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Knapp C, Bhatia K, Columb M, Elriedy M. Remifentanil patient-controlled analgesia for labour in pregnant patients with heart disease. Int J Obstet Anesth 2023; 55:103902. [PMID: 37302184 DOI: 10.1016/j.ijoa.2023.103902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Affiliation(s)
- C Knapp
- Department of Anaesthesia, Health Education England North-West, Manchester, UK
| | - K Bhatia
- Department of Anaesthesia, Saint Mary's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - M Columb
- Intensive Care Unit, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - M Elriedy
- Department of Anaesthesia, University Hospitals of Derby and Burton, Derby and Burton on Trent, UK
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Eusuf D, Bhatia K, Kochhar P, Columb M. A national survey on the availability of prefilled medication syringes and medication errors in maternity units across the United Kingdom. Int J Obstet Anesth 2023; 53:103617. [PMID: 36549952 DOI: 10.1016/j.ijoa.2022.103617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/14/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Affiliation(s)
- D Eusuf
- Saint Mary's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK; Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - K Bhatia
- Saint Mary's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK.
| | - P Kochhar
- Saint Mary's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - M Columb
- Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
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Bhatia K, Columb M, Shelton C, Lie J, Leach S, Froud O, Verma D, Sturgess P, Sawyerr A, Desai J, Gould N, Kumari S, Sen U, Verma P, Kamath P, Koirala A, Kimber‐Craig S, Eccles J, Bewlay A, Eslam E, Radwan M, Hulgur M, Christian J, Aiyad A. Epidural labour analgesia rates during the
COVID
‐19 pandemic in the north‐west of England. Anaesthesia 2022; 77:1055-1056. [DOI: 10.1111/anae.15780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2022] [Indexed: 11/28/2022]
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Knapp C, Bhatia K, Columb M. P.27 Haemodynamic stability of remifentanil patient-controlled analgesia during labour in parturients with cardiac disease. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chambers DJ, Bhatia K, Columb M. Postpartum cerebral venous sinus thrombosis following obstetric neuraxial blockade: a literature review with analysis of 58 case reports. Int J Obstet Anesth 2021; 49:103218. [PMID: 34598860 DOI: 10.1016/j.ijoa.2021.103218] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 07/17/2021] [Accepted: 09/06/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVST) is a rare complication of pregnancy. It usually presents with a headache and may mimic a post-dural puncture headache (PDPH) in women who receive a neuraxial block. METHODS Medline, CINAHL and EMBASE databases were searched to identify postpartum cases of CVST following neuraxial block. The aim was to delineate the characteristics, presentation, investigations, and outcomes of postpartum women who presented with CVST. RESULTS Forty-nine articles with 58 case reports were identified. Forty-two women (72.4%) had an epidural attempted whilst 16 women (27.6%) received a spinal anaesthetic. Accidental dural puncture (ADP) was reported in 17 women (40.5%). Headache was the presenting symptom in 57 women (98.3%); 26 women (44.8%) also experienced seizures. Post-dural puncture headache was reported in 46 (79.3%) and an epidural blood patch was performed in 26 women (44.8%). Superior sagittal sinus, transverse sinus, and cortical veins were the most common sites of thrombosis. The median time to diagnosis was 6.5 days from delivery. Magnetic resonance imaging was the most common diagnostic neuro-imaging modality. Full neurological recovery was reported in 48 (82.8%), whilst neurological deficits were reported in six (10.3%) women. DISCUSSION The diagnosis of CVST may be overlooked in women who present with headache following neuraxial block. A change in character of headache with loss of postural element, and focal neurological signs are the key clinical features that could help anaesthetists differentiate headache of CVST from PDPH. The high reported rates of ADP and PDPH lend support to their possible association with CVST.
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Affiliation(s)
| | - K Bhatia
- Saint Mary's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK.
| | - M Columb
- Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
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Bhatia K, Columb M, Bewlay A, Tageldin N, Knapp C, Qamar Y, Dooley A, Kamath P, Hulgur M. Decision-to-delivery interval and neonatal outcomes for category-1 caesarean sections during the COVID-19 pandemic. Anaesthesia 2021; 76:1051-1059. [PMID: 33891311 PMCID: PMC8251307 DOI: 10.1111/anae.15489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 01/29/2023]
Abstract
General anaesthesia is known to achieve the shortest decision‐to‐delivery interval for category‐1 caesarean section. We investigated whether the COVID‐19 pandemic affected the decision‐to delivery interval and influenced neonatal outcomes in patients who underwent category‐1 caesarean section. Records of 562 patients who underwent emergency caesarean section between 1 April 2019 and 1 July 2019 in seven UK hospitals (pre‐COVID‐19 group) were compared with 577 emergency caesarean sections performed during the same period during the COVID‐19 pandemic (1 April 2020–1 July 2020) (post‐COVID‐19 group). Primary outcome measures were: decision‐to‐delivery interval; number of caesarean sections achieving decision‐to‐delivery interval < 30 min; and a composite of adverse neonatal outcomes (Apgar 5‐min score < 7, umbilical arterial pH < 7.10, neonatal intensive care unit admission and stillbirth). The use of general anaesthesia decreased significantly between the pre‐ and post‐COVID‐19 groups (risk ratio 0.48 (95%CI 0.37–0.62); p < 0.0001). Compared with the pre‐COVID‐19 group, the post‐COVID‐19 group had an increase in median (IQR [range]) decision‐to‐delivery interval (26 (18–32 [4–124]) min vs. 27 (20–33 [3–102]) min; p = 0.043) and a decrease in the number of caesarean sections meeting the decision‐to‐delivery interval target of < 30 min (374/562 (66.5%) vs. 349/577 (60.5%); p = 0.02). The incidence of adverse neonatal outcomes was similar in the pre‐ and post‐COVID‐19 groups (140/568 (24.6%) vs. 140/583 (24.0%), respectively; p = 0.85). The small increase in decision‐to‐delivery interval observed during the COVID‐19 pandemic did not adversely affect neonatal outcomes.
