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M Dresner

Publications and source records attributed to M Dresner.

At least 19 recordsLinked to original sources
PubMed2006

Audit of the influence of body mass index on the performance of epidural analgesia in labour and the subsequent mode of delivery.

OBJECTIVE: To assess the influence of body mass index (BMI) on the performance of epidural analgesia in labour and the subsequent mode of delivery. DESIGN: A retrospective audit of prospectively collected quality assurance data. SETTING: The delivery suite of Leeds General Infirmary, Leeds, UK. This is a 4500-delivery teaching hospital unit. POPULATION: All women receiving epidural analgesia during labour in our unit between April 1997 and December 2005. METHODS: Epidural recipients were divided into BMI groups according to World Health Organization (WHO) categories and compared for indices of epidural performance and mode of delivery. MAIN OUTCOME MEASURES: Midwife and patient satisfaction scores with epidural analgesia, epidural resite rates, and mode of delivery. RESULTS: Data from 13 299 epidural recipients were analysed. Using WHO definitions, 22.8% were of normal body mass, 41.9% were overweight, 31.9% obese, and 3.4% morbidly obese. Epidurals were more likely to fail as BMI increased, as judged by midwife satisfaction scores (P < 0.001) and epidural resite rates (P < 0.01). This trend was not seen for maternal satisfaction scores using the WHO BMI categories. However, if women with BMI below 30 kg/m2 were grouped together, a significant trend was found (P < 0.01). BMI had no influence on vaginal instrumental deliveries, but caesarean section rates rose from 11.5% in women of normal BMI to 29.2% in the morbidly obese women (P < 0.001). CONCLUSIONS: Obesity increases the incidence of analgesic failure and the need for resite of epidurals. The caesarean section rate among epidural recipients increases dramatically as BMI rises.

Adolescent↗
PubMed2003

Meningococcal meningitis after combined spinal-epidural analgesia.

We present a case of bacterial meningitis in a 32-year-old parturient following combined spinal-epidural analgesia for labour. The patient made a full recovery with no residual neurological sequelae, but important lessons were learnt. Firstly, investigating obstetricians and physicians were unaware that a combined spinal-epidural technique included an intrathecal component, so did not consider treating organisms that might be acquired by this route. Anaesthetists, on the other hand, in the absence of an isolated organism, saw this as a likely combined spinal-epidural complication. Infectious disease experts eventually diagnosed community-acquired meningococcal meningitis by analysing bacterial deoxyribonucleic acid (DNA) fragments using polymerase chain reaction studies. This test and the management of suspected meningitis in the post-partum period are discussed.

Journal Article↗
PubMed2002

Haemodynamic changes caused by oxytocin during caesarean section under spinal anaesthesia.

The haemodynamic effects of oxytocin receive scant attention in pharmacology texts, but may be clinically significant in vulnerable patients. Despite prescriber information recommending a dose of 5 international units by slow i.v. injection, it is the authors' experience that it is very common practice in the UK to give 10 units as a rapid injection. We therefore conducted a randomised, double-blind study of the haemodynamic changes induced by rapid bolus of 5 or 10 units of oxytocin in 34 healthy term parturients at caesarean section under spinal anaesthesia. There was a small but statistically significant (P < 0.05) reduction in mean arterial pressure from baseline 30 s after a 10-unit bolus. However, large, statistically significant increases in heart rate and cardiac output occurred 1 min after 5 units and 2 min after 10 units. These changes peaked 1 min after oxytocin administration and were greater in the 10-unit group (P < 0.05). The importance of these findings is that some women with hypovolaemia or cardiac disease may be unable to mount these compensatory responses and are therefore at risk of haemodynamic collapse after oxytocin boluses. This has been illustrated by a maternal death reported to the Confidential Enquiries into Maternal Deaths in the United Kingdom. The need to adhere to a dose regimen of 5 units by slow injection needs re-emphasis, but no evidence exists to claim that even this will be haemodynamically inert. We therefore recommend that oxytocin boluses be avoided in women with hypovolaemia or cardiac disease.

