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ANAESTHESIA TUTORIAL OF THE WEEK

The Labour Epidural: Troubleshooting

This work by WFSA is licensed under a Creative Commons Attribution-NonCommercial-NoDerivitives 4.0 International License.

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What's in this tutorial?

Discover the reasons behind potential epidural failures and how to deal with them.

Anaesthesia

Obstetric Anaesthesia

Target Audience

Designed for anaesthesia professionals and other appropriate healthcare providers

Varied activities

Written lectures, illustrations and quizzes.

Level

Intermediate

Find out more about this topic:

Course instructors

Dr Charlotte Kingsley &
Dr Alan McGlennan

Dr Charlotte Kingsley is an Anaesthetic Registrar at Royal Free Hospital, UK.

Dr Alan McGlennan is a Consultant Anaesthetist at Royal Free Hospital, UK.

This course is provided by WFSA

The World Federation of Societies of Anaesthesiologists (WFSA) is the foremost global alliance of anaesthesiologists, with 133 Member Societies representing over 140 countries and 500,000 anaesthesiologists worldwide.

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This is a private prototype only and must not be shared. Thank you.

Dhananjaya Sharma

Committee Member
General Surgeon

Dr. Sharma is a lifelong activist and campaigner for “appropriate technology for health- care in developing world” with many of his 324 publications focusing on Global Surgery/ low-cost surgical solutions to achieve health equity for underserved populations. Dr. Sharma feels truly blessed to be able to “make a difference” and do God’s work, even though he doesn’t wear a Priest’s collar. He has learned during my travels as Honorary Visiting Professor/ Guest Faculty for teaching a course to many universities in developed and developing countries that the key to Global Surgery is not only the spirit of ‘Noblesse oblige’ shaping the roadmap for innovations for low-cost affordable surgery but also collaborative internationalism; because ‘Global means together’.

Jean O'Sullivan

Committee Chair
Emergency Medicine Physician

Professor Jean O’Sullivan is a Consultant in Emergency Medicine at Tallaght Hospital and a lecturer in Emergency Medicine at Trinity College Dublin. In 2008 Prof O’Sullivan founded an international organisation, Global Emergency Care Skills (www.globalemergencycareskills.ie) which provides skills based training in trauma care, major incident management, ultrasound use, acute paediatric and adult medical emergencies. GECS has run courses in Kenya, Zambia, Tanzania, Ghana, Malawi and Ethiopia over the past 14 years. In 2021 Prof O’Sullivan was awarded the William Rutherford Humanitarian Award by the Royal College of Emergency Medicine. Prof O’Sullivan is the Global Health lead for both the Irish Association of Emergency Medicine, and the Irish Committee on higher specialty training at RCSI. Prof O’Sullivan is the vice Chair of the Global Health Committee of the Forum of Postgraduate Training Bodies in Ireland and is currently creating a national curriculum on Global Health for all doctors in training working in Ireland.

Emilie Joos

Committee Member
Trauma Surgeon

Originally from Montreal, Dr. Joos completed her medical school at McGill University where she obtained her M.D.C.M degree. She then underwent general surgery residency at Laval University, in Quebec city, from 2007 to 2012. From 2012 to 2014 she completed a Trauma and Surgical Critical Care fellowship at University of Southern California/Los Angeles County Hospital. She then joined the group of trauma surgeons at Vancouver General Hospital. She completed a Masters in Global Health Policy at the London School of Hygiene and Tropical Medicine in 2019. She has been working with Médecins Sans Frontières since 2015 and was deployed several times in sub-Saharan Africa. In 2017 she completed her Emergency Response Unit training with the Canadian Red Cross and is now on the roster for deployment. Dr. Joos is the Associate Director of the UBC Branch for Global Surgical Care and the Trauma and Acute Care Surgery Fellowship program director.

Pauline Wake

Committee Member
Anaesthesiologist

Dr. Wake is an Anaesthesiologist in Papua New Guinea with interest in medical education, paediatric anaesthesia, regional anaesthesia, pain and global health.