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Affiliation(s)
- K Bhatia
- Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK.,Manchester Medical School, University of Manchester, Manchester, UK
| | - M Columb
- Department of Anaesthesia, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK.,Department of Intensive Care Medicine, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - A Bewlay
- Department of Anaesthesia, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - N Tageldin
- Department of Anaesthesia and Peri-operative Medicine, Saint Mary's Hospital, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - C Knapp
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - Y Qamar
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - A Dooley
- Department of Anaesthesia, Liverpool Women's Hospital, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - P Kamath
- Department of Anaesthesia, Royal Bolton Hospital, Bolton NHS Foundation Trust, Bolton, UK
| | - M Hulgur
- Department of Anaesthesia, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh NHS Hospital Foundation Trust, Wigan, UK
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Bhatia K, Columb M, Bewlay A, Eccles J, Hulgur M, Jayan N, Lie J, Verma D, Parikh R. The effect of COVID-19 on general anaesthesia rates for caesarean section. A cross-sectional analysis of six hospitals in the north-west of England. Anaesthesia 2020; 76:312-319. [PMID: 33073371 DOI: 10.1111/anae.15313] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2020] [Indexed: 12/16/2022]
Abstract
At the onset of the global pandemic of COVID-19 (SARS-CoV-2), guidelines recommended using regional anaesthesia for caesarean section in preference to general anaesthesia. National figures from the UK suggest that 8.75% of over 170,000 caesarean sections are performed under general anaesthetic. We explored whether general anaesthesia rates for caesarean section changed during the peak of the pandemic across six maternity units in the north-west of England. We analysed anaesthetic information for 2480 caesarean sections across six maternity units from 1 April to 1 July 2020 (during the pandemic) and compared this information with data from 2555 caesarean sections performed at the same hospitals over a similar period in 2019. Primary outcome was change in general anaesthesia rate for caesarean section. Secondary outcomes included overall caesarean section rates, obstetric indications for caesarean section and regional to general anaesthesia conversion rates. A significant reduction (7.7 to 3.7%, p < 0.0001) in general anaesthetic rates, risk ratio (95%CI) 0.50 (0.39-0.93), was noted across hospitals during the pandemic. Regional to general anaesthesia conversion rates reduced (1.7 to 0.8%, p = 0.012), risk ratio (95%CI) 0.50 (0.29-0.86). Obstetric indications for caesarean sections did not change (p = 0.17) while the overall caesarean section rate increased (28.3 to 29.7%), risk ratio (95%CI) 1.02 (1.00-1.04), p = 0.052. Our analysis shows that general anaesthesia rates for caesarean section declined during the peak of the pandemic. Anaesthetic decision-making, recommendations from anaesthetic guidelines and presence of an on-site anaesthetic consultant in the delivery suite seem to be the key factors that influenced this decline.
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Affiliation(s)
- K Bhatia
- Department of Anaesthesia and Peri-operative Medicine, University of Manchester, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Columb
- Department of Anaesthesia, Peri-operative and Intensive Care Medicine, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - A Bewlay
- Department of Anaesthesia, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - J Eccles
- Department of Anaesthesia, Royal Oldham Hospital, Oldham Care Organisation, Northern Care Alliance NHS Group, Oldham, UK
| | - M Hulgur
- Department of Anaesthesia, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh NHS Hospital NHS Foundation Trust, Wigan, UK
| | - N Jayan
- Department of Anaesthesia, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh NHS Hospital NHS Foundation Trust, Wigan, UK
| | - J Lie
- Department of Anaesthesia, Burnley General Teaching Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - D Verma
- Department of Anaesthesia, Liverpool Women's Hospital, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - R Parikh
- Department of Anaesthesia, Liverpool Women's Hospital, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
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Al-Sulttan S, Bampoe S, Howle R, Setty T, Columb M, Patel A, Fernando R, Husain T, Sultan P. A prospective, up-down sequential allocation study investigating the effectiveness of vital capacity breaths using high-flow nasal oxygenation versus a tight-fitting face mask to pre-oxygenate term pregnant women. Int J Obstet Anesth 2020; 45:28-33. [PMID: 33129656 DOI: 10.1016/j.ijoa.2020.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 08/03/2020] [Accepted: 08/16/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The role of high flow nasal oxygenation (HFNO) for pre-oxygenation before obstetric general anaesthesia remains unclear. This study aimed to determine the number of vital capacity breaths using HFNO required to pre-oxygenate 90% of parturients to an end-tidal oxygen concentration fraction (FETO2) of ≥0.90 (termed EN90). METHODS Using up-down, sequential allocation trial design, volunteer term parturients undergoing caesarean delivery were investigated with HFNO with their mouth closed, followed by mouth open, and if FETO2 ≥0.90 was not achieved after a maximum of 20 vital capacity breaths, pre-oxygenation was attempted with a face mask. The primary outcome was the number of vital capacity breaths required using HFNO (mouth open and closed) to achieve EN90. Secondary outcomes included assessment of EN90 using mouth open versus mouth closed and face mask pre-oxygenation, maternal satisfaction and evaluation of fetal cardiotocography. RESULTS Twenty women at term were recruited. Successful pre-oxygenation occurred in 4 (20%), 3 (15%) and 14 (70%) women with HFNO mouth closed, HFNO mouth open, and via face mask respectively. At up to 20 vital capacity breaths, face mask pre-oxygenation was more successful at achieving EN90 compared with both HFNO with a closed (P=0.006) or open (P=0.001) mouth. Closed mouth HFNO did not outperform open mouth pre-oxygenation. CONCLUSION Face mask pre-oxygenation is more effective at achieving EN90 compared with to HFNO within a clinically acceptable number of vital capacity breaths. Further studies are needed to determine the role of HFNO in optimising the time before desaturation and for apnoeic oxygenation in term parturients.
