(Anaesthesia. 2018;73:71–92) The objective of this comprehensive consensus statement was to provide practical and independent advice to physicians for treating and managing spinal anesthesia-induced maternal hypotension in both resource-rich and resource-poor environments. This clinical best practices summary was necessary as there has been much variation in the methods used to manage spinal anesthesia-induced hypotension during cesarean section, and maternal hypotension increases risks to both maternal and fetal/neonatal health. While generalized recommendations have been made for the management of this problem by professional organizations, the authors indicated this was the first consensus statement providing specific, pragmatic recommendations for managing spinal anesthesia-induced hypotension.

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(Anesth Analg. 2019;128(6):1208–1216) Care providers frequently use point-of-care ultrasound (POCUS) on pregnant women diagnosed with preeclampsia to prevent serious afflictions such as cerebral complications or cardiorespiratory failure. Present-day ultrasound research has found a number of indicators for pulmonary interstitial syndrome (PIS) and a higher optic nerve sheath diameter (ONSD), the latter of which could indicate elevated intracranial pressure. As of now, irregular laboratory markers of oncotic pressure and cardiac dysfunction have inconclusive clinical applications; many experts posit that reduced serum albumin level is a contributor to excessive brain fluid and brain swelling. These investigators examined patients with preeclampsia to determine how PIS, ONSD, brain natriuretic peptide (BNP), and serum albumin level contribute to cardiac dysfunction. They also aimed to study the comparison of information acquired from a POCUS examination to information recorded with traditional clinical methods.

Only a minor increase in block height as assessed by temperature occurred in group O at 25 minutes. Vasopressor requirements during the first 30 minutes of SA were equivalent. Time for regression of SA block level was longer in the group O, which may be beneficial considering the longer surgical time. A dose of spinal bupivacaine 10 mg for single-shot SA should not be reduced in morbidly obese parturients.

Diabetes mellitus (DM) is a common condition, affecting an estimated 15.5 million people in Africa. Importantly, the prevalence of DM across the continent is expected to double by 2045. [1] Since 2015, this condition has been ranked as the second most common cause of natural death in South Africa (SA), and its impact on healthcare provision is substantial. [2] Accurate assessment of prevalence is difficult owing to the high burden of undiagnosed DM (estimated at 69% in Africa) and the lack of large population studies. [1] In SA, the prevalence of DM is estimated to be between 5.4% and 9.2%. [1,3] There are limited data reporting the prevalence of DM in Western Cape Province, SA, and information with regard to elective surgical patients is minimal. Many studies have shown that DM, especially if poorly controlled, is associated with an increased risk of perioperative complications and mortality. [4-9] In SA, insulin-dependent surgical patients are twice as likely as non-diabetics to die in hospital. [10] Objectives The primary objective of this study was to establish the prevalence of DM in patients presenting for elective surgery over a 1-week period in six Western Cape hospitals. This included patients with a previous diagnosis of DM, and those with a new diagnosis based on screening capillary blood glucose (CBG) testing and a confirmatory elevated glycated haemoglobin (HbA1c) level. The secondary objectives were to assess: (i) the glycaemic control of known diabetics presenting for This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

To assess the reliability and within subject variability of steady-rate ventilation (VE), oxygen uptake (VO2), heart rate, systolic and diastolic blood pressure, 4 subjects exercised for 10 minutes at 3 work rates on a bicycle ergometer: 50 W, 125 W and 55% of maximum work rate (55% max). Each testing session included two work rates and only 2 testing sessions were scheduled per week. The order of the work rates was counterbalanced. In 8 to 10 weeks, 3 of the subjects completed 20 trials at 50 W while the fourth subject completed 11 trials, and all the subjects completed 10 trials at 125 W and 55% max. The within subject variability (S2w) was expressed as a percent of the mean steady-rate response. VO2 ranged from 21.2% to 27.5% of VO2max at 50 W, from 37.7% to 49.7% at 125 W and from 42.9% to 63.7% at 55% max. The S2w averaged 6.8% for VE, 4.3% for VO2, 3.2% for heart rate, 7.3% for systolic blood pressure and 10.5% for diastolic blood pressure. Reliability coefficients were calculated for the steady-rate scores by dividing the between subject variation by the total variation. The reliability was similar for VE, VO2 and heart rate and ranged from r = 0.69 to r = 0.97. Systolic and diastolic blood pressure reliabilities were lower and ranged from r = 0.27 and r = 0.80. In summary, the steady-rate ventilation, oxygen uptake and heart rate responses were reliable and consistent. The reliability of blood pressure was low. It is possible that this low reliability may result from variability in stroke volume or total peripheral resistance.

(Anesth Analg. 2018;126(1):190–195) Maternal core temperature is difficult to monitor during cesarean delivery (CD) under spinal anesthesia (SA). A drop in maternal core temperature <36.0°C during the perioperative period is associated with increased risks of postoperative morbidity. Current knowledge of the thermal insult associated with obstetric SA is limited to small randomized controlled trials. In the present study, the authors used continuous core temperature recording to generate high-resolution data on thermal insult and thermal recovery associated with CD under SA.