What mothers know, and want to know, about the complications of general anaesthesia.

BACKGROUND: Informed consent should be sought when performing anaesthesia on pregnant patients. There is no standard for consent for general anaesthesia on the delivery suite. This study was designed to assess post-partum women's awareness of the complications of general anaesthesia and the level of risk at which they felt these risks should be discussed. METHODS: One hundred and fifty parturients from two London hospitals who had undergone uncomplicated vaginal deliveries were asked on the first post-partum day about their knowledge of the potential complications of general anaesthesia for obstetrics. They were also asked about the level of risk at which they would wish to be informed before consenting to a general anaesthetic procedure. RESULTS: The knowledge of the risks of general anaesthesia among the parturients was poor, with awareness, allergy, nausea and vomiting being known by over 50%. Knowledge of difficult intubation and its consequences, dental damage, malignant hyperpyrexia and suxamethonium apnoea was known by less than 30% of the respondents. The level of risk at which mothers felt they should be informed was variable, with 50% wishing to know all risks up to 1 : 1000, and 19% wishing to know risks of greater than 1 : 1,000,000. All known risks were wished by nearly 30% of those questioned. CONCLUSIONS: Anaesthetists must be flexible when providing information to mothers about general anaesthesia and should provide more information to mothers if they wish it.

Abstracts and papers published in the International Journal of Obstetric Anesthesia since inception.

BACKGROUND: Since the International Journal of Obstetric Anesthesia (IJOA) was first published in 1991, barriers to conducting and publishing research in the UK have increased, as has the pressure to improve practitioners' curricula vitae. We speculated that the type and geographical origin of abstracts and papers published in IJOA might reflect these changes. METHODS: We analysed all substantive papers and Obstetric Anaesthetists' Association abstracts published in IJOA, using online access. Full articles and abstracts were categorised and the location of the submitting hospital recorded. Those published in the period 1991-99 inclusive were compared with those in 2000-08. RESULTS: A total of 890 substantive papers were reviewed, 387 in 1991-99 and 503 in 2000-08. We found non-significant changes (P = 0.065) in the type of paper between the two time periods; the number (proportion) of observational studies increased from 178 (46%) to 256 (51%), respectively, while randomised and non-randomised interventional trials remained similar. Changes in geographical origin were also not significant (P = 0.17), with most coming from the UK and outside Europe. Non-UK European papers accounted for only 54 (14%) and 65 (13%), respectively. Abstract numbers have increased greatly, from 190 in 1991-99 to 702 in 2000-08, with increases in all categories but a doubling of the proportion of observational studies and a reduced proportion of interventional trials: observational 17% and 34% respectively; randomised 23% and 13% respectively; and non-randomised interventional 29% and 26% respectively (P < 0.0001). Most abstracts were from the UK although this proportion fell from 92% in 1991-99 to 86% in 2000-08, whilst those from non-UK European countries and the rest of the world increased (respectively 2% and 6% in 1991-99; 7% and 8% in 2000-08; P = 0.001). CONCLUSION: Substantive papers and abstracts show different trends but observational studies are the most frequent type in both forms of presentation. Trends in abstracts suggest a decrease in the proportion of randomised controlled trials, although the absolute numbers of interventional trials has increased. Non-UK European papers and abstracts are relatively few compared with those from the UK and rest of the world.

Forces required to remove bougies from tracheal tubes.

Following a critical incident on our labour ward, we investigated the forces required to remove different bougies from different tracheal tubes and the effect of lubrication on ease of removal. Two studies were conducted: firstly examining the differences between six different bougies with a standard tracheal tube, and secondly examining the differences between four different tracheal tubes with a standard bougie. The forces varied amongst both the different bougies (p < 0.0001) and the different tracheal tubes (p < 0.0001). Removal was generally easier with lubrication but when corrected for multiple comparisons this did not reach statistical significance.

The TEG vs the ROTEM thromboelastography/thromboelastometry systems.

We have evaluated the TEG thromboelastograph and the ROTEM thromboelastometer, two point-of-care devices that measure blood coagulation. During a one-week period, seven consultant anaesthetists, one consultant haematologist, one associate specialist anaesthetist and two senior trainee anaesthetists were trained by the manufacturers and set up, calibrated and used both systems, after which their views were obtained and specific technical/support information was sought from the manufacturers using a questionnaire. Although the devices shared common features, they differed in complexity and aspects of ease of use, and in their purchase and running costs.