Dr. Dolores McKeen - Womenâ??s and Obstetric Anesthesia
Safety and comfort: Dr. Dolores McKeen seeks best practices for risk reduction and pain relief
Women’s safety and comfort is Dr. Dolores McKeen’s top priority in her role as an anesthesiologist at the IWK Health Centre.
“Giving birth and having surgery carry serious risks and the potential for acute pain that can lead to chronic pain if not properly managed,” notes Dolores, medical director of research in Women’s and Obstetric Anesthesia. “Our goal is to identify ways we can improve practice in the delivery and operating rooms to protect women from harm and suffering.”
Dolores has used her expertise in clinical epidemiology to identify what types of women are most likely to run into complications when given general anesthesia for an emergency C-section. “As a rule it’s safer for moms to stay awake during cesarean delivery, but general anesthesia may be quicker than spinal or epidural anesthesia, or the mother may be too unstable to stay awake,” she explains. “However, we found it is more difficult to place a breathing tube in women who are older or overweight. And, women with a pregnancy complication or chronic health condition are more likely to need cesarean delivery. With these patients, we now prepare to establish early epidurals to avoid general anesthesia when appropriate.”
Despite being safer, some women experience extreme headaches after epidural or spinal anesthesia. Dolores and her colleagues are examining how these headaches can be prevented or treated. Post-partum hemorrhage is another labour complication she has sought to treat more safely by identifying a lower effective dose of oxytocin, which stops bleeding with fewer side effects than the standard dose.
Many women experience severe pain the day after giving birth, whether the delivery was vaginal or surgical. These women, explains Dolores, are more susceptible not only to chronic pain but also to postpartum depression. She and Dr. Ron George have launched a clinical trial to see if adding an ultrasound-guided local nerve block to standard pain relief will better prevent post-delivery pain.
Dolores also works with colleagues to find better ways of managing surgery pain. They are running several clinical trials to see if a dose of pregabalin before hysterectomy and breast cancer surgery will alleviate women’s post-operative pain.
“My clinical and research training, along with a collaborative multidisciplinary research team both here at the IWK and abroad, allows me to ask the right questions and find the best answers, so we can to improve women’s health care and outcomes,” Dolores says. “Research is an essential part of our work as clinicians… it’s how we find solutions to the dilemmas we face every day.”
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