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Biomedical subjects

C B Collier

Publications and source records attributed to C B Collier.

At least 19 recordsLinked to original sources
PubMed1999

Epidural abscess in an obstetric patient.

Epidural abscess is a rare complication of epidural block and occasionally presents in the post partum period. A case is described where a thoracolumbar abscess presented with backache and headache 10 days after an apparently uneventful block for labour and caesarean section. The abscess was treated medically with a satisfactory outcome. The literature is reviewed in order to assess several recent reports of infectious complications of epidural block in obstetric patients.

Adult↗
PubMed1998

Potential intrathecal leakage of solutions injected into the epidural space following combined spinal epidural anaesthesia.

A combined spinal epidural anaesthetic (CSE), by design, produces a deliberate multicompartment block across a breached dural membrane. Since the lateral holes of the epidural catheter may lie in close proximity to the dural puncture site, a bolus solution of drug injected via the epidural catheter has the potential to leak through the dural puncture into the subarachnoid space. The aim of this study was to determine the incidence of intrathecal leak by performing an epidurogram. Fifteen patients undergoing surgery with a CSE anaesthetic using a 16 gauge Tuohy/26 gauge pencil point needle were studied. Within three hours of catheter insertion, 12 ml of contrast (iohexol 300 mg/ml) was injected via the epidural catheter under fluoroscopic control with screen recording and exposure of lateral and anteroposterior X-ray plates. All films were later reviewed for evidence of intrathecal spread. We did not observe any evidence of intrathecal spread of contrast. However, caution should be observed during administration of an intraoperative bolus dose of analgesic agent via a catheter inserted as part of a combined spinal epidural anaesthetic technique, particularly with the use of hydrophilic opiods.

Adult↗
PubMed1993

A continuous subdural block.

We describe a case of accidental subdural block, after attempted extradural puncture for Caesarean section. Fractionation of the local anaesthetic dose led to avoidance of more serious complications. Subdural fentanyl and a continuous low-dose subdural infusion were used satisfactorily for intraoperative management and postoperative analgesia. As little as 0.5 ml of bupivacaine, hourly, provided satisfactory analgesia over a 15-h period.

Adult↗
PubMed1993

A new epidural catheter. Closer eyes for safety?

A new design of epidural catheter with three lateral eyes placed in close proximity to its closed end is described. Prototype models of this catheter were tested in 200 obstetric and surgical patients. In a single-blind randomised study it was found to be easy to insert and highly satisfactory in use, when compared to the current catheter type, with three widely spaced lateral eyes. It is hoped that the close spacing of the eyes will eliminate the complication of multicompartment block, as seen with earlier multihole catheters, and improve the safety of epidural block.

Adolescent↗
PubMed1989

The disposition and placental transfer of diazepam in cesarean section.

The disposition parameters and placental transfer of diazepam were determined from blood and both plasma total and free concentration data in five women who had not undergone labor and who received diazepam (5 mg intravenously for 2 minutes) 1 1/2 to 3 hours before cesarean section at term. All patients exhibited smooth log plasma free concentration-time profiles. In contrast, marked increases in plasma total (approximate 50% increase) and blood (approximate 40% increase) diazepam concentrations occurred at delivery. The plasma total and blood concentration fluctuations were associated with reciprocal variations in diazepam percent free in plasma. For each patient there was a substantial increase in plasma nonesterified fatty acid (NEFA) concentration during the surgical period. There was a significant correlation (p less than 0.02) between diazepam percent free and plasma NEFA concentration on the day of delivery, suggesting that the fluctuations in percent free, and hence plasma total and blood diazepam concentrations, were mediated in part by variations in plasma NEFA concentration. Disposition parameters were calculated for four of the patients; the mean free plasma clearance of diazepam was 42.5 ml/min/kg, similar to the mean value reported previously for nonpregnant women of comparable age. For each mother-infant pair at delivery the ratio of total plasma diazepam concentration in umbilical vein plasma to that in maternal vein plasma was considerably greater than unity (mean +/- SD = 1.73 +/- 0.47), whereas the corresponding ratio for free plasma diazepam concentration was near unity (0.92 +/- 0.09).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Differential transplacental binding of diazepam: causes and implications.

Diazepam plasma binding was determined in 17 matched pairs of maternal and foetal plasma, collected at delivery. Diazepam % free was higher (p less than 0.001) in maternal (mean 3.24%) than in either umbilical venous (mean 1.50%) or umbilical arterial (mean 1.24%) plasma. The data from in vitro dialysis studies were consistent with the reported higher diazepam concentrations in infants than in mothers at delivery. Plasma nonesterified fatty acids (NEFA) concentrations were higher (p less than 0.001) in maternal (mean = 643 microM) than in matched umbilical venous plasma (means = 211 microM) and there was a significant correlation (p less than 0.01) between diazepam % free and corresponding plasma NEFA concentration for pooled data (r = 0.871, n = 34). Multiple and partial regression analysis indicates that transplacental differences in albumin, bilirubin and total protein concentrations made a minimal contribution to diazepam binding differences between mother and foetus and that approximately 76% of the variability in diazepam % free was accounted for by plasma NEFA concentration. The binding of diazepam to human serum albumin (HSA) was markedly perturbed by the presence of NEFA but not by bilirubin and there was no apparent cooperativity between bilirubin and NEFA on diazepam-HSA binding. Moreover, our findings provide further evidence that substantial differences in binding affinities exist between foetal and maternal plasma albumins.

Adult↗
PubMed1983

Disposition of betamethasone in parturient women after intravenous administration.

The pharmacokinetics of betamethasone and its phosphate ester are described in nine women in late pregnancy who each received a bolus intravenous dose of 10.6 mg betamethasone phosphate. Both compounds were measured by high-performance liquid chromatography with ultra-violet detection using sample handling methods which prevent in vitro hydrolysis of the ester. The plasma clearance of betamethasone phosphate (mean = 980 ml/min) and its apparent distribution volume (mean = 5.61) were both higher than previously found for nonpregnant subjects, but its half-life (mean = 4.6 min) was unchanged. Plasma concentrations of betamethasone reached a peak 5-37 min after dosing with betamethasone phosphate, then declined biexponentially with a mean terminal half-life of 262 min. Plasma clearance in pregnant patients (mean = 287 ml/min) was higher than previously reported for nonpregnant subjects. Evidence from urinary excretion and plasma binding measurements and the previously reported transplacental plasma concentration gradient indicated that the increase in clearance was due to increased metabolism possibly by the placental/fetal unit. Plasma binding of beta-methasone was higher in maternal than fetal plasma; binding to alpha 1-acid glycoprotein was more important than binding to albumin as a determinant of this difference. In pregnant patients the decline of endogenous cortisol concentrations in maternal venous plasma was less marked and slower than in nonpregnant subjects. The data now available allows comparison of pharmacokinetic properties between betamethasone and its stereoisomer dexamethasone with respect to their use in preventing neonatal respiratory distress syndrome.

Adult↗