Anaesthesia
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Three quarters of all critical incidents and a third of all peri-operative cardiac arrests in paediatric anaesthesia are caused by adverse respiratory events. We screened for risk factors from children's and their families' histories, and assessed the usefulness of common markers of allergic sensitisation of the airway as surrogates for airway inflammation and increased risk for adverse respiratory events. One hundred children aged up to 16 years with two or more risk factors undergoing elective surgery were included in the study. ⋯ There was a significant difference (p = 0.001) between the presence of adverse respiratory events in patients with more than four (p = 0.006), compared with less than four (p = 0.001), risk factors. We conclude that while risk factors taken from the child's (or family) history proved good predictors of adverse respiratory events, immunological markers of allergic sensitisation demonstrated low predictive values. Pre-operative identification of children at high risk for an adverse respiratory event should rely on clinical, rather than immunological, assessment.
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Observational Study
The effect of coughing at extubation on oxygenation in the post-anaesthesia care unit.
We prospectively studied 84 patients to investigate whether there is a relationship between coughing during emergence and tracheal extubation, and impaired oxygenation in the post-anaesthesia care unit. Our primary outcome measure was a change in the alveolar-arterial oxygen partial pressure gradient ((A-a)DO2 ) between time A (during general anaesthesia) and time B (1 h after extubation). ⋯ An overall linear regression model was not predictive for the observed change (adjusted R(2) = 0.01, p = 0.31) and nor were any of the individual predictors studied, including subjective cough score (p = 0.33), number of coughs (p = 0.95) and duration of coughing (p = 0.39). Despite the abnormal cough that occurs while tracheally intubated, we have been unable to demonstrate that coughing at extubation is associated with impaired oxygenation in the immediate postoperative period.
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Methods used to assess the height of spinal block before caesarean section vary widely across literature, textbooks and individual anaesthesia practice.
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