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Biomedical subjects

S M Kinsella

Publications and source records attributed to S M Kinsella.

At least 37 records · Page 2Linked to original sources
PubMed2000

Randomized study of intravenous fluid preload before epidural analgesia during labour.

We performed a randomized controlled trial of the effect of intravenous fluid preload on maternal hypotension and fetal heart rate (FHR) changes in labour after the first epidural injection. Group 1 (49 women) received 1 litre of crystalloid preload. Group 2 (46 women) received no preload. No statistically significant difference was shown between the two groups for either of the outcomes. Hypotension was found in three women in group 1 and five in group 2 (P = 0.4). Deterioration in FHR pattern was found in four women in group 1 and 11 in group 2 (P = 0.08). This study has not shown a significant increase in the incidence of hypotension when intravenous preload is omitted before epidural analgesia using a low concentration of bupivacaine during labour. Because of the clinical importance of the difference in the rate of FHR deterioration between the two groups, we continue to administer preload for high-risk cases.

Analgesia, Epidural↗
PubMed2000

Urgency of caesarean section: a new classification.

A new classification for caesarean section was developed in a two-part study conducted at six hospitals. Initially, 90 anaesthetists and obstetricians graded ten clinical scenarios according to five different classification methods--visual analogue scale; suitable anaesthetic technique; maximum time to delivery; clinical definitions; and a 1-5 rating scale. Clinical definitions was the most consistent and useful, and this method was then applied prospectively to 407 caesarean sections at the same six hospitals. There was close agreement (86%) between anaesthetists and obstetricians for the five-point scale (weighted kappa 0.89), increasing to 90% if two categories were combined (weighted kappa 0.91). We suggest that the resultant four-grade classification system--(i) immediate threat to life of woman or fetus; (ii) maternal or fetal compromise which is not immediately life-threatening; (iii) needing early delivery but no maternal or fetal compromise; (iv) at a time to suit the patient and maternity team--should be adopted by multidisciplinary groups with an interest in maternity data collection.

Anesthesia, Obstetrical↗
PubMed1999

Dose response study of subarachnoid diamorphine for analgesia after elective caesarean section.

Subarachnoid diamorphine provides excellent analgesia after elective caesarean section but the optimum dose is still uncertain. We therefore investigated the effects of three regimens of subarachnoid diamorphine. Forty parturients were assigned to one of four groups. A control group received no diamorphine in their subarachnoid bupivacaine and three study groups received 0.1 mg, 0.2 mg or 0.3 mg diamorphine added to 12.5 mg hyperbaric bupivacaine 0.5% in a semi-blind randomised design study. All women received a 100 mg diclofenac suppository at the end of the caesarean section and were provided with morphine patient controlled analgesia (PCA) postoperatively. The patients were assessed for pain, morphine usage and side-effects at 2, 4, 8 and 24 h after the subarachnoid injection. Postoperative visual analogue scores for pain and PCA morphine consumption were significantly lower, and mean time to first use of morphine was significantly longer in the 0.3 mg diamorphine group. The mean (SD) dose of PCA morphine used over 24 h was 39.4 (14.7), 25.6 (16.5), 21.6 (15.9) and 3.1 (3.6) mg, and mean time to first use of morphine was 1.6 (0.5), 3.0 (1.4), 3.4 (2.4) and 14.1 (9.4) h, in the 0, 0.1 mg, 0.2 mg and 0.3 mg groups respectively. Side-effects of pruritus, nausea and vomiting were dependent on the dose of spinal diamorphine but did not require treatment in any patients. We conclude that 0.3 mg subarachnoid diamorphine provides significantly better postoperative pain relief than the smaller doses with an acceptable increase in side-effects.

Clinical Trial↗
PubMed1998

Reporting of 'hypotension' after epidural analgesia during labour. Effect of choice of arm and timing of baseline readings.

We studied 20 women in labour to see how reporting 'hypotension' after obstetric epidural analgesia is affected by position of the blood pressure cuff and baseline definition. Blood pressure was recorded from both arms simultaneously while the woman was semirecumbent and then in the left lateral position. Three readings were then taken after epidural bupivacaine, one left lateral and the remainder right lateral. Before the epidural, blood pressure in the dependent arm in the lateral position was similar to blood pressure in either arm in the semirecumbent position and an average of 10 mmHg (systolic) and 14 mmHg (diastolic) higher than blood pressure in the uppermost arm (p < or = 0.00005). This difference persisted in both lateral positions as epidural analgesia became established. Choosing different definitions of hypotension, baselines and arm to measure blood pressure resulted in 'hypotension rates' between 0% and 75%. For blood pressure measurement in the lateral position, the blood pressure cuff should be placed on the dependent arm.

Analgesia, Epidural↗
PubMed1996

Advance prediction of hypotension at cesarean delivery under spinal anesthesia.