Ainhoa Costas

Committee Member
General Surgeon

Dr. Ainhoa Costas-Chavarri, MD, MPH, FACS trained in General Surgery at the University of Illinois at Chicago and Hand Surgery at the Christine M. Kleinert Institute for Hand and Microsurgery. As a Paul Farmer Global Surgery Clinical Fellow, she obtained an MPH from the Harvard School of Public Health and worked in Haiti for Partners In Health. Dr. Costas-Chavarri came to Rwanda as part of the Human Resources for Health Rwanda Program. Currently she is a full-time consultant surgeon focusing on surgical oncology and breast surgery at Rwanda Military Hospital. Her clinical and research interests include global surgical oncology and surgical education in low resource settings.

Sherry Wren

Committee Member
General Surgeon

Sherry Wren MD, FACS, FCS (ECSA), FISS is a Professor of Surgery at the Stanford School of Medicine, Director of Global Surgery at the Center for Innovation and Global Health, and Director of Surgery at the Palo Alto Veterans Health Care System. She is current Secretary of the American College of Surgeons, Professor Extraordinary at the Centre for Global Surgery, Stellenbosch University, South Africa, former Honorary Professor in the Centre for Trauma at the London School of Medicine, Queen Mary University of London, and Adjunct Professor at Uniformed Health Services University in Bethesda, MD. Dr. Wren is a member and in the leadership of numerous national and international organizations and has served on the boards of the Society of American Gastrointestinal and Endoscopic Surgeons, American College of Surgeons, and other surgical societies. She is an editorial board member of JAMA Surgery, and associate editor of the World Journal of Surgery and East and Central African Journal of Surgery. Clinical focus is gastrointestinal malignancy and surgical robotics. Research interests are in surgical outcomes, robotics, cancer, and global/humanitarian surgery. Dr. Wren has also worked with Doctors Without Borders/ Médecins Sans Frontières.

Lilian Mwape

Committee Member
Nurse

Lillian Mwape is a Perioperative Nurse working with the SADC TEWG as a Focal Point Person for Zambia. She is also the former Chairperson for Clinical Practice for ECSACON Zambia Chapter. She is currently working at National Heart Hospital as a Principal Nursing Officer. In addition, she has been instrumental in formulation of Hospital systems. She has vast experience in managing operating theatres in the country with notable success in opening the first ever Emergency Obstetric theatre in the country

Sara Mohan

Committee Member
Gynaecologist

[bio]

Jackie Rowles

Committee Vice Chair
Nurse Anaesthetist

Dr. Jackie Rowles is President of the International Federation of Nurse Anesthetists (IFNA), and a former President of the American Association of Nurse Anesthesiology (AANA). She is board certified as an Adult Nurse Practitioner and also in Nonsurgical Pain Management. Dr. Rowles is an Associate Professor of Professional Practice and Director of the Advanced Pain Management Fellowship at Texas Christian University's School of Nurse Anesthesia (Fort Worth, TX). She is a highly sought out speaker/educator internationally and with over 10 years experience working at the global level.

Rahel Nardos

Committee Member
Gynaecologist

Rahel Nardos, MD, MCR Dr Nardos is an associate professor in the division of Female Pelvic Medicine and Reconstructive Surgery and the inaugural director of global women’s health at the Center for Global Health and Social Responsibility, UMN. Dr Nardos was born and raised in Ethiopia. After completing her medical training in OBGYN in the US, she returned to Ethiopia to serve as a staff surgeon at the Addis Ababa Hamlin Fistula Hospital. She later completed a fellowship training in urogynecology and a master’s in clinical research, and served in various leadership roles including Division head of Urogynecology at Kaiser Permanente NW and Director of Global Health in OBGYN at Oregon Health and Science University. She has served in various humanitarian service roles including board member and programming chair of Worldwide Fistula Fund which supports obstetric fistula partners in five different countries. She is cofounder and vice chair of Global Perm NW and co-chair of the women and girls work group at the G4 Alliance. Dr Nardos has been engaged in many local and international pelvic floor health capacity building projects with partners in many countries focusing on training healthcare teams in comprehensive pelvic floor care and contributing extensively to research to advance the care of women with pelvic floor disorders.

Claude Martin Jr.

