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Biomedical subjects

R R Gaiser

Publications and source records attributed to R R Gaiser.

At least 19 recordsLinked to original sources
PubMed2005

Predicting prolonged fetal heart rate deceleration following intrathecal fentanyl/bupivacaine.

BACKGROUND: Intrathecal opioids for labor analgesia are occasionally associated with fetal heart rate abnormalities. We wanted to identify risk factors for this occurrence. METHODS: The fetal tracings of 151 consecutive patients were reviewed for the period including 30 min before and 60 min after combined spinal-epidural analgesia using intrathecal bupivacaine with fentanyl. Their progress of labor at injection was also recorded. RESULTS: Lack of fetal head engagement (odds ratio 5.5, 95% CI 2.1-14.2) and the presence of variable fetal heart rate decelerations (odds ratio 3.6, 95% CI 1.6-8.4) were associated with prolonged fetal heart rate deceleration after combined spinal-epidural analgesia. CONCLUSION: This case-control study suggests that if the fetal head is not engaged or if the fetus is experiencing variable decelerations, there is an increased risk of prolonged fetal heart rate deceleration following intrathecal fentanyl/bupivacaine. This finding must now be confirmed in a cohort study.

Adult↗
PubMed2004

Glass recycling in the labour suite is environmentally sound and economical.

BACKGROUND: Glass bottles are used for the storage of local anaesthetics in the US and are recyclable. Recycling would result in hospital solid waste reduction. METHODS: The members of the Department of Anaesthesia were surveyed to determine where these local anaesthetic bottles were disposed of. From November 2002 to April 2003, glass bottles used on the labour and delivery suite were saved for recycling. The number of bottles and the weight recycled were recorded. The number of procedures involving anaesthesia were also recorded during this time period. RESULTS: Residents dispose of the local anaesthetic bottle in the sharps container while consultants dispose of them in the trash (P<0.05). Both means of disposal are not recycled in the US. The average amount of glass recycled per month was 19.37 (3.15) kg. Our hospital pays $0.46/kg (0.26 UK pound/kg) for sharps disposal. By not disposing of the glass in the sharps container, the average savings per month was $8.95 (1.45) (5.15 UK pounds (0.84)). CONCLUSION: The recycling of glass is good for the environment through waste reduction and results in small savings to the hospital.

Anesthesia, Obstetrical↗
PubMed2000

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

PURPOSE: To compare the combined spinal-epidural (CSE) technique with the epidural technique with regard to time to initiate and manage, motor block, onset of analgesia and satisfaction during labour. METHODS: Upon requesting analgesia, 50 healthy term parturients were randomized in a prospective, double-blind fashion to receive either CSE analgesia or lumbar epidural analgesia in the labour floor of a university hospital at an academic medical centre. The epidural group (n = 24) received bupivacaine 0.0625%-fentanyl 0.0002% with 0.05 ml in 10 ml local anesthetic sodium bicarbonate 8.4% and epinephrine 1:200,000. The CSE group (n = 26) received intrathecal 25 microg fentanyl and 2.5 mg bupivacaine. Additional analgesia was provided upon maternal request. RESULTS: There were no differences (P>0.05) in time to perform either technique, motor blockade, or parturient satisfaction or in the number of times that the anesthesiologist was called to perform any intervention. Although the first sign of analgesia was not different between the two groups, the onset of complete analgesia was more rapid with the CSE technique (Visual Analogue Pain Score (VAPS) at five minutes < three: 26/26 vs. 17/24, P+/-0.001). CONCLUSION: Although epidural analgesia with a low concentration of local anesthetic and opioid mixture takes longer to produce complete analgesia, it is a satisfactory alternative to CSE.

Analgesia, Epidural↗
PubMed2000

Teaching airway management skills. How and what to learn and teach.

It is important to instruct all individuals involved in patient care in airway management. The degree of skills actually taught depends on the student. Currently, there are many options for teaching. Mannequin training is the one best suited to instruct a large number of students in a variety of skills. Training of surgical and obstetric residents improves relations, may improve patient safety, and educates these individuals regarding the risks of failed intubation. Actual clinical decisions regarding patient management are based on the airway examination. There is room for improvement in instruction, even in anesthesiology programs. Various techniques must be taught and practiced. As more anesthesiologists become trained and then train other physicians, the number of cases in the Closed Claims Study involving the airway will continue to decrease.

Airway Obstruction↗
PubMed2000

Should intrathecal lidocaine be used in the 21st century?

