sitting position, tell him to lie down immediatly and call it a day.

 

[Idiopathic]

shouldnt be any testicular work its for hidradenitis, i may need two hours also

 

[bostonblaz]

Heavy marcaine 10mg, and make him sit for two to three min. I had my a achilles done with 8 mg heavy marcaine and I sat for two min and my sac was numb for a good five hours. Add epi if you wish, plus the duramorph will cover you on the tail end. I stoped using fen in my spinals and I noticed no difference in on set or block quality, but did notice that people don't itch much any more. Blaz

 

[aredoubleyou]

I am assuming that the surgery is on the scrotum as well as the testicles, so a saddle block alone might not be enough.
Just do the spinal with 10mg hyperbaric Marcaine in the sitting position, tell him to lie down immediatly and call it a day.

I thought the testes were innervated higher than a saddle block would cover...I'm too lazy to google it, so I thought I'd throw that out there and have somebody educate us on how I'm a ***** with numerous pub med articles 🙂

 

[Planktonmd]

I thought the testes were innervated higher than a saddle block would cover...I'm too lazy to google it, so I thought I'd throw that out there and have somebody educate us on how I'm a ***** with numerous pub med articles 🙂

That was what I said

 

[sevoflurane]

T10 = gonadal innervation (so T6-8 should work).

Saddle block should work for what idio is gonna do.

Can't say I've done a cuadal spinal in an adult either.

 

[Idiopathic]

well i put him to sleep, he told me two other times attendings had tried spinals and spent upwards of 45 minutes and failed ended up going to sleep. he ended up being moderate mask with Grade III view but plastic ended up in the trachea - good thing cause it took the OR team 75 minutes just to prep

 

[Licoricestick]

it took the OR team 75 minutes just to prep

Glad to hear it isn't just where I work 😡
For an urgent section they can get going quickly, but otherwise every time I think about a spinal I worry that it won't last cause they won't start soon enough.
Anyone got any tips for hurrying the theatre team up?

 

[Planktonmd]

good thing cause it took the OR team 75 minutes just to prep

He must have a really big scrotum!

 

[rsgillmd]

He must have a really big scrotum!

😆

Plank, you made my morning.

 

[rsgillmd]

Glad to hear it isn't just where I work 😡
For an urgent section they can get going quickly, but otherwise every time I think about a spinal I worry that it won't last cause they won't start soon enough.
Anyone got any tips for hurrying the theatre team up?

I don't think there is anything simple. When I'm in L&D we have the clerk announce overhead that we are ready for the surgeons. But since that doesn't necessarily garner a quick response, if the patient is stable, I'll walk out of the room (I work with CRNAs) and tell them directly also. I use a very generic statement: "We are ready and just waiting for you." The bolded part is what the residents hear -- they know in a subtle way that the pressure is on them.

Our good OR techs are already prepping the patient by the time the surgeons enter, and have sometimes even finished draping. That also helps save some time.

I can't do much about surgical time, nor do I try to pressure them. The reason is because I don't want to hear later on, "We could have done a better job of making sure everything was good before closing, but the anesthesiologist was pressuring us to finish."

If I really want to subtly pressure them, the most I'll say is "If you don't finish in the next couple of minutes, I may have to put this patient to sleep." The residents, and even some of the attendings, at this program seem to have an inordinate fear of general anesthesia.

Most of the time I try to save is before a case and in between cases (turnover). I don't wait on the CRNAs to do anything. If I'm really busy, I'll give specific instructions, ex: "We will be finished in OR 1 in 10 minutes. Make sure you are ready to roll with the next patient." Then I follow this up by going to the L&D nurse and saying, "We will be finished in OR 1 in 10 minutes. We are ready whenever you are to roll with this next patient." Usually the L&D nurses are the main delay because they tend to leave off prep towards the end.

Forget about rushing our main ORs. I've given up on any hope for there. I just make sure I'm ready to go, and then just wait.

 

[aredoubleyou]

That was what I said

Ha! You're right! Was on a busy call at the time. Words should never be held against one when they are either drunk or on call...brain is functioning at about the same level.