hi all,
      i just want to discuss one case .one lady 38 year old known case of hypothyroidism treated with tab thyroxine for one month underwent transsphenoidal hypophysectomy for pituitary adenoma was extubated in operation theatre and shifted to critical care unit with bradycardia,not responding with fixed and dilated pupil.INJ.ATROPINE .6 MG was given.she had cardiac arrest.CPCR started according to AHA guideline.when i tried to intubate failed twice with stylet ,there was laryngeal edema and larynx was anterior.i immediately secured the airway with size 3 LMA.saturation went upto 95%.patient had massive swelling of neck,chest and ventilation was difficult.percut tracheostomy tried failed.i put size 6 endotracheal tube with bougie.SPO2 65%.surgical tracheostomy was done.chest x ray done there was air in mediastinum.what was cause of subcutaneous emphysema?
                                                    thanks.regards.

HI,
  any role of INTRAAORTIC BALOON PUMPMING during or after CPR if shock persists? regards

sirs,
i expect you people will be giving your ideas.
             regards

sirs,
i want to know whether you people prefer low flow of gases during controlled ventilation ,for example total 1.5 litre of gases per minute(900 ml of N2O +600 ml of 02) using a bain circuit or closed circuit.what are the advantages & disadvantages,regards

hi all,
i think all the intensivists might have used MGSO4 in acute severe asthma.i want to know the mechanism of action.thanking you all.regards

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

please vote.with regards.

hi everyone,
     i want to know is cardiopulmonary resuscitation effective in prone position?
                                  thank you all.with regards.

hi,
  i want to know from all of you regarding utility of thoracic paravertebral block.i have given few paravertebral blocks all in case of mastectomies.when i compared it with thoracic epidural block,i found paravertebral thoracic block superior to thoracic epidural block.i found wonderful painfree period after giving paravertebral block.rescue analgesics after 12 hours.if you put catheter then there is no question of rescue analgesics.no pulmonary complications in each cases.i think it can be used where thoracic epidural block is contraindicated like hypovolemia etc
                                                                        DR.SIMANT

SIR,
    I,DR.SIMANT KUMAR JHA, GAVE SPINAL ANAESTHESIA IN A CASE OF LSCS.LADY WAS 35 YR OLD.IT WAS HER THIRD ISSUE.IT WAS A CASE OF IUD WITH PLACENTA PREVIA.I EXAMINED THE PATIENT.MY CVS FINDING WAS MITRAL AREA-1st HEART SOUND LOUD,TACHYCARDIA,PULMONARY AREA-P2 LOUD/I WAS NOT ABLE TO DETECT ANY MURMUR/CHEST AUSCULTATED-RT AXILLARY AREA-COARSE CREPITATIONS/AS PATIENT GAVE A HISTORY OF CHRONIC COUGH WITH DYSPNOEA ON EXERTION/ON TABLE PATIENT WAS BREATHLESS WITH SPO2-75%/ I THOUGHT IT WAS A CASE OF MITRAL STENOSIS WITH NO ECHO AVAILABLE/CHEST XRAY FINDING-CARDIOMEGALY,PROMINENT AORTIC KNUCKLE,VASCULAR MARKING PROMINENT IN RT HILAR REGION.
I IMMEDIATELY SOUGHT A PHYSICIAN' OPINION/HE SAID IT WAS NOT A CASE OF VOLVULAR HEART DISEASE/AS IT WAS A CASE OF PLACENTA PREVIA TOO & PATIENT WAS NOT IN A POSITION TO SIT WITH CHANCES OF PROFUSE BLEEDING,I GAVE SPINAL ANAESTHESIA IN LEFT LATERAL POSITION IN L3-L4 SPACE WITH 25 GUAGE NEEDLE..5% BUPIVACAINE ONLY 2.5 ML GIVEN/PRE OP BP WAS 130/80 MM OF HG WITH 200 ML OF URINE OUTPUT/AS INCISION WAS GIVEN & DEAD BABY WAS TAKEN OUT.IT TOOK 20 MINUTES FOR THE SURGEON/IN THE MEANTIME I GAVE O2 THROUGH MASK CONTINUOUSLY/TWO IV LINES WERE SECURED/THROUGH 1 LINE FRESH BLOOD WAS BEING GIVEN & THROUGH ANOTHER LINE RL WAS GIVEN,PATIENT SUFFERED CARDIAC ARREST/IMMEDIATELY PATIENT WAS INTUBATED & CPR GIVEN/RT INTERNAL JUGULAR WAS CANNULATED/12 MG OF IV EPHEDRINE GIVEN/DOPAMINE IN 5% DEXTROSE STARTED/IV ATROPINE 5 AMPOULES AT REGULAR INTERVAL GIVEN WITH 2 AMPOULES OF DILUTED ADRENALINE USED/CARDIAC MASSAGE CONTINUED IN A RATIO OF 100 PER MINUTE WITH 10 VENTILATION PER MINUTE/AFTER 1/2 AN HOUR  OF CPR HEART STARTED BEATING ,BUT STILL NO SPONTANEOUS RESPIRATION/IT TOOK ANOTHER 1 HOUR FOR SPONTANEOUS RESPIRATION TO RETURN/IN THE MEANTIME IPPV GIVEN THROGH BAG/SPO2 FINALLY WAS 85%/PATIENT STILL HYPERVENTILATING WITH SLIGHT EXTENSOR RESPONSE/BOTH PUPIL WERE DILATED & SLUGGISHLY REACTING TO LIGHT/I SHIFTED THE PATIENT TO ICU/PUT ON VENTILATOR ON SIMV MODE/STARTED NORADRENALINE & DOBUTAMINE/WITH BP NONRECORDABLE/PATIENT REMAINED ON VENTILATOR FOR 5 HOURS/PATIENT WAS TO BE TAKEN TO AHIGHER CENTRE/WAS TAKEN OFF FROM VENTILATOR ,SUFFERED CARDIAC ARREST/COULDN'T BE REVIVED/I WANT TO KNOW where i went wrong?
   DR.SIMANT KUMAR JHA,RIMS,RANCHI,JHARKHAND,INDIA

