Evidence exists for a positive impact of training in obstetric emergencies, although the majority of the available evidence applies to evaluation at the level of participants' confidence, knowledge or skills rather than at the level of impact on clinical outcomes. The model of simulation-based training is an appropriate one for the Australian setting and should be further utilised in rural and remote settings.

SummaryThe presence of a facemask leak significantly reduces the effectiveness of pre-oxygenation and increases the risk of post-induction hypoxia. We randomly assigned 24 healthy volunteers to a six-period crossover trial with and without a simulated facemask leak. Pre-oxygenation was performed using a standard anaesthesia machine circuit supplemented either by nasal prong oxygen or by anaesthesia machine flush oxygen. Each intervention was completed with both 3-min tidal breathing and 8 deep breath techniques: end-tidal oxygen fraction was used as the measure of preoxygenation effectiveness. The presence of a stimulated mask leak significantly reduced the effectiveness of preoxygenation regardless of the breathing method used. With a simulated facemask leak introduced, the mean (SD) end-tidal oxygen fraction with the 3-min tidal breath technique was 74.7 (9.3)% compared with 57.5 (6.2%) for the 8 deep breath technique with 3-min tidal breathing and a leak. End-tidal oxygen fractions increased by 11.0% (95% CI 7.8-14.3%) (p < 0.0001) with the addition of nasal prong oxygenation and 16.8% (13.6-20.0%) (p < 0.0001) with machine oxygen flush compared with standard pre-oxygenation. When a leak is present, 3-min tidal breathing with either nasal prong or anaesthesia machine flush oxygenation is an effective pre-oxygenation method, and preferable to the 8 deep breath method.