"If we had no winter, the spring would not be so pleasant; if we did not sometimes taste of adversity, prosperity would not be so welcome."
~Anne Bradstreet

There is something about the start of spring that awakens everybody's senses. After several months of gray, wet and cold weather the simple appearance of the sun and blue skies makes everybody smile. It seems like we all have a renewed sense of energy. I think that springtime helps remind us all that every day is a new beginning and we have to make the most of it. I hope that your spring season has started on a positive and bright note.

There has been a lot of change in the industry in the past year or so but National is still going strong, we're approaching 21 years in the business. We are here to offer quick and creative staffing solutions to clients and we continue to connect with you on a personal level, working to find permanent or locum jobs for providers.

As for this month's stories, we've continued our involvement with supporting the relief mission in Haiti, which you can read about in "Haiti Anesthesia Relief." In the article "In Labor, a Snack or a Sip?" you will read about whether it is necessary for women in labor to be restricted from food and drink. To wrap up this month's newsletter we have a fun interactive test of free will in "How Smart is Your Right Foot?"

As we wrap up this month, I hope that all of you are looking forward to a fresh start this spring. Last but no least, in the spirit of March Madness and in support of my home state, Go MSU!

Stephen Read, President
National Anesthesia Services, Inc.

"Every thought you produce, anything you say, any action you do, it bears your signature."

----- Thich Nhat Hanh

It is so easy to forget about other people's struggles when we are dealing with our own lives and going about our day to day challenges. We are so fortunate to have running water, a roof over our heads and basic medical care. Yet, on a daily basis I find myself frustrated because my bottle of water is empty again or I can't find a band-aid in my desk drawer, my purse or my car. How lucky am I that I have so many places to even look for that band-aid! The people in Haiti, and countless other locations, have to stand in line for a drink of water, their roofs have crumbled and to find a band-aid, heck; they have to stand in line for that, too!

As mentioned in previous newsletters, National established a website, www.haitianesthesiarelief.com, and program in hopes of using our connections with the anesthesia community to support the relief efforts of many different individuals and organizations.

Recently, we were able to connect Pam Chambers, CRNA with an organization called Mercy Works, out of Lindale, TX. Pam has been able to coordinate with the group and donate much needed surgical supplies, which Mercy Works brings with them on their mission trips to Haiti. Pam will continue to support this organization with more donations in the future. If you would like to learn more about Mercy Works and their mission, please visit their website at www.mercyworks.org.

National Anesthesia is so proud to be associated with people like Pam and groups like Mercy Works. I know next time I am thirsty or looking for simple band- aid for a paper cut, I'll check myself and remember these groups and their mission.

Maternity wards have long forbidden women in labor to eat or drink. Even when labor goes on and on, the bill of fare is usually limited to ice chips.

Now a systematic review of existing studies has found no evidence that the restrictions have any benefit for most healthy women and their babies.

The prohibitions are meant to reduce the risk of Mendelson's syndrome (named for Dr. Curtis L. Mendelson, the New York obstetrician who first described it in the 1940s), which can occur if the contents of the stomach are drawn into the lungs while the patient is under general anesthesia.

While rare, the syndrome can be fatal. But nowadays the use of general anesthesia during labor and delivery is also rare. Caesarean sections are generally done using regional anesthesia.

"My own view of this has always been that you could say one shouldn't eat or drink anything before getting into a car on the same basis, because you could be in an automobile accident and you might require general anesthesia," said Dr. Marcie Richardson, an obstetrician and gynecologist at Harvard Vanguard Medical Associates in Boston, who was not connected to the new study.

Beth Israel Deaconess Medical Center, where Dr. Richardson delivers, estimates that just 1 to 2 percent of women in labor are given general anesthesia.

The restrictions date back almost seven decades, said Joan Tranmer, an associate professor of nursing at Queen's University in Kingston, Ontario, an author of the new review, published last week by the Cochrane Collaboration.

"We thought it was time to question this, now that we're in the 2000s," said Dr. Tranmer, who said she had seen all too many women in labor complaining of thirst and dry mouth resort to sucking wet washcloths.

"With improved anesthetic techniques, we don't do general anesthesia a lot anymore," she said. "And even when they have to administer general anesthesia, they've improved the techniques, and the risk is very, very low.

"So we turned the question around and asked: Is there any benefit to restricting oral food and fluid during labor? And we found no benefit and no harm."

The authors acknowledged that they found relatively little evidence to analyze: 11 studies, including just 5 randomized controlled trials encompassing 3,130 women.

All of the studies looked at women who were in active labor and at low risk of requiring general anesthesia. One compared complete restriction of food and drink with complete freedom to eat and drink at will, two compared water with other liquids and foods and two compared water with carbohydrate drinks.

There were no statistically significant differences in such primary outcomes as the rate of Caesarean sections and fetal Apgar scores, or in secondary outcomes, like the need for pain relief or duration of labor. One small study, however, did find an increase in C-sections among women taking carbohydrate drinks compared with those limited to drinking water.

Some hospitals have lifted restrictions on drinking during labor in recent months, since the American Congress of Obstetricians and Gynecologists issued new guidelines last August allowing patients to drink clear liquids. But the guidelines kept the restriction on solid foods.

"The problem is going to be for emergency C- sections, which are rare but not unheard of," said Dr. William Henry Barth Jr., chairman of the society's committee on obstetrics practice. "There's just not time in that setting to stop and do regional anesthesia. And it can be unpredictable."

Anesthesiologists were critical of the review, saying none of the studies were large enough to evaluate the impact of eating on risks during general anesthesia.

"From an anesthesiologist's perspective, they missed the boat on this one," said Dr. Craig M. Palmer, chairman of the committee on obstetrical anesthesia for the American Society of Anesthesiologists.

"They looked at the impact on the progression of labor, but to be honest, that's not an issue for anesthesiologists. Our primary concern is patient safety."

Roni Caryn Rabin
http://www.nytimes.com

This is hysterical. You have to try this. It is absolutely true. I guess there are some things the brain cannot handle.

It is from an orthopedic surgeon. This will boggle your mind and it will keep you trying over and over again to see if you can outsmart your foot, but, you can't. It's preprogrammed in your brain!

1) Without anyone watching you (they will think you are Goofy) and while sitting at your desk in front of your computer, lift your right foot off the floor and make clockwhise circles.

2) Now, while doing this, draw the number 6 in the air with your right hand.

Your foot will change direction. And there's nothing you can do about it!

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