Neuraxial Ultrasound and Combined Spinal-Epidural (CSE) Anesthesia for Cesarean Delivery
Lauren Blake, MD; Fatine Karkri, MD; Brendan Carvalho, MBBCh, FRCA, MDCH, FASA
Stanford University School of Medicine
Neuraxial anesthesia is the gold standard approach for cesarean delivery, offering surgical anesthesia while optimizing maternal and fetal outcomes. This video provides a stepwise demonstration of a combined spinal-epidural (CSE) technique for cesarean delivery. This technique covers patient positioning, identification of the appropriate interspace, sterile preparation, infiltration of local anesthetic, and spinal/epidural needle placement. For single-shot spinal (SSS), a spinal needle is advanced into the subarachnoid space, cerebrospinal fluid return is confirmed with aspiration, and intrathecal medication is administered. For CSE, an epidural needle is advanced into the epidural space using a loss-of-resistance technique, followed by spinal needle insertion through the epidural needle for intrathecal medication administration. This needle-through-needle technique concludes with epidural catheter insertion and securement. Indications and medication dosing for cesarean delivery are discussed for each technique.
Neuraxial Ultrasound and Epidural Blood Patch for Post-dural Puncture Headache
Fatine Karkri, MD; Lauren Blake, MD; Brendan Carvalho, MBBCh, FRCA, MDCH, FASA
Stanford University School of Medicine
This video demonstrates a stepwise technique for performing an autologous epidural blood patch (EBP) to treat post-dural puncture headache (PDPH). The video covers identification of the target interspace, skin cleaning, local anesthesia infiltration, epidural needle placement using loss-of-resistance technique, aseptic collection of autologous blood, controlled injection into the epidural space, and immediate assessment of EBP effect. Indications, contraindications, expected immediate responses, and troubleshooting (including repeat EBP and alternative interventions) are discussed. The technique shown aims to maximize efficacy and enhance safety, and is applicable to PDPH after dural puncture from spinal anesthesia or inadvertent dural puncture during epidural placement.
Neuraxial Ultrasound and Spinal Anesthesia for Cesarean Delivery
Fatine Karkri, MD; Lauren Blake, MD; Brendan Carvalho, MBBCh, FRCA, MDCH, FASA
Stanford University School of Medicine
This video provides a step-by-step demonstration of preprocedural neuraxial ultrasound for lumbar neuraxial procedures. The film shows probe selection and orientation, sonoanatomy landmarks (sagittal and transverse views), measurement of skin-to-posterior complex depth, and skin marking. Indications and evidence for improved procedural accuracy and reduced needle passes are discussed. The technique is applicable to routine obstetric neuraxial procedures and is especially useful in patients with challenging surface landmarks or a history of difficult neuraxial placement.
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