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J A Crowhurst

Publications and source records attributed to J A Crowhurst.

35 records · Page 2Linked to original sources
PubMed1990

Monitoring epidural analgesia in the parturient.

Appropriate monitoring during obstetric epidural analgesia consists of: 1. Indirect BP and pulse monitoring before epidural insertion, frequently after every dose, and intermittently thereafter. 2. The aspiration test before all injections. 3. Frequent clinical monitoring for signs of intravascular injection during administration of small intermittent doses (not more than 3-5 ml at a time). 4. Frequent clinical monitoring for sympathetic, sensory and motor signs indicating upward extension of the block. 5. Frequent monitoring of the fetal heart rate (FHR) and other signs of fetal welfare. In many instances continuous tocogram with fetal heart rate (CTG) monitoring is useful. We do not believe CTG use is mandatory for epidural analgesia in the uncomplicated pregnancy, but we do advocate that it (and other appropriate fetal monitoring techniques) be used when risk factors or complications, either fetal or maternal, are present or suspected. The anaesthetist should be familiar with fetal monitoring techniques, their use and interpretation. He or she should be prepared to recommend their use when it is considered appropriate to do so.

Analgesia, Epidural↗
PubMed1989

Acid aspiration prophylaxis in Australian obstetric hospitals--a survey.

During 1987 a confidential survey of all hospitals in Australia providing obstetric services was undertaken to determine the antacid medications used routinely as prophylaxis against acid aspiration pneumonitis. Of the 567 hospitals surveyed, 379 (67%) responded. Of these, 243 hospitals provide an obstetric service which includes caesarean section, and 67% of these perform less than 500 deliveries per annum. Aspiration prophylaxis during labour was used in 22.4% of responding hospitals. Prior to elective caesarean section, 11.5% used no prophylaxis, and 39.4% used particulate antacids such as magnesium trisilicate mixture (33.3%) or Mylanta (6.1%). Sodium citrate mixture was the most popular therapy (37%). Results were similar in the emergency caesarean section group. The use of cimetidine or ranitidine was uncommon in all groups. Results of this survey suggest marked differences in attitudes towards acid aspiration prophylaxis between Australian and British obstetric anaesthetic practices.

Anesthesia, General↗
PubMed1984

General anaesthesia for caesarean section in severe pre-eclampsia. Comparison of the renal and hepatic effects of enflurane and halothane.

In a randomized study of patients undergoing Caesarean section, either enflurane (mean 0.24 MAC-h) or halothane (mean 0.23 MAC-h) and 50% nitrous oxide in oxygen were administered to women (n = 12) with severe pre-eclampsia-eclampsia and to 16 healthy pregnant patients with normal renal and hepatic function. No evidence of nephrotoxicity was found in any pre-eclamptic or normal patient. Metabolism of enflurane resulted in plasma inorganic fluoride concentrations (max 15 mumol litre -1) which were well below the toxic value. Postoperative liver function tests showed no important changes from preoperative values, although reductive metabolites of halothane were not measured. In patients with severe pre-eclampsia there appears no contraindication to enflurane or, probably, halothane as volatile supplements during general anaesthesia.

Adult↗
PubMed1983

Foot trauma in a rural hospital.

The authors made a survey of a rural hospital emergency room to determine the types of foot injuries seen and the frequency of foot injuries in relation to total emergency room visits. The study showed that foot fractures made up a significant portion of emergency room admissions.

Emergency Service, Hospital↗
PubMed1980

Salbutamol, obstetrics and anaesthesia: a review and case discussion.

Salbutamol and related beta-2 sympathomimetic drugs have been used in Australia recently for the inhibition of premature labour and also to prevent uterine activity in acute foetal emergencies during labour. General anaesthesia in these situations presents the anaesthetist with a number of pharmacological difficulties, which can have profound effects on both mother and neonate. The use of beta-blockers to correct the cardiovascular and metabolic instability is discussed and recommendations are made for their use in association with anaesthesia for operative delivery. Ante-natal beta-blockade of mother may increase the morbidity and possibly the mortality of an already at risk pre-term neonate. The case report illustrates some of the hazards associated with salbutamol, obstetrics and anaesthesia.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Combined spinal-epidural technique.

BACKGROUND: For the past 16 years the combined spinal-epidural (CSE) technique has been extensively researched and developed to the point where it is now in widespread use. Along with the use of low-dose mixtures of local anesthetics and opioids, and the introduction of fine-gauge pencil-point needles, CSE is being increasingly recognized as another important addition to the armamentarium of the anesthesiologist. METHOD: One hundred and forty-two publications focusing on the CSE technique, or on questions concerning CSE-related issues, were reviewed. Out of 33 double-blind or controlled studies, 23 directly investigated the CSE technique. Fifty-four prospective studies and letters made directly relevant points on advantages or problems with CSE. Twenty-one book chapters, reviews and editorials were included, 11 of them concerning the use of CSE technique. RESULTS: All CSE techniques which may be used for surgical anesthesia, for analgesia in labor or for postoperative pain management are described. Indications, advantages, disadvantages, and the various methods for performing CSE procedures, including sequential CSE block, are described and reviewed, along with the equipment currently available for their administration. CONCLUSION: The CSE technique offers many potential advantages over continuous epidural or subarachnoid methods alone, including a reduction in drug dosage, the ability to eliminate motor blockade and to achieve highly selective sensory blockade and optimize analgesia. These features hold great promise for minimizing the hazards and side effects of traditional epidural and subarachnoid techniques. Controversial fears, risks, and pitfalls of the CSE technique and of continuous epidural and subarachnoid methods are debated and discussed.

Anesthesia, Epidural↗
PubMedDate not supplied

Implant arthroplasty of the first metatarsophalangeal joint: a 12-year retrospective study.

A study was conducted of the long-term results on Silastic implant arthroplasties of the first metatarsophalangeal joint in 88 feet. Silastic implants were evaluated on the basis of patient satisfaction, function, and radiographic findings. The period of follow-up ranged from 6 months to 12 years, with an average follow-up of 6.3 years for hemi-joint implants and 2.1 years for total joint implants. The results showed that a majority of patients with hallux valgus and hallux limitus had good results with either hemi-implant or total implant. The most common complication found was hallux extensus.

Adult↗