The commonest complications seen by respondents were failure of either the spinal or epidural component of the block. Reported causes were inability to thread the epidural catheter (61%), presence of blood in the epidural catheter (59%) and pain on catheter advancement (40%). Post-dural puncture headache was estimated to be less frequent than 1 in 100 by the majority of anaesthetists (93%) with 19 reporting never having seen one. The observations of other more serious complications were recorded (see Table 1).The results show a wide variation in practice of CSE amongst experienced obstetric anaesthetists. The variation in practice reflects controversy over the technique used [1] and the potential for higher failure rates of CSE than individual spinal or other anaesthetic techniques [2,3]. There is concern over the frequency of complications with CSE [4][5][6]. A large prospective study or establishment of a database might shed further light on the frequency of failure and complications associated with different CSE techniques.

A 31-year-old woman with Ehlers-Danlos Type IV syndrome developed multiple intensive care related complications following laparotomy for perforated bowel. Complications are more likely to occur with the Ehlers-Danlos syndrome.

Neonatal stridor is an important sign of upper airway obstruction. This is most commonly secondary to laryngeal pathology and investigated by otolaryngologists. However neurological causes of stridor, secondary to vocal cord paralysis also occur for a variety of reasons (1). In cases of meningomyelocele up to 20% of infants may develop stridor (2). Respiratory distress may be severe and require prompt surgical and medical intervention. We describe a neonate born with a meningomyelocele, who developed stridor secondary to evolving hydrocephalus after surgical repair of the meningomyelocele. This was treated acutely by direct tapping of cerebrospinal fluid from the right coronal horn via the coronal suture with immediate symptomatic improvement prior to a definitive shunt procedure.

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