Difficult and failed intubation in 3430 obstetric general anaesthetics.

A retrospective audit was performed of all obstetric general anaesthetics in our hospital over an 8 year period to determine the incidence of difficult and failed intubation. Data was collected from a number of sources to ensure accuracy. A total of 3430 rapid sequence anaesthetics were given. None of the patients had a failed or oesophageal intubation (95% CI, 0-1:1143). There were 23 difficult intubations (95% CI, 1:238-1:100). This was anticipated in nine cases, requiring awake fibreoptic intubation in three cases. Consultants or specialist registrars were involved in the management of all cases. We attribute the low incidence of airway complications to the above average rate of general anaesthesia in our hospital, senior cover and specialised anaesthetic operating department assistants.

Comparison of intrathecal fentanyl and diamorphine in addition to bupivacaine for caesarean section under spinal anaesthesia.

BACKGROUND: Co-administration of small doses of opioids and bupivacaine for spinal anaesthesia reduces intraoperative discomfort and may reduce postoperative analgesic requirements in patients undergoing Caesarean section. Fentanyl and diamorphine are the two most frequently used agents in UK obstetric anaesthetic practice. METHODS: Seventy-five healthy parturients scheduled for elective Caesarean section under spinal anaesthesia using hyperbaric 0.5% bupivacaine, were randomly allocated to additionally receive intrathecal fentanyl 20 micrograms, diamorphine 300 micrograms or 0.9% saline. Patients also received i.v. cyclizine and rectal diclofenac. RESULTS: Less supplementary intraoperative analgesia was required by patients in either opioid group (4%) compared with the control (32%) (P < 0.05). Twenty four hours after spinal injection, total mean (SD) postoperative morphine requirement was significantly lower if diamorphine was administered (31 (21) mg), in comparison with the other two groups (control 68 (26) mg; fentanyl 62 (26) mg) (P < 0.05). Reduced visual analogue pain scores were evident 12 h following diamorphine, but observed only for 1 h after fentanyl when compared with the control (P < 0.05). Mild pruritus was more common for 2 h after either spinal opioid (P < 0.05), but no inter-group differences were observed for the remainder of the first 24 h. Patients displayed deeper levels of sedation both acutely and 12 h after administration of intrathecal fentanyl (P < 0.05). CONCLUSIONS: Both intrathecal opioids reduce intraoperative discomfort, but only diamorphine reduced postoperative analgesic requirement beyond the immediate postoperative period.

Sedation and analgesia for transvaginal oocyte retrieval: an audit resulting in a change of clinical practice.

The aim was to audit the standard of care at oocyte retrieval with respect to the analgesia used. Before June 1999, a combination of intramuscular pethidine and prochlorperazine was given as a single dose. Many women found this to be unsatisfactory and requested general anaesthesia for subsequent oocyte retrievals. An intravenous sedation and analgesia regimen was introduced using a combination of midazolam and fentanyl. The introduction of this regimen was audited and compared with the established regimen. This study describes the experience with this technique, its patient acceptability, safety and cost implications.

Intrapartum epidural catheter migration: a comparative study of three dressing applications.

We compared three types of catheter fixation application for their ability to minimize the incidence and magnitude of epidural catheter movement during labour. Patients were randomized to have their epidural catheter secured by a Tegaderm dressing (group T; n = 35), a Tegaderm dressing plus filter-shoulder fixation (group F; n = 39), or a Niko Epi-Fix dressing (group N; n = 37). The length of catheter visible at the patient's skin surface was recorded (to the nearest 0.5 cm) after insertion and before removal; the difference was defined as 'catheter movement'. Outward movement of the catheter was greatest when a Niko Epi-Fix was used (P < 0.01). Concerning minimization of displacement of the epidural catheter per se, only a Tegaderm dressing with additional filter-shoulder fixation proved more effective than using a Niko Epi-Fix dressing (P < 0.05).