Biomedical subjects
Publications and source records attributed to G A Rees.
The development of a High Dependency Unit (HDU) which caters for the early postoperative care of patients undergoing major surgery, and for the seriously ill, is described. During its first six months, 320 patients have been treated in the unit, and its initial objectives have been successfully achieved.
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A patient aspirated soup 36 h after delivery, developed Mendelson's syndrome but survived. She was small and fat and was immobilized in bed for longer than usual because of inadvertent dural puncture; these factors are thought to have predisposed to the accident.
The administration of general anaesthesia for Caesarean section is described in a patient with an established biochemical diagnosis of acute intermittent porphyria. The technique used did not precipitate an acute exacerbation of the disease. Drugs associated with obstetric care are considered in the context of their use in porphyria.
In a randomised controlled trial of mothers in labour intramuscular pethidine 150 mg, repeated if necessary, was compared with self-administered intravenous pethidine (0.25 mg/kg available at 10-min-intervals). Each mother agreed to have either method of pain relief and could opt for epidural block. The intramuscular group had significantly more pethidine than the intravenous group (mean differences, primipara 29 mg; multipara 16 mg). Ratings by mothers of the pain of 1st, 2nd stage and overall (analogue scores and gradings) were consistently better for the intravenous group although not significantly different. There were no differences in mean Apgar scores between the babies in the groups. In mothers who do not choose epidural block, similar pain relief is afforded by adequate intramuscular pethidine or self-demand intravenous pethidine; however, intravenous self-administration is more efficient since the pain relief is achieved with a lower dose of pethidine.
In a randomised controlled trial epidural analgesia with bupivacaine 0.5% (mean dose 112.8 mg) was compared with pethidine (mean dose 200 mg) and inhalational analgesia in primipara (28 and 30 mothers) and multipara (17 and 18 mothers). Mothers who had an uneventful pregnancy and labour and agreed to have either treatment were studied during labour and followed-up at interviews for 5 months after delivery. Epidural block was rated significantly superior in respect of pain relief and comfort, there were no differences between the groups in reports of perineal discomfort. Twice as many primipara required forceps delivery after epidural block. Very few mothers, in each group, reported something missing in their experience of childbirth. Two thirds of each group would use the same method again. Epidural block can therefore be recommended to uncommitted mothers as a satisfying and effective method of pain relief for labour.
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