Difficult Spinal in Obese Patient- Crash course with Dr. Hadzic

00:46 Factors associated with difficult spinal
02:09 Spinal needles
02:48 Anatomy
03:12 Anatomy of needle insertion
04:31 Steps for success in large BMI patients
07:14 Summary

Difficult lumbar punctures and difficult spinal or epidural anesthesia frequently cause complications in patients with a large body mass index (BMI). Traumatic needle placements as well as multiple attempts during a neuraxial blockade have been related to neuraxial complications, ranging from a bad experience for patients all the way to neurologic injury. It's generally easier to perform spinal punctures in younger patients, which is to be expected due to lesser incidence of spinal deformities, osteophytes, and better tissue compliance during the procedure in most cases.

However, larger patients may have poorly palpable interspinous space. In these patients, determining the space for needle introduction can be difficult, leading to multiple attempts and failures. In this video, Dr. Hadzic demonstrates the role of ultrasound, the technique, and the choice of equipment that can facilitate spinal anesthesia in patients with difficult landmarks or a large BMI. The video is richly animated with NYSORA’s reverse ultrasound anatomy (RUA) illustrations and is a great educational tool for students and practitioners alike. This video is a must-watch.

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