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Author Topic: Regional  (Read 3769 times)

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drnups

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Regional
« on: April 12, 2011, 11:35:19 PM »
Sir,
Which is better for abdominal hysterectomy, G.A or spinal? At what level should spinal be given?
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jafo1964

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Re: Regional
« Reply #1 on: April 14, 2011, 11:38:29 PM »
There is nothing called as better anaesthesia
there is only safe and scientific anaesthesia or otherwise
extensive studies are available that show that the choice of anaesthetic does not change outcomes in ASA 1 to 3 patients
ASA 4 patients do well with controlled, titrated GA

All peripheral  limb surgeries are better done under RA.

Most of the centres do abdominal hysterectomies under SAB and the surgery is completed in 90 mins

What i do

IF extremely obese or has contraindication for surgery give a GA

In other cases SAB at L3L4 ISS - 3.5 ml of hyperbarIc bupivacaine + 150 mcg of buprenorphine
Adequate in 95 % of cases
In the remaining 5%,  if surgery gets prolonged pt experiences discomfort during start of closure. Also poses problems for the surgeon.
 I induce with propofol 2 mg/kg + Suxa 1 mg / kg and put in a LMA. Once patient recovers -  leave her on spontaneous  ventilation with o2 + n2o and sevo

Rarely in cases that are likely to be prolonged I might opt for a combined spinal epidural (CSE) 2 needle 2 interspace sequential technique
start with SAb - same dose as mentioned without bupre
After 90 mins top up the epidural catheter with fractionated 5 ml doses of 0.5% bupivacaine

regs
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