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Biomedical subjects

W R Camann

Publications and source records attributed to W R Camann.

At least 19 recordsLinked to original sources
PubMed2006

Resident training in obstetric anesthesia in the United States.

BACKGROUND: Limited information exists on obstetric anesthesia experience and training within residency training programs in the United States. METHODS: A survey was sent to every academic anesthesiology training program in the United States (n=120), with follow-up reminders to non-responders. The survey included 14 questions divided into staffing, didactic teaching and epidemiology regarding the practice of obstetric anesthesia at each academic institution. RESULTS: A response rate of 78% (93/120) was achieved. The returned surveys were grouped into three tiers by the number of deliveries/year from the lowest (Group 1) to the highest (Group 3). The total number of obstetric deliveries at each institution ranged from 340 to 15 800. The average number of residents/month rotating on obstetric anesthesia was 2.6 and the number of months spent on the obstetric anesthesia service was 2.7. The average number of obstetric anesthesia lectures given was 12 per month. A total of 21.5 obstetric anesthesia fellows were reported to train at these institutions, with fellows being more common in larger institutions. Group 1 institutions were more likely to have anesthesiologists covering the main operating room and obstetric suite simultaneously. The average number of obstetric anesthesia staff members/institution was 4.3. The average cesarean section rate was 27.8%, with 5.8% being performed under general anesthesia. Neuraxial techniques were used in an average of 70.3% of laboring parturients, with combined spinal epidurals accounting for 24.6% of the techniques. CONCLUSION: The average number of obstetric deliveries per year for institutions with a resident training program was 3498+/-2383. Dedicated obstetric anesthesia staffing was more common when >3700 deliveries/year were performed; the presence of this staffing corresponded with a reduction in the use of general anesthesia for cesarean deliveries. Few differences in the resident lecture didactic exposure were observed in terms of numbers of lectures and months on the obstetric anesthesia service, although a significantly greater number of clinical cases was available to each resident in those institutions with greater overall numbers of obstetric cases.

Anesthesia, Conduction↗
PubMed2003

Neuraxial block for labour analgesia--is the combined spinal epidural (CSE) modality a good alternative to conventional epidural analgesia?

AIM: Apart from conventional epidural analgesia (EA), the combined spinal-epidural (CSE) modality is fast becoming a popular technique for treating labour pain. In this study, we investigated the differences in the patient profile and outcome between CSE and EA for labour pain in KK Women's and Children's Hospital. METHODOLOGY: Data pertaining to 1,532 healthy parturients who had received either CSE or EA for labour pain during a six-month period was systematically collected by using a specially designed form. Multiple logistic regression analysis was used to determine the independent predictors of patient satisfaction and the relation of parturient factors on the choice of block. The side effects and the outcome of labour were also compared. RESULTS: CSE accounted for 80% of all neuraxial blocks performed for labour analgesia (vs 20% for EA). Anaesthesiologists were more inclined to using CSE than EA for multiparous parturients (OR 2.03, p<0.01) in a more painful (OR=1.61, p=0.03) and advanced stage of labour (OR=1.12, p=0.03). The need for supplemental analgesics was greater for EA (p<0.01). Patient satisfaction was higher for CSE (OR=1.77, p<0.026). CSE had a higher risk of pruritus (29% vs 14%, p<0.01) but lower risk of post block neural deficits (0% vs 2%, p<0.01) than EA. No difference in the mode of delivery was detected between the two groups. CONCLUSION: CSE is a safe and good alternative to EA as a technique of neuraxial block for labour analgesia.

Analgesia, Epidural↗
PubMed1999

Clinical effects and maternal and fetal plasma concentrations of 0.5% epidural levobupivacaine versus bupivacaine for cesarean delivery.

