Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Unanticipated difficulties continue to occur in airway management. While newer systems of evaluation show some promise, the problem of poor predictive value limits their usefulness. ⋯ The anaesthetist should have a clear "fall back" plan of which of these techniques to use in emergency or urgent situations. Published algorithms may aid in the selection of appropriate techniques, but the anaesthetist must also develop dexterity with the particular technique chosen.
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The practice of obstetric anaesthesia can be highly rewarding. The clinician prepared with an understanding of maternal-fetal physiology (obstetric requirements), systemic narcotics, and regional anaesthesia can be highly effective at relieving pain and bringing about a successful delivery. While alternative techniques should always be considered, particularly those that stress childbirth education, continuous lumbar analgesia remains the most flexible and satisfactory approach. While there is new equipment (fine needles and smaller catheters) on the horizon, it remains to be demonstrated if they can match the success and safety record of present lumbar epidural practice.