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Biomedical subjects

S M Yentis

Publications and source records attributed to S M Yentis.

At least 19 recordsLinked to original sources
PubMed2006

Anaesthetic management of labour and caesarean delivery of a patient with hyperkalaemic periodic paralysis.

We describe a parturient with hyperkalaemic periodic paralysis who presented for induction of labour and subsequently, caesarean section. Epidural analgesia and anaesthesia were used successfully in a multidisciplinary plan aimed at avoiding a peripartum attack and providing safe delivery. Management of this rare condition is discussed along with a review of the available literature.

Adult↗
PubMed2006

Practical management of the parturient with congenital heart disease.

Cardiac disease is becoming more common in women presenting for maternity care and is a major cause of maternal mortality in the UK. We present a review of the management of parturients with congenital heart disease, focusing on practical aspects and the problems that may be expected.

Adult↗
PubMed2006

Reports on Confidential Enquiries into Maternal Deaths: management strategies based on trends in maternal cardiac deaths over 30 years.

In the latest Report of the Confidential Enquiries into Maternal and Child Health (CEMACH; formerly Confidential Enquiries into Maternal Deaths (CEMD)), cardiac disease was the second commonest cause of maternal mortality. Currently there is much emphasis on appropriate referral and multidisciplinary planning for women with known cardiac disease. However, examining all maternal cardiac deaths in the CEMACH/CEMD reports over the last 30 years, to see whether the condition was known before pregnancy or developed during pregnancy, suggests that while reported maternal mortality due to cardiac disease overall has approximately doubled, the number due to known disease has changed little. Thus significant and increasing numbers of deaths occur in women without known disease, either in those with risk factors or in those who develop conditions in the absence of risk factors. Therefore, while there is a continuing need to counsel, refer and appropriately manage women with known pre-existing cardiac disease, attention must also be paid to screening women before pregnancy for evidence of cardiac disease or risk factors, and also to cardiac disease that develops de novo during pregnancy, since early screening and referral strategies alone will not prevent units from encountering such cases. All units therefore require processes for monitoring and managing women for the development of cardiac disease throughout their pregnancies.

Cause of Death↗
PubMed2006

A national survey of obstetric anaesthetic handovers.

The handover of patient information between shifts enables continuity of care and increases patient safety. We surveyed UK practice during handovers in obstetric anaesthesia. A questionnaire was sent to 239 lead consultant obstetric anaesthetists to record routine practice in their unit and individual opinion about handover procedures. Responses were received from 168 anaesthetists, a 70% response rate. Handover policies were available in 10% of units. Most (76%) responding units had an allocated time for handover. In most units (76%), the duration of handover was reported as being < 15 min but the actual duration and depth of any discussion involved were not specified. Handovers were rarely documented in writing (7%). Consultant anaesthetists were most likely to be present at the morning handover and few handovers were multidisciplinary. Four percent of units reported critical incidents following inadequate handovers in the past 12 months. We identify features in handover procedures that could be improved.

Anesthesia, Obstetrical↗
PubMed2005

A comparison of the lateral, Oxford and sitting positions for performing combined spinal-epidural anaesthesia for elective Caesarean section.

One hundred women were randomly allocated to the left lateral, Oxford or sitting position for induction of combined spinal-epidural anaesthesia for Caesarean section using 2.5 ml hyperbaric bupivacaine 0.5% and 10 mug fentanyl. Women in the left lateral were then turned to the right lateral position; women in the Oxford position were turned to the same position on their opposite side; and women in the sitting group were turned to the supine left tilt position. Women remained in these positions until ready for surgery, which was conducted in the supine position with a wedge placed under the right hip. Ephedrine requirements before re-positioning for surgery were less in the sitting position than in the other two positions: median (IQR [range]) doses for the lateral, Oxford and sitting groups were 21 (12-30 [6-48]), 18 (7.5-24 [6-48]) and 12 (6-21 [6-42]) mg, respectively; p = 0.04. Sensory block to touch sensation at the T5 dermatomal level was most quickly achieved in the lateral position with median (IQR [range]) block onset times for the lateral, Oxford and sitting groups of 9 (6-13 [4-30]), 15.5 (9-22 [4-34]) and 14 (9-18[6-36]) min, respectively; p = 0.004. In the Oxford position, more epidural catheters required dosing to achieve a sensory block of T5 before surgery: the number of patients (proportion) bolused in the lateral, Oxford and sitting groups was 1 (3%), 7 (22%) and 1 (3%), respectively; p = 0.01. We did not demonstrate any advantage in using the Oxford position for combined spinal-epidural anaesthesia for elective Caesarean section.

Adult↗
PubMed2004

Complications of obstetric regional analgesia: how much information is enough?

Two hundred parturients who had received epidural analgesia during labour (100 in Melbourne, Australia and 100 in London, UK) were asked on the first postnatal day about their sources of antenatal information on pain relief in labour, their awareness of potential complications of epidural analgesia and the level of risk at which they would wish to be informed before consenting to a procedure. Sources of antenatal information were similar in the two countries although more women in Australia received information from an anaesthetist or obstetrician than in the UK, whilst more women in the UK received information from the media than in Australia. Knowledge of risks was also similar although the Australian subjects were more aware of infective complications while those in the UK were more aware of intravascular injection of local anaesthetic; these differences may reflect recent high-profile cases in the two countries. The preferred level of risk at which women wanted to be informed about a complication varied from 1:1 to 1:1,000,000,000 in all three centres. The majority of women considered that the benefits of epidural analgesia outweighed each of the potential complications. Women differ in their requirements for antenatal information about regional analgesia and its complications, with some wanting to know every complication, however rare. Anaesthetists should be flexible in their disclosure of information when obtaining consent for regional analgesia and consider the particular wishes of each patient rather than follow rigid centralised guidelines.

Adult↗
PubMed2004

Synacthen Depot for the treatment of postdural puncture headache.

We conducted a prospective, randomised, double-blind trial to study the effect of Synacthen Depot in 18 parturients with postdural puncture headache following deliberate or accidental dural puncture. Women were randomly allocated to receive either Synacthen Depot 1 mg (1 ml) or 0.9% saline 1 ml intramuscularly. Using a 10-cm visual analogue scale, severity of headache was measured before and at intervals until 48 h after injection. There was no difference in the severity of headache or requirement for epidural blood patch. We conclude that there is no advantage to the use of Synacthen Depot 1 mg for the treatment of postdural puncture headache.

Adult↗
PubMed2004

Extending low-dose epidural analgesia for emergency Caesarean section using ropivacaine 0.75%.

We compared ropivacaine 0.75% and bupivacaine 0.5% for extending low-dose epidural analgesia for emergency Caesarean section, using a prospective double-blind randomised controlled trial design. The trial was halted after 45 patients were studied (23 ropivacaine; 22 bupivacaine) because bupivacaine was replaced by levobupivacaine in our unit. Time to reach T4 for loss of cold sensation was similar in both groups, although analgesic supplementation was required less often in the ropivacaine group than in the bupivacaine group (2/23 vs. 9/21; p = 0.01).

Adult↗