Gasbag Anaesthesia Forums

HI,
At times the lumber discoidectomy is done in Jack-Knife position.
Here, the chances of the drug going cephaloid, is very high due to gravity.
Have you ever thought of Ropivacain Isobaric? It will stay where it is , as gravity does not act on it.
I will try when possible and give a feed back,
Regards.

Just for information:
She was shifted to a multi specialty hospital, was safely operated, shifted to ICU but died over next 4 days.
Regards

Hi all,
A lot is written and opposed about regional anaesthesia for laparoscopic surgeries.
In fact, a lot of people use regional anaesthesia during Lap Choles, Lap Hysterectomies, Myomectomies, Appendicectomis and so on.
It is done under regional blocks for variety of reasons. May be need based, as in low economy patients or areas, may be drugs or materials are not available, or may be the patient does not deserve GA due to physical or medical problems.
All the same all of us have done the cases under Regional.
Is it that we have done something Illegal?
If anything happens, nothing can protect us?
IN short, is there enough evidence to do lap surgeries under regional blocks?
Can we not create evidence?
Enough is done and no one presents these cases in Journals and Conferences, for many unknown reasons.
Can we all, together bring it in black and white and make the whole thing safer for those who are regularly practicing and us who occasionally practice it. 
Not very easy, but if all of us start reporting it in articles and local meets, it is a question of time.
May be some of our teachers and seniors can give us guidelines to make a presentation.
Regards.

Hi,
Got a case posted for LSCS elective. As a routine we do all LSCS under SAB.
She was operated for Psoas Abscess 6 years back. The site was L1- L2. Post OP X-ray is now clear, All tests are normal.
How safe will be spinal for her.? She is short and obese.
What about legal implications?

HI,
Not uncommon at all.
Best is to accept that it is not working.
Repeat the Epidural if possible, or give a single shot spinal and manage it.
Hypotension is not very difficult to manage, while the complications of GA in this pt will be difficult to manage.
Time and again, when we have realised that our epidural is not working in Labour Anagesia, we have resited the cath and sucessfully.
It is catheter placement related.
A good statement is " the epidural catheter does not have an eye at its tip", it is a blind procedure.
Regards

HI,
DOING A LAP SURGERY UNDER REGIONAL IS NOT NEW OR UNUSUAL. MANY DOCTORS PRACTICE IT.
AS YOU ARE  IN THE CITIES AND MAJOR TOWNS, MORE GA CASES ARE PERFORMED. BUT AS YOU GO INTERIORS, THE REGIONAL PRACTICE IS QUITE COMMON. ( PURELY MY OPINION, MANY MAY STRONGLY OBJECT AND RIGHTLY)
IT IS NEED BASED. COSTINGS INVOLVED, RISK, SMALLER SETUPS, LESS QUALIFIED MANPOWER, UNAVAILABILITY OF DRUGS AND MATERIALS, POST OP MONITORING IN HIGH RISK CASES, AND SO ON.
I DO NOT SAY THAT THEY WILL DO A SUBSTANDARD JOB OR SOMETHING THAT IS NOT RECOMMENDED. THE AVAILABILITY OF ANASTHESIOLOGIST IS SO LESS, THAT IT BECOMES NEED OF THE HOUR.
HERE SURGEONS TOO BECOME VERY ADJUSTABLE AND FAST TOO.
ALL THIS CONSIDERED DOING A LAP SURGERY UNDER SPINAL IS JUSTIFIED.
WE HAVE TRIED OUT DOING CASES UNDER REGIONAL, AND GIVEN UP, AS WE NEVER ENJOYED IT. BUT IT CAN BE DONE.
LEGALITIES ARE TO BE THOUGHT OF. NO TEXT BOOK, AS TO MY KNOWLEDGE, TELLS THAT ALL LAP SURGERIES ARE TO BE DONE UNDER GENERAL ANAESTHESIA. AS FAR AS LAW IS CONCERNED, AS LONG AS YOU CAN PROVIDE REFERENCES TO THEM, THEY ARE FINE.

I do not know where and who you might be.
But we, at the site are proud to have an excellent teacher with vibrant knowledge and willingness to share and guide us.
Bravo,
Keep it up. It is all for free for all of us.
Only we have to come out with questions. You always have a scientific reply for it.
Regards

Back in reply mode after some time.
At a rate of 140 bpm, there is hardlly any time for a ventricle refill. But still he is maintaining all parameters.
The PUNDITS ( Cardios) must have evaluated him and given a go signal too.
I would prefer to give him an epidural block, which itself will give a sympathetic blockade and help me with a lower rate.
But again GA might be safer if we can give shorter acting Betablockers and manage the case.
I am sure u must have done the case by now.
We are all eager to know what you did and how.
Regards

Just to add to your comments,
Burns patients have consumed lots of Analgesics and Sedatives, as they are in extreme pain.
Due to this their need of drugs is much higher than calculated doses. They keep coming out much faster and the procedures last very long if the areas are more and needs lot of cleaning and dressing.
But overall, high risk and expensive.

HI,
Thanks, That is a great scientific explanation.
We had thought of the same. Only because the patient was fat I went to 13 cm ( Keeping 6 cm of tissues and next 7 cm inside) but I still withdrew the cath and it worked too.
2nd dose, I am not sure what happened. Nor did I wait sufficient to see if it works, as I honestly said that at 3 in the morning alone I had no intention of giving a GA to this obese patient.
Either case the theory of the cath entering outside the space and not acting is quite possible.
Regards. ( It is so surprising that one can build an opinion on each other simlpy by reading replies. Best wishes to you )

Hi,
I am glad that many members keep records at home for future use( God knows what use), but ppl at my home wonder why I should keep records of cases done in early practice of 1979 onwards.
I would also like to have a look at various formats, I am now out of stock of my records book.
Will be much obliged if I can see a few charts.
I never made carbon copies, but now I feel that I should make copies.
regards.( yogenbhatt1@gmail.com)

Gave an Epidural Labour Analgesia.
23 yr, tall, 106 kg primie.
Gave Epidural. The one who gives, knows that he is in the space, the way the feel is there, the way the NS goes, the way the catheter slides smoothly.
Catheter was fixed at 13 cm.
There was no action after first 15 ml of 0.1 % Bupivacain with 30 mic Fent.
Waited for 30 mins. Withdrew Catheter to 9.5 cm. Gave 10 ml again.
Epidural acted in 5 mins and the patient was actually smiling and went off to sleep after 10 mins.
Next dose again had poor action.
Anyway LSCS was now decided, and I had no intention to give GA if Epidural does not act, at 3 in the morning.
Removed the cath, gave spinal and finished it.
I invite comments.
May be many will learn through that.
Regards

A prompt action is appreciated.
We all love the site. It is quite informative. Specially some of the replies sent by Dr. JAFO and many other colleagues.
Regards

Dr. Loskota,
Is it that I do not understand the Anaesthesia and the Monitors used by you, or is it that I am growing old already and being in India in private practice that  I am not used to the terms and the monitors. I feel too premitive now.
I must say that you are lickyto be able to practice the way you are practicing. I do envy you.
Regards Dr. Bhatt