Outcomes After Institution of a New Oxytocin Infusion Protocol During the Third Stage of Labor and Immediate Postpartum Period

Abstract

scores for each fruit were compared using a repeatedmeasures general linear model.Twenty-nine consultants, 12 specialist registrars, and 9 senior house officers completed the study. Thirty-four used a 16-G Tuohy needle, and of these 27 (79%) used 0.9% NaCl for the loss of resistance, whereas the other 7 used air. Sixteen anesthetists used an 18-G needle; 14 of them used NaCl, and 2 used air. The simulation rating of the different fruits did not differ significantly based on grade of anesthetist, experience, needle gauge, or loss-ofresistance technique (P = 0.505, 0.640, 0.794, and 0.751, respectively). When comparing among all the 4 fruits, the banana received the highest rating for realistically simulating the "feel" of loss of resistance, which was statistically significant (P < 0.001). In paired comparisons, however, no significant differences were found between the melon and banana, kiwi and melon, or the orange and kiwi, leading the investigators to rank the melon as a close second to the banana for simulating loss of resistance.On the basis of the results of their study, the authors recommended that anesthesiology residents be encouraged to use bananas to learn the loss of resistance "feel" before they perform their first epidural procedure in a patient. COMMENTThe authors should be commended for having done a great deal of work to attempt to identify the effectiveness of an inexpensive simulator for the initiation of neophytes into the tactile pleasures of identifying the human peridural space with an epidural needle. Unfortunately, the presentation of part of their data was not clearly explained, but it appears that the best of their 4 optional models (fruits) only ranked about 62/100 as a satisfactory simulation of the real experience on humans.A further step would also have been interesting: did neophytes having experienced any of the stimulator options in the study later establish a better learning curve than other neophytes who had not experienced the simulator?The cost and time expended on any simulator of a variety of medical procedures is presumably justified in reducing hazard to the patient of errors by the learner. Anesthesiology resident physicians and nurse anesthetist trainees who have reasonably extensive previous experience with intentional subarachnoid puncture have only a slightly elevated inadvertent dural puncture rate during the learning period, perhaps around 2% or less. Of these punctures, only about r50% result in morbidity. 1 One would assume that to justify the time and cost of any simulation model the chance of unnecessary patient discomfort should be demonstrably reduced by employment of the simulator. Indeed, 31 or more ultrasonic-based devices for this purpose have recently been reviewed and found wanting. 2 It is not clear that the piece of fruit as simulator investigated in this report satisfies this criterion either. Comment by Bradley E. Smith, MD REFERENCES 1. Watterson LM, Hyde S, Bajenov S, et al. The training environment of junior anaesthetic registrars learning epidu...