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General anaesthesia for obstetric surgery has distinct characteristics that may contribute towards a higher risk of accidental awareness during general anaesthesia. The primary aim of this study was to investigate the incidence, experience and psychological implications of unintended conscious awareness during general anaesthesia in obstetric patients. From May 2017 to August 2018, 3115 consenting patients receiving general anaesthesia for obstetric surgery in 72 hospitals in England were recruited to the study. Patients received three repetitions of standardised questioning over 30 days, with responses indicating memories during general anaesthesia that were verified using interviews and record interrogation. A total of 12 patients had certain/ probable or possible awareness, an incidence of 1 in 256 (95%CI 149-500) for all obstetric surgery. The incidence was 1 in 212 (95%CI 122-417) for caesarean section surgery. Distressing experiences were reported by seven (58.3%) patients, paralysis by five (41.7%) and paralysis with pain by two (16.7%). Accidental awareness occurred during induction and emergence in nine (75%) of the patients who reported awareness. Factors associated with accidental awareness during general anaesthesia were: high BMI (25-30 kg.m -2 ); low BMI (<18.5 kg.m -2 ); out-of-hours surgery; and use of ketamine or thiopental for induction. Standardised psychological impact scores at 30 days were significantly higher in awareness patients (median (IQR [range]) 15 (2.7-52.0 [2-56]) than in patients without awareness 3 (1-9 [0-64]), p = 0.010. Four patients had a provisional diagnosis of post-traumatic stress disorder. We conclude that direct postoperative questioning reveals high rates of accidental awareness during general anaesthesia for obstetric surgery, which has implications for anaesthetic practice, consent and follow-up.

Objective: To determine whether the occurrence of new-onset bronchospasm or the recrudescence of asthma is associated with the use of cocaine. Methods: A consecutive sample of patients presenting to an inner-city adult ED with new-onset bronchospasm or recrudescence of bronchospasm after >5 years were prospectively enrolled in a case-control prevalence study. The bronchospasm patients were queried as to their exposure to illicit drugs, and urine was obtained to screen for cocaine and its metabolite, benzoylecgonine. An age-and sex-matched control group was composed of randomly chosen subjects without respiratory complaints or a history of asthma. The control group was also screened by urine toxicology for cocaine and its metabolite, benzoylecgonine. Results: In the asthma group, 21/59 (36%) had a urine toxicologic screen positive for cocaine metabolite (benzoylecgonine). Of the 21 with a positive screen for cocaine, 8 denied illicit drug abuse. Among the 13 patients reporting drug use, 10 said that they smoked crack and 3 snorted cocaine. In the control group, 8/53 (15%) were positive. Multivariate logistic regression analysis, with adjustment for age and sex, indicated that the use of cocaine was associated with a 3-fold higher prevalence of new-onset bronchospasm or recrudescence of asthma (OR = 3.28, 95% CI: 1.26 to 8.50).Conclusions: There appears to be an association between cocaine use and new-onset bronchospasm or recrudescence of asthma in this inner-city ED population. Further study is necessary to determine the basis for this association. Key words: asthma; bronchospasm; allergy; cocaine; substance abuse. IThe epidemic use of cocaine, especially in the smoked freebase form ("crack"), has paralleled the increasing incidence of asthma. In our inner-city ED, we noticed a high incidence of cocaine abuse among patients with new-onset bronchospasm. Isolated case reports,'-' small case series,6-8 an unpublished prospective study,g and a prospective, case-control study using a convenience sample of asthmatic patients" have described the coincidence of cocaine abuse and pulmonary complications. However, few of the patients described had bronchospasm, and The current study addresses the potential association of asthma with cocaine use in adult patients with newonset bronchospasm or the recrudescence of asthma after a prolonged period of quiescent disease. I METHODSStudy Design: We performed a prospective, case-control, cross-sectional, prevalence study to determine whether an association existed between cocaine use and new-onset bronchospasm or recrudescence of asthma in an inner-city ED population. The project was approved by the local institutional review board (IRB). The IRB ruled that since urine toxicology testing for new-onset bronchospasm or recrudescent asthma was routinely performed in our ED, and since the testing in the control group was anonymous, informed consent was not necessary. Population and Setting:T h e study was performed in an inner-city teaching hospital ED with a census of approximately...

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Exchange transfusion was utilized in the treatment of a 1871 gram female, 32 weeks gestational age, who received an IV bolus of aminophylline at 11 h for the treatment of apnea, with subsequent tachycardia and hypotension. At 22 h, plasma theophylline was 369.29 mumol/L (67 mg/L). During a single volume exchange transfusion at 33 h, the plasma theophylline decreased 19% and the estimated removal of theophylline was 13.5% of the whole body theophylline. The theophylline apparent half-times before, during, and after the exchange were 52.5, 6.6, and 53.3 h respectively.