Awareness is the key.
We all will have to work very hard in creating a general awareness about Anaesthesia in public. Let them know about us and our branch and the short comings. Let us teach them safety measures  during surgeries. Some people hide their illnesses, so that their mediclaim does not get rejected. But we will have to teach them how important is their history to us.
Creating awareness programs will be the key.
We will have to project ourselves as qualified medicos and see the patients and relatives perioperatively, so they remember us as persons.
Long way to go, but not impossible.
regards.

Hi,
I have never used Morphine intrathecal. Because of its lack of availability.
How ever I have always used Buprenorphine  to 60 / 90 mcg along with my Bupivacain.I have used it by default in all cases over last more than 15 years or so.
This includes an LSCS  and IT fractures, and even my Caudal Blocks in children.
Once I was called by another anaesthesiologist, because his IT fracture patient had gone in post op respiratory arrest. He had injected about 150mcg. He took it in a 10ml syringe, so "about" 150 mcg. The old man of 79 went in respiratory arrest 3 hours after surgery.
We gave him Naloxone, 200 mcg stat and 200mcg in drip over 10 hours. He recovered instantly.

Did you read the article showing a Senior lady Anaesthesiologist of Chennai, India was brutally stabbed to death by husband of a patient who died after surgery????
A case of Foetal death for LSCS at 8 mth pregnancy, got pulm edema and later died.
Husband and 3 others went to her house and stabbed her.
Where are we practicing?
A black day for all of us.

I see that you have made good observation of our friends across the table.
Do you know that some of us, specially the pretty young ladies in our branch, feel that it is not just sufficient to hate them.
So, to make up, they even marry them and continue harassing them later too and for life long!!!!!!!!!!!!!!! ;D ::)

I think the tracing did not get attached in the file. or can you just put it in words and explain the picture?

HI,
Got a good one. Love these  challengers.
Since the case is too small, not much to worry about. But given a choice I would still use only Sevo with Gases, a touch of 30 mic Fent may be. Propofol, only if very apprehensive, in low dose, just about 30mg as a hypnotic, but not as a main inducing agent. May or may not insert an LMA depending upon the speed of the surgeon.
But, I am sure, you must have done the case by now. Do let the group know how you managed.
Have always respected your judgement.
Regards.

Hi, Sir,
Your reply is so apt.
This must be happening quite often, but luckily nothing happens to the patient.
Though patient safety of LMA is always questioned, is ETT without a bad track record?

Got called for an ETT placement by an Anaesthesiologist. They had tried but failed to intubate. Postponed to next day and I was invited to intubate.
The Anaesthesiologist was quite senior. I told him that, if you could not intubate, chances are that I will also not be able to do it. Why not invite a chest physician who has a Bronchoscope? We did that and tube was placed by Chest Physician with a conscious patient. Later we gave GA and finished the surgery.. Extubated the patient when all was over and patient was fully conscious. All was ok.
Patient worsened next day onwards and developed ARDS and was transferred to higher institution where the patient succumbed to death.
Diagnosis was Mediastinitis. May be the Esophagus was perforated in the first attempt?
Any such experience to share?

HI all,
Sounds silly,

But have not used Morphin IV for an Era.
Can any one tell the latest protocols  on dosages for post op analgesia IV and Epidural. By a pump or drip form or PCA.

Funniest is that I have not used much in Spine surgery. would be most ideal because patient tolerates the LMA very nicely. But I do not have much spine work. May be at a later date when possible, we will give it a try.

Can any one help me with this?
We get frequent call for CSF Manometry.
We do not have any ready made CSF Manometer. I have seen one set where a needle is attached to a line and a measure tape.
We normally use a 20G BD Spinal needle. Do an LP in lateral position. connect a pressure line( used in ICU for an arterial line) and crudely measure the height of the column.
If needed we remove some CSF afterwards to reduce a raised ICT.
ANYONE CAN SUGGEST A BETTER WAY?

Hi,
Thanks for the prompt reply. The name was new to me, but I knew that you will reply soon.
better to show your ignorance once and learn something new.
Thanks again,
With Regards.
Yogen Bhatt

Alpha Card ECG check.
New for me. No more in ICU running and management.
Can you explain a bit more?
May be easier learning a new thing from you.
Regards

HI,
There are two concerns.
One is Aspiration. Mother Gravity takes care of it. Nothing can go backward in the trachea.
Second is displacement. It was easy to insert in the the first place, it is equally easy second time and more.
One has to do it once to feel that it is so easy though unconventional.
There are always so many other ways of doing every thing that we all do in general, which had a better way of doing it.
Are we playing with life?
No way. and there are so many international papers supporting this.

has anybody been using Dexmedito for ERCP?
I have used it in 5 cases now.
The patients were high risk with very high Billirubin levels.
Just for trying, I had given 30 mcg slowly IV and only Propofol.
My average consumption of Propofol was about 50-60 mg for a procedure lasting for over an hour.
Too early to come to conclusions, but can be used as a sedative and good analgesia.
Please send your feed back for further improvements.
Yogen Bhatt