BACKGROUND: Bupivacaine exists as a mixture of two enantiomers, levobupivacaine and dexbupivacaine. Data suggest that levobupivacaine has equal local anesthetic potency, with reduced potential for central nervous system and cardiovascular toxicity. The present study compares the efficacy of 0.5% levobupivacaine with 0.5% bupivacaine for epidural anesthesia in parturients undergoing elective cesarean delivery. METHODS: Sixty healthy obstetric patients undergoing elective cesarean delivery with epidural anesthesia completed the study. Patients were randomized to receive 30 ml of either 0.5% levobupivacaine or 0.5% bupivacaine in a double-blind fashion. The efficacy endpoint measures included onset, offset, and quality of anesthesia. Neonatal blood gas analyses, Apgar score determinations, and neurobehavioral examinations were performed. Venous samples for pharmacokinetic studies and serial electrocardiograms were obtained in 10 patients in each group. RESULTS: Levels of sensory block, motor block, muscle relaxation, and overall quality of anesthesia did not differ between groups. The frequency of hypotension was 84.4% in the levobupivacaine group and 100% for the bupivacaine group (P < or = 0.053). No significant difference in observed maximum concentration of drug after dosing or area under the plasma drug concentration versus time curve were seen. The maximum concentrations were 1.017 and 1.053 microg/ml, and the areas were 4.082 and 3.765 h(microg/ml) for the levobupivacaine and bupivacaine groups, respectively. Umbilical vein-to-maternal vein ratios were 0.303 for the levobupivacaine group and 0.254 for the bupivacaine group. CONCLUSIONS: The use of epidural 0.5% levobupivacaine for cesarean delivery results in equally efficacious anesthesia compared with 0.5% bupivacaine. Pharmacokinetic parameters were similar in the two groups.

Adult↗
PubMed1998

General anesthesia for cesarean section at a tertiary care hospital 1990-1995: indications and implications.

Complications of general anesthesia for cesarean section remain the leading cause of anesthesia-related maternal mortality. General anesthesia, however, is becoming less popular for obstetric anesthesia, and thus fewer cesarean sections are conducted using this technique. As the number of general anesthesia cases decrease, the number of difficult intubations witnessed and managed by residents decreases. In addition, patients who undergo general anesthesia may have co-morbidities which, while not contraindicating regional anesthesia, may increase the risk of providing anesthesia. We reviewed the medical records of 6 calendar years (1990-1995) at our busy tertiary center, to determine patient demographics, indications for cesarean section, indications for general anesthesia, time of day, and complications related to airway management. From 1990 through 1995, cesarean sections under general anesthesia decreased from 7.2% to 3.6% (P=0.0001), however, they were performed on parturients with more maternal diseases (17.2% to 35.8%; P=0.0034). Although the incidence of difficult intubations in those years ranged from 16.3% to 1.3%, only one failed intubation with resultant maternal mortality occurred. Few residency programs offer instruction on the difficult airway in the parturient population. Organized airway management programs specifically for the obstetric population may assist efforts to decrease the morbidity and mortality associated with the provision of general anesthesia for cesarean section.

Journal Article↗
PubMed1998

Intrathecal ropivacaine for labor analgesia: a comparison with bupivacaine.

UNLABELLED: Ropivacaine has less potential for central nervous system and cardiovascular toxicity than bupivacaine; in pregnant patients and volunteers, it produces less motor block in equianalgesic doses than bupivacaine. We compared two doses of intrathecal ropivacaine combined with sufentanil with a standard dose of intrathecal bupivacaine plus sufentanil for labor analgesia using a combined spinal-epidural (CSE) technique. In a prospective, randomized, double-blind fashion, 48 patients requesting labor analgesia received either 2.5 mg of intrathecal bupivacaine plus sufentanil 10 microg (B), 2 mg of intrathecal ropivacaine plus sufentanil 10 microg (R2), or 4 mg of intrathecal ropivacaine plus sufentanil 10 microg (R4). Duration of analgesia and side effects, such as motor block, pruritus, hypotension, ephedrine requirements and fetal bradycardia, were recorded. Duration of analgesia (mean +/- SD) was 79+/-30 min for R2, 98+/-19 min for R4, and 92+/-38 min for B (P = not significant). No differences in motor block or side effects were detected among the groups. We conclude that ropivacaine, when combined with sufentanil, is effective for providing CSE labor analgesia and offers no advantage over bupivacaine in the studied doses. IMPLICATIONS: In this study, we compared a standard dose of intrathecal bupivacaine with sufentanil for combined spinal epidural analgesia with two doses of the new local anesthetic ropivacaine. Both local anesthetics provided similar labor analgesia duration with equivalent side effect profiles in the doses studied.

