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153: An overview of a high risk obstetric anaesthetic clinic
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Posters
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Obstetrics
153. An overview of a high risk obstetric anaesthetic clinic K.M.P. Salaunkey, D. Radhakrishnan, C. Mannakkara Whipps Cross University Hospitals, London, UK Background: Whipps Cross Hospitals is a large district general hospital in London, has a busy Obstetric unit catering to a cosmopolitan population with an increased incidence of high risk pregnancies. There are over 4500 deliveries conducted here per annum, The Department of Anaesthesia runs a high risk pregnancy clinic since 2002 in accordance with CEMAC regulations which came in later. We looked at the last hundred patients who attended the clinic approx 7 to 9 per week regarding their reason for referral, its outcome and its bearing on our service provision. Method: We looked into the medical notes of the last hundred patients and also followed them up by a telephonic survey, the response to the telephonic survey was 75%, and only these patients were included in this study. Results: The reasons for referral to the clinic were as follows Morbid obesity 26%, Cardiovascular symptoms/signs 18%, Back ache and allied problems 17.3%, Haematological diseases 9.3%, Anaesthetic/ Epidural related concerns 8%, Obstetric risks 6.6%, Respiratory system involvement 5.3%, Allergic Reactions 4%, Endocrine diseases 2.6%, Musculoskeletal involvement 1.3%. 90% of the patients spoken to, were satisfied with the provision and delivery of the high risk obstetric service. Conclusions: The clinic helped anaesthetists to anticipate problems, develop a multidisciplinary approach towards solving them, plan their management in terms of personnel and equipment. The incidence of supermorbid obese women is increasing greatly in our community.
References 1. Satya Francis et al, Antenatal anaesthetic assessment of the pregnant woman, Anaesthesia and Intensive Care Medicine, volume 5:7 July 2004. 2. Rai MR et al, Antenatal anaesthetic assessment of high risk pregnancy: a survey of UK practice. Int J Obstetric Anesthesia, 2005 Jul;14(3):219-22. 3. CEMACH Report 2002-2004.
155. Analgesia after cesarean section: the comparison of intrathecal morphine 0.2 mg and intrathecal morphine 0.1 mg with suppository diclofenac S. Karaman, I. Gunusen, S. Bilgin, V. Firat Anaesthesiology and Reanimation Department,Ege University Medical Faculty, Izmir, Turkey Aim: The concept of balanced analgesia suggests that a combination of analgesic drugs may enhance analgesia and reduce side effects after surgery. The purpose of this study was to evaluate the quality of analgesia and the incidence of side effects after the combination of small dose of subarachnoid morphine with suppository diclofenac for postoperative pain control after cesarean delivery. Methods: After institutional approval and informed consent, we studied 40 term pregnant patients, ASA I, undergoing elective cesarean delivery. Patients were randomly allocated into two groups to receive the following treatments: Group 1⫽ 0.2 mg of subarachnoid morphine; Group 2⫽ 0.1 mg subarachnoid morphine plus 100 mg of suppository diclofenac every 12 hours. Spinal anaesthesia was performed with 12 mg of 0.5% hyperbaric bupivacaine. Pain scores and side effects were evaluated at 1, 2, 3, 4, 8, 16 and 24 h after spinal anaesthesia. Results: The patients characteristics did not differ significantly between the groups. There was no significant difference between the two groups in the Apgar score of infants, pH in umblical cord arterial and venous blood. The two groups were comparable for quality of postoperative analgesia. The incidence of pruritus and vomiting was significantly higher in the group 1 than the group II (p⬍0.05). No patient experienced respiratory depression. Conclusions: Intrathecal morphine 0.1 mg and diclofenac suppository 100 mg given every 12 hours produced effective postoperative analgesia with minimum side effects after caesarean section.
Posters
•
Obstetrics
153. An overview of a high risk obstetric anaesthetic clinic K.M.P. Salaunkey, D. Radhakrishnan, C. Mannakkara Whipps Cross University Hospitals, London, UK Background: Whipps Cross Hospitals is a large district general hospital in London, has a busy Obstetric unit catering to a cosmopolitan population with an increased incidence of high risk pregnancies. There are over 4500 deliveries conducted here per annum, The Department of Anaesthesia runs a high risk pregnancy clinic since 2002 in accordance with CEMAC regulations which came in later. We looked at the last hundred patients who attended the clinic approx 7 to 9 per week regarding their reason for referral, its outcome and its bearing on our service provision. Method: We looked into the medical notes of the last hundred patients and also followed them up by a telephonic survey, the response to the telephonic survey was 75%, and only these patients were included in this study. Results: The reasons for referral to the clinic were as follows Morbid obesity 26%, Cardiovascular symptoms/signs 18%, Back ache and allied problems 17.3%, Haematological diseases 9.3%, Anaesthetic/ Epidural related concerns 8%, Obstetric risks 6.6%, Respiratory system involvement 5.3%, Allergic Reactions 4%, Endocrine diseases 2.6%, Musculoskeletal involvement 1.3%. 90% of the patients spoken to, were satisfied with the provision and delivery of the high risk obstetric service. Conclusions: The clinic helped anaesthetists to anticipate problems, develop a multidisciplinary approach towards solving them, plan their management in terms of personnel and equipment. The incidence of supermorbid obese women is increasing greatly in our community.
References 1. Satya Francis et al, Antenatal anaesthetic assessment of the pregnant woman, Anaesthesia and Intensive Care Medicine, volume 5:7 July 2004. 2. Rai MR et al, Antenatal anaesthetic assessment of high risk pregnancy: a survey of UK practice. Int J Obstetric Anesthesia, 2005 Jul;14(3):219-22. 3. CEMACH Report 2002-2004.
155. Analgesia after cesarean section: the comparison of intrathecal morphine 0.2 mg and intrathecal morphine 0.1 mg with suppository diclofenac S. Karaman, I. Gunusen, S. Bilgin, V. Firat Anaesthesiology and Reanimation Department,Ege University Medical Faculty, Izmir, Turkey Aim: The concept of balanced analgesia suggests that a combination of analgesic drugs may enhance analgesia and reduce side effects after surgery. The purpose of this study was to evaluate the quality of analgesia and the incidence of side effects after the combination of small dose of subarachnoid morphine with suppository diclofenac for postoperative pain control after cesarean delivery. Methods: After institutional approval and informed consent, we studied 40 term pregnant patients, ASA I, undergoing elective cesarean delivery. Patients were randomly allocated into two groups to receive the following treatments: Group 1⫽ 0.2 mg of subarachnoid morphine; Group 2⫽ 0.1 mg subarachnoid morphine plus 100 mg of suppository diclofenac every 12 hours. Spinal anaesthesia was performed with 12 mg of 0.5% hyperbaric bupivacaine. Pain scores and side effects were evaluated at 1, 2, 3, 4, 8, 16 and 24 h after spinal anaesthesia. Results: The patients characteristics did not differ significantly between the groups. There was no significant difference between the two groups in the Apgar score of infants, pH in umblical cord arterial and venous blood. The two groups were comparable for quality of postoperative analgesia. The incidence of pruritus and vomiting was significantly higher in the group 1 than the group II (p⬍0.05). No patient experienced respiratory depression. Conclusions: Intrathecal morphine 0.1 mg and diclofenac suppository 100 mg given every 12 hours produced effective postoperative analgesia with minimum side effects after caesarean section.