Is Remifentanil a Safe and Effective Alternative to Neuraxial Labor Analgesia? It All Depends

(Anesth Analg. 2014;118(3):491–493

Hemorrhagic stroke following elective cesarean delivery

We present a case of hemorrhagic stroke after cesarean delivery under combined spinal-epidural anesthesia in an 35-year-old Hispanic patient treated with anticoagulants for protein C deficiency. She required vasopressor therapy for intraoperative hypotension and developed severe headache immediately after administration. To our knowledge, this is the first case of stroke occurring in a pregnant woman following vasopressor therapy for spinal anesthesia-induced hypotension. Although the exact cause of her hemorrhagic stroke is uncertain, the hypertensive response that may have led to the hemorrhagic stroke occurred following administration of commonly used doses of vasopressor agents. We discuss the possible causes of stroke

Using embedded simulated persons (aka "confederates")

From the perspective of a simulation program the effectiveness of a training program may be seen as the product of three components: the training platform, the skills of the educators, and the curricular integration (Issenberg, 2006). If any of these components is missing or deficient, the overall result will be diminished, and effective training may not occur. For example, it is not uncommon for an institution to purchase an expensive simulator only to see it sit unused because the faculty and staff are not adequately trained in the use of the equipment or the proper methods to integrate simulation into healthcare education. One group of simulation staff for which proper training is vital is that of embedded simulated persons (ESPs), also known as simulation confederates. Simulation programs that lack training and assessment of ESPs do their learners and their programs an injustice, robbing them of the full spectrum of engagement and learning that can take place in a well-rehearsed, well-rounded, and well-acted simulation experience. This chapter provides 10 recommendations aimed at improving the performance of all levels of ESPs from novice to experts, as well as enhancing the effectiveness of scenario coordinators who guide ESPs scenario production personnel who interact with ESPs and simulation center directors who employ ESPs. Using these recommendations will help to develop and improve clinical training programs. © 2015 Society for Simulation in Healthcare (SSH). All rights reserved

Duration of analgesia and pruritus following intrathecal fentanyl for labour analgesia: no significant effect of A118G μ-opioid receptor polymorphism, but a marked effect of ethnically distinct hospital populations

(Br J Anaesth. 2013;111(3):433–444

Ultrasound Assessment of the Vertebral Level of the Intercristal Line in Pregnancy

(Anesth Analg. 2011;113(3):559–64