Hyperbaric 5% lidocaine has been available for intrathecal use since 1954. The initial studies concluded that it was a safe drug for short procedures. Recently, the use of this drug for spinal anesthesia has been questioned. There were cases of cauda equina syndrome following its use for continuous spinal anesthesia. Following these occurrences, it was felt that lidocaine should not be used for continuous spinal anesthesia, rather for single-shot spinal anesthesia only. Intense follow-up of patients receiving intrathecal lidocaine for single-shot spinal anesthesia revealed a higher incidence of back pain radiating to the thighs and legs as compared to other drugs or general anesthesia. Although these symptoms have been linked to the drug, there were other factors affecting the incidence. Lithotomy position was a more significant predictor for developing these symptoms. Furthermore, there are seven cases of cauda equina syndrome following single-shot hyperbaric lidocaine. Cauda equina syndrome is a permanent disability. It occurred in patients of varying ages and with doses ranging from 60 mg to 120 mg. There are safe alternatives to lidocaine for outpatient spinal anesthesia, such as bupivacaine, prilocaine, or mepivacaine. These drugs have a lower incidence of transient neurologic symptoms and do not delay discharge. Given the possibility of permanent neurologic injury and given that safe alternatives exist, one has to question whether intrathecal lidocaine should still be used in the 21st century.

Anesthesia, Spinal↗
PubMed2000

Anesthesia for fetoscopic fetal surgery: twin reverse arterial perfusion sequence and twin-twin transfusions syndrome.

IMPLICATIONS: Twin reversed arterial perfusion sequence and twin-twin transfusion syndrome can be managed by fetoscopic fetal surgery. It is important to consider the fetal, uteroplacental, and maternal issues when choosing an anesthetic technique. We report on three patients with differing anesthetic issues using fetoscopic surgery for umbilical cord coagulation.

Adult↗
PubMed1999

Obstetricians' ability to assess the airway.

OBJECTIVES: To assess the ability of obstetricians to recognize parturients at risk for difficult intubation and to examine the effect of education in airway examination on that ability. METHODS: The airways of 160 parturients were examined by four physicians: one attending and one resident obstetrician, and one attending and one resident anesthesiologist. After each airway examination, the physicians completed questionnaires about possible difficult intubation, use of antepartum consultation, and choice of analgesia early in labor. RESULTS: Instruction in airway examination did not affect obstetricians' ability to assess airways. Compared with the attending anesthesiologist's opinion, the sensitivity and specificity of the attending obstetrician before instruction were 0.59 and 0.82, respectively, and for the obstetric resident, 0.41 and 0.89, respectively. After instruction, the sensitivity and specificity for the obstetric attending physician were 0.60 and 0.83, respectively and for the obstetric resident, 0.50 and 0.87, respectively. In airways judged possible difficult intubations by the obstetricians, instruction did not affect the use of antepartum consultation or early epidural analgesia by the residents. In the obstetric attending physicians there was a significant increase in use of early epidural analgesia. CONCLUSION: Although instruction in airway examination did not affect obstetricians' ability to predict difficult airways, it did affect treatment of labor analgesia.

Adult↗
PubMed1999

Anesthetic considerations for fetal surgery.

This article outlines the perioperative management of the parturient who presents for fetal surgery. Anesthetic considerations include the physiological changes of pregnancy, preterm labor, the consequences of tocolytic drugs, maternal and fetal anesthesia, and postoperative analgesia.

Anesthesia↗
PubMed1998

Comparison of three different doses of intrathecal fentanyl and sufentanil for labor analgesia.

STUDY OBJECTIVE: To compare the duration of analgesia and incidence of side effects of three doses of intrathecal fentanyl (25 micrograms, 37.5 micrograms, 50 micrograms) with three doses of intrathecal sufentanil (5 micrograms, 10 micrograms, 15 micrograms). DESIGN: Randomized, double-blind study. SETTING: Labor suite of the Hospital of the University of Pennsylvania. PATIENTS: 60 ASA physical status I and II parturients in active labor who requested analgesia. INTERVENTIONS: Patients received one of the six doses of opioid diluted with normal saline to achieve a volume of 1.5 ml intrathecally. MEASUREMENTS AND MAIN RESULTS: Duration of analgesia, contraction pain, degree of pruritus, maternal blood pressure, maternal heart rate, fetal heart rate, Apgar scores, and neurologic and adaptive capacity scores were measured. There was no statistical difference among the doses of fentanyl in duration of analgesia. In addition, there was no statistical difference among the doses of sufentanil. The durations of analgesia for all doses of sufentanil were statistically longer than that for all doses of fentanyl. There was no difference among all the groups for maximal pruritus score. The duration of pruritus did not differ among doses of fentanyl or sufentanil; the duration of pruritus was significantly longer for sufentanil. All groups had a decrease in blood pressure. There was no difference among the groups in regard to the effect on the systolic or diastolic blood pressure. CONCLUSIONS: Intrathecal sufentanil produced analgesia of longer duration than fentanyl for all doses studied. The duration of pruritus with sufentanil was also longer.

