Kieran Downey

• University of Aberdeen

( Can J Anesth . 2024;71(6):802–807. doi:10.1007/s12630-023-02638-5) The prevailing choice for mothers requesting pain management during labor and delivery is epidural analgesia (EA). The use of a sensory block assessment is necessary to understand how the body is responding to the analgesia, both in an effort to ensure pain is effectively managed...

While regional anesthesia (RA) is considered preferable to general anesthesia (GA) for Cesarean delivery (CD), certain situations necessitate GA. This study reviewed the practice patterns around the use of GA for CD to identify modifiable predictors of GA with the goal of reducing GA rates. This was a retrospective, case–control study. Patients und...

( Anesth Analg . 2024;138(4):814–820. doi:10.1213/ANE.0000000000006309) Multiple pregnancies pose a well-known danger for postpartum hemorrhage (PPH). Compared with single pregnancies, individuals expecting multiples face heightened risks like uterine atony, severe PPH, blood transfusion, hysterectomy, prolonged hospital stays, and mortality, regar...

( Can J Anesth/J Can Anesth. 2023; 70:202–210) Rising obesity rates have reached a high of one third or one fourth of adults in the United States and Canada, respectively. This leads to many individuals with this condition requiring medical care including anesthesia for labor and delivery. Obesity is known to be associated with complications in the...

( Reg Anesth Pain Med 2022;47:775–779) Epidural analgesia is one of the most common pain relief treatments during labor and delivery and is usually very effective. In a small percentage of epidurals, misplacement of the epidural catheter can cause inadequate anesthetic effects. To reduce instances of insufficient pain relief, it would be beneficial...

( Can J Anesth/J Can Anesth. 2022;69:1471–1476) Currently, one of the most widely used methods of pain management is epidural analgesia, with drug delivery in a programmed intermittent epidural bolus (PIEB) in conjunction with patient-controlled epidural analgesia. Previously the investigators reported 2 sensory block levels associated with epidura...

( Anaesthesia. 2022;77:892–900) Oxytocin and carbetocin are both uterotonics, and are recommended for prophylactically combatting postpartum uterine atony. They are currently used at high doses but some advocate for lower doses that would carry less risk for adverse effects. This double-blind, randomized, controlled non-inferiority study compared c...

(Reg Anesth Pain Med. 2022;47:364–369) Despite epidural labor analgesia use being widespread, unintentional dural puncture (UDP) occurs at a rate of 0.5% to 1.5% depending on the type of institution (training vs. nontraining). The short-term adverse outcome—postural postdural puncture headache (PDPH), and associated nausea, vomiting, auditory distu...

(Can J Anesth/J Can Anesth. 2022;69:750–755) Sensory block, or a decreased sensitivity to sensory stimuli, occurs with epidural anesthesia during labor. Assessing the degree of sensory block is important both for clinical practice and for patient safety, yet the assessment procedure is not standardized. A variety of stimuli have been used, as well...

(Can J Anaesth. 2022;69:97–105) Postpartum hemorrhage increases mortality, morbidity, potential blood transfusion, and length of hospital stay. Usually oxytocin, an effective agent with a short half-life and various possible side effects, is most used to treat postpartum hemorrhage. Carbetocin, though an unpopular method of treatment, has a longer...

(Can J Anaesth. 2022;69:86–96) Previous studies have shown that programmed intermittent epidural bolus, the automatic delivery of boluses at certain times during epidural analgesia, decreases pain, motor block, and local anesthetic consumption while increasing patient satisfaction. However, unnecessarily high sensory levels have been noted in prior...

( Anaesthesia . 2021;76:918–923. [Epub November 23, 2020]) Worldwide, postpartum hemorrhage (PPH) continues to be a major cause of maternal mortality. Uterine atony is a leading cause of PPH in high-income countries and is known to be associated with obesity. Oxytocin is administered to achieve acceptable uterine tone following cesarean delivery (C...

( Can J Anaesth . 2021;68:653–660. doi: 10.1007/s12630-021-01922-6. Epub February 2, 2021) Programmed intermittent epidural bolus (PIEB) has been increasingly recommended and used during labor analgesia. This study aimed to determine the recommended time interval between boluses of 2.5 mL of bupivacaine 0.25% plus fentanyl 8 µ/mL to provide effecti...

Carbetocin or oxytocin are given routinely as first‐line uterotonic drugs following delivery of the neonate during caesarean delivery to prevent postpartum haemorrhage. Low doses may be as effective as high doses with a potential reduction in adverse effects. In this double‐blind, randomised, controlled, non‐inferiority trial, we assigned low‐risk...

( Reg Anesth Pain Med . 2021;46:157–163. doi: 10.1136/rapm-2020-101873. [Epub November 6, 2020]. PMID: 33159006) Randomized controlled trials show neuraxial analgesia minimizes pain and improves patient experience across North America, yet these findings are under controlled conditions within homogenous populations. Also, practice changes were made...

( Int J Obstet Anesth. 2021;45:67–73) Postpartum hemorrhage (PPH) is often underrecognized due to difficulty estimating blood loss and delayed intervention due to underestimation of blood loss can lead to poor outcomes. An alternative tool to diagnose PPH is shock index, defined as heart rate divided by systolic blood pressure. Another option, cont...

( Anaesthesia . 2020;75:331–337) Uterotonics are widely used in cesarean deliveries to prevent postpartum hemorrhage, which can cause maternal death or severe morbidity. Obesity, among other factors, has been implicated as a contributing factor to the rise in atonic postpartum hemorrhage in developed countries. The use of carbetocin, a synthetic ox...

