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1  Anesthesia Discussion / Regional Anesthesia / Re: Intrathecal Ropivacain Isobaric on: July 16, 2016, 02:05:27 PM
I use it for lower limb surgeries. very useful if you restrict it to lower limb surgeries. a little unpredictable for segments higher than L1
2  Anesthesia Discussion / Ask an Expert - Case Studies / Re: DEXETOMIDATE on: August 31, 2014, 01:40:42 AM
excellent drug for intraop sedation. i do not follow the mcg/kg regime suggested in the literature. just put 50mcg in 500ml of normal saline and give at the rate of 15 drops/min. after about 10 minutes patient starts snoring then slow it down to 10 drops.min and maintain at the same rate till the end of surgery. recovery is prompt
3  Anesthesia Discussion / Regional Anesthesia / Re: spinal anaesthesia and sepsis on: September 13, 2010, 03:12:01 AM
make it a hemi-spinal and all your problems are solved. thecal tap with affected side down, volume of injectate less than 2ml [of 0.5% bupivacaine hyperbaric], keep in position for 10 minutes and then supine or surgical position.
4  Anesthesia Discussion / Regional Anesthesia / Re: Post Spinal CSF leak on: August 02, 2010, 07:04:03 PM
csf leak was a common shortlived problem in the good old days when i was a student. we used 19g and 18G spinal needles then to do LP and at the end of the surgery one could see a pool of csf at the small of the back it was always a short lived problem and many did not even complain of headache or backache
5  Anesthesia Discussion / Regional Anesthesia / Re: prone spinal anaesthesia on: August 02, 2010, 07:00:43 PM
would someone please post the details of the technique with pictures please or give info on where i can get it? details regarding the positioning, difficulties encountered if any, the level of block achievable etc etc would be welcome.
6  Anesthesia Discussion / General Discussion / Re: Size of IV for blood transfusion on: August 02, 2010, 12:21:42 AM
RBCs have no difficulty in going through the smallest venflon but the fluid is viscous and this generates a lot of resistance to flow occurs. the largest size possible in that patient is the ideal size for blood transfusion.
7  Anesthesia Discussion / General Discussion / Re: Induction+ Intubation with halothane? on: August 02, 2010, 12:18:30 AM
induction and intubation with halothane is a very useful technique in children
who are struggling and difficult to control and who do not cooperate to put in a i.v. line.
the best method is to start with a 2% concn of halothane with o2 and n2o . within say about 10
breaths, there will be some relaxation and respiration will become regular and smooth.
continue to give inhalation for 2 or more minutes before you attempt to put in a venflon. another
anaesthetist may be required for this while mask inhalation is going on. give a pinch stimulation
to see the response. if there is muscle movement continue the inhalation for 2 more minutes.
problems are: 1. a calibrated vaporiser if available is safer. you may even give greater than 2%
concentration in oxygen. if only goldman vaporiser is available , you may have to go up to the
last mark. 2. watch out bradycardia; precordial stethoscope is a must. 3. premature attempt to
start i.v line may cause laryngospasm in some cases. remember, halothane is anti-analgesic.
just to ensure pt is analgesic,pinching may be required.
8  Anesthesia Discussion / Regional Anesthesia / Re: laproscopic cholecystectomy under spinal anesthesia on: April 14, 2010, 02:13:24 AM
if anything goes wrong during lap choly, you may be blamed for selecting spinal anaesthesia for the procedure. your method would not pass the "bolam's test'. you may not find experts to support your technique.
9  Anesthesia Discussion / General Discussion / Re: Repeat dose of succinylcholine on: January 24, 2010, 09:30:53 PM
dear jafo, you are quite right. the repeat suxa was necessary because of somewhat unexpected prolongation of the minor surgical procedure originally expected to be finished with a single dose of suxa. it was a counsel of desperation.  and not of voluntary choosing. however, for intubation we prefer suxa especially in cases where some difficulty in laryngoscopy or intubatioon is expected.
10  Anesthesia Discussion / General Discussion / Re: Repeat dose of succinylcholine on: January 17, 2010, 01:09:00 PM
i have frequently administered repeat does of suxa, sometimes even 3 successive doses; generally i co-administer a small doose of atropine 0.2 mg along with the repeat dose. even with this sometomes brady occured but not of alarming degree.
11  Anesthesia Discussion / Obstetric Anesthesia / Re: Epidural with Air or Saline on: October 22, 2009, 02:03:46 AM
identifying the epidural space by loss of resistance to air is a time tested technique; nobody need be ashamed about it; me too, i use only air for epidural technique and it has let me down so far.
12  Anesthesia Discussion / Regional Anesthesia / Re: blended anesthesia vs epidural anesthesia: on: September 18, 2009, 09:15:42 PM
best indication for Epi-GA would be extensive visceral surgery wherein the two techniques supplement and complement each other.
13  Anesthesia Discussion / Regional Anesthesia / Re: experence of dry tap in spinal on: June 21, 2009, 03:06:15 AM
dry tap followed by full effect could be due to coring of tissue in the needle which was probably pushed away by the force of injection. i have had dry taps but did not have the courage to inject the LA.
14  Anesthesia Discussion / Regional Anesthesia / Re: Central Neuraxial Blocks and Dopamine infusion on: June 08, 2009, 02:14:17 AM
dopamine drip plus basic requirement of fluids is one of the many options available to combat spinal hypotension and fall in CO. just because many are not using it routinely it does not mean the regime has no value. we all tend to think highly of regimes we are accustomed to. sharing of experience is the core value of this forum and i think i have upheld it. regards.
15  Anesthesia Discussion / Regional Anesthesia / Re: Central Neuraxial Blocks and Dopamine infusion on: June 06, 2009, 11:11:40 AM
Circulation is a leaky one in that it allows low mol.wt.substances like iv fluids to escape. within 20 minutes the fluids would leak out of intravascular space. strictly speaking trying to correct spinal hypotension with iv fluids is like trying to fill a leaking bucket. colloids with their greater staying power is a better option anytime. what shall we do in patients who are already retaining fluid like cardiac or renal if they receive a spinal?
there is no pure vasoconstrictor except probably noradrenaline and methergine. all possess inotropic activity to some extent. the difference is only one of degree.what about ephedrine? is it not an inotrope? if only vasoconstrictors are required, how can one justify the use of ephedrine? there is need for inotrope during spinal anaesthesia - block of cardioaccelerator fibres can lead to fall in CO for which only inotropes are suitable. anyway, the proof of pudding is in eating. to me, the pudding tastes very nice.
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