Committee Member
Orthopaedic Surgeon

Dr. Claude Martin Jr. is Executive Director of the AO Alliance Foundation, a non-profit development organization dedicated to improving care for the injured in low-income countries. He was previously Executive Director of the AO Trauma Clinical Division at AO in Davos. After receiving his medical degree from McGill University in Montreal, Canada, he completed his orthopedic surgery residency at the University of Toronto in 1990. Dr. Martin practiced as a community orthopedic surgeon until 1995, before enrolling in the Hand and Upper Extremity Fellowship Program at Harvard Medical School - Massachusetts General Hospital in 1996. The following year, he was awarded an AO Fellowship in Hand and Wrist Surgery in Berne, Switzerland. Claude, a Canadian citizen who has lived in London, Tel Aviv, Boston, Berne, Alabama, Toronto, Montreal, Trois-Rivières, and now Zurich, also holds an MBA from the University of Tennessee - Knoxville. He successfully defended his thesis for his Master of Education at the University of Cincinnati College of Education in 2012. His dream is to see every injured patient in low resource countries receive timely and appropriate care that every human being deserves.

Adolfo Leyva-Alvizo

Committee Member
General Surgeon

General Surgeon in Academic Hospital in MX. Surgical Residency Academic Coordinator and Researcher at TEC Salud.

Andrea Parker

Committee Chair
General Surgeon

Dr. Parker is a general surgeon and surgical educator who lives and works in rural Kenya. She serves as the Head of Medical Education at Tenwek Hospital, where she has worked since 2015. Since 2017, she has overseen the development of a large-scale, standardized surgical curriculum for surgical trainees of the College of Surgeons of East, Central, and Southern Africa (COSECSA). The curriculum is currently in use by over 600 surgical trainees in 20 countries. She serves on the International Task Force of the Association of Surgical Education, the Education Committee of the Association of Academic Global Surgery, and she is an Associate Member of the Academy of Master Surgeon Educators. She completed medical school at Indiana University School of Medicine, followed by a residency in general surgery at Brown University. She is an Associate Professor in the Department of Surgery at Brown University.

Lubna Kahn

Committee Member
General Surgeon

Lubna Khan is a general surgery resident in the Global Surgery track at Baylor College of Medicine. She completed her Bachelor's in Biochemistry & Biophysics with an Honors thesis in Civil Engineering at Oregon State University. While there, she served in multiple elected student government roles which involved lobbying in Washington, DC for affordable higher education. She is the Founder of Ettihad Cultural Center - the first of its kind cultural center representing students from the Greater Middle East. She served as an advisor to Pakistan Mission to the United Nations prior to starting medical school at Oregon Health and Science University. Her research interests are in developing models of healthcare delivery systems for post-conflict war zones and post-disaster areas as well as biomedical device innovation.

Musliu Adetola Tolani

Committee Member
Urologic Surgeon

Musliu Tolani is urologist, senior lecturer and researcher from Nigeria. He graduated with a medical degree from Ahmadu Bello University and received postgraduate fellowships in Urology from the West African College of Surgeons and the National Postgraduate Medical College of Nigeria. He also holds a Masters of Surgery in Urology from the University of Edinburgh and a postgraduate certificate in Public Health from the University of Liverpool. His research focus is on global surgery and global oncology.

Sabina Siddiqui

Committee Member
Paediatric Surgeon

[bio]

Rick Gardner

Committee Member
Orthopaedic Surgeon

[bio]

Luiz Fernando dos Reis Falcão

Committee Member
Anaesthesiologist

Professor and Chair, Federal University of São Paulo. Council, World Federation of Societies of Anaesthesiologists.

Rebecca Silvers

Technical Advisor
Pediatric Neurosurgery & Critical Care Nurse Practictioner

Dr. Rebecca Silvers is an assistant clinical professor at the University of California, San Francisco. She is the founding director of the UCSF Center for Global Nursing at the Institutes of Global Health Sciences and holds clinical positions in her role as a nurse practitioner in the divisions of pediatric critical care and neurosurgery at UCSF Benioff Children's Hospitals. Dr Silvers also serves as the Director of Education for the UCSF Center for Health Equity in Anesthesia and Surgery and the nursing lead for the UCSF WHO Collaborating Center for Emergency, Critical, and Operative Care.

