PubMed Health⌕ Search

Biomedical subjects

D L Hepner

Publications and source records attributed to D L Hepner.

10 recordsLinked to original sources
PubMed2005

Effect of amniotic fluid on coagulation and platelet function in pregnancy: an evaluation using thromboelastography.

Amniotic fluid embolism is a rare obstetric complication. The exact pathogenesis of this syndrome remains unknown and significant controversy exists whether coagulopathy should always be present. We used thromboelastography to assess the effect of amniotic fluid on coagulation and platelet function in pregnant women. Different volumes of amniotic fluid (10-60 microl) were added to blood (330 microl) from pregnant women and thromboelastography variables determined. There were three important findings. R time, reflecting time to first clot formation, was significantly decreased with the addition of 10 microl amniotic fluid; platelet function, as determined by Reopro-TEG technique, was increased with the addition of 30 microl of amniotic fluid; and there was no evidence of fibrinolysis in any samples studied. In conclusion, our study substantiates the hypothesis that coagulation profile changes are invariable accompaniments of amniotic fluid embolism.

Adult↗
PubMed2000

Comparison of combined spinal-epidural and low dose epidural for labour analgesia.

PURPOSE: To compare the combined spinal-epidural (CSE) technique with the epidural technique with regard to time to initiate and manage, motor block, onset of analgesia and satisfaction during labour. METHODS: Upon requesting analgesia, 50 healthy term parturients were randomized in a prospective, double-blind fashion to receive either CSE analgesia or lumbar epidural analgesia in the labour floor of a university hospital at an academic medical centre. The epidural group (n = 24) received bupivacaine 0.0625%-fentanyl 0.0002% with 0.05 ml in 10 ml local anesthetic sodium bicarbonate 8.4% and epinephrine 1:200,000. The CSE group (n = 26) received intrathecal 25 microg fentanyl and 2.5 mg bupivacaine. Additional analgesia was provided upon maternal request. RESULTS: There were no differences (P>0.05) in time to perform either technique, motor blockade, or parturient satisfaction or in the number of times that the anesthesiologist was called to perform any intervention. Although the first sign of analgesia was not different between the two groups, the onset of complete analgesia was more rapid with the CSE technique (Visual Analogue Pain Score (VAPS) at five minutes < three: 26/26 vs. 17/24, P+/-0.001). CONCLUSION: Although epidural analgesia with a low concentration of local anesthetic and opioid mixture takes longer to produce complete analgesia, it is a satisfactory alternative to CSE.

Analgesia, Epidural↗
PubMed2000

Sudden bronchospasm on intubation: latex anaphylaxis?

I present a case of a patient with a history of cerebral palsy and asthma, living in a group home, who developed acute onset bronchospasm immediately after intubation. The patient developed hypotension 5 minutes after intubation. The bronchospasm lasted 20 minutes, and the case was complicated further by continued hypotension and a pneumothorax. A diagnosis of latex-mediated anaphylaxis was made in the intensive care unit after immunoglobin E (IgE), serum tryptase, and latex-specific IgE antibody were shown to be markedly elevated. This case report demonstrates that immediate onset of bronchospasm on intubation of an asthmatic patient is not always an asthma attack, and that other causes of bronchospasm should be considered in the differential diagnosis. Patients with a history of atopy, including those with a history of asthma, have an increased risk of developing latex sensitivity. It is important to remember that more than one etiology may be responsible for this kind of bronchospasm, and that it may be difficult to differentiate between multiple etiologies of bronchospasm.

Adult↗