Stephen H. Halpern

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Neuraxial analgesia is frequently administered to women in labor. For many years, bupivacaine has been used because of its long duration of action, lack of excessive motor block, and minimal fetal and neonatal effects. However, bupivacaine is one of the most cardiotoxic local anesthetics in current use and motor block is still a problem. Many local(More)
Background. Caesarean birth rates in North America continue to rise, in the absence of benefit for mothers and babies. One reason may be that hospitalized labouring women spend most of their labours in recumbent or semi-recumbent positions. Although hands-and-knees position has theoretical advantages, efforts to encourage its adoption in practice are(More)
Chronic renal failure is rare in pregnancy and often results in significant maternal and neonatal morbidity. When possible, preoperative dialysis is useful to optimize fluid and electrolyte balance. We describe the perioperative management of a parturient who persistently refused dialysis, had an uneventful cesarean delivery under graded epidural anesthesia.
Obstructive sleep apnea (OSA) is characterized by upper airway collapse and obstruction during sleep. It is estimated to affect nearly 5% of the general female population. Obesity is often associated with OSA. The physiological changes associated with pregnancy may increase the severity of OSA with a higher risk of maternal and fetal morbidity. However,(More)
PURPOSE Modern neuraxial labour analgesia reflects a shift in obstetrical anesthesia thinking - away from a simple focus on pain relief towards a focus on the overall quality of analgesia. However, advances in the methods used to measure outcomes have not kept pace with clinical progress, and these approaches must evolve to facilitate meaningful assessment(More)
Epidural analgesia is an extremely effective and popular treatment for labor pain. In this review, we trace the history of the use of epidural analgesia and its refinements. We then outline the goals of treatment and methods used to attain those goals. The use of low concentrations of local anesthetics, combined with lipid-soluble opioids, does not impede(More)
We present a method whereby the geometric registration of a series of ion microscopic images is performed by applying a two-step procedure. After applying a global linear transformation that corrects for geometric differences, a non-linear elastic transform is used in order to match local properties and structures of the images. Transformation parameters(More)
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