Severe pain during local infiltration for spinal anaesthesia predicts post-caesarean pain.

BACKGROUND: Quantitative sensory testing (QST) measures response to painful stimuli and has been used to predict post-caesarean pain. Pain reported upon intravenous cannulation was shown to predict epidural analgesic use and pain intensity during labour. We hypothesized that pain intensity reported by women upon local anaesthesia injection (ILA) for spinal anaesthesia may predict acute pain after caesarean delivery (CD). METHODS: In a prospective observational trial, 229 women undergoing elective CD under spinal anaesthesia were enrolled. Using standardized script before ILA, women received ILA (lidocaine 1% 2.5 mL via 25 G needle), and provided an ILA score after the injection [verbal numeric pain scale (VNPS); 0-100]. Demographic data, average, peak pain (at rest, with movement and uterine cramping) and analgesic requests were recorded for the first 24 h. RESULTS: Fourteen percent of women experienced severe pain (VNPS ≥70) upon ILA. Good correlation was noted between ILA and pain scores at rest and upon mobilization during the 24 h following surgery (average resting pain r = 0.529, p < 0.001, average pain at mobilization r = 0.483, p < 0.0001). Severe acute postoperative pain (VNPS ≥70) was predicted by severe ILA pain with a sensitivity of 91.6% and specificity of 93.3%. CONCLUSION: This is the first study evaluating a clinical measure to predict post-caesarean pain. Our main findings were that 14% of women experience severe pain upon ILA, which was associated with increased pain during the first 24 h.

Peripartum anesthetic management of renal transplant patients--a multicenter cohort study.

As the number and success of renal transplantation has grown, there has been an increase in the number of renal transplant patients giving birth. To date, there has been no data on obstetric anesthesia management of these patients. The purpose of this study was to build an Israeli national database on parturients after renal transplant. A sixteen-year (calendar years 1996-2011) retrospective study was conducted at three major tertiary centers with a combined current birth rate of approximately 25,000 deliveries annually. We found 83 labors in 64 women. Forty-two percent of this population suffered from hypertension while 12.5% had diabetes. Forty-seven percent of women had a vaginal delivery while 53% of women had a cesarean section. The rate of epidural analgesia for labor was 59%, and rate of regional anesthesia during cesarean section was 75%. There were no anesthetic complications in any cases. Standard ASA monitoring was used in all cases except for one woman with severe hypertension who required an arterial line during her cesarean section. Forty-seven percent of newborn were under 37 weeks with average gestational week 36 ± 3 days and birth weight 2.5 ± 0.7 kg. Average Apgar was 8.4 ± 1.3 at one minute and 9.3 ± 0.7 at five minutes. There was one neonatal death in the CS group due to placental abruption. Patients after renal transplant can safely undergo birth and obstetric analgesia.

Effect of hypothermia on the survival of the immature pig in a confined atmosphere.

The rat has an optimal body temperature (TB = 20 degrees C) for hypoxic survival in a confined space. The general applicability of this finding and the influence of body size was studied in immature pigs (27 kg). The pig consumed oxygen in a sealed chamber until it reached the terminal state. We measured blood pressure, inspired O2 and CO2, minute ventilation, ECG, ambient and body temperatures, and PO2, PCO2, O2-content and pH in arterial and venous blood. Four different cooling procedures produced a terminal TB of 26 +/- 3.1 degrees C, 30.1 +/- 2.9 degrees C, 30.0 +/- 2.8 degrees C and 22.6 +/- 2.1 degrees C and a terminal PIO2 of 28.0 +/- 10.2 torr, 30.8 +/- 7.6 torr, 31.5 +/- 5.6 torr and 41.7 +/- 15.4 torr respectively (mean +/- SD). Oxygen consumption, minute ventilation and cardiac output increased from baseline values of 0.5 l.h-1.kg-1, 10 l.min-1, and 6 l.min-1 respectively at the start of cold exposure, and declined moderately as a function of PIO2 below 60 torr. With respect to the relation between terminal body temperature and terminal PIO2 (but not PaO2), we found an optimal body temperature (26 degrees C) at which the animal can survive to the lowest PIO2. Using the allometric approach, i.e. linear extrapolation of temperature as a function of logarithm body mass, the optimal body temperature for man would be 27.5 degrees C. The advantage of hypothermia in the hypoxic survival of the whole animal is its effect on the reduction of the inspired-arterial O2 difference.

Stiffness variability and stress-dependent elastic response of synthetic fibre-reinforced composites for biomedical applications.

A major design requirement of biomaterial prostheses is to match their elastic properties with those of the natural host tissue. Composite materials address this requirement because their elastic properties can be altered accurately through composition and directionality parameters, and they can be designed to match closely the elastic properties of the biological tissues, in isocompliance, modulus gradient and anisotropy. This adds to a range of advantages of synthetic composite materials with respect to potential biomedical applications, which draw on their heterogeneity and anisotropy. This paper focuses on the elastic properties of synthetic fibre-reinforced composite materials that pertain to biomedical applications, and demonstrates the range of stiffnesses obtainable through selection of constituents and by choice of angle of reinforcement.

Ultrasonography in developmental displacement of the hip: a critical analysis of our results.

In a prospective study to evaluate developmental displacement of the hip, we have used real-time sector scanner ultrasonography. One thousand eight ultrasonographic examinations performed on 444 hips were evaluated. The study was performed by an independent assistant who compared his interpretations to the interpretations of the principal authors. The results show that real-time sector scanning has not been proven to be an absolute imaging method. We believe that these disadvantages might be eliminated by proper use of real-time linear scanners.