Quote from: sandiphari on August 07, 2010, 01:53:21 PM
AWAYS PREFERRED REG.ANAESTHESIA  OVER GA IN OLD PT.PERTIC.IN ORTHO CASES. POST OP. ANALGESIA IS EXCELLANT.

Can you cite some literature to support that?

Especially the "ALWAYS" part.

No way.

No how.

I always prefer GA for uncompensated cardiac patients (but that's a different discussion) because I can control the hemodynamics better than with a spinal. I can be gentle, use etomidate and slowly get the vapor where I need it for the procedure. Of course, there's always a little muscle relaxant, if you need it.  :D

As far as sepsis goes, as far as I know, there's no evidence that you can cause CNS sepsis in this scenario (I'd love to be proved wrong, by the way), but if, just if, it does happen, you're without a leg (pun intended) to stand on.

The older I get (and I'm in practice for 30 years now), the more dangers I see with regional (particularly spinal) anesthesia.

You're jostling some very old memories!

We did these for hemorrhoidectomies. The patient would position him/her self onto a Wilson frame (used for laminectomies). This position afforded the right amount of curve to the lumbar spine to make lumbar puncture (a bit) easier. We would perform the LP, and you have to aspirate to get CSF, and inject the drug. Because the patient was in a bit of head-down position, the block get the anal, sacral areas.




If I recall correctly, we used tetracaine, diluted with sterile water to render it hypobaric.

Of course, now, 20 years later, I don't remember the last time I used tetracaine.

(sorry to reply to an (almost) dead thread, but I have to get my 2¢ in.)

Back in the old days, when dinosaurs walked the Earth, I used to do hypobaric spinals in the prone position. I don't even remember the drug we used. It was a great anesthetic, however.

Now, in private practice, the goal is to get the patients home as quickly as possible, and everyone gets a general.

Hello, all.

Been in practice since 1980. Almost 10 years in academia, and 20 years in private practice.

Nice to "see" you all, and hope that I can learn and share some good stuff.