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.

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.

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?

Anyone in this branch?
We are doing a great number of Ovum Pickups.
Still would like to make it safer for the results.
The setups where we work are typical daycare centres, with minimum beds and there are times I have done 9-10 different patients in a span of 2 hours and in a 1-2 bedded clinic. We have to discharge them fast.
Let us have suggestions from members about speed of cases and results of IVF kept in minds. ::)

Anyone practicing Ropivacain Isobaric Intrathecally?
It has an advantage, it can not go higher than you want even if you give head low or Prone( Keeping Thoracic curve in mind).
There are times I use upto 5.5 ml of 0.5% Ropivacain Isobaric to get a higher level for my Liposuctions in Prone/Supine.
Comments?????????????????????

Hi all,
A lot is written and opposed about regional anaesthesia for laparoscopic surgeries.
In fact, a lot of people use regional anaesthesia during Lap Choles, Lap Hysterectomies, Myomectomies, Appendicectomis and so on.
It is done under regional blocks for variety of reasons. May be need based, as in low economy patients or areas, may be drugs or materials are not available, or may be the patient does not deserve GA due to physical or medical problems.
All the same all of us have done the cases under Regional.
Is it that we have done something Illegal?
If anything happens, nothing can protect us?
IN short, is there enough evidence to do lap surgeries under regional blocks?
Can we not create evidence?
Enough is done and no one presents these cases in Journals and Conferences, for many unknown reasons.
Can we all, together bring it in black and white and make the whole thing safer for those who are regularly practicing and us who occasionally practice it. 
Not very easy, but if all of us start reporting it in articles and local meets, it is a question of time.
May be some of our teachers and seniors can give us guidelines to make a presentation.
Regards.

Hi,
Got a case posted for LSCS elective. As a routine we do all LSCS under SAB.
She was operated for Psoas Abscess 6 years back. The site was L1- L2. Post OP X-ray is now clear, All tests are normal.
How safe will be spinal for her.? She is short and obese.
What about legal implications?

Gave an Epidural Labour Analgesia.
23 yr, tall, 106 kg primie.
Gave Epidural. The one who gives, knows that he is in the space, the way the feel is there, the way the NS goes, the way the catheter slides smoothly.
Catheter was fixed at 13 cm.
There was no action after first 15 ml of 0.1 % Bupivacain with 30 mic Fent.
Waited for 30 mins. Withdrew Catheter to 9.5 cm. Gave 10 ml again.
Epidural acted in 5 mins and the patient was actually smiling and went off to sleep after 10 mins.
Next dose again had poor action.
Anyway LSCS was now decided, and I had no intention to give GA if Epidural does not act, at 3 in the morning.
Removed the cath, gave spinal and finished it.
I invite comments.
May be many will learn through that.
Regards

I do not know, but for quite some time when ever I type gasbag.net in the browser, some site that is selling gift items open up.
The items are not related to Anaesthesia.
Is it part of our forum? Is there a means to rectify?

HI,
I have started using Ropivacain for Labour Analgesia for some time. I am still trying to come to a proper dosage, concentration and combination.
Though the literature( Published by manufacturer) says that 0.2 % along with 2mcg of Fentanyl is the best combination, we are not happy with it.
We have tried out many permitation and combination, and now we are giving 0.12% with Fent 1 mcg/ml (15 ml each dose)
This is the best combination so far.
But the patient gets no feel of contraction at all.
Shall I go a bit lowers still?
It acts nicely for almost 150 mins per dose.
would like to learn more from you all.
Please guide us.
Regards

Hi,
Feeling lost for a while. No one filling Gas in our Bag for over a month. Does it mean that I alone have to have a complication and put it on net for ppl to disect it?
A lot is said about saline. But I , being an oldtimer, am still in pref of Air. I use NS most of the time for location of epidural space, but still I am fond of Air. No, I do not inject air in the space, just use it to feel the give way sensation. Not even half ML of air goes in.
Am I wrong in this tech?
Should I change over to only NS?
Group members are all quite young and bruoght up with NS only. But I still preffer air. Not always, but I do use it in treaky cases.
comments!!!!!

