Women's & Children's Hospital Research Report

Transcription

1 Anaesthesia - Women's and Paediatric Head Women s: Dr Johan van der Walt; Dr SW Simmons Head Paediatrics: Dr Margaret Wiese Contact: cynaa@wch.sa.gov.au 1 Development of the Adelaide Regional Connector (ARC) AM Cyna, SW Simmons, K Osborn, M Andrew In the UK and Australia, deaths of patients have been reported following inadvertent administration of intravenous (IV) medications into the intrathecal space and inadvertent administration of an epidural solution into the intravenous compartment. Training, experience, protocols and being careful when administering medications help, but despite our best efforts, humans are fallible and error is inevitable. The common luer coupling (Australian Standards ) of intravenous, epidural and spinal equipment allows the possibility of administering drugs, intended for the IV route, into epidural or intrathecal access ports and vice versa. The simplicity in use and construction of this system is attested by its adoption on a global scale. If confronted today with epidural and spinal anaesthesia as completely new techniques, it is hard to imagine that any regulatory or professional body would countenance their introduction using compatible equipment. Our proposed solution the Adelaide Regional Connector (ARC) is currently under prototype development and its incompatibility with the current luer system has been bench tested. Although anaesthetists represent the largest specialty using regional equipment, this safety issue is relevant to all practitioners administering medications into the intra-thecal or epidural space such as interventional radiologists, critical care personnel and haematologists. 2 Anaesthetic risk factors associated with opioid use during pregnancy: a clinical notes audit B Cassidy, AM Cyna A retrospective clinical notes audit of anaesthetic risk factors associated with women giving a history of chronic opioid drug use during pregnancy. This audit found 86 opiod dependant women over a two-year period. We identified an increased requirement for anaesthetic resources despite a lower intervention rate for obstetric reasons. Nearly all women present hepatitis infection risks to staff and have markedly increased analgesia requirements following painful procedures. 3 Development of the Adelaide Anaesthesia High Risk Database A computerised audit system allowing optimal management of patients, identified as having increased anaesthetic risk, during pregnancy and delivery. M Andrew, SW Simmons J Varni (Children s Hospital and Health Centre, San Diego, USA) 1. Women's & Children's Hospital Adelaide: Research Report

2 4 Expectations of analgesia use versus actual analgesia used in childbirth: a prospective survey I Walkley, AM Cyna; with J Holding (University of Adelaide) We aimed to assess women s expectations of their analgesia requirements compared with actual use during childbirth. We used structured interviews before and after childbirth of 26 women attending our tertiary maternity hospital. Average pain scores for labour were high and not affected by parity. Important outcomes for women from their labour and delivery were a healthy baby and healthy mother, their partner s presence during the labour and delivery, and a choice in delivery position. Antenatal expectations regarding labour analgesia, level of comfort during labour, and knowledge about analgesic techniques were met by the experience of labour analgesia. Increasing a woman s sense of control in her labour and delivery can have positive psychological benefits and affect the perception of pain. 5 An audit of hypnotherapy use in pregnancy and childbirth AM Cyna, M Andrew We are auditing the practice of hypnosis as an adjunct for labour analgesia and to assess its usefulness to women in labour from the prospective of patients, midwives and medical staff. Hypnosis is a relaxed state of consciousness with increased suggestibility that can alter perception or behaviour (for example, the suggestion can be made that during labour the onset of contractions can trigger the initiation of a relaxed comfortable state). Medical staff are frequently called upon to manage women in distress requiring analgesia for labour and delivery. Hypnosis has a long history of use as an adjunct for labour analgesia. Recently two anaesthetists at WCH have been using hypnosis antenatally and in labour as an adjunct to standard analgesic interventions. Contrary to popular belief, the hypno-therapist does not need to be present during labour for hypnosis to be effective. To date, the investigators have used hypnosis with approximately 180 patients who have requested this intervention to assist with labour and childbirth. We are currently auditing this practice by studying women s perceptions of their childbirth experience using hypnosis. 6 Hypnotherapy as an adjunct for induction of labour AM Cyna, M Andrew We have attempted induction of labour using hypnosis and switchbox imagery in pregnant women scheduled for chemical induction. These women independently experience unprompted, similar colours when looking for the switch to turn on their labour. Red to green colour changes are experienced by the most of the 13 women this has been attempted with to date. Two women experienced visual hallucinations of these images during the hours preceding childbirth. The women, who do not see a colour change, experienced a uterine contraction or an increase in the strength and frequency of contractions during or immediately after hypnosis. We believe hypnosis can contribute to the establishment of labour in a significant minority of patients (probably between 20 to 40%). A formal, well-designed RCT is planned for the near future. 2. Women's & Children's Hospital Adelaide: Research Report

