Perhaps leave spinal catheters on the shelf

I am not sure of the current availability in Australia of spinal catheter kits, but a paper in Feb 08 Anesthesiology by Arkoosh et al does not make me at all enthusiastic to use them for labour analgesia. In this FDA sanctioned RCT, a 28 G catheter through a 22 G Sprotte needle worked well for 90 + % majority, but 8% were dislodged (including one on transfer for emergency CS), one broke in situ (and was retained) and one broke on the outside. Later, 9 % had PDPH and 5.3 % required blood patch for the headache. It seemed to be a fiddly technique in the investigators' hands, although a 4% PDPH rate in the epidural control group makes me wonder about their proficiency. Nonetheless, I cannot see how spinal catheter analgesia could surpass epidural catheter analgesia as a first choice for labour analgesia. Even if spinal catheter analgesia or anaesthesia is warranted in an extreme situation (and Drasner and Smiley in the accompanying epidural writes:

of course, CSA is the clear answer for the anxious Oral Boards candidate when faced with the semimythical case of the morbidly obese, severely preeclamptic, asthmatic parturient with the class 4 airway presenting for urgent cesarean delivery)

then I think the stronger 20 G catheter we usually use for epidural analgesia may be a better option. If the clinical situation is dire, then the PDPH problem has to be deferred to a later time. Thankfully obesity and previous spinal surgery or disease are protective against PDPH.

Course notes

An updated version of the notes for the Melbourne ANZCA refresher course are available at: http://tinyurl.com/39nlrx

Who needs a good diet and exercise?

Kaneda et al in Anesthesia Analgesia (Jan08) conclude: Sevoflurane enhances cardiac preconditioning induced by regular EtOH consumption. We should turn off the scavenging during then day and continue to quaff the AMA cellarmaster's red wine specials by night to reduce our morbidity and mortality.