Andrew Katz

Committee Member
Intellectual Property Lawyer

Andrew Katz studied Natural Sciences and Law at Cambridge University, qualified as a barrister, and then requalified (and now practises as) a solicitor at Moorcrofts LLP near London where he is the partner heading the Technology Team. He practises technology law, with particular interest in Open Source Software, Hardware, Content and Data. He is a visiting researcher at the University of Skövde, Sweden, and has worked with businesses worldwide, as well as WIPO, the UN, and CERN. He regularly talks at conferences throughout the world on Open Technology and AI.

Somprakas Basu

Committee Chair
General Surgeon

Dr. Basu is a general surgeon and specialize in colorectal surgery, wound healing, and surgical education. Currently, Dr. Basu is the Professor and Chair of General Surgery at the All India Institute of Medical Sciences, Rishikesh, India, and serve as the Chair of the Surgical Skills Center of the institute. He completed his MBBS and postgraduation in Surgery from the University of Calcutta and Delhi respectively and my Masters (MSc in Wound Healing and Tissue Repair) from Cardiff University Medical School. Dr. Basu is also a fellow of the Royal College of Physicians and Surgeons of Glasgow and the American College of Surgeons. In his spare time Dr. Basu loves to travel, draw, and paint.

Emilio Velis

Committee Member
E-learning Expert

Emilio Velis is an industrial engineer from El Salvador, focusing on the intersection of innovation, design, and technology with social impact. He currently is the Executive Director of the Appropedia Foundation, an organization that promotes access to knowledge on sustainability and poverty reduction, applying his experience in community development, open hardware and open licensing. Emilio advocates for the responsible use of new technologies to solve global issues that range from community violence to climate change and contributes to various organizations and networks in these subjects. He has mentored, done research and taught at the undergraduate and masters level regarding these subjects. His research includes topics related to community empowerment, collaborative methodologies for open-source documentation, and the importance of open knowledge for science and social impact.

Anna Darelli-Anderson

Committe Member
Educationalist

Anna Darelli-Anderson is the Associate Director of Education and Programs Manager for the University of Utah Department of Surgery’s Division of General Surgery and Center for Global Surgery. She has a Master of Education in Organizational Leadership and Adult Education with an emphasis on medical education and is a certified Graduate Medical Education Training Administrator (C-TAGME). Anna’s extensive background encompasses diverse areas, including military service as a Cryptologic Language Analyst in the U.S. Air Force and leadership roles such as Vice Chair and Education Manager for the Society of One-Place Studies. Her expertise spans research and analysis, technical writing, curriculum development, teaching methods and learning techniques, program management and evaluation, faculty training, and linguistics and cultural relations.

Vincenzo Palatella

Committee Vice Chair
Information Specialist

Vincenzo is an experienced Information Specialist, currently working for the training team at the EPFL Library. He organizes and run trainings and workshops on several topics (information literacy, copyright literacy, plagiarism, academic publishing and more) to different publics, from bachelor students to researchers. Among his professional interests are learning and e-learning strategies, Open Access, the evolution of the publishing context and tech gadgets.

Advait Gandhe

Committee Member
Orthopaedic Surgeon & E-learning Expert

Advait is an Orthopaedic Trauma Consultant at Portsmouth Hospitals University NHS Trust and an Honorary Senior Lecturer at the University of Portsmouth. He specialises in lower limb revision arthroplasty and is on the AO UK and international faculties. He has dedicated his career towards developing technology that makes an impactful change on medicine globally. He invented Touch Surgery, the award winning app that changed surgical teaching using smartphone technology and hence founded Digital Surgery Ltd which was successfully acquired by Medtronic in Feb 2020. He is the CEO and Founder of AMODISC, which delivers tech driven medical education globally in collaboration with NGOs and institutions. He graduated in London, trained in Oxford and is a proud father of 2.

