Prevention and management of intra-operative pain during caesarean section under neuraxial anaesthesia: a technical and interpersonal approach.

A woman who experiences pain during caesarean section under neuraxial anaesthesia is at risk of adverse psychological sequelae. Litigation arising from pain during caesarean section under neuraxial anaesthesia has replaced accidental awareness under general anaesthesia as the most common successful medicolegal claim against obstetric anaesthetists. Generic guidelines on caesarean section exist, but they do not provide specific recommendations for this area of anaesthetic practice. This guidance aims to offer pragmatic advice to support anaesthetists in caring for women during caesarean section. It emphasises the importance of non-technical skills, offers advice on best practice and aims to encourage standardisation. The guidance results from a collaborative effort by anaesthetists, psychologists and patients and has been developed to support clinicians and promote standardisation of practice in this area.

A survey of antenatal and peripartum provision of information on analgesia and anaesthesia.

Pregnant women should receive information about what they might expect to experience during their delivery. Despite this, research shows many women are inadequately prepared for anaesthetic interventions during labour. We surveyed 903 postnatal women across 28 Greater London hospitals about: the analgesic and anaesthetic information that they recalled receiving during pregnancy and delivery; their confidence to make decisions on analgesia; and their satisfaction with the analgesia used. Wide variation was observed between hospitals. Overall, 67 of 749 (9.0%) women recalled receiving antenatal information covering all aspects of labour analgesia, and 108 of 889 (12.1%) covering anaesthesia for caesarean section. Regarding intrapartum information, 256 of 415 (61.7%) respondents recalled receiving thorough information before epidural insertion for labour analgesia, and 102 of 370 (27.6%) before anaesthesia for caesarean section. We found that 620 of 903 (68.7%) women felt well enough informed to be confident in their analgesic choices, and 675 of 903 (74.8%) stated that their analgesia was as expected or better. Receiving information verbally, regardless of provider, was the factor most strongly associated with respondents recalling receiving full information: odds ratio (95%CI) for labour analgesia 20.66 (8.98-47.53; p < 0.0001); epidural top-up for caesarean section 5.93 (1.57-22.35; p = 0.01); and general anaesthesia for caesarean section 12.39 (2.18-70.42; p = 0.01). A large proportion of respondents did not recall being fully informed before an anaesthetic intervention. Collaboration with current antenatal service providers, both in promoting information delivery and providing resources to assist with delivery, could improve the quality of information offered and women's retention of that information.

Towards broad-bandwidth polarization-independent nanostrip waveguide ring resonators.

We demonstrate a new method for accessing the broad-bandwidth polarization-independent operation of a microring resonator based on the standard photonic nanostrip waveguides. The method employs the selective application of atomic layer deposition to form highly uniform TiO(2) overlayers with the specific dispersion properties. The wide operation window is achieved by matching the wavelength dependencies of the free spectral ranges of the two orthogonal polarizations.

Thoracoscopic repair for right congenital diaphragmatic hernia.

PURPOSE: The aim of this study is to describe the surgical technique and initial results of thoracoscopic repair for the right congenital diaphragmatic hernia (CDH). METHODS: Patients underwent surgery under conventional general anesthesia. The operation was carried out by using one optical and two operating trocars. Pleural insufflation with carbon dioxide was maintained at a pressure of 2-4 mm Hg. The hernia defect was repaired by using nonabsorbable interrupted sutures with extracorporeal knots. RESULTS: There were 16 patients, including 13 boys and 3 girls. Six patients were newborns and the other 10 patients were infants or elders. The mean operative time was 82 minutes. Conversion was required in 1 patient. There were no operative or postoperative complications. However, there was one postoperative death. There was one recurrence on postoperative day 39. Follow-up ranged from 2 to 77 months. A normal chest X-ray was shown in all patients. CONCLUSION: Thoracoscopic repair is feasible and safe for children with a right CDH, including selected newborns.

Circadian phase-shifted rats show normal acquisition but impaired long-term retention of place information in the water task.

It is thought that circadian rhythms may influence learning and memory processes. However, research supporting this view does not dissociate a mnemonic impairment from other performance deficits. Furthermore, published reports do not specify the type of memory system influenced by the circadian system. The present study assessed the effects of phase shifting on acquisition and expression of place navigation in the water maze, a task sensitive to hippocampal dysfunction. The results showed that phase-shifting circadian rhythms in rats impaired the expression of place information on a retention test but not initial acquisition or encoding of place information. These results suggest that disruption of circadian rhythms may impair consolidation of previously encoded hippocampal place information.