Uterotonics for Non-emergent Caesarean Section: Protocol Change During UK-Licensed Drug Shortage.

The aim was to assess the efficacy of Syntometrine ® (500 micrograms ergometrine with 5 units oxytocin) as an appropriate alternative first-line uterotonic for use in elective caesarean section (CS) during a national shortage of UK-licensed IV oxytocin from April-June 2014. An observational study was performed involving 2 groups of 22 women undergoing elective CS in a UK DGH during this period. Primary endpoints included mean estimated blood loss (EBL), haemoglobin drop post-operatively and transfusion requirement. Secondary endpoints were use of antiemetics and mean post-operative nausea and vomiting (PONV) score. Results for Syntometrine ® groups and syntocinon groups respectively: mean EBL (ml) 527.3 vs. 550.0 (p=0.5820), mean haemoglobin drop (g/dL) 0.977 vs. 0.982 (p=0.98), blood transfusion 1/22 vs. 0/22 (p=1). Intra-operative antiemetics 20/22 vs. 6/22 (p=<0.001), post-operative antiemetics 2/22 vs. 2/22 (p=1), mean PONV score 11.5 vs. 3.5 (p=0.099). As no significant difference in primary endpoints or PONV scores was observed between regimes, we conclude Syntometrine ® was a safe first-line haemostatic agent for elective CS during oxytocin shortage.

A comparison of the I-gel supraglottic airway as a conduit for tracheal intubation with the intubating laryngeal mask airway: a manikin study.

BACKGROUND: Insertion of a supraglottic airway and tracheal intubation through it may be indicated in resuscitation scenarios where conventional laryngoscopy fails. Various supraglottic devices have been used as conduits for tracheal intubation, including the intubating laryngeal mask airway (ILMA), the Ctrach laryngeal mask and the I-gel supraglottic airway. METHODS: A prospective study with 25 participants evaluated the success rate of blind intubation (using a gum-elastic bougie, an Aintree intubating catheter (AIC) and designated tracheal tube) and fibrescope-guided tracheal intubation (through the intubating laryngeal mask airway and the I-gel supraglottic airway) on three different airway manikins. RESULTS: Twenty-five anaesthetists performed three intubations with each method on each of three manikins. The success rate of the fibrescope-guided technique was significantly higher than blind attempts (P<0.0001) with both devices. For fibreoptic techniques, there was no difference found between the ILMA and I-gel (P>0.05). All blind techniques were significantly more successful in the ILMA group compared to the I-gel (P<0.0001 for bougie, Aintree catheter and tracheal tube, respectively). CONCLUSIONS: The results of this study show that, in manikins, fibreoptic intubation through both ILMA and I-gel is a highly successful technique. Blind intubation through the I-gel showed a low success rate and should not be attempted.

Feigning psychopathology among adolescent offenders: validation of the SIRS, MMPI-A, and SIMS.

Clinical decision rules for the assessment of feigning and related response styles have not been systematically investigated in adolescent populations. For instance, evaluations of feigning on the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) involve cutting scores extrapolated from adult studies with the MMPI/MMPI-2. Such extrapolations are unwarranted because (a) adolescents perform differently than adults on MMPI/MMPI-2 validity scales and (b) the MMPI-A validity and clinical scales are substantively different than the MMPI/MMPI-2. Given the dearth of adolescent data, this study examined the clinical usefulness of three measures in the assessment of feigning: MMPI-A, Structured Interview of Reported Symptoms (SIRS), and Screening Index of Malingered Symptoms (SIMS). Employing a within-subjects analogue study on 53 dually diagnosed adolescent offenders, we found that commonly used MMPI-A scales (F, F1, and F2) were ineffective, but that F-K > 20 appeared promising. For the SIRS, classification of feigning based on adult criteria yielded moderate positive predictive poser and superb negative predictive power. As a screen, the SIMS proved to be moderately effective in identifying feigned protocols. Finally, two-stage discriminant analysis offered initial support of the incremental validity of a combined SIRS and MMPI-A evaluation of adolescent feigning.