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Affiliation(s)
- S Al-Sulttan
- Department of Anaesthesia, University College London NHS Trust, London, UK
| | - S Bampoe
- Department of Anaesthesia, University College London NHS Trust, London, UK; University College London, UK.
| | - R Howle
- Department of Anaesthesia, University College London NHS Trust, London, UK
| | - T Setty
- Anaesthesia, Queens Medical Centre, Nottingham, UK
| | - M Columb
- Anaesthesia & Intensive Care Medicine, University of Manchester Hospitals NHS Foundation Trust, Wythenshawe Hospital, UK
| | - A Patel
- University College London, UK
| | - R Fernando
- The Women's Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar
| | - T Husain
- Anaesthesia, Ashford & St Peters NHS Foundation Trust, UK
| | - P Sultan
- Stanford University School of Medicine, CA, USA
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Gutierrez J, Perry H, Columb M, Bampoe S, Thilaganathan B, Khalil A. Cardiac output measurements during high-risk Cesarean section using electrical bioreactance or arterial waveform analysis: assessment of agreement. Ultrasound Obstet Gynecol 2019; 54:232-238. [PMID: 30302868 DOI: 10.1002/uog.20142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/28/2018] [Accepted: 10/02/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Maternal hemodynamics change significantly during Cesarean section complicated by massive hemorrhage or severe hypertensive disease. Cardiac output (CO) monitoring aids early, goal-directed hemodynamic therapy. The aim of this study was to record hemodynamic changes observed during Cesarean section in pregnancies at high risk of hemodynamic instability, using invasive (LiDCOrapid™) and non-invasive (NICOM®) devices, and to assess agreement between the two devices in measuring CO. METHODS Simultaneous intraoperative hemodynamic measurements were taken using the LiDCOrapid and NICOM devices, following standardized techniques, in women at high risk of hemodynamic instability undergoing Cesarean section. Agreement in CO measurements between the two devices was assessed using Bland-Altman plots and the agreement:tolerability index (ATI). Agreement analyses were performed for repeated measures in subjects, using centiles. RESULTS From 10 women, 307 paired measurements were analyzed. Mean bias (defined as the mean difference in CO measurements between the LiDCOrapid and NICOM devices) was 3.05 (95% CI, 1.89 to 4.21) L/min. Limits of agreement ranged from -1.58 (95% CI, -4.47 to -0.14) to 7.68 (95% CI, 6.24 to 10.56) L/min. The resulting agreement interval was 9.26 L/min which returned an ATI of 2.3. CONCLUSIONS There are large mean differences between CO measurements obtained during Cesarean section using the LiDCOrapid and NICOM hemodynamic monitors in pregnant women at high risk of hemodynamic instability, indicating that they should not be considered interchangeable clinically. There is an unacceptably low level of agreement (ATI > 2) in CO measurements between the devices, conferring a high risk of clinical misclassification during massive hemorrhage. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J Gutierrez
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - H Perry
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - M Columb
- Manchester University Hospitals NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - S Bampoe
- Centre for Anaesthesia and Perioperative Medicine, University College London, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Chandra A, Yan J, Soenjaya Y, Demore C, Columb M, McLeod G. Identifying the needle-tip position during regional anaesthesia with needle-tip pressure at different flow rates. Br J Anaesth 2018. [DOI: 10.1016/j.bja.2018.05.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Marhofer P, Columb M, Hopkins P. Corrigendum to “Perineural dexamethasone – the dilemma of systematic reviews and meta-analyses” [Br J Anaesth 2018; 120: 201–203]. Br J Anaesth 2018; 120:1142. [DOI: 10.1016/j.bja.2018.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Mustafa A, Seeley J, Munirama S, Columb M, McKendrick M, Schwab A, Corner G, Eisma R, Mcleod G. Investigation into the visual perceptive ability of anaesthetists during ultrasound-guided interscalene and femoral blocks conducted on soft embalmed cadavers: a randomised single-blind study. Br J Anaesth 2018; 120:854-859. [DOI: 10.1016/j.bja.2017.12.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/19/2017] [Accepted: 12/27/2017] [Indexed: 11/29/2022] Open
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Marhofer P, Columb M, Hopkins P. Perineural dexamethasone: the dilemma of systematic reviews and meta-analyses. Br J Anaesth 2018; 120:201-203. [DOI: 10.1016/j.bja.2017.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 10/16/2017] [Accepted: 10/19/2017] [Indexed: 11/17/2022] Open
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Griffiths S, Woo C, Mansoubi V, Riccoboni A, Sabharwal A, Napier S, Columb M, Laffan M, Stocks G. Thromboelastography (TEG®) demonstrates that tinzaparin 4500 international units has no detectable anticoagulant activity after caesarean section. Int J Obstet Anesth 2017; 29:50-56. [DOI: 10.1016/j.ijoa.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 09/15/2016] [Accepted: 10/01/2016] [Indexed: 11/28/2022]
