hi, can be done under regional anaesthesia or local anaesthesia.biggest disadvantage patient goes for hyperventilation to combat hypercarbia leading to excessive movements in the sugical field hampering surgery.2nd disadvantage hypoxemia due to trendelenberg position & reducedFRC.at the same time reduced cardiac output due to sympathetic blockade caused by regional anaesthesia.should go for regional or local anaesthesia only if patient not fit for GA.WITH REGARDS.

hi,
  choose GA .induction with thiopentone & intubation with succinylcholine & vecuronium as muscle relaxant for maintenance with nitrous oxide & oxygen.isoflurane  or sevoflurane or desflurane as inhalation agent.least use of opioids.nasogastric tube to be passed.no use of sedatives.with regards.

hi,
in my opinion volume correction with fluid & vasopressors like mephenteramine & ephedrine are ist line drugs.phenyleherine & noradrenaline are 2nd line drugs to quickly combat hypotension.with regards.

hi,
its not advisable at all to give spinal in multiple sclerosis patient as spinal cord without sheath & demyelinated will lead to neurotoxicity by bupivacaine or whatsoever drug used.even epidural block also not safe.

hi,
  i think your sister is having psuedocholinesterase deficiency that is needed to metabolise succinylcholine .it has nothing to do with muscle weakness she is suffering from as succinylcholine' side effects are transient one.better take her to a neurologist & in future be cautious succinylcholine not to be used again in future if anaesthesia needed in case of any surgery?

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

hi,
in my view if laryngoscopy is not difficult& mallampati grading is ok,then rapid sequence intubation with succinylcholine with cricoid pressure will suffice.with regards

hi,
  any blind technique can't be 100% accurate like LOR technique.ultrasound guided detection of epidural space will be better option.with regards

hi,
  priming definitely reduces the intubation onset time.for your delight i wanted to attatch the PUBMED file ,but couldn't succeed.just go through the pubmed article by GRIFFITH KE.,JOSHI GP,WHITMAN PF,GARG SA,deptt. of anaesthesiology & pain management,university of TEXAS,southwestern medical center at DALLAS,75235-9068,USA;I.J.CLIN ANAESH.1997;MAY9(3);204-7.even you will be surprised use of ephedrine before induction also reduces intubation onset time.with regards

hi everyone,
    i want to know from all of you that probably it was a case of cardiomyopathy with heart failure as per the discussions in the meeting,so what could have been the ideal mode of anaesthesia?

hi,
  what we do & is recommended to stop clopidogrel 7 days before surgery,you are right.i don't know how surgeons advise & insist on continuing such potent antiplatelet drugs.evan unfrac.heparin is to be stopped.drugs like aspirin & NSAIDS can be continued in special situations as these are not that potent.now you are the better judge if you are encountering any sort of complications like epidural hematoma leading to paraplegia etc.one aticle i have attatched regarding indications & contraindications of regional  anaesthesia that will boost your morale.

hi,
its risky to do the things under thoracic epidural block,but you have to be extra vigilant so that your block is not higher,always titrate the dose through catheter.even such cases under GA also risky.what i did i was providing oxygen to the patient through mask & i was ready to meet any catastrophe.i could have intubated the patient,but everything remained alright.see whatever mode of anaesthesia you choose has got its own advantages & disadvantages.i thought that time giving thoracic block will be beneficial for the patient & patient is fine now.

hi,
  the condition of the patient was really serious,so i opted to go for thoracic epidural/one reason was patient rt lung was involved as i found crepitations on auscultation which was hampering patient' breathing leading to decreased SPO2.so i didn't want to take the chance as i thought this may create problem while reversal & i may have to put the patient on ventilator .with my previous bad experiences in such cases while weaning i thought to give thoracic epidural/patient BT,CT,PT,PLATELET COUNT WERE ALL NORMAL/YES POST OP ANALGESIA WAS AN ADDED ADVANTAGE/

blood loss was  minimal as surgeon was dam good.only one unit of fresh blood used intraoperatively i.e is 300cc.when last i enquired 1 month before patient is fine leading his normal life.regarding anaesthetic technique you have to keep in mind either give epidural or combined spinal epidural if these procedures are not contraindicated in old ages like this.one more advantage of epidural anaesthesia is  peripheral vasodilatation leading to lower mean arterial pressure,so less blood loss & other advantage is no abrupt fall in blood pressure,so can be given in cardiac compromised patients & old ages.thank you

hi,
its difficult to choose a single drug.almost all of them can be used.but the best choice will be 5HT3 antagonists like ondensetron,granisetronetc.next metoclopramide can be used if 5HT3 antagonist not available.if PONV is refractory to single drug therapy then it will respond to dexamethasone+5ht3 ANTAGONIST.regarding droperidol i don't have much idea.propofol offcourse is an antiemetic.