Spinal cord stimulator and epidural haematoma.

reserve bag, during spontaneous ventilation. There is a selfinflating bag for controlled ventilation. The machine is robust with no electronic and few moving parts, thus requires minimal maintenance and disposables. An oxygen concentrator can be added to allow the use of supplemental oxygen if electricity is available. We visited Hoima Referral Hospital in Uganda with a team from North Hampshire Hospital in Basingstoke, Hampshire, UK. A well-established link with this hospital enables groups of volunteers to visit Hoima three to four times a year and work alongside the medical professionals, providing clinical teaching. We anaesthetized four patients for Caesarean section using the portable Diamedica Glostavent during our stay. Two of the women were suffering with eclampsia, a third patient had cord prolapse, and the last presented haemorrhaging with grade 4 placenta praevia. All cases would have been classified as ‘category 1’ Caesarean sections according to the classification system suggested by Lucas and colleagues widely used in the UK. We used thiopental and succinylcholine for a rapid sequence induction for all four patients. Positive pressure ventilation was maintained by hand until spontaneous respiration resumed. Anaesthesia was maintained with 2% isoflurane using the draw-over vaporizer. Monitoring comprised a manual sphygmomanometer, a hand-held portable oxygen saturation finger probe, and a stethoscope. End-tidal gas monitoring was not available. We found that the portable Diamedica Glostavent worked smoothly with and without oxygen, all the patients made a good recovery. The breathing circuits were reliable in both spontaneous and in intermittent positive pressure ventilation modes. In particular, the spinning disc in the centre of the exhaled limb is an ingenious and simple respiratory monitor where there is no end-tidal gas monitoring. Moreover, in unfamiliar surroundings, it was helpful to be able to use a volatile agent that was familiar to us (isoflurane rather than ether) and to deliver it using equipment which, although novel, felt instinctively familiar. The only problems we encountered were difficulty with filling the vaporizer (a funnel larger than the steel one supplied was require to avoid spilt liquid isoflurane) and the inevitable fragility of using disposable tubing—this would not be robust over the course of prolonged use and carrying lots of disposables defeats the purpose. We would highly recommend using this equipment in similar circumstances.