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M Y K Wee

Publications and source records attributed to M Y K Wee.

8 recordsLinked to original sources
PubMed2006

Caesarean section in a patient with torsion dystonia.

We present a case of torsion dystonia in a 35-yr-old primigravida who presented for a Caesarean section under general anaesthesia. She had limb contractures and severe kyphoscoliosis associated with limited respiratory reserve and function. General anaesthesia was induced using thiopental and divided doses of mivacurium for rapid sequence induction. After the delivery of a healthy male baby, she received i.v. morphine and bilateral iliohypogastric, ilioinguinal blocks and had an uneventful recovery. Technical issues of supine positioning, intubation and respiratory support need to be considered during anaesthesia planning. Although regional anaesthesia is commonly offered for caesarean section, maternal compromise and technical factors may preclude this approach.

Adult↗
PubMed2004

Obstetric epidurals and chronic adhesive arachnoiditis.

It has been suggested that obstetric epidurals lead to chronic adhesive arachnoiditis (CAA). CAA is a nebulous disease entity with much confusion over its symptomatology. This review outlines the pathological, clinical, and radiological features of the disease. The proposed diagnostic criteria for CAA are: back pain that increases on exertion, with or without leg pain; neurological abnormality on examination; and characteristic MRI findings. Using these criteria, there is evidence to show that epidural or subarachnoid placement of some contrast media, preservatives and possibly vasoconstrictors, may lead to CAA. No evidence was found that the preservative-free, low concentration bupivacaine with opioid mixtures or plain bupivacaine currently used in labour lead to CAA.

Anesthesia, Epidural↗
PubMed2003

Written information about epidural analgesia for women in labour: did it improve knowledge?

There is evidence that despite a distressed appearance, women in labour should be informed about the side effects and risks associated with epidural analgesia. An audit of 100 women who had used epidural analgesia for labour in our hospital and who had received a verbal explanation of the benefits, risks and side effects of epidural analgesia showed that the level of knowledge was low. An A5 laminated epidural information card was prepared summarising this information. The midwife and the anaesthetist used the card during labour as a focus for verbal discussion and as written reinforcement for the woman and her partner. A repeat audit of a further 100 women showed a statistically significant improvement in the level of knowledge about epidural analgesia. This audit suggests that the use of a written information card is beneficial. It improves and reinforces the process of giving information thus assisting the consent process.

Journal Article↗
PubMed2003

Obstetric anaesthesia training in the Wessex region before and after introduction of Calman training.

We canvassed the opinions of anaesthetic trainees by questionnaire in 1995 and 1998, before and after the introduction of Calman training in which the registrar and senior registrar grades were replaced by the specialist registrar grade. We received replies from 106 trainees in 1995 (90%) and 115 (92%) in 1998. The survey results demonstrate that the total experience in obstetric anaesthesia gained by trainees has not decreased. Experience of regional techniques (epidural, spinal and combined spinal-epidural) increased, but the proportion of senior trainees who had performed fewer than 20 general anaesthetics for caesarean section rose from 0/23 in 1995 to 4/33 (12%). In 1998, the majority of senior trainees had experience of general anaesthesia for fetal distress, severe preeclampsia, eclampsia and massive obstetric haemorrhage. Only a minority had experienced failed intubation or a total spinal. In 1995, 5/21 (24%) of senior house officers agreed or strongly agreed that they were on call before they felt confident about dealing with common problems. The proportion was still 4/23 (17%) in 1998.

Journal Article↗
PubMed2002

Obstetric anaesthetists' workload.

The current recommendation of one consultant session per 500 deliveries with full sessional cover for units over 3000 deliveries is arbitrary and is not based on workload. The Audit Commission has questioned the wide variability of anaesthetic staffing on labour wards. The aim of this study was to investigate whether there is a relationship between current workload and obstetric anaesthetic staffing in five maternity units. In 1998, a 2-week diary of workload in the participating obstetric units was assessed in terms of staffing and clinical and nonclinical activities. The busiest time was 08:00 to 12:30. The working patterns between consultants and trainees varied considerably. Time spent on nonclinical activity by consultants averaged 51%. Any calculation of consultant sessions will need to take into account nonclinical activities. Other factors requiring consideration are the number of high-risk cases, as well as the number and experience of trainees.

Anesthesiology↗