Early experiences with the new awake oesophageal Doppler probe.

Editor—I have been reading with interest the recent articles in your journal concerning epidural abscesses after insertion of epidural catheters, 1–3 and am in favour of the suggestions made to minimize the risk. However, I would like to highlight the point previously made in this journal that epidurals are not the only cause of an epidural abscess. 4 I recently anaesthetized a 30-yr-old woman for drainage of epidural abscesses at L3–4 and L5–6, which could easily have been mistaken for having been caused by a labour epidural. Two weeks earlier the multiparous lady had delivered a healthy male infant after having an episiotomy under local infiltration and a Ventouse delivery. No epidural had been given. For the hour preceding the birth she had been requesting an epidural, which could unfortunately not be inserted because of another obstetric emergency. Postpartum, the mother became increasingly unwell and developed an abscess of her episiotomy wound. Abscesses and compartment syndrome of both forearms followed. Finally she developed abscesses in her psoas and posterior paravertebral muscles as well as the epidural space, diagnosed at surgery after a suspicious CT scan. The frequency of spinal epidural abscess is rare, counting for less than 1 in 10 000 hospital admissions, although currently increasing in frequency. The pathogenesis has been described as being attributable to: (i) iatrogenic causes; (ii) direct invasion from a primary focus; or (iii) metastatic infection secondary to septicaemia. They can occur at any age but are more common in patients >50 yr. People at risk are i.v. drug abusers, diabetics and immunocompromised patients. Staphylococcus aureus is the most common culprit. 5 Although on methadone, the mother in this case denied ever injecting drugs, but admitted to previously smoking heroin. No needle marks were observed. She had been routinely tested during the pregnancy and was found to be HIV negative. After surgery and antibiotic treatment, this patient is now recovering well. She appeared to have a metastatic Staphylococcus aureus infection, the source of which is unclear. If she had received an epidural catheter during labour, would the cause remain unknown? Coincidental diagnosis of an extradural abscess while siting an extradural catheter for postoperative analgesia. Early experiences with the new awake oesophageal Doppler probe Editor—We would like to report our early experiences with a new naso-oesophageal Awake Doppler Probe (ADP; Deltex Medical Ltd, Chichester, UK) for monitoring cardiac output. We used it in the setting of …