Adult↗
PubMed1996

Hemodynamic effects of intrathecal sufentanil compared with epidural bupivacaine in laboring parturients.

STUDY OBJECTIVES: To provide information on the central hemodynamic effects of intrathecal sufentanil after a standard intravenous preload using thoracic bioimpedance monitoring to obtain noninvasive measurements of cardiac index (CI), stroke index (SI), and systemic vascular resistance (SVR). To compare hemodynamic parameters after intrathecal sufentanil labor analgesia to those after a standard dose of epidural bupivacaine in laboring parturients. DESIGN: Randomized, double-blind study. SETTING: Labor and delivery unit in a university hospital. STUDY DESIGN: 40 ASA status I parturients were randomized into two groups receiving analgesia with combined spinal-epidural technique. Group SUF received 10 micrograms of intrathecal sufentanil followed by 12 ml of saline through an epidural catheter; Group BUP received 2 ml of intrathecal saline followed by 12 ml of 0.25% epidural bupivacaine. Heart rate (HR), blood pressure (BP), and thoracic bioimpedance monitoring were recorded. Pain scores, fetal HR, and side effects were noted. MEASUREMENTS AND MAIN RESULTS: No significant changes from baseline were seen in CI, SI, or SVR index. Mean arterial pressure was lower in Group BUP at 10 and 20 minutes after induction of analgesia. Mean HR was lower in Group SUF at 20 and 30 minutes after induction. Two patients in Group SUF and four patients in Group BUP experienced hypotension requiring ephedrine. Pain scores were lower in Group SUF at 10 minutes after induction of analgesia; subsequent pain scores and duration of analgesia were similar. Fourteen patients in Group SUF experienced itching. CONCLUSIONS: No significant differences in CI, SI, or SVR index were seen after either method of analgesia. A few patients in both groups experienced hypotension requiring treatment with ephedrine. Both techniques of labor analgesia appear to provide effective pain relief but care must be taken with either method to monitor maternal BP.

Adult↗
PubMed1995

The addition of bupivacaine to intrathecal sufentanil for labor analgesia.

We designed a prospective, randomized, double-blind study to evaluate the efficacy of the combination of intrathecal sufentanil with a low dose of local anesthetic in an attempt to prolong analgesia in labor. Fifty-two patients received one of the following intrathecal study solutions: 2.5 mg of bupivacaine; 10 micrograms of sufentanil; or 2.5 mg of bupivacaine plus 10 micrograms of sufentanil. The mean duration of analgesia (min +/- SD) was significantly different among all three groups: 70 +/- 34 min for bupivacaine, 114 +/- 26 min for sufentanil, and 148 +/- 27 min for bupivacaine-sufentanil (P < 0.001). Visual analog scale (VAS) scores for pain were significantly higher in the bupivacaine group compared to both the sufentanil group and the bupivacaine-sufentanil group (P < 0.02), and were significantly higher in the sufentanil group compared to bupivacaine-sufentanil at 75 min postinjection and beyond (P < 0.02). Hypotension was not observed in the sufentanil group but occurred transiently in the other two groups (P = 0.09). There was no evidence of motor blockade, excessive somnolence, fetal heart rate (FHR) abnormalities, or postdural puncture headache (PDPH) in any of the patients. The addition of 2.5 mg of bupivacaine to 10 micrograms of intrathecal sufentanil significantly prolonged labor analgesia without adverse maternal or fetal effects.

