International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2018
Theoretical optimal cricothyroidotomy incision length in female subjects, following identification of the cricothyroid membrane by digital palpation.
Misidentification of the cricothyroid membrane is frequent in females, placing them at risk of difficult or failed cricothyroidotomy in the event of failed oxygenation. If anatomy is impalpable, the current guidelines of the Difficult Airway Society, based on expert opinion, recommend an 8-10 cm vertical incision to facilitate access to the cricothyroid membrane. At present no evidence-based guideline exists regarding optimum site or length. We investigated the likelihood of inclusion of the cricothyroid membrane, within hypothetical vertical midline incisions, in a female population. ⋯ Based on clinical estimation of the location of the cricothyroid membrane, an incision length of 8 cm, using the clinician's best estimate as its midpoint, would overlie all cricothyroid membrane locations. Our data support the current Difficult Airway Society guidelines for cricothyroidotomy incision length.
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Int J Obstet Anesth · Nov 2018
Risk factors for post-dural puncture headache following injury of the dural membrane: a root-cause analysis and nested case-control study.
Post-dural puncture headache following trauma to the dural membrane during neuraxial anaesthesia occurs in 0.13-6.5% of pregnant patients. Identifying factors beyond individual performance that contribute to this adverse event is crucial to developing improvement strategies. ⋯ Post-dural puncture headache in this setting is not the result of the individual anaesthetist's characteristics alone. Additional factors including team composition, the presence of obstetrical perinatal pathology, and associated patient's conditions, are also associated with this event. Improvement strategies should consider all these factors.