We have compared the protective effect of 1000 ml preload with 200 ml preload of crystalloid solution, administered during the 10 min before spinal anaesthesia was induced, in 60 healthy women with no fetal compromise undergoing elective Caesarean section. The spinal anaesthetic was managed identically in both groups by an anaesthetist who was unaware of the volume of fluid administered. A prophylactic infusion of ephedrine 60 mg in Hartmann's solution 500 ml was given according to maternal arterial pressure. Hypotension was defined as > or = 30% reduction from baseline or < 90 mm Hg, and was treated by i.v. ephedrine bolus doses. There was no significant difference in ephedrine requirements between the two groups or in the incidence, severity or duration of hypotension: 10 women in the 1000-ml group, five episodes lasting > or = 3 min compared with nine women in the 200-ml group, four lasting > or = 3 min. There was no difference between neonates in each group. We have now abandoned the routine of preloading before regional anaesthesia.

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Summary Spinal needles with a pencil-point tip and those of a finer

Subarachnoid block (SAB) or general anaesthesia (GA) was induced in 85 patients undergoing total hip replacement. The frequency of deep vein thrombosis (DVT), assessed by fibrinogen uptake studies and venography, was 29% in those patients receiving SAB and 54% in the GA group. Total blood loss (intra-operative and post-operative wound suction drainage) in SAB group was 66% and total transfusion volume 52% of that of GA group. No morbidity attributable to SAB or to the associated arterial hypotension was detected.

We have compared three techniques used to provide extradural analgesia during the first stage of labour: 0.25% plain bupivacaine 10 ml demand top-ups delivered by the midwife; continuous infusion of 0.125% plain bupivacaine 10 ml h-1; and patient-controlled extradural analgesia (PCEA) delivering 3-ml boluses of 0.25% bupivacaine. Each technique produced comparable analgesia achieving equivalent maternal satisfaction, with no difference in mode of delivery and no complications. This regimen for PCEA proved a viable alternative for continuous extradural analgesia and was popular with the mothers, midwives and anaesthetists.