Current methods of crystalloid preload administration prior to spinal anaesthesia for elective caesarean section are relatively ineffective in preventing hypotension. This study examined the relevance of the timing of the fluid administered. Fifty women were randomly allocated to receive either 20 ml.kg-1 of crystalloid solution during 20 minutes prior to induction of spinal anaesthesia (preload), or an equivalent volume by rapid infusion immediately after induction (coload). Significantly more patients in the coload group did not require vasopressor therapy pre-delivery (P=0.047). The coload group required a lower median dose (P=0.03) and a lower median number (P=0.04) of ephedrine doses for the treatment of maternal hypotension pre-delivery. There was no between-group difference in either the total cumulative dose, or in the total number of doses of ephedrine. Neonatal outcomes among the two groups were similar. Rapid crystalloid administration after, rather than over 20 minutes before the induction of spinal anaesthesia for elective caesarean section, may be advantageous in terms of managing maternal blood pressure prior to delivery.

Objectives-To investigate the incidence and causes of acute tenosynovitis of the forearm of long distance canoeists. Method-A systematic sample of canoeists competing in four canoe marathons were interviewed. The interview included questions about the presence and severity of pain in the forearm and average training distances. Features of the paddles and canoes were determined. Results-An average of 23% of the competitors in each race developed this condition. The incidence was significantly higher in the dominant than the nondominant hand but was unrelated to the type of canoe and the angle of the paddle blades. Canoeists who covered more than 100 km a week for eight weeks preceding the race had a significantly lower incidence of tenosynovitis than those who trained less. Environmental conditions during racing, including fast flowing water, high winds, and choppy waters, and the paddling techniques, especially hyperextension of the wrist during the pushing phase of the stroke, were both related to the incidence of tenosynovitis. Conclusion-Tenosynovitis is a common injury in long distance canoeists. The study suggests that development of tenosynovitis is not related to the equipment used, but is probably caused by diYcult paddling conditions, in particular uneven surface conditions, which may cause an altered paddling style. However, a number of factors can aVect canoeing style. Level of fitness and the ability to balance even a less stable canoe, thereby maintaining optimum paddling style without repeated eccentric loading of the forearm tendons to limit hyperextension of the wrist, would seem to be important. (Br J Sports Med 1999;33:105-109)

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