A significant number of consultants  are using Dopamine infusion to maintain BP during intra-operative period under CNB including High spinals (T2-4) , Thoracic epidurals or CSE techniques
So any patient coming for an laprotomy or trauma surgery both elective and emergent get a Dopamine infusion started followed by the CNB technique of choice.
Ephedrine and fluids do not play a main role in their management protocol
They claim that all you need to do is maintain BP irrespective of the drug used
I wonder what will be the outcomes in light of the uncorrected volume status,tachycardia and other problems that inotropes produce.

IS this technique scientifically acceptable supported by evidence.
Will the outcomes be affected by this technique

Is there any stadardization regarding the diameter of Adult and Paediatric T pieces at their FGF, patient and machine end.
Is there any reference that details about its ID and the length of the expiratory limb.

I find that different makes seem to have different connector sizes and the Diameter of the FGF tube and length of expiratory limb is also inconsistent.
I also read an article that utilizes a 20 ml syringe with plunger removed and a hole in the middle of it into which the O2 supply is attached. One end of the syringe attaches to the ETT and the other end is open to atmosphere to act as expiratory port.
What FGF will it supply at say  flow of 5 or 1o lpm.
Want it increase resistance to expiration thus increasing WOB

SHO's are arbitrarily using 10 and 5 ml syringes to prepare such T pieces and I wonder about their effectivity

Is there as easy equipment to actually measure the FiO2 being delivered with such contraptions

Thanks for the info

Amongst the myraid of techniques recommended to detect air embolism during neurosurgery the top few based on sensitivity are
Trans-oesophageal echo
Doppler Ultrasound
Decrease in End Tidal CO2
Increase in End Tidal N2.

How did N2 come into the picture since during preoxygenation we had denitrogenated the patient and we are now ventilating with a gas mixture containing only N2O and O2.
What monitoring device are we using routinely that would pick up N2 in the expired gas - ?? multigas monitor working on Mass spectrometry or Raman effect

I have just lost the picture..............

3 degrees under my belt and so much more unlearnt in anaesthesia

We occassionally encounter difficult airway patients for emergency surgery that cannot be accessed by central neuraxial blockade or is deemed not fully safe.
Some of these patients may have distorted anatomical landmarks in the neck due to thyromegaly or other masses thus precluding the performance of percutaneous airway blocks
Also the issue of performing airway blocks in a potential full stomcah patient is an issue.
any ideas on how to approach such a complex case coming for emergency surgery

Our experience with intubation with 0.6mg/kg of rocuronium for intubation offers only acceptable intubation conditions at 60 secs. This is surely inferior to intubating conditions offered by suxamethonium in the same time frame.
Roc 0.9mg/kg offers excellent intubation conditions, but undesirably prolongs the duration of action to more than 50 minutes making it an almost long acting relaxant
I am wondering if priming with 1/10th the intubating dose (0.05mg/kg) of roc given 2-3 mins before the intubating dose will improve intubating conditions at 60 secs.
Wonder if there is any literature or references available
Thanks for the help

Hi Folks
Trauma resuscitation (say B positive group) requiring blood can be given O negative blood for emergency. If Crossmatched B positive blood is sesequently available can we switch over immediately or are there any rules or restrictions to be adhered to.
What is the maximum volume of O negative blood that can be used in such circumstances.
Does it pose any problems during subsequent blood transfusions
Thanks

at our institute we do a lot of lumbar epidural for pain relief in patients with peripheral vascular disease waiting for surgery. These patients are usually on heparin, Clopidrogel and occassionally on low dose unfractionated heparin. Most of the anaesthesiologists out here seem not to worry about it and just do the epidurals and even get away with it. I recently quoted the ASRA recommendation and refused an epidural without stopping clopi for the recommended 7 days. Was met with usual disapproval of surgeons and nonchalance of collagues. Surgeons feel stopping clopi will risk the vascularity. They are willing to take risk.
What should we do in face of conflicting recommendation. Can the surgeons to take risk for potential parplegias that the anaesthetic technique may produce
regards
jafo.

Paediatric peri-op fluid therapy has been a topic of recent debate. All kinds of opinion and views.
In our place a lot of consultants use only Isolyte - P for practically any kind of surgery. This notion is based on the premise that paeds usually end up being hypoglycaemic. But anaesthesia itself produces hyperglycaemia. Also Iso-P is a hypotonic solution. I prefer to use RL exclusively intra-op. Just want to know what is the practice around the world and what does the current evidence support
regards
jafo