General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multi-centre observational study

There are no current descriptions of general anaesthesia characteristics for obstetric surgery, despite recent changes to patient baseline characteristics and airway management guidelines. This analysis of data from the direct reporting of awareness in maternity patients' (DREAMY) study of accidental awareness during obstetric anaesthesia aimed to describe practice for obstetric general anaesthesia in England and compare with earlier surveys and best-practice recommendations. Consenting patients who received general anaesthesia for obstetric surgery in 72 hospitals from May 2017 to August 2018 were included. Baseline characteristics, airway management, anaesthetic techniques and major complications were collected. Descriptive analysis, binary logistic regression modelling and comparisons with earlier data were conducted. Data were collected from 3117 procedures, including 2554 (81.9%) caesarean deliveries. Thiopental was the induction drug in 1649 (52.9%) patients, compared with propofol in 1419 (45.5%). Suxamethonium was the neuromuscular blocking drug for tracheal intubation in 2631 (86.1%), compared with rocuronium in 367 (11.8%). Difficult tracheal intubation was reported in 1 in 19 (95%CI 1 in 16-22) and failed intubation in 1 in 312 (95%CI 1 in 169-667). Obese patients were over-represented compared with national baselines and associated with difficult, but not failed intubation. There was more evidence of change in practice for induction drugs (increased use of propofol) than neuromuscular blocking drugs (suxamethonium remains the most popular). There was evidence of improvement in practice, with increased monitoring and reversal of neuromuscular blockade (although this remains suboptimal). Despite a high risk of difficult intubation in this population, videolaryngoscopy was rarely used (1.9%)

Prediction of the voluntary intake of food by dairy cows: 1. Stall-fed cows in late pregnancy and early lactation

SUMMARYData from 22, 28, 36 and 41 pregnant cows in weeks 4, 3, 2 and 1 before calving respectively and 51, 65, 56 and 36 cows in weeks 1 to 4, 5 to 8, 9 to 12 and 13 to 16 of lactation respectively were used in multiple regression analyses to study the feasibility of predicting the daily total and the roughage organic matter and digestible organic matter intakes of cows given known weights of concentrates plus roughage ad libitum. The digestibility of the total intake and of the roughage component, the weight of concentrates eaten per day, the proportion of roughage in the total intake, age, milk yield, fat-corrected milk yield, live-weight gain and the 1·0, 0·73 and 0·66 exponents of live weight were used as independent variables.The accuracy of the models was assessed from the significance of the partial regression coefficients, the size of the residual standard errors, and the population tolerance limits about predicted values, and by applying selected models to a set of data not included in the study. The results indicated that the precision likely to be achieved in the prediction of intake for individual cows was of limited practical application, but the mean intakes of groups of 30 similar cows could be predicted with an acceptable level of accuracy for practical application. In general, weight of concentrates offered and the digestibility of the roughage were the most effective independent variables in all cows, together with milk yield in lactating cows. The application of the results to conventional feeding systems and to complete diets offered ad libitum is discussed.</jats:p