Sarah Wray

Publications (2)1.87 Total impact

• Article: Role of the anaesthetist in obstetric critical care.

  Felicity Plaat, Sarah Wray
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  ABSTRACT: The anaesthetist plays a key role in the management of high-risk pregnancies, and must be a member of the multidisciplinary team that is required to care for the critically ill obstetric patient. Anaesthetists are trained in advanced life support and resuscitation. They are experienced in the management of the critically ill, and provide anaesthesia, sedation and pain management. The obstetric anaesthetist should undertake education of medical and midwifery staff in the early recognition, monitoring and treatment of the sick mother, resuscitation training, running 'skills drills' for emergency simulations, risk management and audit of maternal morbidity on the labour ward. To date, there is little evidence to inform the anaesthetic management of the critically ill obstetric patient; most recommendations and guidelines are based on the management of non-obstetric, critically ill patients. Management must be adapted to encompass the physiological changes of pregnancy. Evidence-based guidelines on management of the critically ill woman with specific obstetric conditions are also lacking.
  Best practice & research. Clinical obstetrics & gynaecology 11/2008; 22(5):917-35. · 1.87 Impact Factor
• Article: Regional anaesthesia for caesarean section and what to do when it fails

  Sarah Wray, Felicity Plaat
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  ABSTRACT: Almost 90% of caesarean sections in the UK are carried out under regional anaesthesia. Preoperatively, women should be assessed and given adequate information regarding the regional technique. Antacid premedication and, in elective cases, an appropriate starvation period are mandatory. Regional anaesthesia should be established in the operating theatre, with both maternal and fetal monitoring in progress. Single-shot spinal is currently the most popular technique. Before surgery starts, assessment and documentation of the block are essential. Sensory block to light touch, and/or cold, should be measured. Surgery should be halted, if possible, if there is pain. Analgesic options include Entonox, intravenous opioids or ketamine, epidural ‘top-up’ and local infiltration; however, general anaesthesia should always be offered. All women should be followed up within 24 hours by the anaesthetic team.
  Anaesthesia & Intensive Care Medicine.