I works at the same hospital for 6 years and the new chief have banned the use of nitrous oxide. He said that don't have any scientific reason to continuous use of nitrous oxide. I want to know if you agree (or not) and why.
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#2
General Discussion / Re: Surgical face masks
June 26, 2005, 08:17:45 PM
It's of concern this position to not use face mask in theatre... not by "evidences" but in order to maintain the respectability with our specialty and with us... "Surgeon don't have bolls"... And my country is the "third world"!!!!
#3
Regional Anesthesia / Re: How do you do your Epidurals?
June 26, 2005, 08:07:57 PM
In my state in Brazil almost ALL anesthesiologists use AIR.
#4
Regional Anesthesia / Re: prolonged paralysis after spinal anesthesia in a patient with poliomyelitis
June 26, 2005, 08:04:37 PM
We have an interesting case few years ago... see below...
TITLE PAGE
"Cesarean Section in Post-Polio Patient – Case Report"
Gastão D. Neto, MD, PhD – Chief of Anaesthesia Department from Universidade Federal de Pelotas - RS –Brasil.
Florentino F. Mendes, MD, PhD – Chief of Anaesthesia Department from Irmandade Santa Casa de Misericórdia de Porto Alegre – RS – Brasil.
Alexandre R. de Oliveira, MD – Assistant Anaesthesist from Irmandade Santa Casa de Misericórdia de Porto Alegre – RS – Brasil.
Corresponding author:
Alexandre Roth de Oliveira – alroth@terra.com.br
Rua Duque de Caxias, 833/ 404.Centro - Porto Alegre – RS – Brasil - 90010-282.
Phone and Fax Number: (51) 3228.3210.
ABSTRACT
Objective: Although many post-polio survivors have got great anatomical and physiological problems that increase your anesthetic risk, sometimes they present only minimal sequelae that difficult the correct evaluation and anaesthesia procedure. The objective is bringing up the anesthetic evaluation and procedure in similar settings through this case. Case Report: A 26-yr-old primigravida patient, ASA I, 39 wk gestation presented with 24 hs premature rupture of membranes, without active labor. She had been in anesthetic clinic 2 wk before and had described poliomielytis with 1-yr-old and "complete recovering". With 16-yr-old she was submitted to apendicectomy through spinal anesthesia with "weakness" in entire body for approximately 24 hs. At physical examination the only sign was shorter Aquiles tendon of both legs. After volume expansion, the choice was an epidural anesthesia with 15 ml of bupivacaine 0,3% (without epinephrine) and morphine 2 mg. No epidural catheter was placed in. After 4 minutes was initiated the surgery with T4 sensitive level and hipotension/ taquicardia corrected with metaraminol 1 mg. After 50 minutes the procedure was finished with the same anesthesia picture. The entire recovering from anesthesia has occurred after 11 hs. An elevated consume of analgesics (NSAIDS and opioids) and antemetics was observed. Conclusions: This case report describes the fewest practical concepts available about regional anesthesia in post-polio patients with minimal sequelae: the lower dose of local anesthetic, the attention with potential cardiac arritmias (avoiding epinephrine) and the accentuation of emesis and pain. The importance of communications about these "minimal" cases and the anesthetic conducts in this setting are debated.
Key Words: Post-polio, epidural anesthesia, pain, cesarean section.
TITLE PAGE
"Cesarean Section in Post-Polio Patient – Case Report"
Gastão D. Neto, MD, PhD – Chief of Anaesthesia Department from Universidade Federal de Pelotas - RS –Brasil.
Florentino F. Mendes, MD, PhD – Chief of Anaesthesia Department from Irmandade Santa Casa de Misericórdia de Porto Alegre – RS – Brasil.
Alexandre R. de Oliveira, MD – Assistant Anaesthesist from Irmandade Santa Casa de Misericórdia de Porto Alegre – RS – Brasil.
Corresponding author:
Alexandre Roth de Oliveira – alroth@terra.com.br
Rua Duque de Caxias, 833/ 404.Centro - Porto Alegre – RS – Brasil - 90010-282.
Phone and Fax Number: (51) 3228.3210.
ABSTRACT
Objective: Although many post-polio survivors have got great anatomical and physiological problems that increase your anesthetic risk, sometimes they present only minimal sequelae that difficult the correct evaluation and anaesthesia procedure. The objective is bringing up the anesthetic evaluation and procedure in similar settings through this case. Case Report: A 26-yr-old primigravida patient, ASA I, 39 wk gestation presented with 24 hs premature rupture of membranes, without active labor. She had been in anesthetic clinic 2 wk before and had described poliomielytis with 1-yr-old and "complete recovering". With 16-yr-old she was submitted to apendicectomy through spinal anesthesia with "weakness" in entire body for approximately 24 hs. At physical examination the only sign was shorter Aquiles tendon of both legs. After volume expansion, the choice was an epidural anesthesia with 15 ml of bupivacaine 0,3% (without epinephrine) and morphine 2 mg. No epidural catheter was placed in. After 4 minutes was initiated the surgery with T4 sensitive level and hipotension/ taquicardia corrected with metaraminol 1 mg. After 50 minutes the procedure was finished with the same anesthesia picture. The entire recovering from anesthesia has occurred after 11 hs. An elevated consume of analgesics (NSAIDS and opioids) and antemetics was observed. Conclusions: This case report describes the fewest practical concepts available about regional anesthesia in post-polio patients with minimal sequelae: the lower dose of local anesthetic, the attention with potential cardiac arritmias (avoiding epinephrine) and the accentuation of emesis and pain. The importance of communications about these "minimal" cases and the anesthetic conducts in this setting are debated.
Key Words: Post-polio, epidural anesthesia, pain, cesarean section.
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