Anaesthesia
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Comparative Study
Speed of spinal vs general anaesthesia for category-1 caesarean section: a simulation and clinical observation-based study.
Controversy exists as to whether effective spinal anaesthesia can be achieved as quickly as general anaesthesia for a category-1 caesarean section. Sixteen consultants and three fellows in obstetric anaesthesia were timed performing spinal and general anaesthesia for category-1 caesarean section on a simulator. ⋯ The median (IQR [range]) times (min:s) for spinal procedure, onset of spinal block and general anaesthesia were 2:56 (2:32-3:32 [1:22-3:50]), 5:56 (4:23-7:39 [2:9-13:32]) and 1:56 (1:39-2:9 [1:13-3:12]), respectively. The limiting factor in urgent spinal anaesthesia is the unpredictable time needed for adequate surgical block to develop.
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The importance of minimising aortocaval compression during cardiopulmonary resuscitation in late pregnancy is widely accepted. Current European guidelines suggest employing manual displacement of the uterus with left lateral tilt to achieve this. Several methods for producing lateral tilt have been described; however, the optimum method is unknown. ⋯ Chest compressions were least effective with the human wedge (p=0.02). Effectiveness of chest compressions with lateral tilt was comparable to that reported previously in supine manikin studies. We recommend the use of dedicated foam or hard wedges rather than pillows or the human wedge for producing lateral tilt during cardiopulmonary resuscitation.