Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 1982
A three-year survey of an obstetric epidural service with top-up doses administered by midwives.
A three-year survey following the introduction of an epidural service to a maternity unit is presented. 1,438 epidural blocks were attempted (a rate of 30%). Provision of pain relief was the principal indication. There were no serious complications or sequelae although minor complications or difficulties of insertion were noted in 21%. ⋯ Satisfactory pain relief was achieved in 90% during the first stage of labour and 71% during delivery. Of those who delivered, 47% retained an urge to bear down and spontaneous delivery occurred in 43%. 89% of patients interviewed were fully satisfied with, or considerably helped by, the epidural block. Incremental epidural doses were managed by midwives and it is argued that the midwife is ideally suited to this role providing she is trained and experienced and can call for immediate anaesthetic assistance.
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Anaesth Intensive Care · Feb 1982
Biography Historical ArticleThe Yorkshire Connection--Priestley and Waterton. Ellis Gillespie Lecture 1981.
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Anaesth Intensive Care · Feb 1982
Pulmonary artery catheterisation. An assessment of risks and benefits in 220 surgical patients.
The benefits and risks of pulmonary artery catheterisation were assessed in 220 patients having cardiac or vascular surgery. Prior to induction of anaesthesia 20% of patients had pulmonary artery wedge pressure measurements which indicated the need for blood volume support, vasodilator therapy or modification of the anaesthetic induction technique. Of those patients for cardiac surgery, 38% had important changes before cardiopulmonary bypass requiring blood volume support or vasodilator therapy. ⋯ Minor complications occurred in 25% of patients (transient arrhythmias) and more serious complications occurred in 3.6% of patients. There was no mortality or long-term sequelae. We conclude that the benefits of pulmonary artery catheterisation outweigh its risks in patients having major cardiac and vascular surgery.