Article Notes
- 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..."
- 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.
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 retrospective propensity-matched cohort study, used 5 years of data to study 2,644 matched pairs-of-patients with a preoperative diagnosis of severe COPD.
Important exclusions were patients already ventilated, already with pulmonary infections, along with cardiac, emergency & transplant surgery, and those receiving repeat surgery within 30 days.
Receiving general anesthesia was associated with a 43% higher risk of respiratory infection (3.3% vs 2.3%, P = 0.0384), 133% greater risk of prolonged ventilation (2.1% vs 0.9%, P = 0.0008) and 44% greater risk of unplanned post-op intubation (2.6% vs 1.8%, P = 0.0487), when compared with regional anesthesia.
Nonetheless there was no significant mortality difference at 30 days (3.0% vs 2.7%, P = 0.6788).
The mix of regional techniques was 341 epidural, 1713 spinal, and 590 peripheral blocks. Notably, sub-group analysis of epidural-patients showed no difference in pulmonary complications or composite morbidity between epidural and general anesthesia. (Though given relatively small number of epidural patients, this might reflect a lack of power).
This retrospective audit identified an association between the introduction of unrestricted access to sugammadex and a fall in 'anaesthetic theatre time'. Mean hospital stay was also observed to be 0.8 days shorter after introduction of sugammadex, but was not statistically significant after adjusting for confounders.
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)