can thoracic epidural can be applied as a sole procedure for laprotomies

Started by frontier, December 25, 2006, 07:33:21 AM

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how you rate thoracic epidural given in cases of laprotomies

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Total Members Voted: 2

Voting closed: January 24, 2007, 07:33:20 AM

frontier

sir,
   
I,DR,SIMANT KUMAR JHA,RIMS,RANCHI,JHARKHAND HAVE GIVEN AROUND 20 THORACIC EPIDURALS IN ALL SORTS OF LAPAROTOMIES INCLUDING EMERGENCY PROCEDURES ,CHOLECYSTECTOMY ETC/MOST OF THE CSES THE  SPACE CHOSEN WAS EITHER T7-T8 OR T8-T9/EVEN I HAVE GIVEN THORACCIC EPIDURAL IN 10 CASES OF CS/SPACE CHOSEN WAS T9-T10/IN ALL CASES THROGH PARAMEDIAN ROUTE/IN FEW CASES GA WAS CONTRAINDICATED/I
ITS BENEFIT -GOOD ANALGESIA,LESSER DVT COMPLICATIONS,LESSER PULMONARY COMPLICATIONS,POST OP ANALGESIA THROGH CATHETER,LESS MOTOR BLOCKADE/I WANT TO KNOW HOW YOU PEOPLE RATE THIS PROCEDURE
                                                                     DR.SIMANT KUMAR JHA,RANCHI,JHARKHAND,INDIA

isaac


frontier

can you tell me dear isaac why this procedure can't be applied ehen gas anaesthesia is totally contraindicated & hemodynamics are stable

Affertus

First of all ........ nice to meet you
This is my first time in this forum.
I'm Stefano Soriano from Italy, 35 , and i work in a department of anaesthesia and intensive care.

Sorry for my bad english ..........  :P i hope to improve it with all you.

After the presentation id like to partecipate in this discussion.

The thoracic epidural is presented here like an alternative when gas anaesthesia is totally contraindicated: but when gas anaeshesia is total contraindicated ( ie: malignant iperthermia) i think - generally- to prefer TIVA especially if the patient is hemodynemically stable.
Stefano Soriano from Italy My life in the depth of the sea
Sorry for my bad english ...... ;-)
http://www.stefano-soriano.it

frontier

dear affertus,
         thanks for your reply.just i am talking about some pulmonary diseases like COPD,EMPHYSEMA,INTERSTITIAL LUNG DISEASE,YOU JUST GIVE LOWER THORACIC EPIDURAL RESULTS ARE FAR BETTER COMPARED TO GA.AS SUCH THORACIC EPIDURAL IN T7-T10 REGION DON'T UPSET HEMODYNAMICS THAT MUCH,ITS BETTER COMPARED TO SPINAL REGADING HEMODYNAMICS & EQUIVALENT TO LUMBAR EPIDURAL.IT WILL GIVE YOU HIGHER SENSORY COVERAGE NEEDED IN CASE OF LAPAROTOMIES,IF YOU ARE OPERATING ON STOMACH OR ABOVE.I HAVE GOT A VERY GOOD EXPERIENCE OF GASTROJEJUNOSTOMY UNDER THORACIC EPIDURAL.ONLY 100 MG OF KETAMINE IV I USED.EXCELLENT RESULT.THORACIC EPIDURAL ITSELF IS A STRESS INHIBITOR.VERY LOW CHANCES OF POST OP PULMONARY COMPLICATION.I AM TALKING ABOUT ATELECTASIS.VERY GOOD ANALGESIA it provides.so i think it can be a good alternative when you are dealing with the patients having lung disease
                                                                 DR.SIMANT