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Biomedical subjects

D D Moir

Publications and source records attributed to D D Moir.

At least 19 recordsLinked to original sources
PubMed1987

Antacid therapy for emergency caesarean section.

One hundred patients undergoing emergency Caesarean section were treated with cimetidine 200 mg intramuscularly when the decision was made to deliver the patient by Caesarean section and, preceding general anaesthesia, 30 ml of 0.3 M sodium citrate was administered orally. No routine antacid therapy was employed during labour. No patient had a gastric aspirate pH of less than 2.7, and only one of less than 3. The regimen is simple and effective, and treats only those patients at risk of acid aspiration.

Anesthesia, General↗
PubMed1984

Choice of local anaesthetic drug for extradural caesarean section. Comparison of 0.5% and 0.75% bupivacaine and 1.5% etidocaine.

One hundred women undergoing elective lower uterine segment Caesarean section under extradural anaesthesia received either 0.5% or 0.75% plain bupivacaine or 1.5% etidocaine with adrenaline 1:200 000 by random allocation. The time taken to establish satisfactory blockade for surgery was significantly shorter in the etidocaine group compared with either of the bupivacaine groups (P less than 0.001). There were no significant differences in the durations of either analgesia or motor blockade in the three groups. The efficacy of the sensory blockade, measured by the incidence of discomfort during the surgical procedure and the requirements for supplementary analgesia or general anaesthesia, was greater in the bupivacaine groups compared with the etidocaine group. Measurement of plasma bupivacaine concentrations in 34 of the patients revealed significantly increased umbilical venous concentrations at the time of birth in those who received 0.75% bupivacaine (P less than 0.05). There was no advantage in the use of bupivacaine in concentrations exceeding 0.5%. Etidocaine 1.5% may be of some value in situations where minimal delay in establishing adequate extradural blockade for surgery is desirable, but in view of its comparatively poor analgesic effects, routine use is not recommended.

Acetanilides↗
PubMed1984

Effect of naloxone on gastric emptying during labour.

The rate of gastric emptying was studied in 30 women during labour. All the women had received pethidine 100 mg i.m. for analgesia and, subsequently, extradural analgesia had been established for obstetric indications. The women were allocated randomly to two groups: 15 received naloxone 1.2 mg i.v. and 15 were given saline 3 ml (placebo). All 30 patients were then given paracetamol 1.5 g orally with water 100 ml. The amount of paracetamol absorbed, and hence gastric emptying, was significantly greater in the naloxone group in the first 30 min following the administration of the paracetamol.

Acetaminophen↗
PubMed1984

Bupivacaine toxicity in association with extradural analgesia for caesarean section.

Evidence of central nervous system toxicity was noted in two patients undergoing extradural analgesia for Caesarean section. There was no cardiovascular depression and both patients recovered rapidly. The patients had received total doses of bupivacaine plain solution of 357.5 mg and 356.25 mg, respectively and the relationship of these to the clinical signs of bupivacaine toxicity is discussed.

Adult↗
PubMed1981

Extradural analgesia: the influence of volume and concentration of bupivacaine on the mode of delivery, analgesic efficacy and motor block.

Five hundred and seventeen women in labour receiving extradural analgesia, using bupivacaine plain solution, were randomly allocated to one of three groups. Group A received 6-8ml of 0.5% solution, group B 10-14ml of 0.25% solution, and group C 6-8 ml of 0.25% solution. Spontaneous delivery occurred in 31.7% of patients in group A, 38.7% in group B and 53% in group C (P less than 0.001). The percentage of rotational forceps, ventouse and Caesarean section deliveries was similar in the three groups. Analgesia was most effective in group A, and at least in group C, both during labour and at delivery, although assessment by linear analogue score suggested that the differences between the three groups were slight. Motor block was most frequent and rapidly progressive in groups A, but was progressive in all groups, and after five or more top-up injections, was similar in the three groups. Difficulties with micturition following delivery were significantly more common in group A.

Adult↗
PubMed1980

Epidural analgesia for elective Caesarean section. Technique and its assessment.

A technique is described of epidural anaesthesia for electric Caesarean section which has a 98% success rate, and an acceptably low incidence of intra-operative pain. The essentials of the technique are to produce and maintain complete sensory block from S5 to T6, employing a two-stage injection of bupivacaine 0.5% (mean dose 23 ml) and the use of gravity to ensure sacral block. Despite the use of preoperative fluid loading and avoidance of caval occlusion, transitory hypotension occurred in 16% of patients. Vomiting, which occurred in 18% of patients, is a minor but distressing complication.

Anesthesia, Epidural↗
PubMed1979

Ergometrine or oxytocin? Blood loss and side-effects at spontaneous vertex delivery.

Blood loss and the frequency of vomiting were assessed at 88 spontaneous vertex deliveries. An i.v. injection of oxytocin 10 u was as effective as ergometrine 0.5 mg in controlling bleeding from the uterus after delivery. The continuous infusion of a dilute solution of oxytocin in the first stage of labour was not followed by an increased blood loss at delivery. Oxytocin infusions were maintained for 1 h after delivery. Vomiting or retching occurred in 13% of the mothers who received i.v. ergometrine. None of the women who received oxytocin suffered emetic sequelae.

Clinical Trials as Topic↗
PubMed1978

The contribution of anaesthesia to maternal mortality.

Anaesthesia is now an important cause of maternal death. Most deaths which occur in association with anaesthesia are preventable. Mendelson's syndrome and hypoxic cardiac arrest account for almost all maternal anaesthetic deaths. Although routine antacid therapy in labour does not guarantee to prevent Mendelson's syndrome, the use of antacids is nevertheless fully justified. There remains the possibility of pulmonary irritation due to food particles, bile salts and even the antacid itself. The role of difficult or failed tracheal intubation is emphasized in the causation of hypoxia and the pulmonary aspiration of stomach contents.

Anesthesia, General↗