The Anesthetic Hazards in Obstetrics**Presented at the Seventy-eighth Annual Meeting of the American Gynecological Society, Quebec, Quebec, May 23, 24, and 25, 1955.

Lock, Frank R.; Greiss, Frank C.

doi:10.1016/s0002-9378(16)37839-5

Cited by 27 publications

(8 citation statements)

References 12 publications

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“…There were no cases in which shock could be attributed to the analgesia itself. Nevertheless spinal shock has been responsible for maternal deaths; Klein et al (1953) and Lock and Greiss (1955) report 21 maternal deaths from this cause, but in 17 of these cases caesarean section had been performed and a relatively large dose given.…”

Section: Techniquementioning

confidence: 99%

Use of Spinal Analgesia in Forceps and Breech Deliveries

Sears¹

1960

Survey of Anesthesiology

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Formerly Registrar, the City Hospital, Nottingham For many years general anaesthesia has been the anaesthetic of choice for most operative obstetric deliveries, but recent awareness of the danger of inhalation of vomit (Jeffcoate, 1953 ;Parker, 1954Parker, , 1956) has caused concern. The extent of the problem is revealed by reference to the Report on Confidential Inquiries into Maternal Deaths in England and Wales, 1952-4, which (Gordon, 1955;Martin, 1955 ;Barnes, 1955; Rollason, 1955 Although the safety of general anaesthesia has been increased by endeavours to reduce both the incidence of vomit and the risk of inhalation, complete success may not be achieved. The use of apomorphine (J. M. Holmes, 1956) There were no maternal deaths and, headache excepted, few maternal complications, none of which were serious. The results to the baby were also satisfactory. A "saddle block" technique has been used, 0.8 ml. of 0.5% hyperbaric cinchocaine hydrochloride (" nupercaine ") being given. This causes complete loss of sensation in the lower abdomen, perineum, and thighs. Sensation from the uterine cavity is greatly diminished; thus difficult forceps and breech deliveries requiring intrauterine manipulations can be performed without causing distress to the patient. There is complete perineal relaxation, which facilitates delivery and the performance of manipulations such as correction of the malrotated head in forceps deliveries and the bringing down of arms in breech cases.The conscious patient is able to assist delivery by use of her abdominal muscles; this is valuable in assisted breech deliveries. Nevertheless there is considerable loss of power and the perineal reflex is lost. It is therefore advisable to give the injection as late as possible in breech cases to avoid unnecessary extraction.Since uterine tone is retained under spinal analgesia the risk of post-partum haemorrhage is reduced, though intravenous ergometrine (0.25 mg.) has been given with delivery of the anterior shoulder in forceps cases and on completion of the second stage in breech deliveries. Post-partum haemorrhage (loss of 20 oz. (570 ml.) or more) occurred in 32 forceps deliveries and one breech (incidence 7.5%), but in 11 cases bleeding was thought to have arisen from cervical or vaginal tears. Manual removal of the placenta was performed in 13 patients (incidence 3 %); no undue difficulty was experienced.Forceps delivery was difficult in five patients who had mitral stenosis, and in three who had chronic bronchitis. Saddle block analgesia was considered especially suitable in these cases.

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Section: Techniquementioning

confidence: 99%

Use of Spinal Analgesia in Forceps and Breech Deliveries

Sears¹

1960

Survey of Anesthesiology

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“…In a recent review of anaesthetic hazards in obstetrics, Lock and Greiss (1955) report three deaths under trichlorethylene. At least one of these would appear to be of significance.…”

