SummaryCaesarean section was performed under spinal anaesthesia in 55 women using a 25-gauge diamond-tipped needle and in a further 55 mothers with a 24-gauge Sprotte needle. Eight patients (14.5%) developed a headache in the former group, five of whom required a blood patch. There were no headaches reported in the Sprotte group. Key wordsComplications; headache. Equipment; needles.Spinal anaesthesia remains an up-to-date technique. Due to its ease of use, very low cost and retention of consciousness, it is preferred to general anaesthesia in a number of instances. A new spinal anaesthesia needle, the Sprotte needle ( Fig. 1) has recently been marketed and the incidence of postdural puncture headaches in young subjects was reported to have been reduced after its use.' The present study was undertaken to evaluate the use of this needle on the frequency of headache after spinal anaesthesia for Caesarean section. MethodsOne hundred and ten women aged between 18 and 40 years underwent Caesarean section with spinal anaesthesia; 89 were elective sections and 21 emergencies. Informed consent was obtained from the patients and the study approved by the local ethics committee. Exclusion criteria were patient unwilling, coagulation abnormalities, foreseeable or patent hypovolaemia (placenta praevia, retroplacental haematoma) and pre-eclampsia because of possible intracranial hypertension.The patients were randomised into two groups; group 1 (n = 55) included 46 scheduled Caesarean sections and nine emergencies in which a 25-gauge diamond-tipped needle was used, with the bevel kept parallel to the dural fibres. Group 2 included 43 scheduled Caesarean sections and 12The Sprotte needle is manufactured by Pajunk GMBH Medecin Technik, Am Holplatz, 57 D7716 Geisingen, West Germany. emergencies (n = 55) in which the puncture was made with a 24-gauge Sprotte needle. This needle has a blunt, ogival tip; its distal orifice lies laterally and is 1.2 mm long (Fig. 1). In elective cases, the circulation was preloaded with 500 ml of modified fluid gelatin (Plasmion); in emergency cases 30 mg ephedrine was administered in addition to the fluid preload. Thereafter compound sodium lactate was infused at a rate of 10 (ml/kg)/hour. The lumbar punctures were performed in the midline at the L, interspace in the sitting position. The needle was advanced a further 1 to 2 mm after appearance of cerebrospinal fluid (CSF) and a mixture of 0.5% hyperbaric bupivacaine (0.06 mg/cm of patient height) and fentanyl (0.02 pg/ cm of patient height) was injected. The injection was made in approximately 20 seconds in the four quadrants; the needle was rotated during the injection without aspirating

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In 18 women A.S.A. physical status 1, a noninvasive thoracic electrical bioimpedance method was used to evaluate haemodynamic changes during gynaecological laparoscopy. A significant decrease in cardiac index was observed after peritoneal insufflation, from 3.2 to 2.8 L.min-1.m-2 and returned to the initial values after ten minutes of Trendelenburg's position. Elevated intra-abdominal pressure was also associated with a significant increase in mean arterial pressure (from 68 to 88 mmHg) and systemic vascular resistance index (from 1620 to 2491 dyn.s.cm-5.m-2). However, values were not restored after peritoneal exsufflation: systemic vascular resistance index values remained 30 per cent higher than that before insufflation. Decreased venous return may account for the significant decrease in cardiac output but mechanical compression does not explain the persistent elevation of systemic vascular resistance.

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