Sevoflurance is extremely potent drug.It is dangerous in expert hands also.complication include death.don't use it casually.

Thanks jafo for making this forum so educative.we do lot of cleft lip and palate surgery & use isolyte-p till two of our patients had postop hyponatraemia.
      Since then we r using ringer lactate.

hello',
    I was waiting to read replies for this.For I am always in the same dilemma while doing this type of
    patients .
       I avoid epidural & give single shot spinal with 26g needle.Do arthroscopies in femoral block.Real problem is hip surgery in this pt when spinal is problem due to associated cardiac problems.
        would like to know ur protocol.

   Hello;
Inserted a epidural for inguinal hernia patient with COPD + IHD .single shot uneventful.gave 3 cc of 2% adr.xylocaine,followed by 10 cc of 0.75% ropivacaine.Action till thighs. ?? ??waited ;then injected 5cc more.action till ing ligament.After 10 Min's 5cc more.surgeon ready with scalpel on my head.(I had already wasted his so much precious time.).7cc more after 10minutes.pt draped.
I gave 1 MGM fulsed .spo2 94% with nasal o2.surgeon checked with toothforcep action till T10 app.(Everyone happy.)With skin incision patient started screaming ??? ???
???All eyes on me asking for option.
???with total dose of ropivacaine
     1.can I change to epidural sensorcaine.was EP cath a problem.
     2.cant dare to give GA to this pt in this setup.
     3.can I remove the cath and give spinal.scared about hypotension.
     4.Ask the surgeon to supplement with ing block?.Then total so much ropivacaine+his 25ml of 2% adr xylo with 0.5% sensorcaine... ??? ??? ??? ??? ??? ???Plus cant give much iv supplements with his kind of lungs.
     Your suggestions and experiences awaited.

4     4

Hello;
     many of my friends are doing lap chols under SA routinely but whenever I have tried it
      I end up having a very uncomfortable and restless pt whom I end up giving too much of additional iv supplement drugs.(cocktails as mixup is referred).Then started with epidurals with GA for sometime.now with clonidene at hand we give 100mi gm tab 2 hrs before the induction and iv fentanyl 1migm per kg during induction.bp remains around 100mm
systolic till co2 insfn and in good control thruout the surgery.
    sometimes observed severe bradycardia after induction but responds to atropine.
   IN 2 cases had to use iv clonidene upto 75 migms intraop to control the bp.
  I am happy with this,but would like any suggestions for improvement.
     (2)I feel we don't havemuch literature supporting use of regionals in lap surgeries may be because more of the use is very recent,and many times it is done in compromised setups or patients,sonot published. not very sure,
   

Dear sir,   Thankyou for ur reply.I would take a chance here to mention that we always feel good & confident that You are always there when we need it.Thanks.Pt investigated & treated ,is absolutely fine now.

Hello;
      I would like to share this case.40 years old average built ASA Grade 1 female for vaginal hysterectomy.spinal given in sitting position with 26G needle .L4-5 spacemidline.single attempt .4 cc of 0.5% heavy bupivacaine.Level T8.Lithtomy after 10 mins.surgery duration 2 hours.intraop uneventful.vitals stable.I/o satisfactory.
               2 days after surgery pt c/o inability to stand,knee weakness,tingling numbness in rt leg.surgeon started with vit B inj & gave a call.I went to see the pt then she was having difficuty in getting up from sitting position,but once up was able to walk.C/o of tingling numbness on lateral side of right knee & sole of right foot.Other limb NAD.o/e examination reduce touch sensation on rt.sole.pain temp Normal..All other dermatomes NAD.????????????????.culprit....I think lithtomy position.Any advise ,help, similar experience.