The aim of this study was to examine the performance of anaesthetists while managing simulated anaesthetic crises and to see whether their performance was improved by reviewing their own performances recorded on videotape. Thirty-two subjects from four hospitals were allocated randomly to one of two groups, with each subject completing five simulations in a single session. Individuals in the first group completed five simulations with only a short discussion between each simulation. Those in the second group were allowed to review their own performance on videotape between each of the simulations. Performance was measured by both`time to solve the problem' and mental workload, using anaesthetic chart error as a secondary task. Those trainees exposed to videotape feedback had a shorter median`time to solve' and a smaller decrease in chart error when compared to those not exposed to video feedback. However, the differences were not statistically significant, confirming the difficulties encountered by other groups in designing valid tests of the performance of anaesthetists.

No abstract

The effect of ketamine on sympathetic ganglion transmission has been studied using the guineapig isolated hypogastric nerve-vas deferens preparation. Ketamine produced a dose-dependent depression in the response to preganglionic stimulation (IC50 2.05 X 10--4 mol litre--1). No change in the response to postganglionic stimulation was recorded. The anti-cholinergic activity of ketamine was confirmed using the frog isolated rectus abdominis.

Correspondence sequence of events occurred and once again passage of the epidural catheter beyond the end of the Tuohy needle caused another dural tap. This patient was now likely to develop a severe post spinal tap headache, therefore another attempt was made to set up an epidural block, because this could then be followed by an epidural infusion of Hartmans Solution in an attempt to reduce the headache. * However once again the catheter punctured the dura at the L4-Ls space and further attempts to cannulate the epidural space were abandoned. Systemic analgesics were used to control further pain and the 1st stage of labour lasted I 5 hours and 45 minutes with a 2nd stage of 1 hour 37 minutes. Foetal distress developed during the 2nd stage of labour and the baby was delivered by forceps under general anaesthesia.Post partum the mother developed a severe postural headache which was relieved by lying flat. This continued for 8 days and then spontaneously improved so that she was free from headache when standing 10 days after the dural taps.Dural tap with an epidural catheter is one of the hazards of epidural analgesia. Moir' reported a case in which inadvertent dural puncture occurred during continuous lumbar epidural analgesia and dural puncture was probably due to the sharp pencil point of the tip of the epidrual catheter. Crawford3 in .the first loo0 epidural cases he reported-out of 71 dural taps, 9 were with the catheter and in one case dural tap occurred twice. In a further series Crawford4 reported 33 dural taps of which 4 were caused by the catheter in loo0 epidural blocks.In our case there are two possible causes for the multiple taps with an epidural catheter. Firstly there may have been a thin membranous dura which can occur as a congenital abnormality or as a result of expansion of an extra medullary spinal tumour which has thinned out the dura. Secondly it may have been the result of tethering of the dura or adherence to the internal bony surface of the vertebral bodies which is common in the lumbar region and usually not associated with abnormal neurological symptoms. We think this patient had either congenital thin membranous dura or asymptomatic tethering of the dura in the lumbar region.