Thomas Connolly

Thomas Connolly is an instructional designer at the Royal College of Surgeons in Ireland. He graduated in 2017 with a Ph.D. in Literature and worked for a time as Lecturer in English before moving into the field of digital learning. In 2021, he took up a role as an e-Learning Administrator at RCSI before transitioning into instructional design. In his day-to-day work, Thomas works with medical specialists to create self-paced online learning modules aimed at healthcare professionals. He has a particular interest in accessibility and asynchronous learning, and has completed a Moodle Educator Certificate and a Professional Diploma in Digital Learning.

Peter Mossey

Clinical Orthodontic Consultant

Prof. Peter Mossey, is the Associate Dean for Internationalization at University of Dundee Dental School, and Director of the WHO Collaborating Centre for Craniofacial Anomalies. He is the Leader for the Craniofacial Anomalies theme in the WHO Global Burden of Disease (GBD) Birth Defects Initiative. He was appointed Honorary Secretary of the Craniofacial Anomalies Group of the IADR Global Oral Health Inequalities Research Network (GOHIRN) initiative in August 2012. He is also an expert on Smile Train’s – FDI (World Dental Congress) project which aims to create oral health and dental care guidelines and training programs for community dentists, cleft teams and families affected by cleft worldwide.

Madaswamy S. Muthu

Paediatric Dentist

Prof. M S Muthu has recently (since Feb 2021) been appointed as Adjunct Research Associate (ARA), at Centre of Medical and Bio-Allied Health Sciences Research, Ajman University. Currently he is the Chair of the Centre for Early Childhood Caries Research (CECCRe), Department of Pediatric and Preventive Dentistry, Sri Ramachandra Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.

Being an accomplished Pediatric dentist and an exemplary researcher, Prof. Muthu has more than 102 publications in peer-reviewed journals, with 4 Cochrane reviews and 12 systematic reviews to his credit. Since 2010, his primary area of interest has been “Early Childhood Caries”. He is the first Indian to receive the prestigious 2020 American Academy of Pediatric Dentistry’s Paul P Taylor Award for his highly acclaimed systematic review on ‘Risk factors of Early Childhood Caries’. His expertise was also sought in the recently published paper on ‘Oral Health Policies to tackle the burden of Early Childhood Caries: A Review of 14 Countries/Regions’.

He obtained his PhD in 2010 and was the 4th Pediatric Dentist in the country to have a doctorate. He was conferred the Membership of Royal College of Physicians and Surgeons of Glasgow in 2016. He was also an Alumni of Summer Institute on "Dental Clinical Research Methods”, University of Washington, Seattle. Currently he is also the Vice President of Indian Society of Dental Traumatology and the Chair of Global Task Force on "Cleft Without Caries”. He is also the member of the "Membership Committee" of the International Association of Pediatric Dentistry.

Marina Campodonico Frisch

Paediatric Dentist

Dr. Marina Campodonico graduated from the Universidad de Chile in 1986. She is a Pediatric dentist, currently working in private practice and in Fundación Gantz (a foundation for cleft lip and palate children in Santiago de Chile) where she does pre and post-surgical orthopedic work.

She served as a health director for Special Olympics Chile from 2014 -2019, and was part of the board of IAPD Congress 2017 and of SCHOP (Chilean society of pediatric dentistry). She also teaches at post-graduate and graduate level.

Dr. Campodonico is part of SAMAC for Smile Train since its creation, and took part in the the project for Oral Heath in CCC for Smile Train and FDI developed between 2019-2021.

She also collaborated with the Ministry of Health from 2004 to 2008 for the implementation of the GES program for cleft Children.

Advisor for S4CC for the last 4 years.

Omolola O Orenuga (Lola)

Professor & Consultant Paediatric Dentist

Professor Omolola O Orenuga (Lola) BDS-Lagos, FMCDS, MPH,, MD is a Professor & Consultant Paediatric Dentist at the College of Medicine University of Lagos/

Lagos University Teaching Hospital in Lagos, Nigeria.

She also serves as the Coordinator Clinical Dental Services-Lagos University Teaching Hospital (LUTH)

and chairperson of the Scientific Committee Faculty of Dental Sciences College of Medicine University of Lagos.