Hi,
I read a lot about cuff pressure of ETT and LMA going up by 15-20 % in 60 mins of surgery with 66% Nitrous used as gas in any circuit.
I am a bit confused about it. Ofcourse they must have conducted studies and even analysed nitrous presence i n the cuff. Also body temp will also increase the volume of gases in the cuff.
Any second opinion on this?
We have a rule to release and reinflate the cuff after 1 hour because a little tissue edema also takes places and so the cuff fits snuggly leading to no leak on complete deflating also. Is it not a combine effect of gas and edema and temp that the pressure rises?
Or  is it that a lot of nitrous enters the cuff through the PVC or what ever material?

Hi,
Anybody tried insertion of LMA in prone position?
Read an article in Indian Journal of Anst Dec 2008??
Was impressed with the study. Read and read over and over again. They had used LMA Classic in the study of 200 cases with only two cases where they had to reinsert, in variety of cases inclusive Spine and in obese patients.
We made up our mind to try once. We use LMA Supreme. This is much better shaped device. We do Liposuction in obese patients in prone position first and later in supine position.
We tried it in a case. Made the patient sleep in prone position and then induced her. It was easy to ventilate ( as the tongue does not fall back, it rises in prone)and very easy to insert the LMA. We connected the patient to venti.
The patient was in prone for an hour and half, and all was ok.
We made her supine and completed the surgery of front in next 2 hours.
It was most easy.
We tried it in about a dozen cases after that and are happy.
The idea is to try it once, so that one is not afraid, if ever a tube gets dislodged in prone, you can always insert an LMA and manage the case.
Sounded like a creazy idea to start with, but the article was presented nicely and we were tempted in trying it.
Please let me know if any one has tried, and if any difficulties.
Regs.

Just to inform you what all can happen in our set ups.
We gave a continuous brachial plexus block for a case of a bad crush injury of hand. The block was given with a BD Intima needle( a Venflon with an injecting tail like a scalp vein). We wanted the block to work for a very long time, and post op pain relief along with vasodilatation.
Third morning we rec a call that the staff is not able to inject Pantaprazole through that.
We asked them why they are using that port( Labled clearly" Do Not Inect")for injections.
The reply was that, since there were no lines on one side and dressing was  done on the other side, they gave all injections including RL and NS on the previous day in that port.
God only knows how the brachial plexus bared all the insult.
Despite all of us, the patient improved and went home Ok.
Carefullllllll.
This can also happen.

Read This:
21 yr male, Fall from height, fracture L-1 spine with paraplegia.
All investigations normal. Posted for instrumentation under GA in Prone.
Standard induction with Propofol, Fentanyl, Medaz, Roc intubation, Venti with Gas Oxygen and Iso as needed. Well controlled BP.
Goes on nicely for 100 mins. At this the surgeons drill and put a screw at T 11. The ventilation became difficult, taken over hand ventillation, but desaturates. The surgical team complains about air bubbles in the field of surgery. BP started dropping and the ECG showed patterns. Leading to a flat line.
Pt was made supine and CPR started. Recovered after a DC shock.
On observation, there was a great surgical emphysema all over the body from Eyes to Knee and elbows. few needle punctures were made all over, the patient, gradually sattled. Surgery was finished in lateral position and he needed Dopamine support for a while , patient was reversed and  was allowed to go to ICCU with a T- Piece and oxygen.
Portable X ray did not show any tension pneumo after he improved. (now atleast). There was surgical emphe all over in the X ray.
Patient regained full consciousness in next 36 hrs and was extubated.
Our impression on the spot was that either there was some rent in the trachea or some trauma in the lungs during the surgery.
There was no sign of trauma to trachea, no blood in ET tube or throat pack,. No gas in the mediastinum on X ray . Can it be from surgical field???
I am at loss on ideas now. Make geusses.

