In what position did you do the spinal?  If sitting, how long did you let him remain sitting?

B

Generally, with the patient sitting.

What are your thoughts about airway evaluation of the edentulous patient?  Absent trauma or radiation or previous radical neck surgery or severe arthritis, is there any reason to "grade" the airway of an edentulous patient?

Can you cite examples of cases you have had, where the patient was edentulous and the airway was difficult?

Bucky

I'm curious about this face mask-in-the-theatre thingy.

Is not wearing face masks common in England, too?

Do the circulating nurses in the OR also not wear face masks?

Bucky

I was having great trouble with this very issue until I mentioned it to our desflurane manufacturer's representative.  She asked me to describe exactly how I was proceeding with my inductions and made a subtle change suggestion which was proffered to her by an anesthesiologist elsewhere.

The suggestion was to be sure that the product of the fresh gas flowrate times the inspired concentration of des is not higher than 24.  Now typically, I use 3 LPM and 8% des as my post-induction mixture.  In the last 100 or so LMA cases with desflurane, I've not seen any hiccoughs (or other coughing).  Prior to that I was using the likes of 6-8 LPM and 8%-10% des., I was seeing hacking, coughing and hiccoughs at least 25% of the time.

My usual LMA induction: fentanyl 2 ml + 2 mg/kg propofol (with 40mg lidocaine) (sometimes I add midazolam 2 mg to the induction.)

I'm with Dr Coupland - ECGs tell me little of value 99.999% of the time.

Having said that, I do use them for all GAs, but that is entirely for medicolegal reasons.

I'll admit to sometimes forgetting to put them on during spinals and epidurals, particularly short cases such as D&C.

One thing that I'm quite sure is a waste and that is monitoring the ECG is the PACU in most cases.  To that end, I don't require ECG monitoring in PACU.

Pulse Ox rules and tells me far more.

Not common practice in the USA.  I was trained as were you.  In a pinch, I'll go ahead and intubate then look for an IV when others have failed.

One locum tenens site where I worked a week uses this monitor during carotid endarterectomies.  They swear by it.  Looks efficacious from what I could see of its use.

In the USA, morphine is the only narcotic approved by the FDA for intrathecal and epidural use.  Off label use of other narcotics is ubiquitous.

Like Dr Parkins, our OB practice includes wide use of IT or epidural  morphine as part of our C-section anesthetics.  No one in our practice pretends to acknowledge the common opening contamination of the solution contained inside the morphine ampuile.  So far, in thousands of C-sections involving the use of morphine in non-sterilized ampules there have been no untoward effects that have been reported to us.

Didn't really occur to me until I read his post here.

An associate had a similar interscalene block experience with no untoward long term effects.  Probably was an intrathecal installation as described here by Dr Parkins.

One of our anesthesiologists introduced us to a cocktail which is instilled into the shoulder joint at the completion of shoulder surgery.  We have won over only one of our orthopods 100% so far, but since he has started using this mixture, we've not had to give any of his patients an interscalene block for post-op pain.

Cocktail:

30 ml 0.5% ropivacaine
+ 20 ml 2% lidocaine w/ epi
+ 50 mg meperidine

Sounds like a large shunt was induced along with the GA.  Not uncommon in pregnant women.

We have a large OB practice comprising many TOLAC (the term used until successfully delivered vaginally) patients.  We do not alter anything that we do, epidurally.