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%)

Formation of Titanium Nitride, Titanium Carbide, and Silicon Carbide Surfaces by High Power Femtosecond Laser Treatment

Coatings based on titanium nitrides, titanium carbides and silicon carbides can optimize the surface properties of titanium or silicon for various applications ranging from biocompatibility to chemical stability and durability. Here, we investigated a high power (100 W) high pulse repetition rate femtosecond laser process (λ=1030 nm, τ=750 fs, f=1 MHz) for the treatment of titanium and silicon in atmospheres of argon, nitrogen, methane, ethene and acetylene. In a nitrogen atmosphere, a homogeneous coating of TiON is formed on titanium. In an ethene/argon atmosphere coatings of TiOC and SiC are formed on Ti and Si, respectively. The process allows a fast surface transformation with a process rate of 0.33 cm2 s−1 and a high spatial resolution below 0.5 mm with a minimal heat affected zone at the same time. In contrast to low repetition rate femtosecond laser processed samples, the surfaces are more robust against mechanical impact. At the same time, the surfaces reveal a distinct microstructure in comparison to coatings obtained by vapor deposition techniques