Cardiovascular responses to supine inferior vena cava compression might predict hypotension risk during elective cesarean delivery using spinal anesthesia. In this pilot study we investigated 27 women before operation by taking blood pressure and heart rate measurements for 5 min in the left lateral position, 5 min supine, and then performed one further reading in the left lateral position and one sitting. Anesthesia with hyperbaric bupivacaine was rigorously standardised. A pre-operative 'supine stress test', combining an increase in maternal heart rate of greater than 10 beats/min or leg flexion movements while supine, was analysed. A positive supine stress test (SST) was 4.1 times more frequent in those with severe systolic hypotension below 70% of baseline (12 out of 16 women) than in those without (2 out of 11 women), with a sensitivity of 75% (95% C.I. 48% to 93%) and specificity of 82% (95% C.I. 48% to 98%). A positive test was associated with twice as much vasopressor use as a negative test (30.7 +/-/14.5 mg versus 13.5 +/-/ 9.9 mg; P = 0.0014). Unlike the SST, cardiovascular responses to the change from recumbent to sitting (tilt test) were not useful as a predictor of hypotension.

Journal Article↗
PubMed1996

The dermatomal spread of epidural bupivacaine with and without prior intrathecal sufentanil.

Clinicians often use a technique combining intrathecal sufentanil and epidural bupivacaine to provide labor analgesia. This study determines the effect of 27- or 24-gauge dural puncture and intrathecal sufentanil 10 micrograms on the dermatomal spread of epidural bupivacaine. Healthy laboring women received no dural puncture (n = 77) (no puncture group [NPG]) or dural puncture with a 27-gauge Whitacre needle (n = 33) or a 24-gauge Sprotte needle (n = 37) and intrathecal sufentanil 10 micrograms (dural puncture group [DPG]) before epidural injection of 13 mL bupivacaine 0.25%. More dermatomes were anesthetized in the DPG, 16.6 +/- 7.5 vs 13.6 +/- 6.6 in the NPG (P < 0.02). More patients in the DPG had sensory blockade T-4 or higher (17 of 70 DPG patients vs 8 of 77 NPG patients; P < 0.05). No patient in either group showed clinical evidence of respiratory compromise. In conclusion, epidural bupivacaine anesthetized more dermatomes when administered 104 +/- 42 min after dural puncture and intrathecal sufentanil 10 micrograms than when given without prior dural puncture and intrathecal injection.

Analgesia, Epidural↗
PubMed1994

Supine hypotensive syndrome.

OBJECTIVE: To review reports of the supine hypotensive syndrome with reference to clinical presentation, suggestions on the mechanism of onset, and the possibility of advance detection. DATA SOURCES: We used worldwide obstetric, anesthesia, and general medical journals from 1922 onward, a Medline search from 1966 onward, and manual cross-referencing for prior publications. METHODS OF STUDY SELECTION: We selected approximately 100 case reports of supine hypotensive syndrome and studies on supine blood pressure responses during late pregnancy. DATA EXTRACTION AND SYNTHESIS: Publications that recorded novel clinical observations, specific hemodynamic or biochemical measurements, or associated complications were included. CONCLUSIONS: Supine hypotensive syndrome is characterized by severe supine symptoms and hypotension in late pregnancy, which compel the unconstrained subject to change position. Rarely, it may manifest even from the fifth month of pregnancy or postpartum, as well as in the pelvic tilt or sitting positions. Although inferior vena cava compression, influenced primarily by the size of the uterus and exact maternal and fetal position, is the major determinant in its development, other factors may also be important in modulating the circulatory effects of such compression. Advance recognition of susceptibility to the syndrome depends on a history of severe supine symptoms or supine intolerance and an increase in maternal heart rate and decrease in pulse pressure in the supine position. As there seems to be a spectrum of severity from minimal central cardiovascular alterations to severe syncopal shock resulting from supine inferior vena cava compression, it is difficult to define a cutoff point at which the syndrome occurs. Although usually recognizable by maternal symptoms, severe hypotension without symptoms has been reported on three occasions.

Animals↗
PubMed1990

Aortic compression by the uterus: identification with the Finapres digital arterial pressure instrument.

Aortic compression by the uterus at term was diagnosed when reversible reductions in toe pulse pressure, measured using a Finapres digital blood pressure instrument, were found in the absence of systemic hypotension, monitored by a second instrument with the cuff on a finger. Aortic compression was found in the left or right pelvic tilt positions in 14 of 32 women, sometimes with up to 34 degrees of tilt, and was relieved by increasing the amount of tilt, except in a twin pregnancy where compression became more severe as left pelvic tilt was increased from 13 degrees to 28 degrees. Compression was also found in two women in the semi-recumbent position. Factors associated with an increased likelihood of aortic compression were non-engagement of the fetal head, occipito-posterior position of the fetal head, and cervical dilatation less than 5 cm.

Adult↗