Anaesthesia
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The 2003-2005 Confidential Enquiry into Maternal and Child Health report recommended the introduction of the modified early obstetric warning system (MEOWS) in all obstetric inpatients to track maternal physiological parameters, and to aid early recognition and treatment of the acutely unwell parturient. We prospectively reviewed 676 consecutive obstetric admissions, looking at their completed MEOWS charts for triggers and their notes for evidence of morbidity. Two hundred patients (30%) triggered and 86 patients (13%) had morbidity according to our criteria, including haemorrhage (43%), hypertensive disease of pregnancy (31%) and suspected infection (20%). ⋯ There were no admissions to the intensive care unit, cardio respiratory arrests or deaths during the study period. This study suggests that MEOWS is a useful bedside tool for predicting morbidity. Adjustment of the trigger parameters may improve positive predictive value.
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To provide further evidence for the lipid sink theory, we have developed an in vitro model to assess the effect of Intralipid® 20% on methaemoglobin formation by drugs of varying lipid solubility. Progressively increasing Intralipid concentrations from 4 to 24 mg.ml⁻¹ suppressed methaemoglobin formation by the lipid soluble drug glyceryl trinitrate in a dose-dependent manner (p < 0.001). ⋯ Intralipid did not significantly suppress methaemoglobin formation induced by 2-amino-5-hydroxytoluene (partially lipid soluble) or sodium nitrite (lipid insoluble; both p > 0.5). This work may assist determination of the suitability of drugs taken in overdose for which Intralipid might be deployed.
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We examined the light intensity delivered by the Trachlight™ reusable lightwand and the effect of repeated sterilisation on this light intensity. Using a light meter and test chamber, the light intensity of 12 new Trachlights and 31 Trachlights available in operating theatres was measured. In addition, five new devices underwent 30 repeated sterilisations with light intensity measurement after each cleaning. ⋯ The median (range) number of uses for devices currently in service was only 3 (0-9). There was, however, significant light intensity loss after 10, 20 and 30 cleanings (p = 0.001). After 10 cleanings, the mean light intensity was 75% of initial output, and after 30 cycles, light intensity was 59% of initial output.