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Biomedical subjects

C B Collier

Publications and source records attributed to C B Collier.

At least 19 recordsLinked to original sources
PubMed1999

Epidural abscess in an obstetric patient.

Epidural abscess is a rare complication of epidural block and occasionally presents in the post partum period. A case is described where a thoracolumbar abscess presented with backache and headache 10 days after an apparently uneventful block for labour and caesarean section. The abscess was treated medically with a satisfactory outcome. The literature is reviewed in order to assess several recent reports of infectious complications of epidural block in obstetric patients.

Adult↗
PubMed1998

Potential intrathecal leakage of solutions injected into the epidural space following combined spinal epidural anaesthesia.

A combined spinal epidural anaesthetic (CSE), by design, produces a deliberate multicompartment block across a breached dural membrane. Since the lateral holes of the epidural catheter may lie in close proximity to the dural puncture site, a bolus solution of drug injected via the epidural catheter has the potential to leak through the dural puncture into the subarachnoid space. The aim of this study was to determine the incidence of intrathecal leak by performing an epidurogram. Fifteen patients undergoing surgery with a CSE anaesthetic using a 16 gauge Tuohy/26 gauge pencil point needle were studied. Within three hours of catheter insertion, 12 ml of contrast (iohexol 300 mg/ml) was injected via the epidural catheter under fluoroscopic control with screen recording and exposure of lateral and anteroposterior X-ray plates. All films were later reviewed for evidence of intrathecal spread. We did not observe any evidence of intrathecal spread of contrast. However, caution should be observed during administration of an intraoperative bolus dose of analgesic agent via a catheter inserted as part of a combined spinal epidural anaesthetic technique, particularly with the use of hydrophilic opiods.

Adult↗
PubMed1997

Bilateral trigeminal nerve palsy during an extensive lumbar epidural block.

A rare case of trigeminal nerve blockade arising in the course of obstetric lumbar epidural anaesthesia is described. There was extensive bilateral spread of nerve-block up to the C4 level with respiratory distress after top-up for caesarean section, and subsequent epidurography revealed high epidural spread of contrast. The mechanism of the trigeminal nerve palsy was the source of some controversy, particularly as to whether intracranial spread of local anaesthetic had occurred, possibly following accidental subdural or subarachnoid injection.

Journal Article↗
PubMed1996

Why obstetric epidurals fail: a study of epidurograms.

In a study of the factors involved in the occasional failure of continuous obstetric epidural blockade, contrast injections through epidural catheters and radiographic screening were undertaken in 35 postpartum patients. The two major causes of inadequate block were found to be transforaminal escape of the catheter tip, and persistent unilateral block associated with an obstructive barrier in the epidural space. Recommendations for overcoming these problems are discussed.

Journal Article↗
PubMed1993

A continuous subdural block.

We describe a case of accidental subdural block, after attempted extradural puncture for Caesarean section. Fractionation of the local anaesthetic dose led to avoidance of more serious complications. Subdural fentanyl and a continuous low-dose subdural infusion were used satisfactorily for intraoperative management and postoperative analgesia. As little as 0.5 ml of bupivacaine, hourly, provided satisfactory analgesia over a 15-h period.

Adult↗
PubMed1993

A new epidural catheter. Closer eyes for safety?

A new design of epidural catheter with three lateral eyes placed in close proximity to its closed end is described. Prototype models of this catheter were tested in 200 obstetric and surgical patients. In a single-blind randomised study it was found to be easy to insert and highly satisfactory in use, when compared to the current catheter type, with three widely spaced lateral eyes. It is hoped that the close spacing of the eyes will eliminate the complication of multicompartment block, as seen with earlier multihole catheters, and improve the safety of epidural block.

Adolescent↗