Article Notes
- Ensuring at least 30 min since last epidural bolus.
- Reducing spinal dose by 20%. (NB: plain bupivacaine used)
- Delay supine positioning for 2 min after spinal performed.
- Northern Territorians are "... three times more likely to die on the roads than people living in other parts of Australia, and at a rate that is equivalent to that in many low- and middle-income countries."
- After the last open speed limits were abolished in 2007, the "Australian road deaths database shows a decrease in fatalities of 3.4 per year on those NT roads..."
An audit of 115 parturients requiring spinal anesthesia for cesarean section in the setting of an inadequate, pre-existing epidural block. Median dose of 9.38 mg of bupivacaine + 15 mcg fentanyl was used. No patients received an epidural bolus within 30 min of their subarachnoid block.
There were no cases of total spinal block.
Because total spinal after inadequate epidurals had been 'not uncommon' in the department, the researchers had altered the department's practice to be:
(Plus patient weight < 120 kg and height > 1.47 m)
A case study describing a total spinal occurring in a 26 year old having an emergency caesarean section for failure to progress.
On arrival in theatre a block to pin prick was noted to T12, with the last epidural top-up having been 90 minutes earlier with only 5 mL of 0.25% bupivacaine. Total volume of epidural LA is not reported.
The epidural had partially dislodged, so anaesthesia was with 10.5 mg of spinal bupivacaine (equivalent to 2.1mL of 0.5%) resulting in a block to T6. 10 minutes later the patient became distressed, followed by respiratory arrest and unconsciousness.
Baby was delivered uneventfully and the mother made a full recovery. The authors ascribed the case to a total spinal resulting from cephalad spread of intrathecal bupivacaine.
A clear and nuanced critique of the Northern Territory government's policy of removing speed limits on sections of the Stuart Highway. Read explores evidence linking driving speed and posted speed limits with vehicle accidents and trauma, noting that for the Territory:
He concludes that the NT needs a stronger road safety package that includes removing unlimited speed limits along with driver fatigue, alcohol and seatbelt interventions.
Crash risk and trauma severity are directly related to vehicle speed and posted speed limit.
This prospective observational study across eight Canadian hospitals identified post-operative residual paralysis in 64% of patients at extubation and 57% on arrival in the PACU, despite more than 70% of patients receiving reversal with neostigmine.
Rocuronium was the muscle relaxant used in 99% of cases.