dear dr. yogen,
             at last i got cobra PLA from ARIAN HEALTH CARE,NEW DELHI.I BOUGHT one size 3 cobra PLA,MEANT FOR PATIENTS BETWEEN BODYWEIGHT 35-70 KG.cost varying between 3000-3500 rs./though its disposable one/doctors in AIIMS,NEW DELHI are using it.
                               regards
                         

hi all,
can anyone tell me about the availability of COBRA PLA(prelaryngeal airway) in india & about its cost.thanking u all.regards

hi all,
        even midazolam or other benzodiazepines & propofol are related to critical illness  MYOPATHY.electrolyte imbalances like hypo/hyperkalemia/hypermagnesemia /hypophosphatemia etc to be blamed for myopathy/unmasked myesthenia & rhabdomyolysis due to any cause can lead to myopaties too/regards

sirs,
  definitetly  its a case of laryngospasm/i think jafo sir before inducton went for mask ventilation as a demo & everything was alright,so no question of valve or circuit related problem/first auscultation & then quick direct larynoscopy to be sure its laryngospasm followed by 20-25 mg of sux administration as IPPV can't relieve this spasm as well suggested by pascal sir.now placing ETT will be better in this scenario-failed intubation-put LMA & ventilate.regards.

hi dr. yogen,
           difficult topic to be covered.in my opinion causes of pulmonary edema intraoperatively & postoperatively so many like 1.exterme trendelenberg position2.venous CO2 Embolism,fluid overload,preexisting cardiac,respiratory,hepatic & renal disease,adverse drug reaction,postobstructive pulmonary edema,absorption of irrigation fluid etc like in TURP & HYSTEROSCOPY HYSTERECTOMIES.
        non cardiogenic   pulmonary edema secondary to hyponatremic encephalopathy.sepsis,ARDS other thing to be ruled out. now fluid overload -increased hydrostaic pressure-LVF-pulmonary edema.CO2 venous embolism-pulmonary hypertension-pulmonary edema.now to prevent pulmonary edema treat etiologies.pulmonary artery catheterisation to assess fluid volume to be given.jugular venous cnnulation to aspirate emboli in case of venous embolism.while CO2 insuffulation one has to be slow & to see that all four quadrants equally rising.one has to be careful while giving fluid intraoperatively as anaesthetic drugs decrease afterload leading to more fluid administration,later on when the affect of drugs recede leading to pulmonary edema.preexising cardiac & lung diseases has to be dealt with carefully othewise more are the chances of pulmonary edema.oliguria & renal failure again a precipitating factor.now the treatment part treat etiologies +as usual treatment like IPPV,MECHANICAL VENTILATION,use of diuretcis & JUDICIOUS USE OF VASOPRESSORS & FLUID.last not the least is rule out sepsis,ARDS,hyponaremic encephalopathy etc.regards

hi,
its very difficult to say which anaesthetic agent is culprit?both succinylcholine & halothane can cause bradycardia & asystole.even propofol may be contibutory.but it was seen after induction of vecuronium.rapid bolus of vecuronium may also cause this?in my opinion there was no fault in selection of anaesthetic agents?now it may be lignocaine induced toxicity leading to bradycardia & asystole?interaction of propofol & lignocaine-may lead to increased level of lignocaine?interaction of midazolam & lignocaine?regards

sir,
in my opinion most probably due to profound hypotension intraoperatively due to any reason could have led to decreased blood supply to optic nerve resulting into blindness/now you can only tell about hypotension intraoperatively & blood loss?other factors like pressure on globe(eyeball),compression of pial vessels which is supplied by collaterals of opthalmic artery & embolic phenomena may all be responsible for ischemic changes in optic nerve.regards

hi,
  i think not a single anaesthetic drug either midazolam,propofol or ketamine or anything else shouldn't be allowed to be used by non-anaesthesist.it should be strictly followed .in case of any catastrophe only an anaesthesiologist is going to manage the situation.To give sedation in MRI or CT scan room even more difficult due to lack of resususcitative eqipments normally.regards

dear dr. yogen
          i am really thankful to you atlast someone who understood the situation & my difficulties.thanks a lot.with regards

hi jafo sir,
   a very good morning.your anaesthesist versus surgeon article a fantastic & funny one.is this case is a can't ventilate & can intubate scenario? as mallampati scoring is 1 you can choose either of your three options in my opinion.only remote possibility is there if you are not able to intubate after giving sux then put LMA  & ventilate.as you don't know the pseudocholineesterase  status of the patient so other two options have an edge over the intubating the patient with suxamethonium.awake intubation with the help of nerve block is a very good option if patient becomes awake.if you are in real hurry put LMA & ventilate.i fail to understand you were not able to mask ventilate which is either of the two reasons 1.tight fitting mask is not available2.airway not patent.in your case both things  were alright.with regards

hi,
  by writing we don't have a good setup it doesn't mean that we don't have basic anaesthesia machine/when patient suffered cardiac arrest how i could have managed the patient without anaesthesia machine?i mean to say we don't have a good ICU setup.Further to clarify before giving GA to such a bad case one always thinks of proper backup means if needed patient can be put on ventilator.we don't have a ventilator in recovery room & for your surprise only 1 ventilator in medicine ICU WHICH ALWAYS REMAINS OCCUPIED.on that very night i took help of anaesthesia machine & ventilated the patient manually for 2 hours when patient suffered cardiorespiratory arrest. As we don't have ventilator provided in our anaesthesia machine. anyhow on that fateful night one patient who was on ventilator in medicine ICU was weaned off & then i rushed my patient from OT to ICU.now hope you will come to know about the bad setup.now something about drugs even buprenorphine is hardly available & what to talk about fentanyl & morphine?  secondly mainly poor patients come to our hospital & the patient didn't go for a proper antenatal check up.patient was not having ECHO report & physician on duty ruled out the cardiac disease.so i treated the case as non cardiac one & i had to give anaesthesia without further loss of time as it was an emergency case .otherwise my mode of anaesthesia could have been different perhaps a GA or an epidural.thanking you.with regards.

hi everyone,
     now if the surgery is being done in prone position like brain or spinal surgeries or prone position ventilation in case of ARDS if patient suffers cardiac arrest then what to do?if sufficient no. of staffs not available then it will take another 5 minutes to get the patient in supine position.so in that case giving CPR in supine position of no use as its already too late.if a sand bag is placed below sternum than in this case reversed precordial compressions can be given & as the patient already intubated so no question of having problem providing breath to the patient.thank you all.with regards

please vote.with regards.

hi jafo sir,
    i am in favour of succinylcholine as in such cases one should go for rapid sequence intubation with preoxgenation & cricoid pressure with use of sux or another option is awake intubation.the reduced level of pseudocholineesterase is hardly of any clinical significance.now as far as the use of vecuronium is concerned  cisatracurium is drug of choice which is not available in our part.so now the choice is between atracurium & vecuronium.even if we use vecuronium which is biliary excretion dependent if the dose is less than .15 mg/kg body weight the action of vecuronium is not going to be prolonged as per the studies.so vecuronium can also be used in minimal doses .yes post op ventilation important other factors like electrolye imbalance,hypoglycemia,hypotherma,GI bleeding very important.with regards.

HI,
  i am not aware of any such relationship between anaesthetic drugs & schizophrenia.i have tried my best to look for literatures regarding this.unable to find.even asked my seniors,they all said no.with regards.