Anaesthetic management of a patient with multiple pterygium syndrome for elective caesarean section.

We report a case of a pregnant woman with multiple pterygium syndrome who presented for elective caesarean section. Neuraxial anaesthesia failed and the backup plan of awake intubation was extremely difficult.

High-flow humidified nasal oxygenation vs. standard face mask oxygenation.

Ten healthy volunteers received oxygen for 1 min, 2 min and 3 min at 10 l.min-1 via a face mask, or humidified oxygen at 60 l.min-1 via nasal prongs (OptiflowTM ) with the mouth closed and with the mouth open. The mean (SD) end-tidal oxygen partial pressure after 3 min face mask and Optiflow oxygenation, with mouth closed and open, were: 88.5 (6.2) kPa; 85.6 (6.4) kPa and 48.7 (26.4) kPa, respectively, p = 0.001. The equivalent mean (SD) transcutaneous oxygen partial pressures were: 34.6 (5.4) kPa; 36.4 (6.5) kPa and 25.5 (15.7) kPa, respectively, p = 0.03. High-flow humidified nasal oxygenation for 3 min with the mouth closed was as effective as 3 min face mask oxygenation.

Cadaveric feasibility study on the use of ultrasound contrast to assess spread of injectate in the serratus anterior muscle plane.

BACKGROUND: The Serratus anterior muscle plane (SAP) block has recently been described for the purpose of perioperative pain management following cases of trauma and breast surgery. It might prove a safer alternative to the other regional thoracic paravertebral and central neuraxial blockade techniques. There are no descriptive cadaveric studies in the pre-existing literature to delineate the anatomical plane for this novel technique. The main objectives for our study were to examine the location of the Serratus anterior muscle belly, assess the efficacy of achieving adequate delineation of the muscle plane utilising ultrasound imaging with agitated water as the contrast agent, and finally, to observe the extent of the cepahlo-caudal spread of the injectate in the SAP. MATERIALS AND METHODS: Seven cadavers were studied. 20 mls of saline was injected into posterior axillary line (PAL) at the level of the 4-5(th) rib under ultrasound guidance. This was followed by injection of 10 mls of water with air (8 mls water and 2 mls of air). The presence of hyperechoic air bubbles in the fluid distended SAP (hypoechoic) area demonstrated the spread of water and air. RESULTS: In 36% of cadavers, fully formed Serratus Anterior muscle belly was identified at the midaxillary line (MAL), 14% in PAL, and remaining 50% between PAL and MAL. The lower most limit of air-water spread was identified at the subcostal margin. Cephalad spread of contrast was noted in 2(nd) intercostal space ICS (7%), 3(rd) ICS (71%), and 4(th) ICS (22%). CONCLUSION: This study describes that the serratus anterior muscle is well-formed near the PAL and the injectate spread can be determined with the help of agitated water contrast on ultrasound. Furthermore, there was variability in the cephalad spread of the injectate.

A review of Clarias gariepinus invasions in Brazil and South Africa.

African sharptooth catfish Clarias gariepinus is native to most of Africa and small parts of Asia, but has been introduced to 37 countries mainly for aquaculture. This review of introductions, establishment, spread and impact of C. gariepinus in Brazil and outside of its native range in South Africa provides evidence that the species has been able to overcome all barriers to invasion in both countries. Following initial introductions across geographical barriers, containment seems to have been impossible and escape from aquaculture facilities and spread by illegal introductions is an invasion pathway in both countries. There is evidence of individuals dispersing rapidly following escape, and surviving and reproducing at multiple sites in a wide spectrum of habitats in both countries. There is a severe paucity of research on impacts, many of which are inferred from field and laboratory observations, but have not been demonstrated at population or community level. Such impact studies are urgently required to better understand the consequences of these invasions and to develop appropriate strategies to mitigate impacts and spread.