Biomedical subjects
Publications and source records attributed to P N Robinson.
Pulmonary embolism remains one of the commonest causes of maternal death. Regional blockade is reported to decrease the incidence of postoperative thrombo-embolic disease. We describe a case in which a fatal pulmonary embolism followed an emergency Caesarean section for which the patient was given a spinal anaesthetic. We believe it to be the first time this has been reported.
We report the results of a study of the effects of spinal and epidural anaesthesia for Caesarean section on commonly used indicators of a patient's ability to cough effectively. Both spinal and epidural anaesthesia, after the achievement of a block adequate for surgery, were associated with statistically significant decreases (p less than 0.05) in all the respiratory variables recorded: forced vital capacity, forced expiratory volume in one second, peak expiratory flow rate and maximum expiratory pressure. We conclude that although the observed changes are unlikely to impair the normal patient's ability to cough effectively in these circumstances, there may be clinically significant impairment in the presence of an inadvertently high block or in a patient with pre-existing pulmonary disease.
We studied the plasma catecholamine, plasma glucose and cardiovascular responses to cataract surgery in 20 elderly patients allocated randomly to receive either general anaesthesia or local anaesthesia by retrobulbar block. Local anaesthesia prevented the increase in plasma noradrenaline, adrenaline and glucose concentrations found in those patients who received general anaesthesia and also improved cardiovascular stability. The results show the beneficial effects of local anaesthesia in preventing the hormonal, metabolic and cardiovascular changes found when cataract surgery is conducted under general anaesthesia.
We studied the metabolic and hormonal responses to cataract surgery in 18 elderly patients, allocated randomly to receive either general anaesthesia or local analgesia by means of a retrobulbar block. Local analgesia prevented the increases in circulating cortisol and glucose concentrations found in those patients who received general anaesthesia. The results show that complete afferent sensory block of the operative site inhibited endocrine and metabolic responses to ophthalmic surgery.
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Fifteen patients had lumbar sympathetic block using needle localisation by computerised tomography. The technique has the advantage that the needle route to the sympathetic plexus can be accurately planned, avoiding damage to other organs. In this study, 13 patients out of 15 had significant benefit from the procedure.
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In the period January 1980 to February 1984, 91 heart transplant operations were performed at Harefield Hospital. The current statistics of the transplantation programme are presented. The survival rate since the introduction of the immunosuppressive agent Cyclosporin A is 78% at one year. This paper summarises the special care required for these patients with particular reference to the anaesthetic management.