A survey of practice of rapid sequence induction for caesarean section in England.

BACKGROUND In view of newer techniques of preoxygenation and laryngoscopy and recent obstetric guidelines concerning the management of difficult intubation, we aimed to evaluate the current practice of rapid sequence induction for caesarean section in England. METHODS In 2017, 316 questionnaire surveys were posted to all 158 hospitals with caesarean section capabilities in England. At each hospital, one questionnaire was to be completed by the obstetric anaesthetic consultant lead and one by an anaesthetic trainee. Differences in responses between consultants and trainees, regardless of their place of work, were compared for all data using the chi-square and the Fisher's exact tests. RESULTS One-hundred-and-eighty complete questionnaires were returned, with an overall response rate of 57%, 98 (54%) from obstetric anaesthetic consultant leads and 82 (45.6%) from trainees). Both head up (57%) and ramped (56%) were the preferred positions for preoxygenation. Less than half of respondents (43%) preoxygenated until the surgeon was scrubbed. Cricoid pressure was used by almost all respondents (98%). Thiopentone (67%) was the most commonly chosen anaesthetic induction agent and most respondents (82%) supported a change to the use of propofol. Suxamethonium (92%) was the neuromuscular blocker of choice but more than half the respondents (52%) supported a change to rocuronium. In the event of a failed intubation, the rescue supraglottic airway device of choice was the i-gel® (65%). CONCLUSIONS Our survey demonstrated the significant variation in the practice of rapid sequence induction for caesarean section in obstetrics in the United Kingdom

Concesión de socorro al capitán don Ricardo Fanin por cuenta de lo adeudado a los capitanes don Ricardo Fanin y don Duarte Dalon

Fecha del documento: 1662-10-15. 4 páginasCédula real a don Juan de Góngora para que se libre por el Consejo de Hacienda 2.000 reales al capitán don Ricardo Fanin por cuenta de lo que se quedó debiendo a los capitanes don Ricardo Fanin y don Duarte Dalon, difuntos, para pagar algunas deudas. El Consejo de Hacienda resuelve, en 23 de octubre de 1662: "Justificando en fincas de rentas". Hecha. Certificación de don Antonio Ortiz de Velasco, caballero de Santiago y veedor general del ejército de Extremadura, y de Gerónimo Gallo, contador, de que don Diego Fanin sirvió más de ocho años en él, primero como capitán de infantería reformado y después como capitán de compañía de corazas, de lo que se le restaba debiendo a su muerte 4.305 reales y 23 mrs. Igualmente se certifica que al capitán don Duarte Daton, que sirvió algo más de cuatro años, primero en la compañía de caballos del capitán Diego Fanin y después en la de infantería irlandesa del tercio que fue del maestre de campo don Bernardo Fix Patricio, se le restaban debiendo a su muerte 3.600 reales y 2 mrs. (Badajoz, 15 de enero de 1661).Proyecto Proyección Política y Social de la Comunidad Irlandesa en la Monarquía hispánica y en la América Colonial de la Edad Moderna(siglos XVI-XVIII) (HAR2009-11339 - subprograma HIST) del Ministerio de Economía y Competitividad en colaboración con el Consejo Superior de Investigaciones Científicas (CSIC), Embajada de Irlanda en Madrid, National University of Ireland (NUI) Maynooth, University College Dublin y Trinity College DublinFelipe IVJuan de GóngoraNo2.000 realesNoN

Front of neck access : a survey among anesthetists and surgeons

Background and Aims: Emergency front of neck access (FONA) is the final step in a Can't Intubate–Can't Oxygenate (CICO) scenario. In view of maintaining simplicity and promoting standardized training, the 2015 Difficult Airway Society guidelines recommend surgical cricothyroidotomy using scalpel, bougie, and tube (SBT) as the preferred technique. Material and Methods: We undertook a survey over a 2-week period to evaluate the knowledge and training, preferred rescue technique, and confidence in performing the SBT technique. Data were collected from both anesthetists and surgeons. Results: One hundred and eighty-nine responses were collected across four hospitals in the United Kingdom. The majority of participants were anesthetists (55%). One hundred and eleven (59%) respondents were aware of the national guidelines (96.2% among anesthetists and 12.9% among surgeons). Only 71 (37.6%) respondents indicated that they had formal FONA training within the last one year. Seventy-five anesthetists (72.8%) knew that SBT equipment was readily available in their department, while most surgeons (81.2%) did not know what equipment available. One hundred and five (55.5%) respondents were confident in performing surgical cricothyroidotomy in a situation where the membrane was palpable and only in 33 (17.5%) where the cricothyroid membrane was not palpable. Conclusion: This survey has demonstrated that despite evidence of good training for anesthetists in FONA, there are still shortfalls in the training and knowledge of our surgical colleagues. In an emergency, surgeons may be required to assist or secure an airway in a CICO situation. Regular multidisciplinary training of all clinicians working with anesthetized patients should be encouraged and supported