There is no dilemma. As you yourself state "ASRA recommendations advice avoiding anticoagulants after traumatic epidural  for 24 hours if possible or weighing of risk - benefit ratio in such a scenario." Weighing the risk an epidural haematoma against the near certainty of a graft shutdown with the patient losing a leg, I'd choose to give the heparin. However I admit it's not a choice I'd like to have to make. Luck would definetely play a major role

The literature says there is very little increased risk with a block. However ther are also reports of increased duration of blocks. On balance, I would be reluctant to give a central neuraxial block in a patient who already has a demyelinated spinal cord.

He thought about it because he probably anaesthetises for spinal/posterior fossa surgery in the prone position. However, if you get an arrest, you cannot do chest compression adequately in the prone position. you have to get a trolley in and turn the patient supine as fast as you can. You probably also need to pray quite hard.

Never heard anything like this. Probably a coincidence. The family may be predisposed to mental illness.

Where is the advantage?

So whats the bottom line? Since we can't guarantee nothing will go wrong, should we not use the LMA under these conditions ???

I am not snubbing you at all, and I apologise if I hurt your sentiments. However I would still like to reiterate that anaesthesia professionals give anaesthesia. They dont give advice on sexual fantasies. That is the province of psychiatrists and psychologists. I doubt that anaesthetists are competent to answer your queries.

I hope that was put better. Ciao.

Reason I asked was I started an inguinal hernia who refused a spinal on an LMA. The surgeon had a few problems and eventually total time was 3 hours. I would have intubated if I had known from before, but the patient came through well and is ok. Question is, was I just lucky or is it OK  to ventilate through an LMA for 3 hours.

by the way, thanks for your input

Whats the maximum time that you can give positive pressure ventilation through an LMA? Is there a guideline anywhere in the literature?

Walter, I think you are looking for a looking for a site where content is much less scientific and much more erotic. I suggest you spend time there, or on a shrink's couch to sort out your fetishes.

Do you mean spinal anaesthesia for surgery in the prone position? I've done that. But I gave the spinal in lateral position