SummaryWe investigated block heights that anaesthetists considered adequate for caesarean section to proceed under spinal anaesthesia. During 3 months, 15 obstetric anaesthetists recorded block height to touch, pinprick or cold when spinal anaesthesia was considered satisfactory for caesarean section to proceed. Median (IQR [range]) block height for touch, pinprick, first cold and icy were: T10

It is feasible that children with uncomplicated appendicitis given intraoperative NSAID can be successfully managed without PCA.

With regard to preoperative anxiety, it is highly likely that the time of day would play a significant role in the state of mind of any parturient scheduled for an elective cesarean birth. I am sure that waiting around all day, until say 15:00, for your surgery, while remaining NPO, knowing full well that you will be awake when the surgeon makes the incision, is likely NOT conducive to calming or relaxing thoughts. By not controlling this important variable the investigators most likely affected any opportunity for a clinically significant outcome. Further, the lack of correlation between salivary amylase and the VAS anxiety scores and STAI-s scores highlights the controversy surrounding the validity of the relationship between stress and salivary amylase, but may have been as simple as the lack of control of the timing of the surgeries.Although the investigators systematically assessed changes in systolic blood pressure (SBP) with baseline measures obtained immediately before the SA there was no mention of the parturient's antenatal SBP. For many parturients, especially those undergoing either a primary elective cesarean birth or an elective cesarean birth after a previous intrapartum cesarean birth, the concerns about often unfounded complications of SA can be extremely anxiety provoking. For many women the fear of the SA exceeds the fear of the actual surgical procedure. Again, the variable of whether the parturient had experienced a previous elective cesarean birth was not controlled. The investigation's standardized protocol was based, not upon a 25% reduction in parturients normal baseline SBP (as recorded in the antenatal record), but rather an artificial baseline SBP taken immediately before undergoing the anxiety provoking SA procedure. As we commonly see clinically, many parturients' SBP falls to baseline after SA for routine elective cesarean birth and certainly does not require intravenous vasopressor treatment. A normal physiological baseline SBP that is often below 100 mm Hg, and depending upon the parturient' s level of anxiety (and resultant elevated SBP), may be observed to have a >25% decrease after SA. Consequently, by ignoring the parturient's actual antenatal baseline SBP, the investigation's standardized SBP treatment protocol more than likely lead to an increased number of unnecessary vasopressor interventions. Unfortunately, this raises serious concerns regarding the clinical relevance of this entire investigation.Although vasopressors administered were not reported, I was pleased that the investigators recognized the importance of adjusting the hypotension treatment protocol to the parturient's heart rate by providing the option of administering either phenylephrine or ephedrine, rather than standardizing to only the fashionable phenylephrine. This is extremely important as hypotension after SA is multifactorial and is not solely related to vasodilatation of venous capacitance vessels but also dependent upon the height of the SA and its impact on cardiac accelerator fibers.Disappointingly...