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Biomedical subjects

K M Kuczkowski

Publications and source records attributed to K M Kuczkowski.

At least 73 records · Page 4Linked to original sources
PubMed2004

Levobupivacaine and ropivacaine: the new choices for labor analgesia.

For several decades, bupivacaine has enjoyed great clinical popularity as the first choice local anaesthetic for pain control in labour. However, introduction of ropivacaine and most recently levobupivacaine, the two newer and presumably safer (thought to be less cardio- and neurotoxic than bupivacaine) local anaesthetics, has challenged the position of bupivacaine as a gold standard to labour analgesia. Most pregnant patients receive their initial information regarding labour analgesia from primary care providers including family physicians, midwives, and obstetricians. This review article, intended for primary care providers, briefly addresses the current controversies regarding choice of local anaesthetics for pain management in labour.

Amides↗
PubMed2004

Ambulation with combined spinal-epidural labor analgesia: the technique.

The combined spinal-epidural labor analgesia technique (CSEA) has attained wide spread popularity in obstetric anesthesia worldwide. The onset of analgesia is rapid and reliable, and maternal satisfaction is high. While there still remains some concern about dural puncture, the CSEA technique offers many advantages to the parturient. For ambulatory labor analgesia the CSEA technique offers the possibility of combining rapid onset of subarachnoid analgesia with the flexibility of continuous epidural analgesia. This approach with the application of low-dose local anesthetic and/or opioid can provide a very selective sensory block with minimal motor blockade, allowing parturients to ambulate. This article will attempt to assess the validity of some strongly held opinions of whether CSEA offers any advantages for ambulatory labor analgesia as well as highlight some selected technical aspects and controversies of the CSEA specifically applicable to ambulatory labor analgesia.

Analgesia, Epidural↗
PubMed2004

Marijuana in pregnancy.

INTRODUCTION: The prevalence of recreational drug abuse among young adults, including women, has increased markedly over the last 2 decades. Nearly 90 % of these women are of childbearing age. Marijuana remains the drug most commonly used for recreational purposes in pregnancy. However, there appears to be an absence of uniform guidelines for obstetric and anaesthetic management of pregnant patients with a history of marijuana abuse. MATERIALS AND METHODS: A Medline search for articles highlighting drug abuse in pregnancy, with particular emphasis on marijuana abuse in pregnancy, the drug 's impact on the fetus and implications for administration of obstetrical anaesthesia was performed. RESULTS: Because the pharmacological actions of marijuana are complex and include a unique blend of effects, the clinical picture could be very unpredictable, the diagnosis often difficult, and management at times controversial. CONCLUSION: In the absence of uniform anaesthetic guidelines for pregnant patients with a history of drug abuse, including abuse of marijuana, the decision regarding administration of peripartum analgesia or anaesthesia should be individualised and conducted on a case-by-case basis.

Anesthesia, Obstetrical↗
PubMed2004

Post-dural puncture headache in the obstetric patient: an old problem. New solutions.

More than 100 years have passed since the initial description of the postdural puncture headache (PDPH). However, this unique clinical entity still continues to fascinate anesthesiologists, and numerous studies on its pathophysiology, prevention, and treatment, have been published. There is considerable variability in the incidence of PDPH, which is affected by many factors such as age, gender, pregnancy, and needle type and size. The obstetric patient is at particular risk of dural puncture (and the subsequent headache) because of sex, young age, and the widespread application of regional anesthesia. The incidence of epidural needle-induced PDPH in parturients following dural puncture with a large bore needle has been reported to range 76-85%. Although a few measures have been proposed to prevent PDPH (intrathecal injection of saline, insertion of the epidural catheter into the subarachnoid space through the dural hole), none have been shown to work with certainty to date. This article reviews the latest developments (maintaining cerebrospinal fluid volume) aimed at prevention of PDPH.

Adult↗
PubMed2003

Post-dural puncture headache, intracranial air and obstetric anesthesia.

Recently, a controversy has arisen as to whether air or saline should be recommended for the correct localization of the epidural space with the loss of resistance technique. I report a case of a previously healthy parturient who developed pneumocephalus and severe headache following the use of the loss of resistance to air (LORA) technique to identify the epidural space. This case report raises one more time the question about the safety of the LORA technique for labor analgesia.

Adult↗
PubMed2003

Complete recovery from prolonged cardio-pulmonary resuscitation following anaphylactic reaction to readministered intravenous cefazolin.

We describe a patient who developed a type I anaphylactic reaction to intravenous cefazolin. The patient had no known drug allergies and had previously received intraoperative intravenous cefazolin 2 months prior without any problems. Forty-fives after receiving cefazolin 1 g i.v. and while fully awake, the patient experienced shortness of breath, became unconscious, and then suffered a cardiac arrest. Resuscitation included endotracheal intubation, external cardiac compression, electrical defibrillation and multiple large doses of epinephrine, atropine, and sodium bicarbonate over the course of 2.5 h and three cardiac arrests. Nevertheless, the patient fully recovered. The intent of this case report is to address widely held concerns regarding cross-reactivity of cephalosporin, particularly cefazolin, to penicillin, the legitimacy of test dosing as a means to safely identify patients who will have an allergic reaction to cephalosporins and comment on patient-related predictors of survival following cardiopulmonary resuscitation and the good outcome in this case.

Adult↗
PubMed2003

Decrease in the incidence of post-dural puncture headache: maintaining CSF volume.

The incidence of epidural needle-induced post-dural puncture headache (PDPH) in parturients following dural puncture with a large bore (18-gauge) needle has been reported to range 76-85%. We describe seven cases in which the performance of epidural anesthesia in parturients was complicated by an unintentional dural puncture with an 18-gauge epidural needle. In all seven cases, the unintentional dural puncture was followed by (i) injection of the CSF in the glass syringe back into the subarachnoid space through the epidural needle, (ii) insertion of a epidural catheter into the subarachnoid space (now referred to as an intrathecal catheter), (iii) injection of a small amount of preservative free saline (3-5 ml) into the subarachnoid space through the intrathecal catheter, (iv) administration of bolus and then continuous intrathecal labor analgesia through the intrathecal catheter and then (v) leaving the intrathecal catheter in-situ for a total of 12-20 h. PDPH occurred in only one of these cases (14%).

Adult↗