A thoroughly revised third edition of the acclaimed textbook for caregivers involved in the management of pregnant women with uncommon diseases or an unusual or rare condition. The book offers valuable case reports and experience collated by an international team of editors and contributors who are leading experts in the field. This edition contains five additional chapters covering topics like cardiac and neuraxial point of care ultrasound, substance abuse, rare inherited conditions, and anesthesia for rare fetal and placental conditions. Clear, concise management guidelines and algorithms are provided, and each chapter is written from the viewpoint of the obstetric anesthesiologist. Numerous tables, figures and photographs provide visual aids and each chapter contains valuable clinical insights highlighting the essential facts. Featuring updated figures and references, links to useful websites for further reading and a list of commonly used abbreviations. A valuable resource for obstetric anesthetists, perinatologists and other obstetric care providers.

Following introduction of an Anesthesia Information Management System (AIMS) at a tertiary care, academic health sciences centre, a quality assurance initiative was conducted to assess staff opinions of the AIMS using a previously published, anonymous survey tool at 1 and 5 years following AIMS introduction. At 5 years compared to 1 year after implementation of AIMS, the majority (18 of 24, 75%) of responses to the survey questions had a statistically significant change (P < 0.05) in the proportion of respondents favoring AIMS compared to the 1 year survey. Domains noted to be more favorable 5 years compared to 1 year after AIMS introduction included patient safety in the Operating Rooms and Post-Anesthesia Care Unit, quality of handover and overall documentation, and communication amongst healthcare workers. The ideal time period at which to assess AIMS after introduction is not clear.

Purpose Competency-based medical education (CBME) is quickly becoming the dominant organizing principle for medical residency programs. As CBME requires changes in the way medical education is delivered, faculty will need to acquire new skills in teaching and assessment in order to navigate the transition. In this paper, we examine the evidence supporting best practices in faculty development, propose strategies for faculty development for CBME-based residency programs, and discuss the results of faculty development initiatives at the pioneering anesthesia CBME residency program at the University of Ottawa. Source Review of the current literature and information from the University of Ottawa anesthesia residency program. Principal findings Faculty development is critical to the success of CBME programs. Attention must be paid to the competence of faculty to teach and assess all of the CanMEDS roles. At the University of Ottawa, some faculty development initiatives were very successful, while others were hindered by factors both internal and external to the residency program. Many faculty development activities had low attendance rates. Conclusions Faculty development must be considered in the rollout of any new educational initiative. Experts suggest that faculty development for CBME should incorporate educational activities using multiple teaching and delivery methods, and should be offered longitudinally through the planning, development, and implementation phases of curriculum change. Additionally, these educational activities must continue until all faculty have demonstrated an acceptable level of competence. Faculty buy-in is paramount to the successful delivery of any faculty development program that is not mandatory in nature.

*Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada †Department of Anesthesiology, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada The authors have no conflicts of interest to disclose. Reprints: Roanne Preston, MD, FRCPC, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Rm 3300, JPPN 910W, 10th Avenue, Vancouver, BC, Canada V5Z 1M9. E-mail: [email protected]

External cephalic version (ECV) has likely been around for centuries as obstetricians (and midwives) sought to avoid the known dangers of a vaginal breech birth. Perhaps to the surprise of many anesthesiologists, the same issue applies to anesthesia assistance for ECV, as maternal pain is one of the two most common reasons to abort attempted ECV. In 1968, Ellis reported on 314 cases of attempted ECV under general anesthesia. At the time, the perinatal mortality from vaginal breech birth was 8-10%. There were 262 successful versions with a perinatal mortality of just less than 1%, and ‘‘none of the mothers died or suffered significant harm’’. Anesthesia for the procedure typically consisted of chloroform or ether and sometimes a muscle relaxant. In 2000, the Term Breech Trial, a multinational randomized controlled trial of vaginal vs elective Cesarean delivery for breech presentation at term, published results for 2,088 women that showed significant excess perinatal mortality in the vaginal delivery group (relative risk [RR] 0.33, 95% confidence interval [CI] 0.19 to 0.56). This led to an abrupt change in practice in developed countries, as almost all term breech presentations were then booked for elective Cesarean delivery. Subsequently, the trial has received significant criticism, leading to reconsideration of the options available to women presenting close to term with a fetus in breech position. The American College of Obstetricians and Gynecologists and the Society of Obstetricians and Gynecologists of Canada published new guidelines for breech vaginal birth in 2006 and 2009, respectively. The guidelines essentially endorsed a return to a practice condemned for its high perinatal mortality, but with strict provisos for women’s eligibility. Unfortunately, obstetrical expertise in performing a safe vaginal breech birth had faded away in the interim, and that, combined with a concerted effort to reduce the escalating Cesarean delivery rate, has led to a resurgence in interest in ECV and anesthesia-facilitated ECV. External cephalic version is typically performed at 36-37 weeks’ gestation. Prerequisites include adequate amniotic fluid volume, estimated fetal weight\4,000 g, an appropriate breech configuration (frank or complete), and a willing fully informed woman who has given her consent. The reported success rates vary from 30-70% and are highly dependent on the skill of the operator. Rather than considering medical problems up until time of delivery, the reported complications tend to be only those immediately associated with the procedure; therefore, the true risks associated with ECV may be underestimated. Reports most often describe non-recovering fetal bradycardia resulting in stat Cesarean delivery (1-5 per 1,000 attempted ECVs), placental abruption ( 0.3%), and maternal pain necessitating termination of the procedure (10-45%). Since 1994, there have been several articles examining the use of regional anesthesia to facilitate ECV, specifically, eight randomized controlled trials (two of which remain unpublished), six non-randomized studies, several reviews, and three meta-analyses. From an anesthetic perspective, it has been properly concluded that regional anesthesia (spinal, epidural, or the combination), not just Author contributions Roanne Preston and Robert Jee conceived, wrote, and edited the manuscript.