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"Anaesthetists may feel justified in using a high lumbar interspace for spinal anaesthesia when it is condoned by so many texts, but more caution must be exercised. The L2/3 interspace should not be an option, and several textbooks need to be re-written to allow for human variability."
Reynolds F. Logic in the safe practice of spinal anaesthesia. Anaesthesia. 2000 Nov 1; 55 (11): 1045-6.
  Daniel Jolley
pearl
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Anaesthetists are inaccurate when identifying lumbar spinal interspace level using bony landmarks.
Broadbent CR, Maxwell WB, Ferrie R et al. Ability of anaesthetists to identify a marked lumbar interspace. Anaesthesia. 2000 Nov 1;55(11):1122-6.
  Daniel Jolley
summary
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When anaesthetists were assessed on their ability to correctly identify a lumbar interspace level in 100 patients undergoing spinal MRI:
• Only 29% identified the space correctly.
• 68% indicated the space was lower than actual.
• 51% were one space out in their estimate.
• 15.5% two spaces.
• 1% three spaces.
• 0.5% four spaces.
Broadbent CR, Maxwell WB, Ferrie R et al. Ability of anaesthetists to identify a marked lumbar interspace. Anaesthesia. 2000 Nov 1;55(11):1122-6.
  Daniel Jolley
comment
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And surprising to no obstetric anaesthesiologists... 🤔🙄
"...we have a case in our series in which a woman suffering from postpartum paraesthesia attempted a claim against the anaesthetist although she had received neither epidural nor spinal anaesthesia!
It is often only when an anaesthetic medicolegal opinion is sought that the obstetric nature of the injury is appreciated."
McCombe K Bogod DG. Learning from the law. A review of 21 years of litigation for nerve injury following central neuraxial blockade in obstetrics. Anaesthesia. 2020 Apr 1; 75 (4): 541-548.
  Daniel Jolley
pearl
1
Among a prospective French obstetric cohort, 1 in 300 women demonstrated postpartum neuropathy, most commonly primiparous, sensory and in femoral nerve territory.
Tournier A, Doremieux AC, Drumez E et al. Lower-limb neurologic deficit after vaginal delivery: a prospective observational study. Int J Obstet Anesth. 2020 Feb 1; 41: 35-38.
  Daniel Jolley
pearl
1
Duration of pre-operative fasting in children is associated with increased risk of post-induction hypotension.
Simpao AF, Wu L, Nelson O et al. Preoperative Fluid Fasting Times and Postinduction Low Blood Pressure in Children: A Retrospective Analysis. Anesthesiology. 2020 Sep 1; 133 (3): 523-533.
  Daniel Jolley
pearl
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A restrictive transfusion strategy in adult cardiac surgery does not alter mortality or complications.
Kashani HH, Lodewyks C, Kavosh MS et al. The effect of restrictive versus liberal transfusion strategies on longer-term outcomes after cardiac surgery: a systematic review and meta-analysis with trial sequential analysis. Can J Anaesth. 2020 May 1; 67 (5): 577-587.
  Daniel Jolley
pearl
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Legal responses to obstetric neuraxial complications are best minimised by respecting patient autonomy, early provision of information, good communication and record-keeping.
McCombe K Bogod DG. Learning from the law. A review of 21 years of litigation for nerve injury following central neuraxial blockade in obstetrics. Anaesthesia. 2020 Apr 1; 75 (4): 541-548.
  Daniel Jolley
pearl
1
Maternal sedation with local anaesthetic infiltration is comparable to spinal anaesthesia for women undergoing minimally-invasive fetal surgery, and in fact improves maternal hemodynamic stability.
Ferschl MB, Feiner J, Vu L et al. A Comparison of Spinal Anesthesia Versus Monitored Anesthesia Care With Local Anesthesia in Minimally Invasive Fetal Surgery. Anesth. Analg. 2020 Feb 1; 130 (2): 409-415.
  Daniel Jolley
pearl
1
New guidelines for paediatric button battery ingestion recommend preoperative administration with honey and/or sucralfate, and post-removal irrigation with 0.25% acetic acid.
Hoagland MA, Ing RJ, Jatana KR et al. Anesthetic Implications of the New Guidelines for Button Battery Ingestion in Children. Anesth. Analg. 2020 Mar 1; 130 (3): 665-672.
  Daniel Jolley