British journal of anaesthesia
-
We report a case of "crack" cocaine abuse in a pregnant patient associated with haematuria, proteinuria, haemolytic anaemia, renal impairment, thrombocytopenia and pulmonary oedema. The case illustrates the problems for clinicians where unrecognized cocaine abuse interferes with the diagnosis and management of a complicated pregnancy. In addition, we discuss the principles for the safe conduct of anaesthesia in the pregnant cocaine abuser.
-
We report a case of moyamoya disease in a patient presenting for Caesarean section at 37 weeks' gestation. Extradural anaesthesia was administered using 0.5% bupivacaine and pethidine 25 mg. A stable haemodynamic state was produced using left lateral uterine displacement, i.v. crystalloids and an i.v. infusion of ephedrine. The patient suffered no neurological deficit and there was no significant intraoperative decrease in cerebral oxygenation measured by near infrared spectroscopy.
-
Using an airway management training model, we have assessed anaesthesia personnel in their use of correct cricoid force and ability to retain this skill after a short training programme. A perspex device, working on a hydraulic principle, was used to measure cricoid pressure when applied to the model. After initial assessment at two levels of cricoid force (20 and 40 N), participants undertook additional training on 3 consecutive days. ⋯ This trend improved after training. We conclude that the majority of untrained personnel apply inadequate cricoid force, placing patients at risk of aspiration of gastric contents. While a simple training programme improved application of cricoid force, retained for up to 3 weeks, there was often a substantial decrease in the force applied to the cricoid during a single application, even after training.