Dr J C John

Consultant at elective orthopaedic hospital in Oswestry

Passionate about spinal for spine surgery , geniculate blocks for knee replacement analgesia

[Dr J C John @JohnJohnC1]

@DrRobbieErskine Nicely done Robbie

[Dr J C John @JohnJohnC1]

@mick_kerr @BlockIt_Hot_Pod Top quality video , well done and thank you

[Dr J C John @JohnJohnC1]

@DrRobbieErskine If it’s for a hip, often find you might need to add water to your spinal drug to make it hypobaric and get it up to T 10 @KiJinnChin courtesy

[Dr J C John @JohnJohnC1]

@chandra_ri64999 @PeterMerjavy @HouthoffKavita @NavBahal @Steve_Coppens @AlexanderLJones @jon_bailey_anes @EMARIANOMD @KalagaraHari @dr_rajgupta @bobfunn @DrTimJen @PeterRoseAnesth @garrettsbarry @jeffgadsden @Ropivacaine does dexmed in the spinal last as long as morphine does. I find morphine 0.2 mg lasts about 24 hrs

[Dr J C John @JohnJohnC1]

@KartikBSonawane @RAPMOnline good post, Karthik. I have two queries. If ESP block does not affect ant rami, how does a thoracic eco work for rib fractures ? Is it possible that the spread of dye in a cadaver would be different to a live patient

[Dr J C John @JohnJohnC1]

@SMunigangaiah Can't wait to catch up on your story when you get back
Hope you said hello to @KartikBSonawane

[Dr J C John @JohnJohnC1]

@ashwani_doc @BlockIt_Hot_Pod @DrRobbieErskine @jeffgadsden @RCoANews @doctimcook @RegionalAnaesUK Mighty useful for sensory nerves too, lateral female cut, lateral forearm cut n, sup peroneal, sural

[Dr J C John @JohnJohnC1]

@DrRobbieErskine @AlwinChuan Difficult sometimes when they have had a spinal and a GA or heavy TIVA for a hip or a knee to convince them that the GA bit is unnecessary risk

I often get the surgeon to suggest it

They have had a chance to develop better rapport

[Dr J C John @JohnJohnC1]

@syahrul1988 @glauncel @chandra_ri64999 @mjoldman @KartikBSonawane @DrTuhinM @AoraIndia @ESRA_Society @mokaeleni @SGSocAnaes @ASRA_Society @KalagaraHari This is the real question ?
What is the risk of cord damage in thoracic spinals
1 in 23000 is quoted in lumbar spinals
@chandra_ri64999 did 5 in a day , I was was there . So 5days a week = about 1000 a year ,
Similarly other practitioners doing similar no's

[Dr J C John @JohnJohnC1]

@garrettsbarry @KartikBSonawane @glauncel @chandra_ri64999 @DrTuhinM @AoraIndia @ESRA_Society @mokaeleni @SGSocAnaes @ASRA_Society @KalagaraHari It's not deep sedation

I was there !!!

[Dr J C John @JohnJohnC1]

@glauncel @chandra_ri64999 @mjoldman @KartikBSonawane @DrTuhinM @AoraIndia @ESRA_Society @mokaeleni @SGSocAnaes @ASRA_Society @KalagaraHari These patients have less sedation that I see often in awake procedures done in the UK
Drugs used are ketamine under 40 mg, or dexmed under 20 to 50 mcg and buprenorphine
These drugs are ideal due to their lack of resp depression

[Dr J C John @JohnJohnC1]

@mjoldman @glauncel @chandra_ri64999 @KartikBSonawane @DrTuhinM @AoraIndia @ESRA_Society @mokaeleni @SGSocAnaes @ASRA_Society @KalagaraHari 4. I watched 2 lap chole, 3 spinal fusions , 1 pcnl, 1 hysterectomy under thoracic spinal
1 Spine had a fracture at T11, so Richa did spinal at T6 and L3
All patients mild sedation No GA
If I had done a GA, I would have needed tons more drugs,kit
I am convinced this is better

[Dr J C John @JohnJohnC1]

@glauncel @chandra_ri64999 @KartikBSonawane @DrTuhinM @AoraIndia @ESRA_Society @mokaeleni @SGSocAnaes @ASRA_Society @KalagaraHari 3, One should also bear in mind , different cultures will respond differently to surgical situations . Eye taping to reduce stress in theatre is common practice in India
Absolutely doesn't mean they were deeply sedated.
Purpose of my visit was to see for myself how it's done

[Dr J C John @JohnJohnC1]

@glauncel @chandra_ri64999 @KartikBSonawane @DrTuhinM @AoraIndia @ESRA_Society @mokaeleni @SGSocAnaes @ASRA_Society @KalagaraHari 2. Eye taping was a bit strange only because it's so diff to what I do in my European practice
But sedation was very mild, 1 mg buprenorphine, or 20 to 30 mg ketanine or 20 MCG deemed
All patients were responsive to oral commands ,
Spinal makes them sleepy too

[Dr J C John @JohnJohnC1]

@mjoldman @glauncel @chandra_ri64999 @KartikBSonawane @DrTuhinM @AoraIndia @ESRA_Society @mokaeleni @SGSocAnaes @ASRA_Society @KalagaraHari 1. I spent 2 days last week shadowing @chandra_ri64999 and observed 9 cases of thoracic spinal and was blown away by the potential for it
Avoiding GA alone is reason enough to consider this in most patients
Risk of cord damage frightens me, but Richa has done over 2500

[Dr J C John @JohnJohnC1]

@KartikBSonawane @chandra_ri64999 @shiv_cybersurg @Prasannasimha @DrTuhinM @ASRA_Society @KalagaraHari @ESRA_Society @DrDiveshArora @anesthesiadocmd @pritanand @BucksUSGRA @drmohansai Interested to know how he got hold of CSF !!

[Dr J C John @JohnJohnC1]

@KartikBSonawane @chandra_ri64999 @shiv_cybersurg @Prasannasimha @DrTuhinM @ASRA_Society @KalagaraHari @ESRA_Society @DrDiveshArora @anesthesiadocmd @pritanand @BucksUSGRA @drmohansai Like it , what solution is in the vertical tubes mimicking CSF ?

[Dr J C John @JohnJohnC1]

@chandra_ri64999 @SinghDralok1305 Amazing

[Dr J C John @JohnJohnC1]

@chandra_ri64999 Massive case series , nicely done

You were measuring time to achieve block height of T4 and also the bromage scoring lower limb power, but you haven't mentioned it in the results
Interested for spine surgery

[Dr J C John @JohnJohnC1]

@hjas18anes @chandra_ri64999 @KartikBSonawane @DrTuhinM @ASRA_Society @ESRA_Society @mokaeleni @KalagaraHari @AoraIndia Hi Richard

It would be helpful to most of us who have never contemplated a spinal above L2 to know exact dosing for a lap chole

So what drug, % , volume, level , baricity

Thanks