We read with great interest the article by Kinsella et al [1]. We would like to point out two issues regarding this article.Whenever we have an urgent caesarean section, we prefer to obtain IV access using a 14G or 16G intravenous access, and start preloading with colloid at the earliest.
The authors have mentioned that skin preparation was done using a single wipe of 0.5% chlorhexidine solution. The usual practice of our hospital is to use a liberal spray of alcoholic solution of 0.5% chlorhexidine for skin preparation before any regional technique. We have not come across any case of infection that may have been due to suboptimal skin preparation.This technique of skin preparation not only saves time, it is economical and effective in decontaminating patients' skin [2].
Secondly, the authors have not mentioned anything regarding use of local anaesthetic for skin infiltration nor use of introducer in spinal anaesthesia. It is our practice to use local anaesthetic infiltration using the introducer needle itself before introducing the spinal needle through it in case of an emergency caesarean section. This practice may be useful in cases where every minute counts precisely as a rapid sequence spinal anaesthesia for category 1 caesarean section.
Anand Kulkarni
ABM Kamrul Hasan
Department of Anaesthesia
Raja Isteri Pengiran Hajah Anak Saleha Hospial
BSB, Brunei Darussalam.
References:
1. Kinsella SM, Girgirah K, Scrutton MJL, Rapid sequence spinal anaesthesia for category 1 urgency caesarean section: a case series. Anaesthesia 2010; 65: 664-669.
2. Robins K, Wilson R, Watkins EJ, Columb MO, Lyons G. Chlorhexidine spray versus single use sachets for skin preparation before regional nerve blockade for elective caesarean section: an effectiveness, time and cost study. International Journal of Obstetric Anesthesia 2005; 3: 189-192.