Prophylactic oxytocin administration at the third stage of labour reduces blood loss and the need for additional uterotonic drugs. Obesity is known to be associated with an increased risk of uterine atony and postpartum haemorrhage. It is unknown whether women with obesity require higher doses of oxytocin in order to achieve adequate uterine tone a...

( Can J Anesth . 2019 66:1075–1081) Programmed intermittent epidural bolus (PIEB) for labor analgesia has garnered a lot of attention and is the focus of ongoing research. PIEB when compared with continuous epidural infusion results in higher maternal satisfaction, reduced local anesthetic consumption, lower incidence of motor block, fewer unilater...

( Anaesthesia . 2019;74:190–196) Postpartum hemorrhage (PPH) is the most common cause of maternal mortality worldwide and accounts for 35% of maternal deaths. Active management of the third stage of labor is recommended in all parturients, with prophylactic uterotonic drug administration after delivery of the infant being the primary component of t...

( Anaesthesia . 2018;73:459–465) The use of programmed intermittent epidural bolus (PIEB) to provide labor analgesia has been increasing in popularity as commercially available pumps have become available. A variety of dosing strategies have been evaluated but the optimal settings for PIEB have not yet been established. The majority of studies have...

( Reg Anesth Pain Med . 2018;43:92–96) Unintentional puncture of the dura mater is one of the most common complications of epidural catheter placement and can result in a postdural puncture headache. The incidence of this complication has remained unchanged and efforts to identify patient risk factors have been unsuccessful. There has not been succ...

( Anaesthesia . 2018;73:295–303) Bedside gastric ultrasound is used in diverse patient groups for the assessment of gastric content and volume. Using qualitative assessment, a distinction can be made between an empty stomach and one containing solid/thick fluid contents or clear fluids. In addition, quantitative assessment of gastric volume can be...

Postpartum haemorrhage is the leading cause of maternal mortality worldwide and prophylactic uterotonic drug administration after the delivery of the infant is advised. Carbetocin is recommended as an uterotonic, but the minimum effective dose has not been verified. We compared the efficacy of two doses of intravenous carbetocin (20 μg and 100 μg)...

Objective The objective of this study was to determine the pattern of uterotonic drug usage in obstetric units of university-affiliated hospitals in Canada. Methods This was a prospective observational study conducted in the form of an electronic survey. The target group consisted of chiefs or directors of Obstetrics and Anaesthesia at university-...

( Can J Anaesth . 2017;64(8):836–844) Teamwork between anesthesiologists and nurses is very important for patient safety and effective care, particularly in obstetric care. Barriers to effective teamwork between nurses and physicians are varied and can be difficult to identify, but may include lack of role clarity, intimidation and bullying, lingui...

( Anesth Analg . 2017;125(1):212–218) Phenylephrine, which is easy to titrate, is the current first-choice vasopressor for prevention and treatment of maternal hypotension during spinal anesthesia for cesarean delivery (CD). However, it has a propensity to increase afterload and reduce maternal heart rate and cardiac output. Norepinephrine has been...

Bedside gastric ultrasonography can be performed reliably by anaesthetists to assess gastric content in the peri-operative period. We aimed to study the relationship between gastric cross-sectional area, assessed by ultrasound, and volumes of clear fluids ingested by pregnant women. We recruited 60 non-labouring third-trimester pregnant women in a...

The optimum time interval for 10 ml boluses of bupivacaine 0.0625% + fentanyl 2 μg.ml⁻¹ as part of a programmed intermittent epidural bolus regimen has been found to be 40 min. This regimen was shown to be effective without the use of supplementary patient-controlled epidural analgesia boluses in 90% of women during the first stage of labour, altho...

( Anesth Analg . 2017;124(2):554–559) Poorly controlled postpartum pain can place a patient at risk for chronic pain, postpartum depression, and negatively impact maternal-fetal interactions. Although multimodal analgesia has greatly improved pain control in general for these women, there remain a proportion of patients who report inadequate postop...

( Anesthesiology. 2015;123:320–326) Gabapentin is an analgesic that has proven itself to be beneficial perioperatively for several surgeries, some of which, such as abdominal hysterectomy, are similar to cesarean delivery. There is also extensive information on this drug from its use as an anticonvulsant, in which it has been shown to be safe for u...

Background: Pulmonary aspiration of gastric contents in pregnant women undergoing general anaesthesia is one of the most feared complications in obstetric anaesthesia. Bedside gastric ultrasonography is a feasible imaging tool to assess the gastric content. The purpose of this study was to investigate the reliability of qualitative bedside assessm...

Background Cardiac disease is the leading cause of maternal death. Non-fatal ischemic events may go unnoted during the time of delivery. The aim of this study was to assess the incidence of subclinical myocardial ischemia amongst parturients, as evidenced by a raised troponin assay in the postpartum period. Methods We undertook a prospective obser...

Background: Quality of life assessments are increasingly recognised in healthcare. The aim of this study was to evaluate psychometric characteristics of Nottingham Health Profile in the postpartum period. Methods: A random sample of 133 English speaking women completed the scale in hospital between 24 and 48h of delivery and again at 7days postp...

A safe and effective intrathecal dose of bupivacaine alone for cesarean delivery has not yet been established. This study tested the hypothesis that an intrathecal dose of hyperbaric bupivacaine 15 mg would produce equivalent spinal anesthesia for cesarean delivery as the combination of hyperbaric bupivacaine 12 mg and fentanyl 15 μg. This was a si...

When diagnosed antenatally placenta accreta has often been managed by cesarean hysterectomy, but recently techniques involving uterine preservation have been developed. Uterine artery embolization has become an adjuvant treatment, although the potential for obstetric hemorrhage still exists. A multidisciplinary approach has permitted the developmen...

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