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Mon W, Stewart A, Fernando R, Ashpole K, El-Wahab N, MacDonald S, Tamilselvan P, Columb M, Liu YM. Cardiac output changes with phenylephrine and ephedrine infusions during spinal anesthesia for cesarean section: A randomized, double-blind trial. J Clin Anesth 2016; 37:43-48. [PMID: 28235526 DOI: 10.1016/j.jclinane.2016.11.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 10/14/2016] [Accepted: 11/03/2016] [Indexed: 12/13/2022]
Abstract
Hypotension is a common side effect of spinal anesthesia. Phenylephrine and ephedrine are the two most frequently used vasopressors to treat spinal hypotension during cesarean delivery. In this randomized double-blind study, we aimed to evaluate cardiac output (CO) changes with phenylephrine or ephedrine infusions titrated to maintain baseline systolic blood pressure (bSBP) during spinal anesthesia. Women (n = 40) scheduled for elective cesarean delivery received either phenylephrine 100 μg/min or ephedrine 5 mg/min infusions. Baseline hemodynamics (cardiac output, heart rate, systolic blood pressure) were recorded in the left lateral tilt position before fluid preload, and recorded every minute after spinal anesthesia until delivery. Umbilical cord blood gases were analyzed within 5 minutes of delivery. Good systolic blood pressure control was attained in both groups with minimal periods of hypotension (SBP <80% of bSBP) or hypertension (SBP >120% of bSBP). Cardiac output and heart rate increased over time with ephedrine, but decreased with phenylephrine. The maximum increase in CO from the baseline was 12%, in the ephedrine group, and this occurred 20 minutes after spinal injection. Cardiac output fell by more than 17% in the phenylephrine group, maximal at 10 minutes following spinal injection. Despite good systolic blood pressure control and increased cardiac output with ephedrine, administration of ephedrine was associated with significantly more fetal acidosis [Median (Interquartile range, IQR) UApH - phenylephrine = 7.33 (7.31-7.34) and ephedrine = 7.22 (7.16-7.27), P < .05].
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Affiliation(s)
- W Mon
- University College London Hospitals NHS Foundation Trust, London, UK
| | - A Stewart
- University College London Hospitals NHS Foundation Trust, London, UK
| | - R Fernando
- University College London Hospitals NHS Foundation Trust, London, UK
| | - K Ashpole
- St.Richard's Hospital, Chichester, UK
| | - N El-Wahab
- University College London Hospitals NHS Foundation Trust, London, UK
| | - S MacDonald
- Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
| | | | - M Columb
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, UK
| | - Y M Liu
- University College London Hospitals NHS Foundation Trust, London, UK
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Munirama S, Zealley K, Schwab A, Columb M, Corner G, Eisma R, McLeod G. Trainee anaesthetist diagnosis of intraneural injection—a study comparing B-mode ultrasound with the fusion of B-mode and elastography in the soft embalmed Thiel cadaver model. Br J Anaesth 2016; 117:792-800. [DOI: 10.1093/bja/aew337] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 11/13/2022] Open
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Munirama S, Eisma R, Columb M, Corner G, McLeod G. Physical properties and functional alignment of soft-embalmed Thiel human cadaver when used as a simulator for ultrasound-guided regional anaesthesia. Br J Anaesth 2016; 116:699-707. [DOI: 10.1093/bja/aev548] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/14/2022] Open
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Armstrong S, Fernando R, Tamilselvan P, Stewart A, Columb M. The effect of serial in vitro haemodilution with maternal cerebrospinal fluid and crystalloid on thromboelastographic (TEG®) blood coagulation parameters, and the implications for epidural blood patching. Anaesthesia 2014; 70:135-41. [DOI: 10.1111/anae.12911] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2014] [Indexed: 11/27/2022]
Affiliation(s)
- S. Armstrong
- Department of Anaesthesia; Frimley Health NHS Foundation Trust; Frimley UK
| | - R. Fernando
- Department of Anaesthesia; University College London Hospitals NHS Trust; London UK
| | - P. Tamilselvan
- Department of Anaesthesia; The Princess Alexandra Hospital; Harlow UK
| | - A. Stewart
- Department of Anaesthesia; University College London Hospitals NHS Trust; London UK
| | - M. Columb
- Department of Anaesthesia; South Manchester University Hospitals NHS Trust; Wythenshawe UK
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Munirama S, Joy J, Columb M, Habershaw R, Eisma R, Corner G, Cochran S, McLeod G. A randomised, single-blind technical study comparing the ultrasonic visibility of smooth-surfaced and textured needles in a soft embalmed cadaver model. Anaesthesia 2014; 70:537-42. [DOI: 10.1111/anae.12925] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2014] [Indexed: 11/28/2022]
Affiliation(s)
- S. Munirama
- Institute of Academic Anaesthesia; University of Dundee; Dundee UK
| | - J. Joy
- Institute for Medical Science and Technology; University of Dundee; Dundee UK
| | - M. Columb
- Departments of Anaesthesia & Intensive Care Medicine; Wythenshawe Hospital; Manchester UK
| | - R. Habershaw
