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Biomedical subjects

S H Rolbin

Publications and source records attributed to S H Rolbin.

At least 19 recordsLinked to original sources
PubMed1995

Alternating nitroglycerin and syntocinon to facilitate uterine exploration and removal of an adherent placenta.

Nitroglycerin (NTG) has been demonstrated to provide uterine relaxation in the management of various obstetric complications. A 32-yr-old woman presented 40 min postpartum for manual removal of a retained placenta. Repeated, alternating doses of NTG 250 micrograms and syntocinon (SYN) 10U iv were used over 15 min to produce periods of uterine relaxation and contraction respectively for uterine exploration. Multiple attempts to extract the placenta failed and a diagnosis of placenta accreta was made. There were no major side effects from this combination of drugs apart from a transient 20% decrease in blood pressure after NTG, which responded to ephedrine 10-15 mg iv. The rapid change in uterine tone was believed to be due not only to the short duration of action of NTG and SYN, but also to the possible physiological antagonism between the two drugs. The mechanism of interaction may involve calcium mobilization and myosin light chain phosphorylation. We conclude that NTG and SYN can be used to produce alternating periods of uterine relaxation and contraction rapidly and consistently with little sustained effects from either agents.

Adult↗
PubMed1992

Acute intermittent porphyria and caesarean delivery.

A 29-yr-old patient was diagnosed with acute intermittent porphyria (AIP) during pregnancy. She had a Caesarean section under lidocaine/fentanyl epidural blockade. Because of inadequate analgesia, general anaesthesia was induced with propofol. Postoperatively urinary porphobilinogen excretion (625 mumol.day-1) exceeded the upper limit of normal but no symptoms of porphyria developed. In anecdotal clinical reports and in a previously described rat model of porphyria, propofol was found to be safe. This is the first reported use of propofol in a pregnant porphyric patient. Anaesthetic drug safety in porphyria is reviewed and the choice of induction agent discussed. Data on which to base these decisions is limited but we conclude that propofol may be suitable for use in patients with porphyria.

Acute Disease↗
PubMed1991

Epidural anesthesia, episiotomy, and obstetric laceration.

The relationships among epidural anesthesia, forceps use, parity, episiotomy, and laceration were studied in 9493 uncomplicated vertex deliveries of spontaneous onset and normal course. The use of epidural anesthesia was not associated with an increased incidence or severity of birth-canal trauma. Episiotomy was associated with a decreased rate of perineal laceration, but an overall increase in the rate of perineal trauma. The trauma that did occur with episiotomies was four times more likely to be major than that when no episiotomy was performed.

Anesthesia, Epidural↗
PubMed1990

Fluid through the epidural needle does not reduce complications of epidural catheter insertion.

Epidural catheter insertion may be associated with blood vessel trauma or nerve root irritation. The purpose of this study was to assess whether the injection of small amounts of fluid through the Tuohy needle prior to catheter insertion reduced the incidence of these and other minor complications. Two hundred patients in labour, requesting epidural analgesia, were randomly assigned to one of three groups: Group I--the catheter was inserted without previous injection of fluid; Group II--3 ml, 1.5 per cent lidocaine hydrochloride was injected through the needle prior to catheter insertion; Group III--3 ml, saline was injected prior to catheter insertion. There were no differences among the groups in the incidence of blood vessel trauma or paraesthesiae. We conclude that there is no advantage in injecting of fluid routinely into the epidural space prior to catheter insertion.

Adult↗
PubMed1989

Epidural anaesthesia and blood flow velocity in mother and fetus.

Doppler ultrasound has recently been used to assess changes in blood velocity in the uterine and umbilical arteries. Alterations in the ratio of systolic to diastolic velocity (S/D ratio) are believed to reflect changes in placental vascular resistance. We have used this technique to assess potential beneficial or detrimental effects of epidural anaesthesia on blood flow to the placenta. Continuous wave Doppler ultrasound was used to measure the S/D ratio in the uterine and umbilical arteries of 12 patients undergoing epidural anaesthesia prior to elective caesarean section. Anaesthesia was achieved using lidocaine and epinephrine. The S/D ratio in both the uterine and umbilical arteries remained unaltered either by the fluid preload or by the epidural anaesthesia. It is concluded that epidural anaesthesia using this technique has neither a beneficial nor detrimental effect on uterine or umbilical blood velocity in the uncomplicated pregnancy.

Anesthesia, Epidural↗
PubMed1989

Epidural anaesthesia for caesarean section in patients with active recurrent genital herpes simplex infections: a retrospective review.

