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High-flow nasal oxygen has been shown to provide effective pre-oxygenation and prolong apnoeic time during intubation attempts in non-pregnant patients. We aimed to compare pre-oxygenation using high-flow nasal oxygen (30-70 l.min À1 oxygen flow) via nasal prongs with standard 15 l.min À1 oxygen breathing via a tightfitting facemask. Forty healthy parturients were randomly allocated to these two groups, and furthermore each patient underwent the selected pre-oxygenation method with both 3-min tidal volume breathing and 30s tidal breathing followed by eight vital capacity breaths. With 3-min tidal volume breathing, the respective estimated marginal means for high-flow nasal oxygen and standard flow rate facemask pre-oxygenation were 87.4% (95% CI 85.5-89.2%) and 91.0% (95%CI 89.3-92.7%), p = 0.02; with eight vital capacity breaths the estimated marginal means were 85.9% (95%CI 84.1-87.7%) and 91.8% (95%CI 90.1-93.4%, p < 0.0001). Furthermore, high-flow nasal oxygen did not reliably achieve a mean end-tidal oxygen concentration ≥ 90% compared with the standard flow rate facemask. In this physiological study, high-flow nasal oxygen pre-oxygenation performed worse than standard flow rate facemask pre-oxygenation in healthy term parturients.

The study investigated whether online professional development courses with different levels of support have different impacts on teacher outcomes. Variations of an online course for middle school algebra teachers were created for four experimental conditions. One was a highly supported condition, with a math education instructor, an online facilitator, and asynchronous peer interactions among participants available as participants worked through the course together. Another was a self-paced condition, in which none of the supports were available. The other two conditions provided intermediate levels of support. All conditions showed significant impact on teachers' mathematical understanding, pedagogical beliefs, and instructional practices. Surprisingly, the positive outcomes were comparable across all four conditions. Further research is needed to determine whether this finding is limited to self-selected teachers, the specifics of this online course, or other factors that limit generalizability. (

Purpose:To review the effects of the long QT syndrome (LQTS) in the parturient and the current anesthetic management of patients with LQTS. Principal findings:The prevalence of LQTS in the developed world is one per 1,100 to 3,000 of the population. Clinically, LQTS is characterized by syncope, cardiac arrest and occasionally, by a history of seizures. The QT interval can also be prolonged by drugs, electrolyte imbalances, toxins and certain medical conditions. Long QT syndrome patients are at risk of torsades de pointes and ventricular fibrillation. Medical management aims to reduce dysrhythmia frequency. The LQTS is subdivided into different groups (LQT1-6) depending on the cardiac ion channel abnormality. Torsades can be precipitated by adrenergic stimuli such as stress or pain (LQT1 and 2), sudden noises (LQT2) or whilst sleeping (LQT3). Patients with LQTS require careful anesthetic management as they are at high risk of torsades perioperatively despite minimal data on the effects of anesthetic agents on the QT interval. While information on effects of LQTS in pregnancy is limited, the incidence of dysrhythmia increases postpartum. Isolated case reports of patients with LQTS women highlight several peripartum dysrhythmias.Conclusion: An understanding of LQTS and the associated risk factors contributing to dysrhythmias is important for anesthesthesiologists caring for parturients with LQTS.