- Institute for Medical Science and Technology; University of Dundee; Dundee UK
| | - R. Eisma
- Centre for Anatomy and Human Identification; University of Dundee; Dundee UK
| | | | - S. Cochran
- Institute for Medical Science and Technology; University of Dundee; Dundee UK
| | - G. McLeod
- Institute of Academic Anaesthesia; University of Dundee; Dundee UK
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Husain T, Liu Y, Fernando R, Nagaratnam V, Sodhi M, Tamilselvan P, Venkatesh S, England A, Columb M. How UK obstetric anaesthetists assess neuraxial anaesthesia for caesarean delivery: National surveys of practice conducted in 2004 and 2010. Int J Obstet Anesth 2013; 22:298-302. [DOI: 10.1016/j.ijoa.2013.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 06/26/2013] [Accepted: 07/07/2013] [Indexed: 10/26/2022]
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Carle C, Alexander P, Columb M, Johal J. Design and internal validation of an obstetric early warning score: secondary analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database. Anaesthesia 2013; 68:354-67. [PMID: 23488833 DOI: 10.1111/anae.12180] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2013] [Indexed: 02/06/2023]
Abstract
We designed and internally validated an aggregate weighted early warning scoring system specific to the obstetric population that has the potential for use in the ward environment. Direct obstetric admissions from the Intensive Care National Audit and Research Centre's Case Mix Programme Database were randomly allocated to model development (n = 2240) or validation (n = 2200) sets. Physiological variables collected during the first 24 h of critical care admission were analysed. Logistic regression analysis for mortality in the model development set was initially used to create a statistically based early warning score. The statistical score was then modified to create a clinically acceptable early warning score. Important features of this clinical obstetric early warning score are that the variables are weighted according to their statistical importance, a surrogate for the FI O2 /Pa O2 relationship is included, conscious level is assessed using a simplified alert/not alert variable, and the score, trigger thresholds and response are consistent with the new non-obstetric National Early Warning Score system. The statistical and clinical early warning scores were internally validated using the validation set. The area under the receiver operating characteristic curve was 0.995 (95% CI 0.992-0.998) for the statistical score and 0.957 (95% CI 0.923-0.991) for the clinical score. Pre-existing empirically designed early warning scores were also validated in the same way for comparison. The area under the receiver operating characteristic curve was 0.955 (95% CI 0.922-0.988) for Swanton et al.'s Modified Early Obstetric Warning System, 0.937 (95% CI 0.884-0.991) for the obstetric early warning score suggested in the 2003-2005 Report on Confidential Enquiries into Maternal Deaths in the UK, and 0.973 (95% CI 0.957-0.989) for the non-obstetric National Early Warning Score. This highlights that the new clinical obstetric early warning score has an excellent ability to discriminate survivors from non-survivors in this critical care data set. Further work is needed to validate our new clinical early warning score externally in the obstetric ward environment.
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Affiliation(s)
- C Carle
- Critical Care Medicine, Peterborough City Hospital, Peterborough, UK.
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Quinn A, Milne D, Columb M, Gorton H, Knight M. Failed tracheal intubation in obstetric anaesthesia: 2 yr national case–control study in the UK. Br J Anaesth 2013; 110:74-80. [DOI: 10.1093/bja/aes320] [Citation(s) in RCA: 199] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Jones AR, Carle C, Columb M. Effect of table tilt on ligamentum flavum length measured using ultrasonography in pregnant women*. Anaesthesia 2012; 68:27-30. [DOI: 10.1111/anae.12006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Armstrong S, Fernando R, Columb M. A reply. Anaesthesia 2012. [DOI: 10.1111/j.1365-2044.2012.07284.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Armstrong S, Fernando R, Ashpole K, Simons R, Columb M. Assessment of coagulation in the obstetric population using ROTEM® thromboelastometry. Int J Obstet Anesth 2011; 20:293-8. [DOI: 10.1016/j.ijoa.2011.05.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 05/10/2011] [Accepted: 05/24/2011] [Indexed: 12/22/2022]
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Clayton RA, Bannard-Smith JP, Washington SJ, Wisely N, Columb M, Rees L. Cardiopulmonary exercise testing and length of stay in patients undergoing major surgery. Anaesthesia 2011; 66:393-4. [PMID: 21480842 DOI: 10.1111/j.1365-2044.2011.06725.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McCartney C, McNaught A, Shastri U, Columb M. Reply from the authors. Br J Anaesth 2011. [DOI: 10.1093/bja/aer045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kapila I, Columb M. Atlas of Regional Anesthesia. Br J Anaesth 2011. [DOI: 10.1093/bja/aeq409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- G Lyons
- Department of Obstetric Anaesthesia, St James' University Hospital, Leeds, UK.
