Anaesthesia
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Comparative Study
Point-of-care testing apparatus. Measurement of coagulation.
Point-of-care testing of coagulation parameters provides a more rapid assessment of test results compared with laboratory testing. A new coagulation monitor (GEM PCL, Instrumentation Laboratory, Kirchheim, Germany) was evaluated. Point-of-care data for activated partial thromboplastin time and prothrombin time (expressed as the international normalised ratio) and turn-around-time were compared. ⋯ The point-of-care and laboratory test results showed a bias (SD) of -0.26 (4.55) s for activated partial thromboplastin time and -0.011 (0.150) s for prothrombin time. The average turn-around-time was 3 min for point-of-care testing vs. 52 min for laboratory testing. We conclude that the reliability of point-of-care testing is sufficient for clinical use.
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Case Reports
False-positive epidural catheter aspiration tests in needle through needle combined spinal-epidural anaesthesia.
We describe two separate episodes of free aspiration of clear fluid through epidural catheters during needle-through-needle combined spinal-epidural anaesthesia in the lateral position. Although both catheters were assumed to have been located intrathecally, both subsequently gave negative test doses and were used as epidural catheters. In the second patient, the position of the catheter was investigated using contrast spiral computerised tomography scanning, which showed epidural contrast spread only. This is the first time such an occurrence has been recognised, and we consider its significance for catheter site confirmation testing in combined spinal-epidural anaesthesia.