Anesthesiologists' interest in neonatal resuscitation certification.

STUDY OBJECTIVE: To survey graduates from our residency program to determine their involvement and their interest in becoming certified in neonatal resuscitation. DESIGN: Survey questionnaire. SETTING: Graduates from the University of Pennsylvania Anesthesia Program between 1989 and 1999. SUBJECTS: 212 individuals completed the residency; addresses were available for 189 and the response rate for these individuals was 156. RESULTS: Of the respondents with obstetric anesthesia responsibilities, 65% have been involved in resuscitation of the newborn. Sixteen percent were certified, but 81% were interested in certification. If the hospital had less than 1000 deliveries per year, the probability of the anesthesiologist having to perform neonatal resuscitation was 11.0 times greater than if the hospital had more than 1000 deliveries per year (confidence interval, 1.4--86). CONCLUSIONS: Despite guidelines recommending the contrary, anesthesiologists are involved in the resuscitation of the newborn. The majority of these individuals are not certified but are interested in becoming certified. The ASA should establish programs to offer the opportunity to learn and to reinforce these skills.

Airway management in the obstetric patient.

In summary, the need to manipulate the airway in the pregnant patient requires careful consideration and substantial planning. Anatomic and physiologic changes of pregnancy, coexisting conditions, and the potential for aspiration all carry a risk of morbidity and, indeed, mortality. Preparation, including early and repeated airway evaluations throughout pregnancy and labor, is encouraged. Knowledge of an emergency airway algorithm and a well thought-out plan for difficult intubations are imperative. Equipment must be available and in good condition. Finally, proper education and review for individuals involved in the delivery of care on the labor floor are mandatory. Although it is not always possible to control the manner in which these patients present, it is usually possible to control the environment into which they present.

Effects of immediately initiating an epidural infusion in the combined spinal and epidural technique in nulliparous parturients.

BACKGROUND AND OBJECTIVES: Intrathecal fentanyl with bupivacaine provides rapid labor analgesia of limited duration. We investigated the effect of initiating an epidural infusion of 0.1% ropivacaine with fentanyl 2 microg/mL and epinephrine 1:400,000 (REF) on the duration of analgesia and incidence of side effects after intrathecal injection in the combined spinal and epidural technique. METHODS: Thirty-four nulliparous parturients with a cervical dilation of 3 to 5 cm were randomized to receive epidural saline or REF at 10 mL following the intrathecal injection of fentanyl 25 microg and bupivacaine 2.5 mg. Degree of analgesia, severity of pruritus, motor block, blood pressure, and sensory level to coolness were assessed until the patient requested additional analgesia. RESULTS: Analgesia was significantly longer in the REF group, 158.4 +/- 59.6 minutes versus 103.8 +/- 26.2 minutes. The decrease in blood pressure compared with the blood pressure at intrathecal injection was greater for the REF group at all times, but achieved statistical significance at 60 minutes. There was no difference in ephedrine use, pruritus, or motor block between groups. There was no difference in sensory level to coolness at 90 minutes after intrathecal injection between groups. CONCLUSIONS: Initiating an infusion of REF prolongs the duration of analgesia, but also results in a greater decrease in blood pressure. Despite this effect on blood pressure, there was no difference in ephedrine use.

Bromodeoxyuridine immunohistochemical determination of the lengths of the cell cycle and the DNA-synthetic phase for an anatomically defined population.

A cumulative labelling protocol using 5-bromo-2'-deoxyuridine (BUdR) was followed to determine: (1) the growth fraction (i.e., the proportion of cells that comprise the proliferating population), (2) the length of the cell cycle, and (3) the length of the DNA-synthetic phase (S-phase) for proliferative cells in the dentate gyrus of the mouse. On postnatal day 20 (P20), C57BL/6J mice were injected with BUdR at two hour intervals for a total period of 12 hours. Animals were sacrificed at selected intervals, and the brains were processed for immunohistochemistry using a monoclonal antibody directed against single-stranded DNA containing BUdR. The numbers of BUdR-labelled and unlabelled cells in sections through the hilus of the dentate gyrus were counted. The number of BUdR-labelled cells increased linearly from an initial value of about 12% of the total number of cells to a maximum value of just over 24% of the total. These findings indicate that, at P20, a maximum of 24.2 +/- 1.2% of the cells in the dentate hilus are part of the proliferating population. The calculated length of the cell cycle of the cells comprising the intrahilar proliferative zone was estimated to be 16.1 +/- 0.8 h. The length of the S-phase was estimated at 8.0 +/- 0.4 h. In addition, mathematical analysis, using one and two population models, indicates that over 90% of the proliferating cells in the dentate hilus at this age comprise a single population at least in terms of the lengths of the cell cycle and the S-phase.(ABSTRACT TRUNCATED AT 250 WORDS)