Roshan J Fernando

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BACKGROUND Difficulties in inserting an epidural catheter while performing combined spinal-epidural anesthesia for cesarean delivery may lead to undue delays between the spinal injection of the local anesthetic mixture and the adoption of the supine position with lateral tilt. We hypothesized that this delay may affect the intrathecal distribution of local(More)
BACKGROUND Assessment of maternal coagulation to determine suitability for neuraxial anaesthesia and management of obstetric haemorrhage remains a challenge. Thromboelastography provides point of care patient assessment of the viscoelastic properties of whole blood clotting and can assist the clinician in haemostatic decision-making. The study aim was to(More)
The importance of early identification and management of the high-risk obstetric patient is emphasised in the Confidential Enquiry into Maternal and Child Health (CEMACH) report. High-risk patients who need anaesthetic input include those with airway problems, cardiorespiratory disease and rare genetic conditions, such as malignant hyperthermia and(More)
There is a need for safe, effective, and easy-to-administer systemic analgesia that ideally has rapid onset and offset, matches the time course of uterine contractions, and does not compromise the fetus. Although neuraxial blockade is the "gold standard" for labor analgesia, systemic analgesia is useful in those cases in which neuraxial analgesia is(More)
Several strategies and alternative therapies have been used to provide analgesia for labour pain. Over the last few years, a number of improvements have enhanced the efficacy and safety of neuraxial analgesia and ultimately have improved mothers' satisfaction with their birth experience. As labour analgesia is a field of obstetric anaesthesia that is(More)
BACKGROUND Low-dose combined spinal-epidural analgesia in labor has proved popular with women because lower-limb motor power is preserved, allowing ambulation. However, there has been debate about the safety of allowing women to walk following low-dose regional analgesia because of somatosensory impairment. The authors undertook a prospective controlled(More)
BACKGROUND The PFA-100 is a point-of-care platelet function analyzer which measures the speed of formation of a platelet plug in vitro, expressed as closure time (CT) in seconds. This device could potentially be used to assess primary hemostasis prior to regional anesthesia. In this prospective, observational study we sought to establish 95% reference(More)
Posture and baricity during induction of spinal anesthesia with intrathecal drugs are believed to be important in determining spread within the cerebrospinal fluid. In this double-blind prospective study, 150 patients undergoing elective cesarean delivery were randomized to receive a hyperbaric, isobaric, or hypobaric intrathecal solution of 10 mg(More)
We have compared fetal heart rate patterns, Apgar scores and umbilical cord gas values following initiation of labour analgesia using either combined spinal-epidural or epidural. One hundred and fifteen healthy women requesting neuraxial analgesia in the first stage of labour were randomly assigned to receive either combined spinal-epidural (n = 62) or(More)