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Biomedical subjects

T D Ryan

Publications and source records attributed to T D Ryan.

8 recordsLinked to original sources
PubMed1995

Current management of inadvertent dural taps occurring during the siting of epidurals for pain relief in labour. A survey of maternity units in the United Kingdom.

A postal survey of all maternity units in the UK was conducted to gain information regarding the management of inadvertent dural taps occurring during the sitting of epidurals for pain relief in labour. Of the units surveyed only 58.5% had a written protocol for the management of dural taps. Following their occurrence, 99% of the units resited the epidural and in 22%, the midwives continued to give the top-ups. In only one-third of this latter group was the dose of the top-up reduced. In 46% of the units, patients who had a dural tap were allowed to push in the second stage of labour. As prophylaxis against the development of headache, 70% of the units infused crystalloids into the epidural space, whereas only 8.6% were in favour of an early prophylactic blood patch.

Analgesia, Epidural↗
PubMed1993

Current practice of epidural analgesia during normal labour. A survey of maternity units in the United Kingdom.

A postal survey of all maternity units in the United Kingdom was conducted to gain information regarding policies for epidural analgesia for labour. The average epidural rate was 19.7% and 78% of units offered a 24-h service. The majority of units inserted the epidural with the patient in the lateral position, using a midline approach, with loss of resistance to air and saline being used almost equally. Most units used 3 ml of 0.5% bupivacaine as a test dose, and only 10% of units used adrenaline in the test dose. The use of adrenaline in subsequent top-ups was infrequent. Bupivacaine 0.5% was used most frequently for the initial and the second stage top-up, whereas 0.25% was most often used during the first stage of labour. Midwife top-ups were allowed in 75% of units and in only 14% of cases was this from a local anaesthetic reservoir. Epidural analgesia using a continuous infusion of anaesthetic was routinely used in 28% of units, mostly with 0.125% bupivacaine; about half of these units did so because midwives were unable to perform top-ups. Routine use of epidural opioids was most frequent when anaesthetic infusions were used, otherwise it was uncommon.

Analgesia, Epidural↗
PubMed1989

Maternal morbidity associated with in utero transfer.

OBJECTIVE: To determine the extent of maternal morbidity associated with in utero transfer. DESIGN: Retrospective study of 190 consecutive cases over two years. SETTING: Liverpool Maternity Hospital. PATIENTS: 190 Pregnant women were transferred to the hospital under the in utero transfer arrangements from district general hospitals both within and outside the Mersey region. The women admitted were divided into two categories: those in threatened or established uncomplicated preterm labour and those who may or may not have been in threatened or established preterm labour but who had coexisting complicating factors affecting the mother or fetus, or both. INTERVENTIONS: Planned delivery of the fetus if indicated and arrangements for appropriate postpartum care of the mother. MAIN OUTCOME MEASURE: Assessment of the progress of labour and, if appropriate, resuscitation of the mother. RESULTS: Women who were transferred with no coexisting disease (124) had relatively uncomplicated deliveries whereas those transferred with coexisting diseases (66) exhibited considerable morbidity and 17 of these required prolonged intensive monitoring after delivery. CONCLUSIONS: In utero transfer in healthy mothers may have benefits for babies born very prematurely. If mothers have coexisting disease, however, the desirability of transfer should be reviewed urgently in the light of the considerable maternal morbidity associated with these problems. In these cases transfer may introduce an additional hazard.

Adult↗
PubMed1987

The Liverpool urban obstetric flying squad: changing patterns of practice 1965-84.

Obstetric flying squads operate from most maternity units in the United Kingdom. The 20 years from 1965 to 1984 saw 860 calls being made to the obstetric flying squad in the Liverpool urban area, with striking changes occurring in both the number of calls made and the reasons for making the calls. Management of the problems encountered has now become almost exclusively conservative, with such procedures as blood transfusion and general anaesthesia being virtually eliminated from practice.

Ambulances↗
PubMedDate not supplied

Failure of a ventilator alarm to detect patient disconnection.

An East Ventilator pressure monitor, Model VPM, used with an East Radcliffe PNA I Ventilator, failed to detect a patient disconnection at the distal end of the catheter mount. An investigation was undertaken to show why this system failed by measuring pressure and flow whilst using a variety of catheter mounts. It was concluded that the use of the East Ventilarm pressure monitor in conjunction with a pressure generator ventilator is unsuitable for detecting disconnections at the distal end of the catheter mount, the most frequent site of disconnection. Possible alternative methods of detecting this type of disconnection are suggested.

Catheterization↗
PubMedDate not supplied

Anaesthesia for the obstetric trainee.

The practice of obstetric anaesthesia and analgesia ranges from the sublime to the ridiculous. Try to contrast the satisfaction of having produced an effective epidural block with the agonizing personal loneliness of failing to intubate at emergency caesarean section, and you may begin to understand our position: we either love it or loathe it.

Analgesia, Obstetrical↗