hi, i have observed mild to moderate change in pulse and B.P. immediately after cementing in major orthopedic surgery specially femur. almost 20 % of pt showes such responce !!!!
  what is your experience ?????

i have come across two pt who had some differant complain after epidural analgesia for labour.
both the pt where given CSE for labour analgesia, and delivered normally.
Epidural catheter was removed after 12 hr of delivary. on 5 th day pt had complain of back ache which is at the level of epidural insertion site and at the same time sharpe shooting type of pain radiating to lower limb as well as to neck( current like sudden sensation radiating from back to upwards and downwards both.)
this felling is for the moment and it stops by it's own.
it typically happened for once or twice in the day. not related to any posture. and with advice of some extra rest for two day, it dissappear permanently.
any comment????????????????

hi, well managed with the propofol, but is the use of propofol in pregnant lady is FDA approved? please guide us.

in other scenario is the use of propofol safe in new borns?

thanks.

Hi, very frequently we have noticed perioperative hyponitramia in elderly pt spacialy with long bone fractures.
any suugestions to prevant it?????????

regards.
dr. kalpesh shah

Hi, please coment on this case.
50 year old male pt with DM since 10 yr., on OHA since then, regular and controlled. no other medical illeness.
had mild chest disscomfort 6 month back, investiged by MD physicion in remote place, starte with ecosprine, since then taking it regularly, no problem after that.(angiography not done).
posted for removal of sub dental cysts(two moderat cyst below left molar and cannine).
ecosprine stoped since 15 days, CBC, HBSag, HIV, SUGAR, ECG are normal on the day of the surgery.
Taken 4 surger with nasal intubation, intraop hemodynamics were normal. af 1 hr of surgery pt extubated. 3 min af extubation pt has profuse bleeding.reintubated with great difficulties, but hematoma below the tongue in midline, which is reexplored and drained.for saftey tight nasal packing done. BTCT AND PT INR send. PT WAS 24 SEC AND INR was 21.1. pt managed with 4 units of FFP.bleeding stoped. PT came normal af 6 hrs.in retrospactive history nothing significant fount like any other medicine, or childhood trauma bleedig history.
any role of ecosprine? any guielines for pre op investigation?
medicolegal issues?

Hi, it is extremly craditable job in private practice. requires lots of self confidence.

regards

Hi, bhavin
what doses ur using in SA at ur hospiatal?
have u  ancountered prolong hypotension which is generally refractory to fluids?

regards and welcome to gasbag.net!!!!!!!!!!

Hi, sir i regularly use CSE for labour analgesia.
Incidence of PDPH is not realy vary high.
Infact the perineal analgesia largely unsatisfactory in only epidural technique. 
Lots of international publication supports this perticular technique.

REGARDS.

Hi, for CSE in major cases, we give spinal anaesthesia with BUPIVACAINE 2.5 ml + clonidine 30 microgram or fentanyl 25 microgram, almost for all cases and starts epidural after 60 min with bupivacaine 0.25% + fentanyl 2 microgram/ ml, at the rate of 8 ml/hr infusion. at the end of the sugery before shiftng infusion is converted to bupivacaion 0.1% + fentanyl 1 microgram/ml at 8 ml/hr for first 3 hrs and then 6 ml/hr for rest of the post op period.
I am presonaly very happy with this protocol.
We reduce the dose of intrathecal bupivacaine if pt's cardiac status is compromised.

regards.

Thanks for your valuable reply.

Hi, in my views our technique of anaesthesia should minimally alter the physiology(maintain the basic physilogy). so, regularly using dopamine infusion for hypotension is really questionable. If atall required should be second line of treatment not the preffered.

regards.

Hi, incidence of post extubation throat irritation is quite high even after useing all various methods like lignocaine spray, lignocaine gelly, use of HME filter, adequate size ET tube, monitoring endotracal cuff presser(manually!!!!!).
what is the best way for prevantion?

regards.

Hi, with the availbility of good GA medicine and monitoring equipments, GA is much suppirior then EA+sedation in this situation.
regards.

ST segment mapping intra operative, How much significant?

regards.

what is the significance of QT, QTc and deltaQT?