We have been using this drug in good number of cases, our practice is mainly Laparoscopic & Bariatric practice.
All theory is in text books.
We will stick to our experience only.
WE start our first bottle in OT Paracetamol drip 100 ml. I inject 20 mic in this drip which will run over 15 mins. (if injected directly IV, and fast, it can give severe Bradycardia and Hypotension augmented by induction agents, so we put in this 100 ml drip).
By the time induction is over and first drip is over, we put the other 30mcg in the next drip which is a 1000 ml Ringer Lactate, planned to go over 1 1/2 hours.
It is available in form of 50mcg in 1/2 ml amps. Also 1 ml( 100mcg) and 2 ml(200mcg) are available.
This gives an almost perfect result of steady heart rate and BP. In Indian population, I have found that even this small dose is a bit on higher side. Patient wakes up a bit late. In turn one will learn to reduce GA levels and  adjust as per requirement. One has to learn this drug over some time. We have not yet mastered it.
I have not been sticking to mcg/kg regime. We have not yet come to that conclusion.
In our population , 1 mcg/kg as loading dose turns out to be very high. ( Still too early to comment)
Please give your feed back.
Regards.

Writing after a verry long time.
Nor would I recommend it as you said.
I want you to try it once, in presence of a friend for safety.
So that you can intubate a patient in case an ETT ever comes out in prone.
Or if a PCNL is being done in Spinal and the effect is not too good or going down, you may need to intubate.
There are many a things that can go wrong. today you may get time to learn, tomorrow when things go wrong, you may not get time.
So might as well try it out and always be confident that you will be able to put an LMA in prone position.
LMA Supreme and Ambu are easiest to insert in prone.
Best Wishes.

Hi,
BAck again for you to reply to your question.
First, I may probably plan a continuous spinal and do a deliberate dura puncture.
If Dura Puncture, I like to accept it and push my cath inside. The result is sure, and fast, dose minimal and safe. PDPH, I have not yet faced after A dura Puncture, with a cath inside. It blocks the hole partially and little protein from CSF collects there and forms coagulum, blocking  the puncture site.
I have done this often when I am in a situation like you mentioned, specially so if I am in a smaller hospital, where all facilities may not be there.
But I usually knot up my catheter, so that some one does not take it as an Epidural cath and inject something else by error.
I remove the cath on 2nd day.
In your case, we have to also think in terms of Analgesia. I do not like to inject any thing in this cath with a fear of sepsis. May be we can think of something else, like on shot Buprenorphi giving good analgesia for almost 24 hrs. Later plain IV Paracetamol can help.
May not be very agreeble at a few levels, but still works out better than ending up in a GA.
Regards.

Have given Spinal in Prone, Specially for Spine. But I have seen ppl having burnt hands as the level goes high due to Thorecic curve, and also afraid to use if my surgeon likes Jack-Knife position. That is why I like to use Isobaric Ropivacain. It does not go high or low with Postural changes.

Sorry, but she was operated in a larger hospital, where I do not go for Anaesthesia. I do not know what they did. If her general condition is bad, the anaesthesia plans will not alter her situation and morbidity.
She died anyway with MultiSystem failure.

I used to give Medaz, but instead now I give a little more of Propofol, as the Peak action of Medaz is seen at 45 mins, and I can't keep the patients for longer time.
I have brought down my Fent dose to 1/2 mic per kg, to bring down the Emesis rate, at times I only give Paacetamol drip for analgesia.
Great, I am getting input, Thanks

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, knowledge and updates? I am always interested. Send me a link and I will join, regards, Yogen Bhatt

ASA 1, 8 gram and LAVH under GA. Your surgeon is good and does a bloodless job. Ideal will be to transfuse and start. Let there be legal safety. You can start and transfuse after parameter come back to normal.
But, I would give a pint of blood on previous day.

Feel great to be able to open the site after a big lapse.
Just to inform that now we have done a series of 165 cases of insertion of LMA in Prone position.
We have never had to intubate the patient. All were managed successfully. No more broken LMA SUPREME. may be we learned the tricks. Last 5 cases we used INTUBATING LMA because surgeon wanted to do liposuction of Chin, where he was not happy because the LMA cuff was altering the shape of Chin. We intubated these patient just before the Chin part. For trial we intubated all of them in Prone only just to see if it was possible. The first case was difficult as we had not used the tube pusher, and the Tube and LMA both came out. We reinserted LMA and reintubated. The next cases were easy, as we had learned the trick.
Just to emphasize that this can also be done if needed. No need to do as a routine.

A Portex Nasal tube is very soft, the same material as in North Polar Tube. Majority time we do not get a nasal portex tube.
In this case, it is best to use the standard Portex tube. Take some warm water and dip the tube just before inserting( The tube should not be too hot), apply good amount of jelly and insert.
The soft tube goes in very nicely, only, one may need a Magille's Forceps to direct it.
Dipping the tube in warm water makes the tube very soft. Try it next time.

Hi,
I did not give anaesthesia to the patient.
She went away before I planned anything.
They had called me in other hospital to give anaesthesia, but since I had declined once, I refused to go.

Dr. Jafo's replies are always to the point.
There is a note of a perfect teacher ( and a bad examiner may be???)
But class one in my opinion.
How ever, I will summerise in one line.
Hypertension in surgery? Give more anaesthesia, main cause is pain and pain, but do keep CO2 in mind.

HI, there is a fear that your repeat spinal can go much higher and give a total block.
But now there is an option available.
Consider repeating the spinal with a drug that is isobaric. We use a lot of Ropivacain in NS which is isobaric and giving any position will not push drug higher due to gravity.
We do a lot of cases where muscle relaxation is  not much needed. And for that, does the drug have shorter or lesser muscle relaxation? I do not think so, though the manufacturers claim so.
Keep the molecule in mind if stuck in a case next time.