Biomedical subjects
Publications and source records attributed to L E Shutt.
We report a case of "crack" cocaine abuse in a pregnant patient associated with haematuria, proteinuria, haemolytic anaemia, renal impairment, thrombocytopenia and pulmonary oedema. The case illustrates the problems for clinicians where unrecognized cocaine abuse interferes with the diagnosis and management of a complicated pregnancy. In addition, we discuss the principles for the safe conduct of anaesthesia in the pregnant cocaine abuser.
We have studied 150 women undergoing elective Caesarean section under spinal anaesthesia. They were allocated randomly to have a 22-gauge Whitacre, a 25-gauge Whitacre or a 26-gauge Quincke needle inserted into the lumbar subarachnoid space. The groups were compared for ease of insertion, number of attempted needle insertions before identification of cerebrospinal fluid, quality of subsequent analgesia and incidence of postoperative complications. There were differences between groups, but they did not reach statistical significance. Postdural puncture headache (PDPH) was experienced by one mother in the 22-gauge Whitacre group, none in the 25-gauge Whitacre group and five in the 26-gauge Quincke group. Five of the six PDPH occurred after a single successful needle insertion. Seven of the 15 mothers in whom more than two needle insertions were made experienced backache, compared with 12 of the 129 receiving two or less (P < 0.001). We conclude that the use of 22- and 25-gauge Whitacre needles in elective Caesarean section patients is associated with a low incidence of PDPH and that postoperative backache is more likely when more than two attempts are made to insert a spinal needle.
Fifty women in labour were allocated randomly to receive either air or saline to assist in the identification of the extradural space by the loss of resistance technique. A study volume of 4 ml of air or saline was used before 0.5% bupivacaine 8 ml and the spread of analgesia was followed for 30 min. The first segment blocked, time of onset, number of blocked segments and height of block were comparable in the two groups. At 30 min, there were eight patients with an unblocked segment in the air group, compared with two in the saline group (P less than 0.01). All unblocked segments were blocked subsequently by further doses of bupivacaine. We conclude that air is more likely than saline to produce unblocked segments in the initiation of extradural analgesia in labour.
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The drugs atropine and hyoscine are reviewed in the context of their use by anaesthetists. The results of recent studies are stressed and guidelines given for use of these drugs in modern anaesthetic practice.
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BACKGROUND AND OBJECTIVES: The purpose of this review is to draw together a collection of uncommon complications of central neural block that affect the cranial nerves. There have been a small number of case reports, some of which have included a possible mechanism of the nerve dysfunction, but there is no prior review that collected them together and discussed the possible mechanisms. METHODS: Published case reports were identified by searching Medline of the British Medical Association and the Silver Platter CD-ROM library. In addition, the Medical Defence Union and Medical Protection Society were contacted to find cases that were unpublished but the subject of medical negligence lawsuits. RESULTS: The authors collected these cases together to increase awareness of alarming complications. If such cases are recognized for what they are, then the prognosis is good; however, delayed diagnosis can make them a cause of great anxiety and possible litigation. CONCLUSIONS: Increased awareness of these complications can decrease the likelihood of litigation by early diagnosis and explanation. Their mechanisms are not fully understood but the likely possibilities have been discussed. Further work is needed to establish the incidence of these problems, as it is likely that many cases are not diagnosed and not reported.