Clinical Trial↗
PubMed2001

Effect of fluid preload on maternal haemodynamics for low-dose epidural analgesia in labour.

We prospectively studied 30 women in labour who requested epidural analgesia. They were randomly allocated into two groups; one received a preload of 7 mL/kg normal saline and the other no preload. All patients had a standard epidural solution consisting of 0.1% bupivacaine 20 mL containing fentanyl 2 microg/mL. Mean arterial blood pressure and cardiac index were measured serially for 20 min after epidural drug administration. Cardiac index was measured using transthoracic electrical bioimpedance (BOMED). Power calculation showed that a sample size of 30 had 80% power to detect a difference of more than 20% in cardiac index using a two-sided test at a significance level of <0.05. No significant changes in cardiac index or mean arterial pressure occurred at any time in either group. These results suggest that routine fluid preloading is not necessary for 0.1% bupivacaine 20 mL with fentanyl 2 microg/mL as epidural bolus in labour.

Clinical Trial↗
PubMed2001

Incremental spinal anaesthesia for elective Caesarean section in a patient with Eisenmenger's syndrome.

We describe a new approach to anaesthesia for elective Caesarean section in a woman with Eisenmenger's syndrome. Incremental regional anaesthesia was performed using a microspinal catheter and haemodynamic monitoring included transthoracic bioimpedance cardiography. This approach allowed the disadvantages of general anaesthesia and invasive cardiac output monitoring to be avoided.

Adult↗
PubMed2000

Ropivacaine 0.2% versus bupivacaine 0.1% with fentanyl: a double blind comparison for analgesia during labour.

We have performed a randomized, double-blind comparison of two epidural drug regimens for analgesia in labour. In the bupivacaine group (BUPIV), 101 healthy parturients received 0.1% bupivacaine with fentanyl 2 microg ml(-1). In the ropivacaine group (ROPIV), 102 women received 0.2% ropivacaine. Both groups received an initial loading dose of 15 ml, a continuous infusion of 8 ml h(-1), and top-ups of 10 ml. Breakthrough pain not responding to a routine top-up was treated with an 'escape' top-up of 10 ml 0.25% bupivacaine. The two groups were compared for complete analgesia at 30 min, routine and 'escape' top-up requirements, midwife assessment of analgesic efficacy, delivery mode, patient visual analogue scores (VAS) for first and second stage analgesia, overall satisfaction, and patient assessment of motor blockade. Patients receiving ropivacaine received fewer routine top-ups (median 1.0 vs. 2.0, P=0.001) and fewer escape top-ups (9.8% vs. 21.8%, P=0.02). The ropivacaine group was more likely to be pain free in the first stage (51% vs. 33.7%, P=0.01). There were no significant differences in patients' assessment of motor block or mode of delivery between the groups. Pain relief and satisfaction scores from midwives and patients were consistently better in the ropivacaine group, but did not reach statistical significance.

Adolescent↗
PubMed2000

Severe vasovagal attack during regional anaesthesia for caesarean section.

A patient experienced a severe vasovagal attack during regional anaesthesia for elective Caesarean section. The combination of vagal over-activity and sympathetic block produced profound hypotension that threatened the life of the mother and infant. The vasovagal syndrome is described, and its prevention and management discussed.

Adult↗
PubMed1999

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

We have performed a randomized comparison of two low-dose epidural regimens for analgesia in labour, differing only in the manner in which initial analgesia was established. In the epidural (EPI) group, 484 women received a loading dose of 20 ml of 0.1% bupivacaine with fentanyl 2 micrograms ml-1. In the combined spinal-epidural (CSE) group, 524 women received a spinal injection of plain bupivacaine 2.5 mg with fentanyl 25 micrograms. In both groups, these initial doses were followed by 0.1% bupivacaine with fentanyl 2 micrograms ml-1 infused at a rate of 12 ml h-1, with 20-ml top-ups for breakthrough pain. The groups were compared for midwife assessment of analgesic efficacy, delivery mode, patient assessments of first stage analgesia, second stage analgesia, overall analgesia, motor block and complications. Midwives, who were not blinded to the treatment groups, assessed 61.6% of CSE as providing 'excellent' analgesia compared with 56.4% of epidurals (P = 0.02). Patients assessed overall analgesia as 'excellent' in 74.8% of CSE compared with 71.7% of epidurals (P = 0.14). Other comparisons between groups revealed no differences. These findings may have been affected by an uneven distribution of multiparous women between the groups (25% in the EPI group and 34.2% in the CSE group; P = 0.002). However, subgroup analysis of primiparous and multiparous women did not alter the results.