A case for PCNL with a few stones, which the surgeon thought that he may take time. Sequential spinal and Epidural( saperate space) was given to the patient. He was 34 yrs and no positive history.
Surgery got over in 15 mins after scope was put, as he saw the stones just opp the scope and it was over. Since Epidural cath was put, we put Inj. Bupivacain 0.1 % and inj. Buprenorphin 60 mcg( total 15 ml vol) for post op analgesia. We regularly use this combination and we do not have Morphin.
About 2 hours after the shifting of patient in the ward, we recv a call to see the patient urgently.
     He was getting severe pain in the back, severe sposmodic jerks of the lower limbs, and electric current feeling, almost 30 -40 times a min.
      We could not place it, but the patient was in severe pain and with all relatives in the room it was difficult to explain the situation.
      We started Fentany for pain and Medazolam as sedative. He would sleep for some time and when ever disturbed, he would get up and start convulsing again. He was fully conscious. He had raised exensor tone, planter exention, raised knee jerk, and was screaming with discomfort.
A neurologist was involved, and he suspected Epidural Hematoma.( Pt  had increased tone and all sensations were still normal- so not fitting a picture of hematoma). He was taken for MRI, which came normal.
On surfing through net, we could locate few cases reported like this. As per them, it was focal convulsions arising from multiple places, induced by low dose opioids. Though Buprenorphin was not mentioned as one of the drugs, but we presumed that it may be the cause( Topped up with IV fentanyl given by us). Almost all reported cases had a history of Epilepsy.
After this we just put him on Medaz infusion and he was fully controlled in half an hour. Shifted from ICCU  and went home in 3 days.
I request comments and observations.

Got a case of post spinal CSF leak.
A patient of Ca Cervix. H/0 Asthma, HT, age 62, H/O Lumber laminectomy done twice.
Anaesthesiologist decided to try and get away with a spinal and a high epidural, if space can be located.
Space could be located but the cath did not go in. Probably fibrosis in the space. He decided to push the needle and cath intrathecal.
Surgery went perfectly ok.
Third morning the catheter was removed and by evening the patient had a CSF leak.
Now what??? Has any one seen one like this??
   Post laminectomy CSF  leak, due to dura tear, is seen after surgery. At times the ortho surgeon requests us to put in an intrathecal epidural cath to give an alternate drainage till the leak heals. Can this be tried here? or Will it give one more site of leak??
and worsen the problem???
Think.

Was called to see one case that was given Spinal previous day for an LSCS. Patient  got the typical electrical shock feel and shooting pain in the leg while the injection was given. 2.2 ml Bupivacain was given at L3-L4 and the surgery got over in about an hour.
At night the patient complained about not being able to move one leg and lack of sensations in that leg.
Next day I was called and on examination there was total lack of  motor, sensory and reflex activity, a picture of complete transaction of cord.
We advised Methyle Prednisolone 500mg and followed by standard Dexamethasone 8mg TDS.
It could not have been a hematoma, as the effect was purely on one leg. It can't be spinal artery damage as it was given at L3 -L4. A small 26 G needle can not cut the cord or the root. We felt that this must be injection in the nerve root leading to focal ischeamia and swelling, compressing roots on that side.
Next day MRI was done. Surprisingly it showed element of demyelination/ mylitis at T11-T12.
Either way, same treatment was continued and the patient showed steady but slow recovery. Muscle power was 70% back in about 6 days. Sensory power had reached till thigh.
Was discharged home next day and still is steadily recovering.
Any further light on this issue?
I am presenting this in my next meet which is tomorrow. Do enlighten me if we were grossly wrong.

Any news on the new molecule SUGAMADEX?
Has been heard of as hanging on the horison for a very long time. Was to be launched in UK last month? Has any one recd it and actually used it?