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Walsh P, Columb M, Russell R. A comparison of a Neuropen monofilament and ethyl chloride for assessing loss of touch sensation during combined spinal–epidural anaesthesia for caesarean section. Int J Obstet Anesth 2010; 19:365-72. [DOI: 10.1016/j.ijoa.2010.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Revised: 03/25/2010] [Accepted: 06/25/2010] [Indexed: 11/26/2022]
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Kocarev M, Watkins E, McLure H, Columb M, Lyons G. Sensory testing of spinal anaesthesia for caesarean section: differential block and variability. Int J Obstet Anesth 2010; 19:261-5. [DOI: 10.1016/j.ijoa.2010.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2008] [Revised: 09/11/2009] [Accepted: 02/10/2010] [Indexed: 10/19/2022]
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Panchagnula U, Columb M. Atlas of Ultrasound and Nerve Stimulation-guided Regional Anesthesia. Br J Anaesth 2009. [DOI: 10.1093/bja/aep059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Dewandre P, Kirsch M, Bonhomme V, Columb M, Hans P, Brichant J. Impact of the addition of sufentanil 5 μg or clonidine 75 μg on the minimum local analgesic concentration of ropivacaine for epidural analgesia in labour: a randomized comparison. Int J Obstet Anesth 2008; 17:315-21. [DOI: 10.1016/j.ijoa.2008.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 03/27/2008] [Accepted: 05/24/2008] [Indexed: 11/26/2022]
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Schulenburg H, Sri-Chandana C, Dutton M, Lyons G, Columb M, McLure H. �Does hyaluronidase permit volume reduction in sub-Tenon's anaesthesia for cataract extractions? Anaesthesia 2007. [DOI: 10.1111/j.1365-2044.2006.04944_16.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Buyse I, Stockman W, Columb M, Vandermeersch E, Van de Velde M. Effect of sufentanil on minimum local analgesic concentrations of epidural bupivacaine, ropivacaine and levobupivacaine in nullipara in early labour. Int J Obstet Anesth 2007; 16:22-8. [PMID: 17125998 DOI: 10.1016/j.ijoa.2006.07.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim was to assess the effect of epidural sufentanil on relative analgesic potencies of epidural bupivacaine, ropivacaine and levobupivacaine by determining the minimum local analgesic concentrations during labour. METHODS In a randomised, double-blind study, 171 parturients were allocated to one of six groups receiving a 10-mL bolus of bupivacaine, ropivacaine or levobupivacaine alone or with sufentanil 0.75 microg/mL. The concentration of local anaesthetic was determined by the response of the previous parturient using up-down sequential allocation starting at a concentration of 0.13% wt/vol with a testing interval of 0.01%. Effective analgesia was defined as a visual analogue pain score < or = 15/100 mm within 30 min and lasting for 30 min. Median effective concentrations were estimated and two-sided P < 0.05 was significant. RESULTS Local anaesthetic concentration, use of sufentanil and local anaesthetic drug were independent significant predictors of effective and ineffective analgesia. Bupivacaine was significantly more potent than levobupivacaine and ropivacaine. The relative potency ratios without sufentanil of 0.77:0.83:1.00 were reduced to 0.36:0.38:1.00 by the addition of sufentanil. The major factor influencing local anaesthetic requirements was the addition of sufentanil, which reduced overall requirements by a factor of 4.2 (95% CI 3.6-4.8); this effect was proportionately more enhanced for bupivacaine. CONCLUSIONS Local anaesthetic requirements for bupivacaine, levobupivacaine and ropivacaine follow an analgesic potency hierarchy. Any potency differences are small when compared to the effect of sufentanil, which resulted in a four-fold reduction in local anaesthetic requirements. Sufentanil may also enhance the potency differences between bupivacaine and the two S-enantiomer agents.
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Affiliation(s)
- I Buyse
- Departments of Anaesthesiology, Heilig Hart Hospital, Roeselare, and University Hospital Gasthuisberg, Leuven, Belgium and South Manchester University Hospital, Wythenshawe, UK
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Akerman N, Saxena S, Wilson R, Columb M, Lyons G. Effect of intrathecal diamorphine on block height during spinal anaesthesia for Caesarean section with bupivacaine. Br J Anaesth 2005; 94:843-7. [PMID: 15849209 DOI: 10.1093/bja/aei138] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Opioid analgesics are commonly added to intrathecal bupivacaine to improve patient comfort during Caesarean section under spinal anaesthesia, and provide post-operative pain relief. We sought to discover if the addition of diamorphine influenced block height when given with 0.5% w/v hyperbaric bupivacaine. METHOD Eighty ASA I and II women of at least 37 weeks gestation and planned for elective Caesarean section under combined spinal-epidural anaesthesia were recruited. They were randomized into two groups to receive intrathecal hyperbaric bupivacaine 0.5% at an initial dose of 13 mg, with the next dose determined by the response of the previous patient (dose interval 1 mg). One group also received diamorphine 400 microg intrathecally. If a block height of T5 to blunt light touch had been achieved after 20 min, the block was deemed effective. A difference in the ED50 for hyperbaric bupivacaine between the groups would indicate that diamorphine influenced block height. Intraoperative patient discomfort and need for analgesic supplementation was noted. RESULTS The median effective dose (ED50) to achieve a T5 block to light touch for Caesarean section using hyperbaric bupivacaine 0.5% was 9.95 mg [95% confidence interval (CI) 9.0-10.90] and with the addition of diamorphine it was 9.3 mg (95% CI 8.15-10.40), while the ED95 was 13.55 mg (95% CI 10.10-17.0) and 13.6 mg (95% CI 9.15-18.05), respectively. Five women who had received intrathecal diamorphine and 13 who had not received diamorphine needed intraoperative supplementation (not significant). CONCLUSION The addition of intrathecal diamorphine does not appear to influence block height.
