how many of us follow ASA or DAS algorithms

are they really useful in critical situation
or do you work on instincts

hi there,
interesting  observation  of our inevitable relationship
continue thinking you will come up with more complex and interesting thoughts

Hi,
I have recently started using LMA for its various applications as it was not easily available in my part of India.
I have used LMA Classic and its equivalent LMA from other company which are available in disposable form also.
I have a very good experience of using LMA for peripheral surgery like orthopedic limb surgeries, neck surgeries including a neck turned to one side and even neck movements were done during surgery without any problems. i have used lma for hysteroscopy , supplementation required during various regional anesthesia when effect wairs off, and two incidence of difficult intubation were patient was successfully ventilated till alternative arrangement were made.
All this cases i have conducted with controlled and spontaneous ventilation without any problems and ease of airway management, patients compliance  and recovery excellent.
Now i have temptation to use this for short gynecological procedures like diagnostic lapro-hysteroscopy and laproscopic tube ligation (sterilization operation) to start with.
company representative  have shown me many references but i am alway sceptical about data shown by company persons.
i would like to have your opinion and experience regarding  use  LMA ProSeal for laproscopic surgery

there was one study on laproscopic cholecystectomy done under segmental spinal anesthesia with injection of 1 ml of bupivacaine heavy at T10 level  at anesthesia now.com.

any one has conducted lap cholecystectomy by this method?
if yes than what was your experience.
what about co2 washout.
was ET CO2 monitored ? and if yes what was the result?

please share your thoughts as literature has little to offer and surgeons are pressing for regional anesthesia for the laproscopic surgery.
i am anesthesiologist from vadodara, gujarat, India

Quote from: yogenbhatt1 on May 24, 2007, 02:16:33 AM
In an elderly  or severly malnourished patient, try using a running saline drip for locating the epidural space. Just connect a saline drip after entering the skin. keep advancing. In htese patients generally no FEELs are felt. The drip does not go till you enter the space and here the drip starts running. Even the onlookers are amazed.

dear  dr yogenbhai,
is your technique possible in all patients or only very old malnourished patient and if only for this group of patients than can you explain possible mechanisam for this ?

there is no clear data regarding duration between two spinal anesthesia,
but chance of getting spinal headache increases as complete closure of dural puncture site take 2-3 days and chances of  csf leaking and consequently headache chances may increases.
patient can sue you for this if he develop headache

well i am from Gujarat ,
and to my knowledge no one practice lumbar puncture in prone position.
spinal anesthesia is used for PCNL (percutaneous nephro lithotomy) , but LP is done in lateral or sitting position.
kindly give more details about technique and reference from literature if available .
can be of great help in such patients

well i am from samll city than mumbai india, but i have stopped using halothane since atleast 3-4 years.
we were mostly using isoflurane for the maintenance of g/a and now sevoflurane is becoming easily available, we are gradually shifting to sevoflurane. halothane is not used.

recently us FDA alerted for fever and chills after diprivan , i have encountered such fever and rash on face after 3-6 hrs of general anesthesia for laproscopy surgery where maintenance of anesthesia was done by iv propofol infusion with o2 + n20.

i have used different brands of propofol for all this patients and such reactions have happened not in all patients but only few of them who received propofol as iv anesthetic agent apart from other agents for premedication to reversal of anesthesia.

does any else have also experienced such reactions other  than diprivan users as alert by us FDA
i am practising anesthesiologist from  Gujarat, India.