3 7 The effects of hypnosis in pregancy and childbirth: A systematic review AM Cyna, G MacAulliffe, M Andrew We are investigating the available evidence regarding the effects of hypnosis during pregnancy and childbirth. Design: Systematic review of relevant comparative trials. Data sources: Electronic databases Medline, Embase, Cochrane library, reference lists from retrieved papers and standard hypnotherapy texts. Study selection trials where hypnosis has been compared with a non-hypnosis intervention, no treatment or placebo at any time during pregnancy and childbirth. Data extraction: Independent data extraction; discrepancies resolved by consensus. Data synthesis: Six randomised controlled trials (RCTs) and nine non-randomised comparisons (NRCs) were identified. One RCT comparing two types of hypnotic suggestion for labour analgesia was excluded. One RCT, involving 122 women, examined the effect of hypnosis on smoking in pregnancy and two NRCs examined the effect of hypnosis in women suffering hyperemesis gravidarum. The effects of hypnosis on labour pain and other obstetric outcomes has been examined by one systematic review, four RCTs including 207 women and seven NRCs involving 1334 women. 8 A pre-eclampsia scoring system A computerised scoring system is being developed for pre-eclampsia in conjunction with the department of computing at Adelaide University. M Andrew 9 RCT of awake suggestions prior to anaesthesia for caesarean section A double-blind randomised trial of two suggestions prior to antacid administration. Primary outcome is patient response and behaviour prior to surgery. AM Cyna 10 Survey of South Australian anaesthetists knowledge and attitudes to hypnosis and suggestion A survey of all anaesthetists in South Australia suggests nearly 50% have an interest in the use of hypnosis or positive suggestions as part of their clinical anaesthetic practice. J Coldrey, AM Cyna 3. Women's & Children's Hospital Adelaide: Research Report

4 11 Emergency classification and audit of decision for caesarean section to delivery time An audit and new classification of urgency for delivery by caesarean section. I Walkley, SW Simmons Staff participating in research Dr Scott Simmons BSc, BM, BS, FANZCA, MBA, Department Head (Women s) Dr Johan van der Walt MB, ChB, FANZCA, Divisional Chief Dr Marion Andrew MB, ChB, FANZCA, Staff Specialist Dr Brenda Cassidy MBBS, Anaesthetic Registrar Dr Julia Coldrey FANZCA, Anaesthetic Consultant Dr Meredith Craigie Dr Allan Cyna MB, ChB, FRCA, Staff Specialist Dr David Nemeth Dr Ingrid Walkley MBBS, Anaesthetic Registrar Dr Kym Osborn Other research-related Activity P Gartrell Chairman of SA perioperative mortality committee Publications Cyna AM, Andrew MI Induction of labour using switchbox imagery in hypnosis. Anaesthesia () 58 (2) Cyna A.M Hypno-analgesia for a labouring parturient with contra-indications to central neuraxial block. Anaesthesia. 58 (1): Cyna AM A post-partum complication of hypnosis for analgesia during labour. Aus J Clin Exp Hypn () 31 (2): Women's & Children's Hospital Adelaide: Research Report

5 Post-graduate degrees Dr Scott Simmons MBA Dr Allan Cyna Dip.Clin.Hypn Australian Society of Hypnotherapists 5. Women's & Children's Hospital Adelaide: Research Report