Adult↗
PubMed1993

Intrathecal sufentanil for labor analgesia. Effects of added epinephrine.

BACKGROUND: Intrathecal sufentanil has been found to provide profound analgesia during labor. Epinephrine, when added to various local anesthetic agents or opioids, may modify the analgesic profile and incidence of side effects. The authors sought to determine the effect of adding 0.2 mg epinephrine to 10 micrograms sufentanil when administered for analgesia during labor. METHODS: Forty women during active labor received 10 micrograms intrathecal sufentanil either with (n = 20) or without (n = 20) 0.2 mg epinephrine in a randomized, blinded fashion. A combined spinal-epidural technique was used in which a 25-G Whitacre spinal needle was passed through a standard 17-G epidural needle. After injection of the study drug, an epidural catheter was passed, but no local anesthetics were given. Analgesia was quantitated using visual analog scores, as well as time elapsed until first request for additional analgesia via the epidural catheter (0.25% bupivacaine). The incidence and severity of pruritus, nausea, and somnolence were assessed. RESULTS: The duration (median, range) of analgesia was 90 (40-310) min in the plain sufentanil group (SUF) and 90 (45-230) min in the sufentanil-epinephrine (SUF-EPI) group (P = NS). The onset of analgesia was rapid (within 5 min) in both groups and visual analog scores did not differ at any observation point between groups. The incidence of pruritus was 80% (16/20) in the SUF group, and 45% (9/20) in the SUF-EPI group (P = 0.05). Four patients in the SUF group rated the pruritus as severe versus none in the SUF-EPI groups (P = 0.05). Seven patients (35%) in the SUF-EPI group experienced nausea, versus none in the SUF group (P = 0.004). No patient developed hypotension, motor blockade, fetal heart rate abnormalities, excessive sedation, or postdural puncture headache. CONCLUSIONS: Intrathecal sufentanil 10 micrograms, both with and without epinephrine, provided rapid-onset, albeit short-duration, analgesia during labor. Epinephrine did not prolong the duration of intrathecal sufentanil analgesia. The addition of epinephrine increased the incidence of nausea and decreased the incidence and severity of pruritus.

Adult↗
PubMed1993

Obstetric anesthesia in patients with idiopathic facial paralysis (Bell's palsy): a 10-year survey.

During pregnancy there is an increased incidence of idiopathic facial paralysis (Bell's palsy). During a 10-yr period, 36 patients with a diagnosis of pregnancy-associated Bell's palsy were identified retrospectively. Twenty-five patients developed symptoms during the third trimester, whereas the remaining 11 became symptomatic during the first week postpartum. Twenty women delivered vaginally and 16 by cesarean section with a variety of anesthetics being used. Five patients received spinal, 22 epidural, and 3 general anesthetics; 7 patients received no anesthesia. The incidence and distribution of the palsy were similar among patients delivered with and without anesthesia. We conclude that the appropriate anesthetic for a given patient may be chosen without concern for the coexisting Bell's palsy.

Adolescent↗
PubMed1992

Does epidural administration of butorphanol offer any clinical advantage over the intravenous route? A double-blind, placebo-controlled trial.

The differential effects of intravenous versus epidural administration of short-acting, lipid-soluble opioids is controversial. This study was undertaken to compare these two routes of administration using the mixed agonist-antagonist opioid, butorphanol. Forty-five women undergoing elective cesarean delivery at term under epidural lidocaine anesthesia were randomized to receive a single bolus of either epidural or intravenous butorphanol 2 mg or saline control for postoperative analgesia. At precisely 60 min after the last dose of epidural local anesthetic, all patients received a simultaneous epidural and intravenous injection in a randomized, double-blinded fashion. The intravenous group received butorphanol intravenous and saline epidurally; the epidural group received saline intravenous and butorphanol epidurally; and a control group received saline via both routes. When additional analgesia was requested, all patients received patient-controlled analgesia (PCA) with intravenous morphine (2-mg demand dose, 7-min lockout interval). Analgesia was quantitated using a visual analogue scale and subsequent PCA morphine requirements. The interval from study drug injection until first request for PCA use was equivalent for the intravenous and epidural groups (89 +/- 9 and 83 +/- 8 min, respectively) and significantly longer than in control group (39 +/- 4 min, P less than 0.001, intravenous and epidural vs. control). Analgesia was equivalent in the intravenous and epidural groups at all observation points, and pain scores were significantly lower than control for the first 120 min after study drug injection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

