ABSTRACT
In vitro testing of spinal needles is intended to identify a best buy, but such tests are not necessarily good indicators of clinical performance and some bench tests appear to conflict with mock clinical assessments. Discrepancies can be explained by examining the role of the hub. The Visual Probability Test, which assesses the needle as a complete unit, would appear to be more useful than the more complex measurements of shaft flow. Not all needle manufacturers use the same gauge, creating confusion when comparisons are made. Packaging frequently fails to give adequate information. Changes in hub design could permit earlier identification of dural puncture.
Subject(s)
Anesthesia, Spinal/instrumentation , Needles , Equipment Design , Humans , RheologyABSTRACT
A 30-gauge spinal needle was evaluated for Caesarean section, using a combined epidural/spinal technique, in 50 mothers. Spinal anaesthesia failed in six mothers and was inadequate in another six. General anaesthesia was required on one occasion. A 25% overall failure rate suggests that a 30-gauge needle is not a practical proposition for routine clinical practice.
Subject(s)
Anesthesia, Obstetrical/instrumentation , Anesthesia, Spinal/instrumentation , Cesarean Section , Needles , Adult , Anesthesia, Epidural/instrumentation , Anesthesia, Spinal/adverse effects , Female , Headache/etiology , Headache/prevention & control , Humans , Postoperative Complications/prevention & control , PregnancyABSTRACT
A case is reported of a pneumomediastinum which presented as an unexplained dysrhythmia during a routine general anaesthestic in a previously fit 19-year-old girl. The possible precipitating factors in this case are discussed along with a description of the signs and symptoms and an outline of its management.
Subject(s)
Anesthesia, General/adverse effects , Mediastinal Emphysema/etiology , Adult , Female , HumansABSTRACT
Pain, analgesic requirements, mouth opening and emesis were assessed in 60 patients who received either piroxicam 40 mg or placebo before dental surgery under general anaesthesia which included breathing either halothane or isoflurane. Patients went home on the day after surgery and completed a questionnaire concerning pain and emesis. There were four groups of 15 subjects: piroxicam-halothane, piroxicam-isoflurane, placebo-halothane or placebo-isoflurane. Pain increased at 2 and 4 h and had reduced by 18 h after surgery; there were no significant differences between the groups in pain scores. After operation, fewer patients in the piroxicam-isoflurane group required papaveretum compared with the piroxicam-halothane and placebo-halothane groups. Mouth opening was reduced between 2 and 4 h after surgery, but was less restricted after piroxicam-isoflurane than placebo-halothane. There was no difference between the groups in the incidence of emesis within 18 h of surgery. The postal questionnaire suggested that pain and emesis were reduced significantly during the 3 days after surgery in patients who had received piroxicam before surgery, compared with those who had received placebo.
Subject(s)
Anesthesia, Dental , Halothane , Isoflurane , Piroxicam/administration & dosage , Preanesthetic Medication , Adult , Anesthesia, Inhalation , Double-Blind Method , Female , Humans , Male , Pain, Postoperative/prevention & control , Tooth ExtractionABSTRACT
This survey reviews the structure and content of all anaesthetic record charts in use in the 40 hospitals of the Yorkshire Regional Health Authority in the light of previous recommendations. Twenty-two different anaesthetic charts were used by 290 anaesthetists in this region. Some of the charts did not meet the ideal standard for size (A4) and the majority had no colour coding. Fourteen of the 22 charts omitted important headings concerned with patient identification and eight charts did not provide a record of the whole perioperative period. Some comprehensive forms are in use, chiefly in smaller hospitals, but there have been few changes in design in the last 10 years despite increasing medicolegal awareness.
Subject(s)
Anesthesiology , Medical Records , England , Forms and Records Control , Humans , Medical Records/standardsABSTRACT
A 30-year-old woman developed severe chest pain while out shopping and was admitted to the delivery suite. She was 38 weeks pregnant with her second child. A diagnosis of myocardial infarction was made and cardiac arrest occurred shortly afterwards. She went into spontaneous labour 30 hours later and was delivered vaginally. This report reviews myocardial infarction in pregnancy and considers the clinical management of this patient.
Subject(s)
Myocardial Infarction/therapy , Pregnancy Complications, Cardiovascular/therapy , Adult , Anesthesia, Epidural , Anesthesia, Obstetrical , Delivery, Obstetric , Female , Heart Arrest/etiology , Heart Arrest/therapy , Humans , Infant, Newborn , Labor, Obstetric , Pregnancy , Pregnancy Trimester, ThirdABSTRACT
This study was carried out in 30 patients undergoing elective Caesarean section to assess the predictability and reliability of spinal anaesthesia with 5% hyperbaric lignocaine, with a view to incorporating the technique in our failed intubation drill. The spinal was performed with a 25-gauge needle in either the sitting (15 patients) or left lateral position (15 patients). The speed of onset of anaesthesia to T6 was significantly faster (p less than 0.01) in the lateral group, but the duration of action was similar in both groups. Twelve patients had hypotension and four developed severe postspinal headaches. The block progressed to the C2 dermatome in four patients and was associated with dysphagia. This was totally unpredictable and may be due to altered cerebrospinal fluid dynamics in late pregnancy. Therefore, the use of spinal anaesthesia with heavy lignocaine may be inadvisable in obstetric patients, especially following failed intubation.