Adult↗
PubMed1998

Epidural lidocaine for cesarean delivery of the distressed fetus.

Lidocaine with epinephrine and sodium bicarbonate has a rapid onset of action. We therefore wished to compare its use with that of chloroprocaine for urgent cesarean delivery. Thirty parturients for cesarean section under epidural anesthesia were divided into three groups. Group 1 required elective cesarean section and served as the control group for neonatal lidocaine levels. Groups 2 and 3 had been receiving epidural infusions of 0.125% bupivacaine with epinephrine 1:400,000 and required urgent cesarean section. They were randomized to receive either 1.5% lidocaine with epinephrine or 3% chloroprocaine, both with sodium bicarbonate 2 ml in a total volume of 25 ml. All patients had adequate anesthesia and none required supplementation. The time from completion of injection to the achievement of a T4 sensory level was significantly shorter in the chloroprocaine group (3.1 vs. 4.4 min). There were no differences in Apgar scores or Neurologic and Adaptive Capacity Scores between the lidocaine and chloroprocaine groups. Lidocaine was detectable in maternal serum from four of the urgent cases and all of the elective cases. It was detectable in five neonates from the elective group but none from the emergency group. In parturients with preexisting epidural catheters and a baseline epidural infusion to maintain a T10 sensory level, chloroprocaine is faster in onset than lidocaine, but the difference in this study was only 1.3 min, and both agents provided excellent anesthesia.

Clinical Trial↗
PubMed1997

Comparison of 0.25% ropivacaine and bupivacaine for epidural analgesia for labor and vaginal delivery.

STUDY OBJECTIVE: Part 1: To measure ropivacaine levels in the mother and infant at delivery after continuous lumbar epidural infusion. Part 2: To compare epidural ropivacaine to epidural bupivacaine for labor analgesia in regard to effectiveness, motor blockade, and maternal and neonatal effects. DESIGN: Part 1: Open-labelled, non-blind study. Part 2: Randomized, double-blind study. SETTING: Labor and delivery units of two academic hospitals. PATIENTS: Part 1: 20 ASA physical status I and II parturients in active labor. Part 2: 81 ASA physical status I and II parturients in active labor. INTERVENTIONS: For Part 1, 8 to 12 ml of 0.25% ropivacaine was administered through a lumbar epidural catheter to achieve a T10 dermatomal sensory level. An infusion of 0.25% ropivacaine, 8 to 10 ml/hr, maintained this sensory level. Maternal and umbilical cord blood samples obtained at delivery were analyzed for ropivacaine concentration. For Part 2, anesthetic management was similar to that previously described except patients were randomized to receive either 0.25% ropivacaine or 0.25% bupivacaine. Onset, regression, maximal spread of sensory block, and onset and degree of motor blockade were measured. Contraction pain as assessed using a visual analog scale (VAS), maternal blood pressure, and heart rate were determined every 5 minutes until a stable VAS-contraction score was achieved, and every 30 minutes thereafter. Neonatal assessment included Apgar scores and neurologic and adaptive capacity scores (NACS) at 15 minutes, 2 hours, and 24 hours. MEASUREMENTS AND MAIN RESULTS: For Part 1, the total and free maternal arterial concentrations of ropivacaine at delivery were 0.64 +/- 0.14 microgram/ml and 0.10 +/- .02 microgram/ml, respectively; the umbilical venous total and free concentrations were 0.19 +/- 0.03 microgram/ml and 0.12 +/- 0.07 microgram/ml, respectively (n = 12). The umbilical arterial and venous concentrations did not differ for both the free and total concentrations. For Part 2, there was no difference between ropivacaine and bupivacaine in the variables measured. Umbilical cord gases and Apgar scores were not different between the two groups; NACS were higher at 15 minutes and 2 hours in the ropivacaine group (p < 0.05) than the bupivacaine group. CONCLUSION: Both ropivacaine and bupivacaine produced excellent analgesia for labor with no major adverse effect on the mother or neonate.

Adult↗