Section: Survey Of Literaturementioning

confidence: 99%

Cardiac Arrest During Trichlorethylene Anaesthesia

Norris¹,

Stuart²

1957

BMJ

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SEDATION FOR DENTAL OUT-PATIENTS MBzcAsHJou1^Aoften they have failed to appoint independent observers even of behaviour, and less still have they made thorough investigations into the psychological state of their patients. Our experience, we think, emphasizes the importance of design in a trial of this kind and draws attention to the paucity of evidence on which claims are made about drugs alleged to allay apprehension.So far as overt conduct is concerned, we are of the opinion, from our present findings, that for children 6 years of age and over preliminary sedation before dental extractions undertaken with a general anaesthetic is usually unnecessary. Below this age any method of improving behaviour would be an advantage. Methylpentynol, butobarbitone, and chlorpromazine scarcely provide the answer, at least in the doses we used, and there is the risk that with higher doses side-effects might be manifest. Moreover, many " elixirs " are unpalatable, and often their administration may itself contribute to loss of confidence. SummaryThe case for the pre-operative sedation of children before general anaesthesia for dental operations as outpatients is examined.The problem of assessing the effect of a pre-operative sedative drug is considered. A method of solving it by using a behaviour-grading process was evolved and tested.Methylpentynol, butobarbitone, and chlorpromazine were selected as potentially useful premedicant drugs.Using the " double blind " technique and our method of assessment, a pilot trial and a major trial of these three drugs were carried out within the framework of the routine dental gas session in Guy's Hospital. A very marked difference was shown between the patterns of behaviour of the older and the younger children.None of the three drugs could be distinguished from a placebo by their effect on the behaviour of the children about to be anaesthetized.Possible explanations of this negative result are discussed.We thank Mr. R. E. Rix and Mr. K. E. Pringle and their assistants for their courtesy in allowing this investigation to be undertaken at their dental extraction sessions, and also the sisters and nursing staff concerned for the help afforded to us. We are indebted to Dr. W. S. McConnell, the anaesthetist in charge of one session, for his ever-willing and experienced advice, to Dr. A. Cashmore and Miss Putzel for their help as assessors in the pilot trial, and to Miss Treadgold and Miss Waldron for their assistance in the presentation of the results. We are obliged to Mr. Moore, the chief dispenser, for his co-operation with the preparation of the premedications, and to Miss Grossman for her help with the records. Finally, we thank Messrs. May and Baker for supplies of chlorpromazine and butobarbitone and Messrs. British Schering for methylpentynol.

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“…Certainly quite high pressure can be built up if the expiratory valve is inadvertently kept closed. It is noteworthy that Lock and Greiss (1955) in their recommendations again underline the importance of not " forcing" the anaesthetic when retching occurs. Whatever the mechanism of major aspiration, there is now some reason to think that the unskilled occasional anaesthetist might be wise to choose the open mask in preference to the Boyle machine for anaesthetizing women in labour.…”

Section: Prevention Of Disastermentioning

confidence: 99%

“…It is probable that the skilled anaesthetist can invariably av,oid disaster, as is shown by the recent series of 18.648 obstetric anaesthesias without a death by Lock and Greiss (1955). But by the very nature of obstetric work it is unlikely that the services of a skilled anaesthetist can be always and everywhere available.…”

Section: Prevention Of Disastermentioning

confidence: 99%

“…This technique is not popular, and if it is not to be used the Birmingham figures suggest that it may be as safe to use the open mask. That the latter is not entirely safe is apparent from a study of the maternal deaths reported by Lock and Greiss (1955), several of which were associated with open ether. Yet the feeling remains that it would often be safer than the handling of a machine by an inexpert practitioner.…”

Section: Prevention Of Disastermentioning

confidence: 99%

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Maternal Death from Aspiration Asphyxia

Parker¹

1956

BMJ

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16 JULY 7, 1956 CEREBRAL ANGIOGRAPHY MEDICALJOURNAL angiography many admissions.to a neurosurgical department for purely diagnostic measures are avoided. With over half our angiograms performed as an out-patient procedure the occupancy of beds by patients not requiring operation is reduced and the volume of operative surgical work increased. Both air encephalography and Yentriculography necessitate admission to hospital.Angiography can provide the early, accurate, and safe diagnosis of emergencies, a,nd that applies particularly to subarachnoid haemorrhage. It is a relatively safe procedure in brain tumours with high intracranial pressure. The benign may be distinguished from the malignant, and in the above series the pathological type of tumour was correctly diagnosed in 39%. Angiography has given us the accurate situation in 74% of brain tumours and in a further 14% has indicated their presence. That compares well with pneumoencephalography. In the remainder the use of ethyl iodophenylundecylate and air as contrast media was necessary.The mortality of 0.2% has not involved any case of raised intracranial pressure. These cases where the intracranial pressure is extremely high as a result of obstructive hydrocephalus, and mistakenly investigated at first by angiography, are in our experience less disturbed by that and the ethyl iodophenylundecylate ventriculogram that follows than by air ventriculography in the first instance alone.

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The Anesthetic Hazards in Obstetrics**Presented at the Seventy-eighth Annual Meeting of the American Gynecological Society, Quebec, Quebec, May 23, 24, and 25, 1955.

Cited by 27 publications

References 12 publications

Use of Spinal Analgesia in Forceps and Breech Deliveries

Use of Spinal Analgesia in Forceps and Breech Deliveries

Cardiac Arrest During Trichlorethylene Anaesthesia

Maternal Death from Aspiration Asphyxia

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