Hi There,
recently the use of ketamine has renewed the interest of anesthesiologists.
I would like to share with somebody some protocols in the induction of general anesthesia or for sedation in outpatient.
Do you feel the avalaible of BIS strictly mandatory?

Is there anybody who has a particular skill in this field?Sedation or general anesthesia for this kind of operations may be quite different I think.

Dear ELENA,
the matter concern about what technique of anaesthesia u are planning to.
I think that the inalation anesthesia alone is not sufficient to ensure an adequate deep and so is better to have a mixed strategy (gas and ev agents).
For the evaluation of the deepness the clinical methods are unuseful.
Bispectral Index (BIS) is a simple thecnology taht we use often in day surgery anestehsia procedures.
If u are eager of more info u can contact me here.
Many regards
MAGRO

i AGRRE WITH YOU ABOUT THE ROPIVACAINE PROPERTIES;HOWEVER IN MY COUNTRY (ITALY) ROPIVACAINE INTRATHECAL IS NON REGISTERED AND  ALLOWED.
I EXPECT A FEDD BACK FOM U SOON.
MAGRO

Hallo,
Epidural is absolutly controindicated in case of previous spinal puncture.
Can u consider loco regional blocks instead of?
NOMOREGAS

In my opinion and practice the question of repeated spinal anesthesia in case of previous failure depends only from three factors.
The first is at which "level" u have done the former puncture.
The second is the "dose" of local anestethic u have just administered i.e if hyperbaric or plain!
The third the "position" of the patient will take on the bed during surgery and the related spread of the drug.
Of course nobody can ever think to practice a second spinal anestesia in case of labour, in case of shocked or trauma patient,and in every situation in which u might face up a difficult intubation !!!
NOMOREGAS

Hallo everybody italian anestesiolgists.
I`ve an idea for better improvement of our knowledge,practice and cultural grow.
Let´s meet on GASBAG!
We could have an Italian group,discussing and approching with interesting items with teh collegues in the world and make visible italian anesthesia practice.
Dear collegues I´m waiting for you in the ITALIAN ANESTHESIOLOGY GROUP.
Matteo Magro

No problem:you can perform a new spinalö approch one space above.
If the local anesthetic has`nt drenche nervous roots I don`t see the matter of question.
Tell me your point.

I've found a great number of postoperative agitation in the elderly patients undergone knee replacement  receiving spinal anesthesia.
Most of them had agitaton and delirium like syndrome in the first 6 hours aftere surgical procedure.
Sometimes sedation using midazolam was not successfull.
I ask if somebody has expeience administring propofol in bolu doses.
Thanks

I'm interested on indications of propofol administration outside the operating room or the ICU.
On my knowledge treatment of opioid induced pruritus,prebention of nausea and vomiting,sedation for delirium or epileptic seizures.
I'm loking for other uses bedside or out of hospital approved indications and new applications fileds.
Thanks
Matteo
matteomagro@tin.it

I've used propofol after surgical intervention of knee prothesis in a patient with confusion and cognitive impairment.
It seemed to me like an episode of delirium.
The patient was at bed and previous attempt to sedate him by administering drugs like diazepam,midazolam,gardenale,failed.
The operation was started at 9 under spinal anesthesia and was performed in 90 minutes.
7 hours later tehe patient was resteless, agitated,and confabulating and tired to get up from the bed.
After the 2 hours og observation at bed I used propofol 100mg (1,7 mg/Kg),without clinical problems and the result was patient was calm .
I 'ld like to know if some analogous report exist in literature and if the other described use off label of propofol,
Thank you for your answer.

Please email me:matteomagro@tin.it