PubMed Health⌕ Search

Biomedical subjects

J S Sprigge

Publications and source records attributed to J S Sprigge.

10 recordsLinked to original sources
PubMed1996

Dural puncture: the patients' perspective. A patient survey of cases at a DGH maternity unit 1983-1993.

BACKGROUND: This study was designed to investigate the patient experience following accidental dural puncture complicating obstetric epidural analgesia. METHODS: Sixty-three patients who had suffered from accidental dural puncture during obstetric epidural analgesia over a ten-year period were sent a questionnaire enquiring about their experiences. 68% responded. RESULTS: Headache was the most severe symptom, occurring in 86% of this group; it lasted for a median of eight days and recurred after discharge in 47%. Backache occurred in 70% and 58% suffered with backache following discharge. Headache was considered to be the worst aspect by 49% of responders, backache by 19% and bedrest by 33%. Bed rest was frequently voluntary (as opposed to being enforced on medical orders) since many patients only gained relief from their headache when supine. Twenty patients (47%) received a blood patch, which was effective in relieving headache in 14 patients; however, the headache recurred after discharge in 10 of these 14 patients. Only 8 patients (19%) stated that they were aware of the risk of dural puncture prior to their epidural, three of whom were members of paramedical professions. CONCLUSIONS: Headache and backache are both common following dural puncture with a 16 G needle and both frequently recur after discharge from hospital. It was the strongly expressed opinion of this selected group that all mothers should be warned of the risk of dural puncture before undergoing epidural analgesia.

Analgesia, Epidural↗
PubMed1987

Unintentional dural puncture. A survey of recognition and management.

A survey of the recognition and management of 21 unintentional dural punctures that occurred in a series of 3500 obstetric epidurals is presented. In seven cases, dural puncture was not recognised at the time of occurrence and two patients may have subsequently received mixed epidural and subarachnoid analgesia. In two patients with dural puncture in whom air had been used to locate the epidural space, cerebrospinal fluid did not drip from the hub of the needle. A test dose did not reveal incorrect catheter placement in seven patients. The provision of an epidural infusion of Hartmann's solution for 24 hours, together with bed rest, appeared to delay the onset of dural puncture headache rather than prevent it entirely. Blood patching was required only in five of the 21 patients but was entirely successful. The implications of these observations in relationship to obstetric epidural practice are discussed.

Anesthesia, Epidural↗
PubMed1984

Narcotic requirements for intravenous anesthesia.

MAC BAR, the minimum end-tidal alveolar anesthetic concentration that inhibits adrenergic response to a noxious stimulus in 50% of subjects, is a quantifiable physiological parameter that can be used to determine potency and therapeutic indices of volatile anesthetics. We wished to determine whether there is a minimal intraarterial plasma concentration (MIC BAR) of an opiate such as fentanyl that will prevent a hypertensive response to noxious stimuli in 50% of patients undergoing aortocoronary bypass surgery (ACBP). Forty-three patients with good left ventricular function were studied. All patients were premedicated with diazepam, morphine, and scopolamine. Five groups of patients were anesthetized with different fentanyl anesthesia protocols, each designed to produce different plasma fentanyl concentrations (PFC). A 20% increase in systolic blood pressure compared to control was considered an adrenergic response that related to the plasma fentanyl concentration inferred from each patient's PFC time-concentration curve. Only four patients became hypertensive with a PFC greater than 20 ng/ml. One patient became hypertensive at intubation with a PFC of 12.3 ng/ml. There was no statistically significant difference in the mean PFC in patients who became hypertensive at each event. During aortic dissection, when significantly more patients became hypertensive, there was no difference in the incidence of hypertension in patients with a PFC above or below 20 ng/ml. Two patients became hypertensive at skin incision with a PFC over 30 ng/ml. A MIC BAR could not be identified because of the great variability in the PFC of patients who became hypertensive.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Intravenous↗
PubMed1983

Nalbuphine versus meperidine for post-operative analgesia: a double-blind comparison using the patient controlled analgesic technique.

A double-blind study was undertaken to compare nalbuphine, a synthetic partial agonist opiate, with meperidine in providing analgesia in patients following abdominal surgery, using the patient controlled analgesic technique. Both drugs showed a wide variation in demand requirements, but they were equally effective in relieving pain as assessed by the linear analogue technique. Neither drug caused a reduction of respiratory rate. The patient-controlled analgesic technique gave analgesia of good quality and it aided the comparison of the two drugs. However, some of the patients found the technique difficult to manage, and it is expensive and time-consuming. Until further experience is gained with this device its use should be confined to a constant care unit.

Adult↗
PubMed1982

Meperidine infusion for postoperative analgesia in grossly obese patients.

Postoperative analgesia was provided to nine grossly obese patients with a continuous intravenous meperidine infusion. The narcotic was infused at an initial rate of 1.3 mg . min-1 for 45 minutes, then 0.7 mg . min-1 for 30 minutes followed by 0.5 mg . min-1 for the next 24 hours. Pain was assessed at hourly intervals, serial blood samples were taken for measurement of plasma meperidine concentrations, and respiratory function was assessed by serial measurement of vital capacity and arterial blood gas analysis. Analgesia was gradual in onset and from six hours after commencement of the infusion, seven of the patients suffered little or no pain. Plasma meperidine concentrations reached a peak of 0.33 +/- 0.05 microgram . ml-1 at one hour decreased gradually after three hours. Surprisingly, there was poor correlation between analgesia and plasma meperidine concentration. All patients breathed spontaneously and maintained satisfactory blood gas tensions. However, there was a marked reduction in postoperative vital capacity. Thus meperidine administered by continuous intravenous infusion can provide good postoperative analgesia in the obese patient without producing respiratory depression. However, the lack of correlation between analgesia and plasma narcotic concentration suggests that further study is required before intravenous regimes can be prescribed by application of pharmacokinetic principles.

Adult↗
PubMed1982

Fentanyl infusion anesthesia for aortocoronary bypass surgery: plasma levels and hemodynamic response.

Plasma fentanyl concentrations were measured by radioimmunoassay in patients during aortocoronary bypass surgery and correlated with hemodynamic responses to surgical stimulation. Thirty patients scheduled for aortocoronary bypass surgery were divided into three groups of 10. Patients in group 1 received fentanyl, 30 micrograms/kg, as a loading dose followed by an infusion of 0.3 microgram/kg/min; those in group 2 received 40 micrograms/kg as a loading dose followed by an infusion of 0.4 microgram/kg/min; and those in group 3 received 50 micrograms/kg as the loading dose followed by an infusion of 0.5 microgram/kg/min. The total dose of fentanyl administered to each group up to the time of rewarming on cardiopulmonary bypass was 60 micrograms/kg, 90 micrograms/kg, respectively. Each of the dose regimens produced stable plasma concentrations starting approximately 20 minutes after induction and continuing until the infusion was discontinued. Patients in group 1 had a mean plasma concentration of 10 to 12 ng/ml in the stable period compared with 12 to 14 ng/ml in group 2 and 15 to 18 ng/ml in group 3. Fewer patients in group 3 responded to intubation and surgical stimulation than in the other groups, although the differences between groups were not statistically significant. Response to stimulation was treated by the administration of droperidol or volatile anesthetic agents. At a plasma concentration of 15 ng/ml, 50% of patients had an increase in systolic blood pressure which required treatment. This minimal intra-arterial concentration, analogous to MAC, can be achieved by the administration of fentanyl as a loading dose of 50 micrograms/kg followed by an infusion of 0.5 microgram/kg/min.

Anesthesia, Intravenous↗