A comparison of intrathecal, epidural, and intravenous sufentanil for labor analgesia.

A number of recent studies have suggested that the analgesic effects of highly lipid-soluble opioids are similar when these agents are administered either epidurally or intravenously. We sought to test whether the lipid-soluble opioid sufentanil was more effective when administered intrathecally than when administered epidurally or intravenously. Twenty-four women during active labor received sufentanil 10 micrograms either intrathecally (n = 9), epidurally (n = 8), or intravenously (n = 7), using a combined spinal-epidural technique. The sufentanil was administered alone, without concomitant local anesthetics. Analgesia was assessed using the visual analogue score as well as the time elapsed from the administration of study drug to the patient's request for additional analgesia via the epidural catheter (bupivacaine 0.25%). The median duration of analgesia (median, interquartile range) was 84 (70-92) min in the intrathecal group, 30 (23-32) min in the epidural group, and 34 (17-30) min in the intravenous group (P < 0.001). The intrathecal group showed rapid and significant decrease in visual analogue scale scores, whereas visual analogue scale scores in the other two groups did not decrease and remained significantly elevated compared to those of the intrathecal group at all observation points. Side effects were limited to pruritus in 3 patients (2 moderate and 1 severe) in the intrathecal group. No patient developed post-dural puncture headache. We conclude that sufentanil 10 micrograms intrathecally provides rapid and effective analgesia of 1-2-h duration during labor. Epidural and intravenous use of this dose of sufentanil did not provide evidence of satisfactory analgesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Epidural nalbuphine for analgesia following caesarean delivery: dose-response and effect of local anaesthetic choice.

The analgesic profile of epidural nalbuphine for postoperative pain relief and the impact of local anaesthetic choice upon this profile was investigated in 58 patients undergoing elective Caesarean delivery under epidural anaesthesia. Patients were randomized to receive either lidocaine 2% with 1:200,000 epinephrine or 2-chloroprocaine 3% for perioperative anaesthesia, followed by either 10, 20, or 30 mg of epidural nalbuphine administered at the first complaint of postoperative discomfort. Postoperative analgesia was quantitated on a visual analogue (VAS) scale, and by the time from the epidural opioid injection until the first request for supplemental pain medication. The duration of analgesia after lidocaine anaesthesia followed by 10, 20 or 30 mg nalbuphine was 77 (53-127) min, 205 (110-269) min, and 185 (116-241), respectively (median, 95% confidence interval, P less than 0.01, 20 and 30 mg vs 10 mg). Following 2-chloroprocaine anaesthesia, VAS remained consistently elevated: the median duration of analgesia was only 30-40 min and did not differ among the three doses of nalbuphine. Side-effects consisted only of somnolence, and were noted only following lidocaine anaesthesia. Somnolence was observed in 0, 20% and 50% of those receiving 10 mg, 20 mg and 30 mg of nalbuphine respectively (NS). No evidence of respiratory depression was noted in any patient. It is concluded that 20 or 30 mg of epidural nalbuphine provides analgesia for only two to four hours following Caesarean delivery with lidocaine anaesthesia, but anaesthesia with 2-chloroprocaine resulted in minimal or no analgesia from this opioid. Nalbuphine appears to be a disappointing agent for epidural use after Caesarean delivery.

Adult↗