I'm amazed more anesthesiologists do not use this more often. I have used it since my resident days.

Solution used is 0.5% heavy bupivacaine. Patinet positioned on injured side down. You may need a few mL of propofol to get the patient into this position. Needle is a pencil point with a side opening.  Once a dural puncture is acheived, orientate the opening of the needle down (the opening usually corresponds with a little tab on the flange). Then inject the LA SLOWLY to avoid a jet effect - just let the LA sink slowly down. Then, most important, keep the patient on the injured side down for at least 15 and preferably 30 minutes. Once the propofol wears off, the block is effective and the patient is comfortable.

Advantages: almost complete unilateral block. Less hypotension as half the sympathetics are preserved.

I have never worn a surgical face mask in theatre. A few times I work with a new surgeon who asks me to put one on, and I refuse politely, and ask him to show me the evidence that they do any good. I have never been presented with this evidence.

Do others have any strong feelings on this issue.

I should point out that recently two of our surgeons have taken to not wearing face masks, although one had glasses for his own protection.

Does anybody change their epidural technique for woman having a trial of VBAC? I ask because recentlyI had an episode of uterine rupture in a woman who I had previously placed an epidural and using my usual epidural solution and dosing (0.125% bupivacaine with 5mcg/mL fentanyl on a 5mL PCEA). The rupture was picked up quickly because of a worsening CTG and an ultrasound on standby.

Well, does anyone?

I must admit I still use it rarely for bronchoscopeis in children. I breath them down on halothane, get them very deep, spray the airway, and when deep enough, let the ENT guys at them. The long wash-out time enables the surgeon to do a lot of work before I have to re-dose the anesthetic. For adutls I use a propofol infusion (of course).