Anaesthesia
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Patients undergoing anaesthesia in which the laryngeal mask airway was used were prospectively audited over a 6-month period. A simple record sheet was completed at the time of anaesthetic administration and 2359 completed forms were analysed to assess problems encountered with its use. It was used successfully in 2350 patients (99.61%); of these, 1399 patients (59%) breathed spontaneously through the airway and 960 patients (41%) underwent intermittent positive pressure ventilation of the lungs. Two patients (0.08%) were reported to have regurgitated during the use of the laryngeal mask airway, but no serious sequelae associated with its use were encountered.
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A potentially serious complication of epidural bupivacaine used for a repeat, elective Caesarean section is presented. The main features of this reaction were erythema, itching, generalised and pulmonary oedema. In addition, pulmonary oedema was subsequently noted in the baby. An immunological hypersensitivity to bupivacaine or lignocaine is the likely cause.
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A postal survey of all maternity units in the United Kingdom was conducted to gain information regarding policies for epidural analgesia for labour. The average epidural rate was 19.7% and 78% of units offered a 24-h service. The majority of units inserted the epidural with the patient in the lateral position, using a midline approach, with loss of resistance to air and saline being used almost equally. ⋯ Midwife top-ups were allowed in 75% of units and in only 14% of cases was this from a local anaesthetic reservoir. Epidural analgesia using a continuous infusion of anaesthetic was routinely used in 28% of units, mostly with 0.125% bupivacaine; about half of these units did so because midwives were unable to perform top-ups. Routine use of epidural opioids was most frequent when anaesthetic infusions were used, otherwise it was uncommon.
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In a controlled study, gastric emptying was measured during the three trimesters of pregnancy and after delivery, using an indirect paracetamol absorption technique. The peak plasma paracetamol concentration, time to reach the peak, and the area under the plasma paracetamol concentration-time curve, were determined. ⋯ Gastric emptying was significantly delayed in mothers within 2 h after delivery (p < 0.01); median (range) values of peak paracetamol concentration, time to reach the peak and the area under the paracetamol concentration-time curve for this group were 12.5 (0.2-30.5) mg.l-1, 120 (30-120) min and 3.8 (0.1-16.6) mg.l-1 x h respectively, and 20.8 (8.6-64.5) mg.l-1, 40 (10-120) min and 13.5 (5.5-28.8) mg.l-1 x h respectively, for the nonpregnant control group (p < 0.01). Repeated measurements of gastric emptying in these women on the second postpartum day showed no significant delay.
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The critical incident technique was introduced as an additional form of quality assurance to an anaesthetic department of a major Hong Kong teaching hospital. In one year, 125 critical incidents were reported from over 16,000 anaesthetics. The most common incidents reported concerned the airway, breathing systems, and drug administration, with inadequate checking of equipment a frequent associated factor. ⋯ Half of the incidents were detected by the anaesthetist and one third by monitoring equipment. Although there were improvements in anaesthetic care as a consequence of increased vigilance, critical incidents still occurred. Critical incident reporting highlighted problems not otherwise covered by case and peer reviews, and complemented our quality assurance programme.