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.

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

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.

Respiratory obstruction has been reported as a complication of carotid endarterectomy; the causes include traumatic mucosal oedema, direct tracheal compression by haematoma and oedema secondary to lymphatic and venous congestion. We report four cases of acute respiratory obstruction complicating carotid endarterectomy. Two of these cases suffered respiratory arrest in the postoperative ward and required emergency tracheal intubation in difficult circumstances. All of these patients had developed wound haematomas and all required surgical intervention.

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