Regional Anesthesia - Science topic

aprupt discontinuation alcohol or any other drug abuse may confuse with POD

In high risk patients para vertebral block in T2 and T4 level with or without serratus anterior plane block MRM can be done.. should be done under light sedation...

Thoracic epidural is superior among all..

Erector spinae plane block is more safer than Paravertibral block ...

SAP block serratus anterior plane block also a safer option...

Different methods available for recruitment most commonly employed are...

1.High PEEP

2.Prone ventilation

I prefer in plane for precise deposition of drug and to avoid inadvertent complications.

These anecdotes are fun reading, but if you really want to learn how real medical science advanced, and how modern anesthesia evolved during the prelude to WWI, you should read Crile's book "Anoci-Anesthesia" that is available free on the Internet. It is a classic. Crile was a master surgeon and serious researcher who built his own dog laboratory and methodically studied pathophysiology. You should also read the screeds of Ralph Waters, the founder of MD anesthesiology, and the publications of Yandell Henderson, who proved the clinical benefits of CO2.

My personal opinion, I think that any solution including ultrasound gel might be neurotoxic in certain individuals. Depends on many factors.

But if you comply with recommendations (let it dry before puncture, contamination of gloves...) there is only a little evidence to support claims about significant risk. Depends on idividual doctor scrupulous attitude.

Regional anesthesia is safe in such conditions. According to Michael Robinson et al published inBJA Education. https://academic.oup.com/bjaed/article/14/4/171/293792

In theory John Meechan's comments make sense as the effects of the adrenaline as described can increase the delivery of lignocaine to brain. But i am not sure the small amount of epinephrine injected locally (1 in 80,000 adrenaline is 12.5 microgm per ml) can cause a significant systemic effect. 

I am sure you already know that epinephrine added to lignocaine is known to cause local vasoconstriction which helps to minimise the bleeding and also decrease the systemic absorption of lignocaine thus causing decreased plasma levels while improving the depth and duration of block. Hence the actual risks of increased toxicity if there are any as suggested by him hopefully would be nullified. I haven't come across any studies or any other expert opinion to support that there is risk of increased toxicity when combining adrenaline with lignocaine. The confounding factors, i suppose, are the higher dose that is allowable with adrenaline and inadvertent intravascular injection of some of it.  

At the end of the day, the sensible thing to do is to keep the dose to as minimum as possible and exercising caution in detecting and avoiding intravascular spillage especially when using LA combinations in highly vascular areas.   

It is multifactorial, patient side that they are phobic and uncooperative coughing all the time, eye examination before surgery that may affect results postoperatively,surgeon experience also plays an important part.

What is the better anesthesia GA or spinal anesthesia for emergency LSCS

1.Unless very compromised fetal distress and one can give quick spinal anesthesia.

2. GA with intra-uterine fetal resuscitation

NO

Regards

Prof Mo

Was the patient hypotensive for longer time during perioperative period

Anterior spinal artery syndrome

Though chest pain during cesarean section under spinal anesthesia is a common entity, the cause is still obscure and there are several hypothesis. Myocardial ischemia from oxytocin may cause chest pain but this is definitely not a common finding. High thoracic block and inadequate block height are not also the most common reason as there will be other obvious signs.

Hypotension may cause chest pain and it is common after abdominal delivery of the fetus due to hypovolemia, but the more obvious sign will be nausea and vomiting caused by decreased blood supply to chemoreceptor trigger zone (CTZ).

In my personal opinion, the most common cause of chest pain is probably due to peritoneum stretching leading to vagal stimulation. It is specially seen during peritoneal closure (some surgeons still do), uterus manipulation or rough handling of omentum etc. If unattended it can lead to bradycardia and even cardiac arrest. The most effective management is reassurance, sedation and atropine in vagolytic doses.

Again, chest pain under spinal anesthesia is not only unique to C-section, it is also seen during appendicectomy under spinal anesthesia, specially in male appendix probably due to anatomical variability. That is why GA is safer option during appendicectomy,  at least theoretically.

Another explanation of chest pain is microembolism. When uterus is exteriorised and placed above abdomen, microembolism can occur due to concomitant hypotension (hypovolemia following abdominal delivery of fetus) and air entry into microvasculature. This microemboli can lodge in pulmonary circulation leading to chest pain. In support of this theory lies the fact that chest pain is seen in mainly those cases where uterus is exteriorised and placed above abdomen. If surgeons manipulate uterus within abdominal cavity, then the incidence of chest pain is very less. Some anesthesiologists like to administer prophylactic vasopressor beforehand to raise the BP and diminish the chance of microembolism and this technique do actually work!

It is fact that microembolism is definitely a cause for chest pain but this can not explain the occurrence of chest pain during appendicectomy under spinal anesthesia.

Thank you for the suggestion