Anaesthesia
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Editorial Comment
Safety in anaesthesia: reporting incidents and learning from them.
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Multicenter Study
Availability of lipid emulsion in obstetric anaesthesia in the UK: a national questionnaire survey.
There is evidence that administration of lipid emulsion improves outcome in cardiovascular collapse secondary to local anaesthetic toxicity. We sent a questionnaire to the lead consultant anaesthetist in every consultant-led labour ward in the UK asking about local guidelines for treatment of cardiac arrest, and whether or nor lipid emulsion was available on the labour ward and included in the guideline. We received replies from 195 (86%) labour wards. ⋯ Of the 95 labour wards where lipid emulsion was readily available, 80 (84%) had a recommended dose regimen for its administration. Around three-quarters of labour wards in the UK either have lipid emulsion available or plan to obtain it. This uptake should ideally be 100%.
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Review Case Reports
Subarachnoid haematoma after spinal anaesthesia mimicking transient radicular irritation: a case report and review.
I report a patient with a spinal subarachnoid haematoma after difficult spinal anaesthesia who presented with symptoms of radicular irritation, and who recovered with conservative management. Subarachnoid haematoma is rare after spinal anaesthesia; a literature review found nine cases. ⋯ Other risk factors included antiplatelet and anticoagulant therapy, and direct spinal cord trauma. All the previous cases required decompressive laminectomy.
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Randomized Controlled Trial
The effect of bolus administration of remifentanil on QTc interval during induction of sevoflurane anaesthesia.
Stimulation of the sympathetic nervous system associated with tracheal intubation causes corrected QT (QTc) interval prolongation. We postulated that the use of remifentanil during induction of anaesthesia might prevent this. ⋯ The QTc interval was significantly prolonged immediately following intubation in group S and group R0.5, but it remained stable in group R1.0, compared with the QTc interval just before laryngoscopy. It is concluded that the administration of remifentanil 1.0 microg x kg(-1) before intubation can prevent the prolongation of the QTc interval associated with tracheal intubation during induction of anaesthesia with sevoflurane.