The safety of epidural anaesthesia in patients with active, recurrent genital herpes simplex (HSV) infections is controversial. We reviewed the six-year experience of the use of epidural anaesthesia in this patient population in two institutions. Eighty-nine parturients with active genital HSV were administered epidural anaesthesia for Caesarean section. No patient suffered an adverse outcome related to either the anaesthetic or the virus. The theoretical risks of regional anaesthesia in the parturient with active herpes genitalis are reviewed. We conclude from available data that the risk of an adverse outcome is small and does not contraindicate the use of epidural anaesthesia in patients with recurrent infection.

Anesthesia, Epidural↗
PubMed1989

Epidural anaesthesia and thrombocytopenia.

A case is presented of a mother with unanticipated profound thrombocytopenia who received a continuous epidural anaesthetic for labour. No neurological sequelae or excessive bleeding occurred. It is clear, after a review of the literature, that more information is needed to define the lower limits of platelet count at which it is safe to proceed with epidural anaesthesia.

Adult↗
PubMed1988

Epidural anesthesia in pregnant patients with low platelet counts.

A number of patients demonstrate thrombocytopenia in the peripartum period. One hundred four patients with unexplained transient periparturient thrombocytopenia were found over a nine-month period. Sixty-one of them received epidural anesthesia without neurologic sequelae. Epidural anesthesia is safe if the platelet count exceeds 100 x 10(9)/L in otherwise healthy women.

Anesthesia, Epidural↗
PubMed1987

The epidural test dose in obstetrics: is it necessary?

One must distinguish between what is medically safe and what is legally safe. The authors have the impression that in order to be "legally safe" one must perform a test dose. This is despite the fact that it has not been conclusively shown that the use of test doses improve the safety margin of epidural anaesthesia, when administered by a competent person, with the proper resuscitative equipment immediately available. Until a controlled study is performed, test doses should be done for continuous epidural anaesthesia with the understanding that they are neither 100 per cent sensitive nor specific in preventing complications. It is however one more manoeuvre that may be useful in recognizing some of the patients with accidental subarachnoid placement of epidural catheters. The literature suggests that lidocaine 1.5 per cent in dextrose 7.5 per cent should be the test dose of choice in obstetric epidural anaesthesia in an amount known to produce spinal anaesthesia (30-50 mg). The use of epinephrine in test doses in unpremedicated healthy women in active labour is neither sensitive nor specific in signalling intravascular injection, and it may also be detrimental to fetal wellbeing. Epinephrine 15 micrograms as a test dose for intravenous injection appears to create more problems than it solves.

Anesthesia, Epidural↗
PubMed1987

A comparison of two types of epidural catheters.

The purpose of this study was to compare two epidural catheters--the Portex epidural catheter and Vas-Cath catheter. One hundred and fifty patients in labour who received epidural anaesthesia were selected and either one or the other catheter was used, based on random assignment. Ease of insertion, maintenance and removal of the catheter were assessed, as was the incidence of blood return and paraesthesiae during epidural catheter insertion. There were no significant differences between the catheters as far as insertion, maintenance and removal were concerned. However, the incidence of paresthesiae was 44 per cent with the Portex and 24 per cent with Vas-Cath catheters (p less than 0.008). The incidence of blood vessel trauma was 12 per cent with the Portex and 6.7 per cent with the Vas-Cath catheter (p = NS). Choice of epidural catheter is a factor to be considered in minimizing the incidence of blood vessel trauma or paresthesiae.

Anesthesia, Epidural↗
PubMed1982

Epidural morphine for analgesia after caesarean section.

A randomized double blind placebo controlled study of the efficacy, duration and safety of epidural morphine for the management of pain after Cesarean section is reported. Three similar groups of patients received either 0, 4 mg or 8 mg of morphine sulphate in 10 ml of normal saline through an epidural catheter at the completion of the operation. Compared to the saline controls, both the 4 mg and 8 mg epidural morphine groups had significant pain relief as judged by an analogue pain scale (p less than 0.001), the time to the first administration of narcotic analgesics (p less than 0.001) and the amount of supplemental analgesic required in the first 36 hours after operation (p less than 0.001). The side effects occurred in a dose-dependent fashion. Two patients who received epidural morphine 8 mg plus additional narcotic or antihistamine had reduced respiratory rates but were easily rousable. Our experience suggests that the epidural administration of morphine 4 mg may be a safe and reliable method of obtaining prolonged analgesia following Caesarean section.

Cesarean Section↗