Previouslt she as served as the President Nigerian Association of Paediatric Dentistry (NAPD), and has been a member of Smile Train FDI/GSK Expert panel Development of Guidelines for Oral Health in Comprehensive Cleft Care

Paediatric Dentistry. Dr. Orenuga also serves as the team lead for the LUTH Orofacial Cleft Team, and developed Guidelines for the Parents’ section as Member Scientific Committee of IAPD 2017. She also serves as a member in Cleft Without Caries Group, Paediatric Dentistry Working Group, Advisory Board Transforming Faces Canada, Professional & Voluntary Organizations: MWAN, NDA, NADP, WISCAR & AWB (African Women on Board), CEWHIN- Centre for Women’s Health in Nigeria and is on the Board of Trustees/ Foundation Member at the Children Arise Foundation.

ANAESTHESIA TUTORIAL OF THE WEEK

The Labour Epidural: Troubleshooting

What's in this tutorial?

Anaesthesia

Target Audience

Varied activities

Level

Find out more about this topic:

Dr Charlotte Kingsley &Dr Alan McGlennan

This course is provided by WFSA

Course Content

Explore all courses

Download our mobile app!

Courses

About

Contact

Terms

Cookies

Privacy

This is a private prototype only and must not be shared. Thank you.

Dhananjaya Sharma

Committee MemberGeneral Surgeon

Jean O'Sullivan

Committee ChairEmergency Medicine Physician

Emilie Joos

Committee MemberTrauma Surgeon

Pauline Wake

Committee MemberAnaesthesiologist

Ainhoa Costas

Committee MemberGeneral Surgeon

Sherry Wren

Committee MemberGeneral Surgeon

Lilian Mwape

Committee MemberNurse

Sara Mohan

Committee MemberGynaecologist

Jackie Rowles

Committee Vice ChairNurse Anaesthetist

Rahel Nardos

Committee MemberGynaecologist

Claude Martin Jr.

Committee MemberOrthopaedic Surgeon

Adolfo Leyva-Alvizo

Committee MemberGeneral Surgeon

Andrea Parker

Committee Chair General Surgeon

Lubna Kahn

Committee MemberGeneral Surgeon

Musliu Adetola Tolani

Committee MemberUrologic Surgeon

Sabina Siddiqui

Committee MemberPaediatric Surgeon

Rick Gardner

Committee MemberOrthopaedic Surgeon

Luiz Fernando dos Reis Falcão

Committee MemberAnaesthesiologist

Rebecca Silvers

Technical AdvisorPediatric Neurosurgery & Critical Care Nurse Practictioner

Andrew Katz

Committee MemberIntellectual Property Lawyer

Somprakas Basu

Committee ChairGeneral Surgeon

Emilio Velis

Committee MemberE-learning Expert

Anna Darelli-Anderson

Committe MemberEducationalist

Vincenzo Palatella

Committee Vice ChairInformation Specialist

Advait Gandhe

Committee MemberOrthopaedic Surgeon & E-learning Expert

Thomas Connolly

Peter Mossey

Clinical Orthodontic Consultant

Madaswamy S. Muthu

Paediatric Dentist

Marina Campodonico Frisch

Paediatric Dentist

Omolola O Orenuga (Lola)

Professor & Consultant Paediatric Dentist

Dr Charlotte Kingsley &
Dr Alan McGlennan

Committee Member
General Surgeon

Committee Chair
Emergency Medicine Physician

Committee Member
Trauma Surgeon

Committee Member
Anaesthesiologist

Committee Member
General Surgeon

Committee Member
General Surgeon

Committee Member
Nurse

Committee Member
Gynaecologist

Committee Vice Chair
Nurse Anaesthetist

Committee Member
Gynaecologist

Committee Member
Orthopaedic Surgeon

Committee Member
General Surgeon

Committee Chair
General Surgeon

Committee Member
General Surgeon

Committee Member
Urologic Surgeon

Committee Member
Paediatric Surgeon

Committee Member
Orthopaedic Surgeon

Committee Member
Anaesthesiologist

Technical Advisor
Pediatric Neurosurgery & Critical Care Nurse Practictioner

Committee Member
Intellectual Property Lawyer

Committee Chair
General Surgeon

Committee Member
E-learning Expert

Committe Member
Educationalist

Committee Vice Chair
Information Specialist

Committee Member
Orthopaedic Surgeon & E-learning Expert