I use it for lower limb surgeries. very useful if you restrict it to lower limb surgeries. a little unpredictable for segments higher than L1

excellent drug for intraop sedation. i do not follow the mcg/kg regime suggested in the literature. just put 50mcg in 500ml of normal saline and give at the rate of 15 drops/min. after about 10 minutes patient starts snoring then slow it down to 10 drops.min and maintain at the same rate till the end of surgery. recovery is prompt

make it a hemi-spinal and all your problems are solved. thecal tap with affected side down, volume of injectate less than 2ml [of 0.5% bupivacaine hyperbaric], keep in position for 10 minutes and then supine or surgical position.

csf leak was a common shortlived problem in the good old days when i was a student. we used 19g and 18G spinal needles then to do LP and at the end of the surgery one could see a pool of csf at the small of the back it was always a short lived problem and many did not even complain of headache or backache

would someone please post the details of the technique with pictures please or give info on where i can get it? details regarding the positioning, difficulties encountered if any, the level of block achievable etc etc would be welcome.

RBCs have no difficulty in going through the smallest venflon but the fluid is viscous and this generates a lot of resistance to flow occurs. the largest size possible in that patient is the ideal size for blood transfusion.

induction and intubation with halothane is a very useful technique in children
who are struggling and difficult to control and who do not cooperate to put in a i.v. line.
the best method is to start with a 2% concn of halothane with o2 and n2o . within say about 10
breaths, there will be some relaxation and respiration will become regular and smooth.
continue to give inhalation for 2 or more minutes before you attempt to put in a venflon. another
anaesthetist may be required for this while mask inhalation is going on. give a pinch stimulation
to see the response. if there is muscle movement continue the inhalation for 2 more minutes.
problems are: 1. a calibrated vaporiser if available is safer. you may even give greater than 2%
concentration in oxygen. if only goldman vaporiser is available , you may have to go up to the
last mark. 2. watch out bradycardia; precordial stethoscope is a must. 3. premature attempt to
start i.v line may cause laryngospasm in some cases. remember, halothane is anti-analgesic.
just to ensure pt is analgesic,pinching may be required.

if anything goes wrong during lap choly, you may be blamed for selecting spinal anaesthesia for the procedure. your method would not pass the "bolam's test'. you may not find experts to support your technique.

dear jafo, you are quite right. the repeat suxa was necessary because of somewhat unexpected prolongation of the minor surgical procedure originally expected to be finished with a single dose of suxa. it was a counsel of desperation.  and not of voluntary choosing. however, for intubation we prefer suxa especially in cases where some difficulty in laryngoscopy or intubatioon is expected.

i have frequently administered repeat does of suxa, sometimes even 3 successive doses; generally i co-administer a small doose of atropine 0.2 mg along with the repeat dose. even with this sometomes brady occured but not of alarming degree.

identifying the epidural space by loss of resistance to air is a time tested technique; nobody need be ashamed about it; me too, i use only air for epidural technique and it has let me down so far.

best indication for Epi-GA would be extensive visceral surgery wherein the two techniques supplement and complement each other.

dry tap followed by full effect could be due to coring of tissue in the needle which was probably pushed away by the force of injection. i have had dry taps but did not have the courage to inject the LA.

dopamine drip plus basic requirement of fluids is one of the many options available to combat spinal hypotension and fall in CO. just because many are not using it routinely it does not mean the regime has no value. we all tend to think highly of regimes we are accustomed to. sharing of experience is the core value of this forum and i think i have upheld it. regards.

Circulation is a leaky one in that it allows low mol.wt.substances like iv fluids to escape. within 20 minutes the fluids would leak out of intravascular space. strictly speaking trying to correct spinal hypotension with iv fluids is like trying to fill a leaking bucket. colloids with their greater staying power is a better option anytime. what shall we do in patients who are already retaining fluid like cardiac or renal if they receive a spinal?
there is no pure vasoconstrictor except probably noradrenaline and methergine. all possess inotropic activity to some extent. the difference is only one of degree.what about ephedrine? is it not an inotrope? if only vasoconstrictors are required, how can one justify the use of ephedrine? there is need for inotrope during spinal anaesthesia - block of cardioaccelerator fibres can lead to fall in CO for which only inotropes are suitable. anyway, the proof of pudding is in eating. to me, the pudding tastes very nice.