sir,
   
I,DR,SIMANT KUMAR JHA,RIMS,RANCHI,JHARKHAND HAVE GIVEN AROUND 20 THORACIC EPIDURALS IN ALL SORTS OF LAPAROTOMIES INCLUDING EMERGENCY PROCEDURES ,CHOLECYSTECTOMY ETC/MOST OF THE CSES THE  SPACE CHOSEN WAS EITHER T7-T8 OR T8-T9/EVEN I HAVE GIVEN THORACCIC EPIDURAL IN 10 CASES OF CS/SPACE CHOSEN WAS T9-T10/IN ALL CASES THROGH PARAMEDIAN ROUTE/IN FEW CASES GA WAS CONTRAINDICATED/I
ITS BENEFIT -GOOD ANALGESIA,LESSER DVT COMPLICATIONS,LESSER PULMONARY COMPLICATIONS,POST OP ANALGESIA THROGH CATHETER,LESS MOTOR BLOCKADE/I WANT TO KNOW HOW YOU PEOPLE RATE THIS PROCEDURE
                                                                     DR.SIMANT KUMAR JHA,RANCHI,JHARKHAND,INDIA

hi,
  One month before on 17.11.2006 in orthopaedics OT a 108 yr male operated upon for intertrochantric fracture femur rt under epidural anaesthesia.epidural catheter was placed in L4-L5 lavel in sitting position through paramedian approach.a total of 10 cc of 2% lignocaine with adrenaline given+5 cc of .5%bupivacaine given through epidural catheter.only 5 mg of diazepam iv given.a total of 12 mg of ephedrine given iv .2 litres of RL+300 CC of fresh blood given.patient' hemodynaemic changes least.
                                           DR.SIMANT KUMAR JHA,JUNIOR RESIDENT,DEPTT.OF ANAESTHESIA,RIMS,RANCHI,JHARKHAND,INDIA

i, dr.simant kumar jha,writing from ranchi,india.i am an anaesthesiologist by profession .on 19.12.2006 a laprotomy done for ruptured liver abscess with rt pleural effusion done under thoracic epidural given by me.space chosen wa t8-t9.catheter was placed.as oxygen saturation was only 85% preoperatively & patient was breathless with rt lung involved,crepitations found on auscultation.i gave initially 10 cc of 2%lignocainewith adrenaline.later on 5 cco this one again was given as top up.atoat of 10 cc of .5%bupivacaine given through epidural catheter.100 mg of tramadol also given through catheter.50 cc of iv ketamine given initially.again 50 mg of iv ketamine iv given.8 mg of dexamethasone iv given intraoperatively.atotal of 1800 ml of iv fluid given through rt internal jugular vein which also included 300 cc of fresh blood.only once BP CAME DOWN to 90/60mm of hg.a total of 12 mg iv ephedrine used.urine output 440 cc post op.BP was 11o/70 mm of hg postoperatively.next day patient fine ,responding.intraoperatively oxygen given through mask at frequent intervals