The quadratus lumborum block was more effective in reducing morphine consumption and demands than transversus abdominis plane blocks after cesarean section. This effect was observed up to 48 hours postoperatively.

(Reg Anesth Pain Med. 2016;41(6):757–762) Pain relief after cesarean section can significantly enhanced early recovery, ambulation, and breastfeeding. A prior study found quadratus lumborum block (QLB) to be superior to patient-controlled analgesia after cesarean delivery. QLB is a posterior abdominal wall block that allows local anesthetic to spread behind the quadratus lumborum muscle and expand past the middle layer of the thoracolumbar fascia into the lumbar interfacial triangle. The transversus abdominis plane (TAP) block is another regional block being used with increased frequency for postoperative analgesia. The current investigators compared the efficacy of QLB and TAP blocks for postcesarean analgesia.

Key content Myocardial infarction is a rare but life‐threatening medical condition during pregnancy. If unrecognised and not managed appropriately, the associated mortality and morbidity are high. A high index of suspicion, early diagnosis and treatment are essential. Multidisciplinary management involving the obstetric physician, cardiologist, anaesthetists and obstetrician is key to improving outcomes. Learning objectives To revise the physiological cardiovascular changes in pregnancy. To recognise the pathophysiology of myocardial infarction during pregnancy. Identify risks factors for myocardial infarction. Recognise symptoms and signs of myocardial infarction. To learn the general management principles of myocardial infarction in pregnancy. Ethical issues Should asymptomatic pregnant women with multiple risk factors be screened for coronary heart disease?

Background:Failed intubation in obstetrics remains the most common cause of death directly related to anesthesia. Neck circumference has been shown to be a predictor for difficult intubation in morbidly obese patients. The aim of this study was to determine an optimal cutoff point of neck circumference for prediction of difficult intubation in obstetric patients.Methods:Ninety-four parturients scheduled for cesarean section under general anesthesia were included in the study. Preoperative airway assessment and neck circumference were measured. Difficult intubation was the primary outcome according to the intubation difficulty scale (IDS), intubation reported difficult if the IDS score was ≥5.Results:Univariate analysis showed that Mallampati score and neck circumference were positive predictors for difficult intubation (P = 0.005 and P = 0.011, respectively). Mouth opening, thyromental distance, sternomental distance, and the hyomental distance ratio were not useful predictors (P = 0.68, P = 0.87, P = 0.48, and P = 0.27, respectively). Logistic regression for the Mallampati score and neck circumference negative results as independent predictors of difficult intubation in obstetric (P = 0.53). Sensitivity analysis showed that neck circumference of 33.5 cm is the cutoff point to detect difficult intubation with 100% sensitivity (95% confidence interval [CI]: 69.2–100) and 50% specificity (95% CI: 38.9–61.1). The area under the curve for neck circumference was 0.746 (95% CI: 0.646–0.830) with a positive predictive value of 19.2 (95% CI: 9.6–32.5), a negative predicative value of 100 (95% CI: 91.6–100), and a P < 0.0001.Conclusions:In obstetric patients, a neck circumference ≥33.5 cm is a sensitive predictor for difficult intubation.

In anesthetized adult patients with MILS compared with Macintosh, Airtraq provides equal success rate of intubation, statistically significant (although clinically insignificant) longer duration for laryngoscopy and intubation. Intubation with Airtraq was significantly easier than Macintosh as assessed by the IDS score.