Sleep-disordered breathing (SDB) encompasses a wide range of disorders that afflict both adults and children. These disorders are often unrecognised preoperatively and the pathophysiological consequences may impact severely on the patient in the peri-operative period.
Consent for epidural analgesia for labour is unique. The issues of patient autonomy and competence are controversial because of the limited antenatal education that most South African patients receive, and the absence of a culture of structured birth planning. Frequently, such patients are first encountered by the anaesthetist when in advanced labour and limited time is available for explanation. Overall, this represents the most extreme example of obtaining consent in compromised circumstances.
Regional anaesthesia can provide absolute pain relief without the risks of opiate-induced respiratory depression. The purpose of this paper is to (i) provide insight into some new techniques that may improve the success and accuracy of peripheral nerve blocks, with particular reference to the role of nerve mapping, nerve stimulators and portable ultrasound; (ii) introduce methods to reduce the risk of intraneural injection; (iii) suggest methods to prolong the analgesia provided by peripheral nerve blocks, i.e. continuous peripheral nerve catheters appropriate for use in children; and (iv) propose methods to manage local anaesthetic toxicity, with particular reference to the use of intralipid solutions.