Adolescent↗
PubMed1998

High-dose ondansetron regimen vs droperidol for morphine patient-controlled analgesia.

We have performed a randomized, double-blind study comparing droperidol and high-dose ondansetron mixed with morphine for patient-controlled analgesia (PCA). To detect a reduction in the incidence of postoperative nausea and vomiting from 55% to 20% with a power of 80% at the P < 0.05 level, 29 patients per group were required. We studied 60 healthy women undergoing abdominal hysterectomy, anaesthetized using a standard technique. Group D received a bolus dose of droperidol 1.25 mg at induction followed by droperidol 0.1 mg per 1 mg of morphine from the PCA system. Group O received a bolus dose of ondansetron 4 mg at induction followed by ondansetron 0.32 mg per 1 mg of morphine. This dose of ondansetron is more than double that studied previously. Mean nausea and vomiting scores at 4, 8, 12 and 24 h, mean time to first vomit, sedation scores, incidence of side effects, and doses of prochlorperazine did not differ between the groups. In group D, 24 patients did not vomit compared with 23 in group O. The only significant difference between the groups was increased morphine consumption in the ondansetron group up until 12 h after operation (P < 0.05), but by 24 h this difference was not significant. The ondansetron regimen was more expensive (at local prices) by a factor of 27, and our results suggested no clinical advantage over droperidol.

Adult↗
PubMed1997

Extradural pain relief in labour: bupivacaine sparing by extradural fentanyl is dose dependent.

The minimum local analgesic concentration (MLAC) of bupivacaine in labour is defined as the effective concentration in 50% of subjects (EC50). We have used the technique of double-blinded sequential allocation to quantify the bupivacaine sparing effect of the addition of four different doses of extradural fentanyl in 223 labouring women. There were five groups: (1) plain bupivacaine (control); (2) bupivacaine with fentanyl 1 microgram ml-1; (3) bupivacaine with fentanyl 2 micrograms ml-1; (4) bupivacaine with fentanyl 3 micrograms ml-1; and (5) bupivacaine with fentanyl 4 micrograms ml-1. The MLAC of bupivacaine were 0.069% w/v, 0.057% w/v, 0.048% w/v, 0.031% w/v and 0.015% w/v, respectively. We observed a reduction in MLAC of 18%, 31% (P = 0.03%), 55% (P < 0.0001) and 72% (P < 0.0001) with fentanyl 1, 2, 3 and 4 micrograms ml-1, respectively, demonstrating a significant negative linear trend (P < 0.0001) with increasing fentanyl dose. The incidence of pruritus was increased significantly with fentanyl 4 micrograms ml-1 (P = 0.0015). Because of this, fentanyl 3 micrograms ml-1 may be the optimal dose when the aim is bupivacaine sparing extradural analgesia during labour.

Adolescent↗
PubMed1996

Failed intubation revisited: 17-yr experience in a teaching maternity unit.

We have reviewed 5802 Caesarean sections performed during general anaesthesia. Our use of general anaesthesia had decreased from 83% in 1981 to 23% in 1994. Despite this, the incidence of failed intubation has increased from 1 in 1984 to 1 in 250 in 1994. The problems associated with general anaesthesia in the obstetric population are increasing. Asians and African/Afrocaribbeans were represented disproportionately because of the increased use of general anaesthesia in these patients. Exposure of trainees to obstetric general anaesthetics has decreased by one-third.

Adult↗