ABSTRACT
The gene SCN9A encodes for the voltage-gated sodium channel Nav1.7, which is highly expressed in pain sensing neurons. Bi-allelic 'loss of function' mutations result in a channelopathy associated with insensitivity to pain and anosmia. This is the first report of the labour and postpartum outcomes of two sisters who belong to a non-consanguineous Caucasian family with homozygous SCN9A mutations. Neither sister experienced pain during labour; this had major implications for the staff titrating the syntocinon for labour augmentation and contributed towards their ultimate delivery by caesarean section. During the postpartum period, one of the sisters developed lower limb sensory loss and investigations revealed a spinal haematoma and unrecognized bilateral pelvic fractures. The other sister had an uneventful recovery and both babies are well. These case histories underline the importance of pain in labour management and its function in alerting patients and staff to problems during the puerperium.
Subject(s)
Anesthesia, Obstetrical/adverse effects , Anesthesia, Spinal/adverse effects , Cesarean Section , Hereditary Sensory and Motor Neuropathy/physiopathology , Paralysis/etiology , Postoperative Complications/etiology , Adult , Female , Hereditary Sensory and Motor Neuropathy/genetics , Humans , Neurologic Examination , Postpartum Period , Pregnancy , Pressure , Reflex/physiologyABSTRACT
A postal survey of arterial blood sampling practices in 280 intensive care units throughout England and Wales found that very few measures are taken to reduce diagnostic blood loss in adult intensive care patients from arterial sampling. The average volume of blood withdrawn to clear the arterial line before sampling is 3.2 ml; subsequently returned to the patient in only 18.4% of intensive care units. Specific measures to reduce the blood sample size by the routine use of paediatric sample tubes in adult patients occurs in only 9.3% of intensive care units. In paediatric units, the average volume withdrawn was 1.9 ml and this was routinely returned in 67% of units. Some aspects of arterial blood sampling practices identified in this survey may contribute to iatrogenic anaemia in intensive care patients.
Subject(s)
Anemia/prevention & control , Blood Specimen Collection/methods , Intensive Care Units/standards , Nursing Service, Hospital/standards , Adult , Anemia/etiology , Arteries , Blood Specimen Collection/instrumentation , Child , England , Health Care Surveys , Humans , Intensive Care Units/statistics & numerical data , Intensive Care Units, Pediatric/standards , Intensive Care Units, Pediatric/statistics & numerical data , Nursing Service, Hospital/statistics & numerical data , Practice Guidelines as Topic , Surveys and Questionnaires , WalesABSTRACT
A survey of the hospitals with obstetric units within the Anglia and Oxford Region was performed to assess current practices regarding the cleaning of, and use of filters with, Entonox apparatus. The survey revealed that there was no consensus regarding the cleaning of the equipment and, in contrast to anaesthetic machines in which microbiological filters are recommended and in widespread use, only 10% of the hospitals surveyed were using such filters with the Entonox apparatus in their units. Cleaning procedures were changed in 75% of hospitals when dealing with known 'high-risk' patients, the remaining hospitals treating all patients as 'high-risk' or denied caring for such patients. All patients should be protected from potential cross-infection, and the recommendation that a microbiological filter should be placed between patients and the breathing system should be extended to Entonox equipment.
