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Biomedical subjects

R P Griffin

Publications and source records attributed to R P Griffin.

7 recordsLinked to original sources
PubMed1996

A double-blind comparison of 0.25% ropivacaine and 0.25% bupivacaine for extradural analgesia in labour.

Ropivacaine is a new aminoamide local anaesthetic. Compared with bupivacaine, ropivacaine possesses a higher threshold for systemic toxicity and a high selectivity for sensory fibres. We have compared prospectively these two agents in a concentration of 0.25% for extradural analgesia in labour. A total of 104 parturients requesting extradural analgesia were randomized to receive either ropivacaine or bupivacaine. The women in the bupivacaine group required more top-up doses to maintain analgesia (median 3.0 vs 2.0) (P < 0.05). The onset of sensory block, quality of analgesia, ultimate level of maximum sensory block and maternal satisfaction were similar in both groups. The incidence, intensity and duration of motor block were slightly but not significantly less in the ropivacaine group. The ropivacaine group had a higher incidence of spontaneous vaginal delivery (70.59% vs 52.00%). There was no significant difference in neonatal outcome as assessed by Apgar scores, umbilical acid-base status and neurological and adaptive capacity score at 2 and 24 h after delivery. We conclude that ropivacaine and bupivacaine in a concentration of 0.25% produced comparable analgesia for pain relief of labour with no detectable adverse effect on the neonate.

Adolescent↗
PubMed1995

Extradural anaesthesia for caesarean section: a double-blind comparison of 0.5% ropivacaine with 0.5% bupivacaine.

Seventy-three parturients for elective Caesarean section were allocated randomly to receive extradural block with 20 ml of either 0.5% ropivacaine or 0.5% bupivacaine. If the block did not reach T6 within 30 min, another 5 ml of solution was given. If needed, a further 5 ml was given 45 min after the main dose. The mean total dose of bupivacaine was 23.1 ml (n = 35) and of ropivacaine 23.7 ml (n = 37). There was no significant difference between the groups in the profile of sensory block produced. There was no significant difference in the time of onset, or intensity of motor block between the groups but the duration of motor block was significantly shorter in the ropivacaine group. There was no significant difference in neonatal outcome, as assessed by Apgar score, umbilical cord blood-gas tensions at delivery or the neurological and adaptive capacity score 2 and 24 h after delivery.

Adult↗
PubMed1995

Maternal hypoxaemia during labour and delivery: the influence of analgesia and effect on neonatal outcome.

The effect of analgesia on the incidence of hypoxaemia was assessed in an unrandomised trial in 51 parturients from the last hour of the first stage of labour until delivery. Women were retrospectively divided into four groups: no analgesia, pethidine with intermittent Entonox, extradural bupivacaine (either infusion of 0.125% or top-ups of 10 ml of 0.25%): and extradural infusion of 0.1% bupivacaine with 2 micrograms.ml-1 fentanyl. The lowest median incidence of desaturation (SpO2 < 94%) was in the extradural bupivacaine group: 0 min.h-1 in the last hour of the first stage and 0.1 min.h-1 in the second stage. The incidence was significantly lower than in the pethidine/Entonox group (1.4 min.h-1) in the last hour of the first stage (p < 0.001) and the extradural bupivacaine/fentanyl group (0.9 min.h-1) and no analgesia group (3 min.h-1) in the second stage (p < 0.05 in both cases). There was no correlation between maternal oxygenation during the second stage and measures of neonatal outcome including Apgar score and umbilical artery and vein blood gases.

Adult↗
PubMed1994

The association between foot temperature and asymmetrical epidural blockade.

This study was designed to explore the correlation between sensory block asymmetry and a disparity in foot temperature following epidural bupivacaine administration in labour. Sixty parturients requesting epidural analgesia had epidural catheters sited at L 3/4 while in the lateral position. A test dose was followed 5 min later by a main dose of 25-30 mg of plain bupivacaine. A thermistor thermometer recorded the temperature of the feet before and 5, 10, 15, 20 and 30 min after the end of the main dose. The upper and lower limits of sensory blockade on both the left and right sides were recorded at the same time intervals. Spearman's coefficient of rank correlation between sensory block asymmetry and foot temperature difference were at 5 min: 0.4, 10 min: 0.39, 15 min: 0.54, 20 min: 0.59 and 30 min: 0.6. This was significant at 5 and 10 min (P < 0.05) and highly significant at 15, 20 and 30 min (P < 0.001). During the 30 min period after the end of the main dose, 45 midwives, junior and senior medical staff (up to 4 observers per patient) were asked if they could detect foot temperature asymmetry. Their observations were compared with the thermistor readings. Most staff were able to detect a foot temperature difference > 1 degrees C. Our findings indicate a clear association between sensory block asymmetry and the difference between the temperature of the feet. This difference can be detected simply by feeling the feet.

Journal Article↗
PubMed1993

The anaesthetic management of patients with dystrophic epidermolysis bullosa. A review of 44 patients over a 10 year period.

The case notes and anaesthetic charts of 44 patients with dystrophic epidermolysis bullosa were reviewed retrospectively. A total of 390 general anaesthetics were performed for 469 surgical procedures over a 10-year period. Procedures included repair of syndactyly, dilatation of oesophageal strictures, extraction of teeth, excision of skin tumours and other procedures related to dystrophic epidermolysis bullosa. Anaemia, thrombocytosis and hypoalbuminaemia was found in many patients pre-operatively. Damage to skin or mucosa occurred peri-operatively. Four patients developed bullae around the head and neck, two patients developed oral or pharyngeal bullae and three patients developed conjunctival abrasions including one with a new corneal ulcer. There were no reports of laryngeal bullae and no bullae associated with intramuscular injections or the use of limb tourniquets. Thirty-one patients (70%) had evidence of oesophageal strictures and six regurgitated peri-operatively. In all cases there was a history of oesophageal disease. In 10 patients (23%) intubation of the trachea was difficult. It was carried out by various methods including blind nasal and fibreoptic intubation or by using the laryngeal mask airway. One patient requiring a series of general anaesthetics had a tracheostomy formed after fibreoptic intubation. Previous reports have suggested problems with the use of suxamethonium, nondepolarising muscle relaxants and thiopentone. These agents were all used in many of our patients without any adverse effects. There was one intra-operative death in a 35-year-old woman having an oesophageal dilatation which was complicated by oesophageal rupture.

Adolescent↗
PubMed1992

Why doesn't performance pay work?

The NHS is about to embark on the widescale introduction of performance-related pay. A number of recent studies have seriously questioned the efficacy of merit pay. Utilizing the expectancy theory of motivation, explains why performance pay is unlike to motivate NHS staff.

Employee Performance Appraisal↗