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%)

"In questo", il teatro gli scenari della commedia dell'arte "In this", the theater and the scenery of the commedia dell'arte

Il segreto della commedia dell'arte è stato nel paradosso di Maschera e Improvvisazione, Tipo Fisso e Testo Variabile, Conservazione e Innovazione. Per questo è stato nei secoli esaltata o denigrata: considerata reazionaria dalla Rivoluzione francese e esaltata come rivoluzionaria dai Romantici. Nel Novecento, Copeau, Mejerchol'd, Mnouchkine e Fo hanno dovuto fare i conti con questa ambivalenza. Dunque ciò che oggi si chiama commedia dell'arte è "reazionario" o "rivoluzionario"? "Popolare"o "populista"?<br>The secret of the Commedia dell'Arte lies in the paradox between Mask and Improvisation, Fixed Character and Variable Text, Conservation and Innovation. Therefore along the centuries it has been exalted or vilified: considered as reactionary during the French revolution and praised by the romantics. In the 20th century Copeau, Meierhold, Mnouchkine and Fo faced this ambivalence. Is that which is today called commedia dell'arte "reactionary" or "revolutionary"? "Popular" or "populist"