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Biomedical subjects

R J Birks

Publications and source records attributed to R J Birks.

15 recordsLinked to original sources
PubMed2001

A case of extensive block with the combined spinal-epidural technique during labour.

The increasing use of combined spinal-epidural analgesia in obstetric practice has arisen from a desire to achieve a rapid onset of analgesia while reducing the intensity of the motor block. Although the procedure has an excellent safety profile, as with any technique there are potential problems. Difficulty in assessing the position of the epidural catheter after establishment of the spinal blockade may lead to an abnormally extensive block when a full-strength local anaesthetic solution is used. We present a case in which the use of 0.5% bupivacaine to top-up the epidural component of a combined spinal-epidural resulted in a total spinal block. The possible causes of this complication are discussed.

Adult↗
PubMed2001

Safety matters.

Explore the source record for details and available documents.

Anesthesiology↗
PubMed1998

Massive pulmonary embolism in late pregnancy.

PURPOSE: To describe the management problems presented by a case of acute massive pulmonary embolism in a labouring woman. CLINICAL FEATURES: A case of massive pulmonary embolism is described in a woman who presented in early labour at thirty-eight weeks gestation. Immediate management involved the administration of oxygen and intravenous heparin, and transfer to the regional cardiothoracic centre. Pulmonary angiography confirmed the diagnosis of massive pulmonary embolism, but attempts at percutaneous catheter disruption of the clot were of only temporary benefit. The patient subsequently underwent Caesarean section under general anaesthesia, followed minutes later (because of an abrupt deterioration in her condition) by surgical pulmonary embolectomy. The outcome was successful for both mother and child. CONCLUSION: In cases of acute massive pulmonary embolism presenting in late pregnancy and in labour, the risks and benefits of surgical embolectomy, pharmacological thrombolysis, or attempts at mechanical clot disruption have to be weighed on an individual basis. Management at the referral centre was facilitated by having cardiothoracic and obstetric facilities on the same site.

Acute Disease↗
PubMed1997

A comparative multicentre trial of spinal needles for caesarean section.

We studied 681 patients in a randomised, multicentre, double-blind, parallel group trial designed to assess the incidence of headache following spinal anaesthesia for Caesarean section using four different pencil point spinal needles. The needles used were: Whitacre 25G (n = 170), Polymedic 25G (n = 170), Sprotte 24G (n = 173) and Polymedic 24G (n = 168). The incidence of all headaches prior to discharge was 11.1%. Only five headaches (0.75%) were severe with features of post dural puncture headache (PDPH) and required an epidural blood patch: Whitacre 25G = 0, Polymedic 25G = 1 (0.6%), Sprotte 24G = 2 (1.2%), Polymedic 24G = 2 (1.2%). There was no statistically significant difference between the four groups for PDPH. We conclude that all four needles studied performed satisfactorily and comparably.

Adult↗
PubMed1989

A comparison between open-end (single hole) and closed-end (three lateral holes) epidural catheters. Complications and quality of sensory blockade.

A randomised, single-blind study was conducted on 802 parturient women who required epidural analgesia, to compare open-end (single hole) with closed-end (three lateral holes) epidural catheters. The complication rate after catheter insertion was not statistically different between the two groups, but the number of unsatisfactory blocks was significantly higher in the open-end group (p less than 0.001). The closed-end catheters were easier and less painful to place, but gave a higher incidence of bloody taps. The open-end catheters caused sensory blockade to be more frequently unilateral and more frequently missed sensory segments. This resulted in a significantly higher number of open-end catheters that required replacement (p less than 0.001). Open-end catheters despite their theoretical advantages in the detection of intravenous and subarachnoid placement caused an unacceptably high incidence of unsatisfactory sensory blockade.

Adolescent↗
PubMed1980

Termination of anaesthesia--do we pay enough attention to its consequences? Haemodynamic studies following the use of piritramide, flunitrazepam and nitrous oxide anaesthesia for open heart surgery.

After completion of coronary or valve replacement surgery the haemodynamic changes due to cessation of nitrous oxide were measured. Seventy-four patients received piritramide-nitrous oxide anaesthesia. In 20 patients nitrous oxide was continued after operation and no marked haemodynamic changes occurred. However, when nitrous oxide was discontinued immediately after the operation (n=30) a significant rise in systolic arterial pressure (108+/-15 to 153+/-30 mm Hg), systolic pulmonary artery pressure (35+/-9 to 40+/-16 mm Hg), systemic vascular resistance (111 +/-26 to 148+/-44 MN.s.m-5) and rate pressure product (9,600+/-1,600 to 14,300+/-4,000) occurred. Heart rate (89+/-11 min-1), left artrial pressure (13+/---4 mm Hg) CO2 minute production (125+/-19 ml. min-1.m-2) and cardiac index (2.5+/-0.61.min-1.m-2) rose only moderately. When additional flunisternal closure to 24 patients, marked haemodynamic changes were still noted after N2O withdrawal, even though anaesthesia was prolonged. The sudden rise of arterial pressure and vascular resistance implies risks to patients with myoicardial or coronary insufficiency, therefore close monitoring is necessary, when nitrous oxide has to be stopped, to enable undelayed antihypertensive therapy.

Adult↗