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Biomedical subjects

I F Russell

Publications and source records attributed to I F Russell.

At least 37 records · Page 2Linked to original sources
PubMed1997

Epidural abscess in association with obstetric epidural analgesia.

A 31-year-old woman gravida 4 para 2 who had received epidural analgesia during labour (duration of catheterization 6.5 h) was readmitted 8 days later with a complaint of flu-like symptoms, severe backache and numbness of her thighs. She had a sensory deficit from T4 to L1 and was unable to stand without support. The severe backache prevented adequate assessment of motor function. An MRI scan suggested an epidural mass. Surgical decompression by hemilaminectomy was carried out within 24 h of admission and revealed an epidural abscess. Culture of the drained pus grew Streptococcus pneumoniae. She made a complete recovery and was discharged home on the tenth day. This case illustrates the problem of diagnosing serious postnatal problems that arise following the now fashionable early discharge from hospital.

Journal Article↗
PubMed1997

A double-blind assessment of the analgesic sparing effect of intrathecal diamorphine (0.3 mg) with spinal anaesthesia for elective caesarean section.

In a randomized double-blind study, 40 healthy women undergoing elective caesarean section with spinal anaesthesia received either 0.3 mg diamorphine or saline with bupivacaine 0.5% in 8% dextrose. The study recorded time to the first morphine demand delivered by patient-controlled analgesia (PCA), and total morphine requirement over 24 h. In addition pain, sedation, and pruritus were assessed by non-graduated visual analogue scores (VAS). Six patients in the diamorphine group required no postoperative morphine. The median (interquartile range) time to first morphine demand was significantly longer in the diamorphine group at 340 min (127, never used), than in the control group at 80 min (53, 159) (P 0.0006, 95% confidence interval for the difference between the medians is 60 to 1235 min). The use of PCA morphine over 24 h was significantly less in the diamorphine group than in the controls. The medians (interquartile ranges) were 5 (0, 36) mg vs 45 (26, 72) mg (P 0.0045, 95% confidence interval for the difference between the medians is 12 to 46 mg). In the diamorphine group, postoperative VAS for pain was significantly lower at 2 h and 3 h both at rest (P 0.0003, 0.003) and on moving (P 0.009, 0.002), at 8 h on moving (P 0.01), and at 12 and 24 h at rest (P 0.005, 0.029). Significantly more women suffered pruritus in the diamorphine group for the first 12 h after surgery (P 0.01).

Clinical Trial↗
PubMed1997

Absence of memory for intraoperative information during surgery under adequate general anaesthesia.

Using the isolated forearm technique (IFT), we wished to determine if patients known to be unresponsive to commands during general anaesthesia with nitrous oxide, halothane and neuromuscular blocking agents had any evidence of explicit or implicit recall. Two groups of women, studied in a single-blind sequential block design, heard different tapes, either a command and information tape (n = 34) or radio static (n = 34), throughout surgery. Four women (two radio static, two command) had unequivocal evidence of explicit recall for a period near the beginning or end of the procedure, at a time when the IFT was not being used. With or without hypnosis, category generation, serial position of category exemplars and word association tests did not reveal evidence of priming. We conclude that during light general anaesthesia with nitrous oxide, halothane and atracurium, patients had neither explicit nor implicit memory for information presented during a period when they are known to be unresponsive to commands.

Adolescent↗
PubMed1997

A comparative multicentre trial of spinal needles for caesarean section.

We studied 681 patients in a randomised, multicentre, double-blind, parallel group trial designed to assess the incidence of headache following spinal anaesthesia for Caesarean section using four different pencil point spinal needles. The needles used were: Whitacre 25G (n = 170), Polymedic 25G (n = 170), Sprotte 24G (n = 173) and Polymedic 24G (n = 168). The incidence of all headaches prior to discharge was 11.1%. Only five headaches (0.75%) were severe with features of post dural puncture headache (PDPH) and required an epidural blood patch: Whitacre 25G = 0, Polymedic 25G = 1 (0.6%), Sprotte 24G = 2 (1.2%), Polymedic 24G = 2 (1.2%). There was no statistically significant difference between the four groups for PDPH. We conclude that all four needles studied performed satisfactorily and comparably.

Adult↗
PubMed1995

A survey of anaesthesia for caesarean section.

