Biomedical subjects
Publications and source records attributed to B L Duffy.
A 19-year-old primigravida had a normal vaginal delivery after a 90-minute second stage of labour. Within two hours she complained of dyspnoea and was noticed to have unusual swelling of the face and neck. The diagnosis of subcutaneous emphysema was confirmed by chest X-ray and pneumomediastinum was also detected. Uneventful recovery over four days followed conservative management, administration of oxygen and use of simple analgesics.
Explore the source record for details and available documents.
A 77-year-old female received uneventful spinal anaesthesia for a total knee replacement. Upon the advice of the microbiologists and at the request of the orthopaedic surgeon, a vancomycin infusion was commenced prior to the application of the leg tourniquet. Five minutes later, having received only 40 mg of the antibiotic dose, she became unconscious and suffered severe cardiovascular collapse, from which she was resuscitated with intravenous ephedrine and adrenaline.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Uterine rupture is extremely rare in the absence of any of the commonly recognized risk factors. We describe here a case of incomplete uterine rupture in a woman in her first pregnancy who had no previous instrumentation to the genital tract. Her only significant history was that of 2 episodes of minor antepartum haemorrhage occurring prior to induction of labour with artificial rupture of membranes and intravenous oxytocin. The rupture was manifested by 450 mL blood in the peritoneal cavity when an emergency Caesarean section was performed for persistent fetal bradycardia.
Explore the source record for details and available documents.
The analgesic effect of intramuscular ketorolac was assessed by double blind study in forty women presenting for day-case laparoscopic sterilisation. The patients were randomly allocated to receive either ketorolac 30 mg or saline by intramuscular injection immediately following induction of general anaesthesia. There was no statistically significant difference between the groups in pain scores, opioid requirements or incidence of nausea and vomiting in the postoperative period. In view of the potential side-effects of ketorolac, and the apparent lack of efficacy when used prophylactically, the routine use of the drug in this group of patients cannot be recommended.
Explore the source record for details and available documents.
Accidental dural puncture is a well-recognised complication of epidural anaesthesia. The technique of inserting the epidural needle with the bevel parallel to the spinal ligaments is still taught in some centres. Evidence is presented that the subsequent turning of the needle to allow passage of the epidural catheter may increase the likelihood of dural puncture. There would also appear to be a greater chance of subdural catheterisation. The epidural needle should be introduced with the bevel in the direction in which the catheter is to go and not moved once the epidural space is located.
Explore the source record for details and available documents.
A case of the HELLP syndrome in a pregnant woman, which was diagnosed initially as obstructive cholecystitis, is presented. The diagnostic difficulties and some management problems are discussed. Practitioners should be aware of the HELLP syndrome and related conditions when caring for pregnant patients.
Four pregnant patients are described who had varying signs of pre-eclampsia plus haemolysis, elevated liver enzymes and a low platelet count. Two of the patients presented without hypertension and all posed considerable diagnostic difficulties, with problems in clinical management. Pregnancy induced hypertension is only one manifestation of a much more diverse pathophysiological process. Anaesthetists need to be aware of these other pregnancy related disorders in order to avoid diagnostic pitfalls and to enable them to provide safely the appropriate general and regional anaesthetic techniques.
Explore the source record for details and available documents.
Forty patients presenting for vaginal termination of pregnancy, divided randomly into four groups, received either no medication, sodium citrate 30 ml orally, ranitidine 150 mg orally or ranitidine 50 mg intravenously. During the procedure, gastric contents were removed by orogastric tube for volume and pH measurements. Ranitidine, orally and intravenously, significantly increased gastric pH and reduced gastric volume. In the control group only one pH was greater than 2.5. Sodium citrate raised the pH above 2.5 in 6 out of 10 patients. Fasting patients in the first months of pregnancy may be at risk of developing Mendelson's syndrome. Ranitidine is very effective in increasing gastric pH and at the same time reducing gastric volume in such patients.
Explore the source record for details and available documents.