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Affiliation(s)
- N Akerman
- Department of Obstetric Anaesthesia, St James' University Hospital, Leeds, UK
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Camorcia M, Capogna G, Lyons G, Columb M. Epidural test dose with levobupivacaine and ropivacaine: determination of ED 50 motor block after spinal administration. Br J Anaesth 2004; 92:850-3. [PMID: 15096445 DOI: 10.1093/bja/aeh155] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND When a test is required to detect a possible intrathecal catheter, many would seek to use the same local anaesthetic as that used for epidural analgesia. The rapid onset of inappropriate motor block after a local anaesthetic administered epidurally implies intrathecal spread. Because of claims of greater sensory-motor separation, or because of reduced potency compared with bupivacaine, the efficacy of the new local anaesthetics in intrathecal testing has been questioned. The aim of this study was to establish the feasibility of a test dose for an inadvertent intrathecal catheter using ropivacaine and levobupivacaine, and to establish the dose required. METHODS Sixty women undergoing elective Caesarean section with a combined spinal- epidural technique were enrolled into this prospective, double-blind sequential allocation study. The women were randomized to receive plain levobupivacaine 0.5% or ropivacaine 0.5% intrathecally. The dose was determined according to up-down sequential allocation. The end-point was any evidence of lower limb motor block within 5 min of injection. RESULTS The ED(50) motor block at 5 min was 4.8 mg (95% CI, 4.49, 5.28) for levobupivacaine and 5.9 mg (95% CI, 4.82, 6.98) for ropivacaine (95% CI difference, 0.052, 1.98) (P=0.04). The estimated ED(95) motor block was 5.9 mg (95% CI 5.19, 6.71) for levobupivacaine and 8.3 mg (95% CI, 6.30, 10.44) for ropivacaine. The potency ratio between the two drugs was 0.83 (95% CI, 0.69, 0.99). CONCLUSIONS Both local anaesthetics produce evidence of motor block within 5 min of intrathecal injection and could serve as tests of intrathecal administration. Derived ED(95) values suggest 10 mg doses should be effective, but this study did not measure predictive value. Ropivacaine is less potent for motor block than levobupivacaine by a factor of 0.83 (P<0.04).
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Affiliation(s)
- M Camorcia
- Department of Anaesthesia, Clinica Città di Roma, Roma, Italy.
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Maddock H, Columb M. Saunders Manual of Critical Care. Br J Anaesth 2003. [DOI: 10.1093/bja/aeg605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zuokumor P, Columb M. Epidural anaesthesia for pain relief in labour. Eur J Anaesthesiol 2003; 20:674-5; author reply 675-6. [PMID: 12932072 DOI: 10.1017/s0265021503211091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Capogna G, Parpaglioni R, Lyons G, Columb M, Celleno D. Minimum analgesic dose of epidural sufentanil for first-stage labor analgesia: a comparison between spontaneous and prostaglandin-induced labors in nulliparous women. Anesthesiology 2001; 94:740-4. [PMID: 11388522 DOI: 10.1097/00000542-200105000-00009] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this prospective, double-blind, sequential allocation study was to compare the effects of spontaneous and prostaglandin-induced labor on the minimum analgesic dose of epidural sufentanil in the first stage of labor. METHODS Seventy healthy, nulliparous women, at more than 37 weeks' gestation with cervical dilatation from 2 to 4 cm, requesting epidural pain relief in labor were enrolled. The subjects were assigned to two different groups according to whether labor was spontaneous or induced with dinoprostone 0.5 mg. Parturients received 10 ml of the study solution through a lumbar epidural catheter. The initial dose was sufentanil 25 microg, and subsequent doses were determined by the response of the previous patient in the same group using up-down sequential allocation. The analgesic effectiveness was assessed using 100-mm visual analog pain scores. The up-down sequences were analyzed using the method of independent paired reversals and probit regression. RESULTS The minimum analgesic dose of sufentanil in spontaneous labor was 22.2 microg (95% CI: 19.6, 22.8) and 27.3 microg (95% CI: 23.8, 30.9) in induced labor. The minimum analgesic dose of sufentanil in induced labor was significantly greater (P = 0.0014) than that in spontaneous labor (95% CI difference: 2.9, 9.3) by a factor of 1.3 (95% CI: 1.1, 1.5). CONCLUSION Prostaglandin induction of labor produces a significantly greater analgesic requirement than does spontaneous labor.
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Affiliation(s)
- G Capogna
- Department of Anesthesiology, AFaR-CRCCS Fatebenefratelli General Hospital, Rome, Italy.
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Abstract
AIM To assess the effectiveness of the ILCOR Advisory Statements on Advanced Life Support adopted by the Resuscitation Council (UK), as the standard for resuscitation following cardiac arrest. METHOD Over the period May to November 1997, data on the process and outcome of cardiopulmonary resuscitation following in-hospital cardiac arrest were collected from 49 hospitals throughout the UK. RESULTS Of 2074 audit forms submitted, 1368 were included in the final analysis. The initial rhythm monitored was ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) in 429 patients, of whom 181 (42.2%) were discharged alive, compared to 6. 2% when the initial rhythm was non-VF/VT. Overall, 240 (17.6%) patients were discharged alive. At 6 months after discharge 195 (82. 3%) of 237 patients were still alive. Successful initial resuscitation, defined as return of spontaneous circulation lasting longer than 20 min (ROSC>20 min), was significantly associated with VF/VT as the initial arrest rhythm, return of circulation in less than 3 min, age less than 70 years and the use of an advanced airway (P<0.01). There was a significant increased likelihood of survival to discharge when the circulation was restored in less than 3 min and age was less than 70 years (P<0.05). The administration of any adrenaline (epinephrine) was significantly associated with a reduced likelihood of ROSC>20 min or alive discharge (P<0.0001). CONCLUSION Compared to the last major multiple hospital study published in 1992, the results of this study suggest that there appears to have been an improvement in survival of in-hospital patients in the UK who have a VF/VT cardiac arrest. How much of this is directly attributable to the adoption of the latest guidelines is uncertain.