In 1993 a postal survey of maternity hospitals within the UK was carried out to obtain data on the types of anaesthesia used for caesarean section. The poor response rate (79/226, 35%) reflects the paucity of data available in many centres. The data returned indicated a wide range of anaesthetic practice: from units with a general anaesthesia rate less than 10% to those with a general anaesthesia rate approaching 90%. Overall, during the 11-year period covered by the survey there was a significant reduction in the percentage use of general anaesthesia (77% in 1982 declining to 44% in 1992), but because of a 51% increase in the caesarean section rate the real reduction in the actual number of general anaesthetics used was modest (13%). If this holds true nationally, then factors other than a simple change from general anaesthesia to regional anaesthesia must contribute to the reduced maternal mortality from anaesthetic causes.

Journal Article↗
PubMed1995

Epidural clonidine-fentanyl combination for labour analgesia: a comparison with bupivacaine-fentanyl.

This open study of 20 women compared epidural clonidine (300 microg)/fentanyl (100 microg) with bupivacaine (25 mg)/fentanyl (100 microg) in the provision of pain relief in labour. Sensory tests in the clonidine group revealed slight alterations in the appreciation of pin prick and temperature but motor power was unchanged. Analgesia after the first dose was similar in the two groups, but thereafter the analgesia provided by clonidine/fentanyl was less than that from bupivacaine/fentanyl. Despite the incomplete pain relief provided by clonidine/fentanyl, mothers appreciated their essentially normal sensations and muscle power. Midwives also commented favourably on the normal mobility of these labouring mothers. There was no difference between the two groups in the duration of labour or the condition of the infants.

Journal Article↗
PubMed1995

Levels of anaesthesia and intraoperative pain at caesarean section under regional block.

This prospective study recorded levels of analgesia (loss of sharp pin prick sensation) and anaesthesia (loss of touch sensation) in 220 women during caesarean section under regional anaesthesia (70 epidurals, 150 spinals). At delivery the difference between analgesia and anaesthesia varied from 0-7 segments for epidurals and 0-9 segments for spinals. During surgery the level of anaesthesia at the time pain was experienced varied between T5 and T10. No patient with a level of anaesthesia which remained above T5 experienced pain. These results indicate that assessing the adequacy of block by sharp pin prick may be misleading and that in the absence of spinal or epidural narcotics a level of anaesthesia up to and including T5 is required to prevent pain during caesarean section.

Journal Article↗
PubMed1993

Midazolam-alfentanil: an anaesthetic? An investigation using the isolated forearm technique.

Thirty-two women underwent major gynaecological surgery with a midazolam-alfentanil total i.v. anaesthetic regimen. Adequacy of anaesthesia was assessed using a "pressure, rate, sweating and tears" (PRST) scoring system in conjunction with the isolated forearm technique (IFT). The IFT revealed that 72% of patients responded during surgery, but none had spontaneous, unprompted postoperative recall for the event. Three patients, on prompting, provided evidence of recall. The IFT, while indicating which patients are responsive, cannot be used to predict who will have postoperative recall. Lack of explicit postoperative recall does not indicate unconsciousness during surgery. Twenty patients, asked specifically during surgery to indicate the presence or absence of pain, experienced pain at some time during their surgical procedure. The PRST score could not be used to predict when a patient was awake. This low-dose i.v. anaesthetic technique cannot be recommended for general use.

Adult↗
PubMed1992

Spinal anaesthesia for caesarean section: 0.125% plain bupivacaine 12 ml compared with 0.5% plain bupivacaine 3 ml.

Forty women had elective Caesarean section under spinal anaesthesia with either 0.5% bupivacaine 3 ml or 0.125% bupivacaine 12 ml, injected at a rate of 1 ml/5 s. For 30 min after the spinal injection, each patient lay on her right side. Compared with the patients given 3 ml, in those given bupivacaine 12 ml there was a significantly greater spread of block (P less than 0.02 for analgesia; P less than 0.002 for touch) and significantly less variation in levels of block (P less than 0.02 for analgesia; P less than 0.04 for touch). However, within 5 min of placing the women in a supine, tilted (right hip up) position, there were no clinically or statistically significant differences in the levels of block between the two groups.

Adult↗