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Affiliation(s)
- C L Gwinnutt
- Department of Anaesthetics, Hope Hospital, Eccles Old Road, M6 8HD, Salford, UK
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Abstract
We have used the technique of randomized, double-blind sequential allocation to compare the minimum local analgesic concentrations (MLAC) of epidural bupivacaine and ropivacaine for women in the first stage of labour. The test bolus was 20 ml of local anaesthetic solution. The concentration was determined by the response of the previous woman to a higher or lower concentration of local anaesthetic, according to up-down sequential allocation. Efficacy was assessed using a 100-mm visual analogue pain score (VAPS). The test solution had to achieve a VAPS of 10 mm or less to be judged effective. For bupivacaine, MLAC was 0.093 (95% CI 0.076-0.110)% w/v, and for ropivacaine, 0.156 (95% CI 0.136-0.176)%w/v (P < 0.0001, 95% CI difference 0.036-0.090). The analgesic potency of ropivacaine was 0.60 (0.47-0.75) relative to bupivacaine. Claims for reduced toxicity and motor block must be considered with differences in analgesic potency in mind.
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Affiliation(s)
- G Capogna
- Department of Anaesthesia, Fatebenefratelli General Hospital, Rome, Italy
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Abstract
We have compared the minimum local analgesic concentrations (MLAC) of levobupivacaine relative to racemic bupivacaine in a prospective, randomized, double-blind, sequential allocation study. Women in labour were given a 20-ml bolus of epidural levobupivacaine or bupivacaine diluted to a concentration determined by up-down sequential allocation. The initial concentration was 0.07% w/v for both drugs. Efficacy was defined using a visual analogue pain score (VAPS) at 10 mm or less within 30 min. The MLAC of levobupivacaine was 0.083% w/v (95% CI 0.065-0.101) and the MLAC of bupivacaine 0.081% w/v (95% CI 0.055-0.108). In molar terms, the MLAC of levobupivacaine was 2.87 mmol litre-1 (95% CI 2.25-3.49) and the MLAC of bupivacaine 2.49 mmol litre-1 (95% CI 1.69-3.32). With regard to the commercial preparations, the potency ratio levobupivacaine: bupivacaine was 0.98 (95% CI 0.67-1.41), and this is unlikely to be of clinical relevance. In molar terms, the ratio was 0.87 (95% CI 0.60-1.25). With regard to toxicity, the evidence should be evaluated in the light of a possible 13% potency difference in molar concentration in favour of racemic bupivacaine.
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Affiliation(s)
- G Lyons
- St James' University Hospital, Leeds
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Capogna G, Celleno D, Lyons G, Columb M, Fusco P. Minimum local analgesic concentration of extradural bupivacaine increases with progression of labour. Br J Anaesth 1998; 80:11-3. [PMID: 9505770 DOI: 10.1093/bja/80.1.11] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We have used the technique of double-blind sequential allocation to quantify the minimum local analgesic concentration (MLAC) of extradural bupivacaine for women in early (median cervical dilatation 2 cm) and late (median cervical dilatation 5 cm) labour. The first bolus was 20 ml of the bupivacaine test solution. The concentration was determined by the response of the previous woman to a higher or lower concentration of bupivacaine according to up and down sequential allocation. Efficacy was assessed using a 100-mm visual analogue pain score (VAPS). The test solution had to achieve a VAPS of 10 mm or less to be judged effective. In early labour, the MLAC of bupivacaine was 0.048% w/v (95% confidence intervals (CI) 0.037-0.058% w/v), and 0.140% w/v (95% CI 0.132-0.150% w/v) in the late group. The MLAC of bupivacaine in late labour was greater by a factor of 2.9 (95% CI 2.7-3.2) compared with the MLAC in early labour (P < 0.0001, 95% CI difference 0.08-0.11). We conclude that advancing labour requires an increased concentration of extradural bupivacaine for pain relief.
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Affiliation(s)
- G Capogna
- Department of Anaesthesiology, Fatebenefratelli General Hospital, Rome, Italy
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Abstract
The minimum local analgesic concentration (MLAC) of bupivacaine in labour is defined as the effective concentration in 50% of subjects (EC50). We have used the technique of double-blinded sequential allocation to quantify the bupivacaine sparing effect of the addition of four different doses of extradural fentanyl in 223 labouring women. There were five groups: (1) plain bupivacaine (control); (2) bupivacaine with fentanyl 1 microgram ml-1; (3) bupivacaine with fentanyl 2 micrograms ml-1; (4) bupivacaine with fentanyl 3 micrograms ml-1; and (5) bupivacaine with fentanyl 4 micrograms ml-1. The MLAC of bupivacaine were 0.069% w/v, 0.057% w/v, 0.048% w/v, 0.031% w/v and 0.015% w/v, respectively. We observed a reduction in MLAC of 18%, 31% (P = 0.03%), 55% (P < 0.0001) and 72% (P < 0.0001) with fentanyl 1, 2, 3 and 4 micrograms ml-1, respectively, demonstrating a significant negative linear trend (P < 0.0001) with increasing fentanyl dose. The incidence of pruritus was increased significantly with fentanyl 4 micrograms ml-1 (P = 0.0015). Because of this, fentanyl 3 micrograms ml-1 may be the optimal dose when the aim is bupivacaine sparing extradural analgesia during labour.
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Affiliation(s)
- G Lyons
- St James's University Hospital, Leeds
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