Bio

Clinical Focus


  • Anesthesia
  • OB Anesthesia

Academic Appointments


Professional Education


  • Residency:Chesterfield Royal Hospital (2008) UK
  • Residency:Doncaster Royal Infirmary (2008) UK
  • Residency:Barnsley District General (2007) UK
  • Residency:Northern General Hospital (2007) UK
  • Residency:Doncaster Royal Infirmary (2006) UK
  • Medical Education:University of Glasgow (1998) Scotland
  • Residency:Sheffield Children's Hospital (2009)
  • Residency:Glasgow Royal Infirmary (2005) Scotland
  • Residency:Royal Alexandra Hospital (2000) UK
  • Residency:Hairmyres Hospital (2000) UK
  • Residency:Sheffield Children's Hospital (2006)
  • Residency:Royal Hallamshire Hospital - Jessop Wing (2006) UK
  • Residency:Royal Hallamshire Hospital (2005) UK
  • Residency:Stobhill Hospital (2004) Scotland
  • Residency:Western Infirmary (2002) Scotland
  • Residency:Glasgow Royal Infirmary (2001) Scotland
  • Internship:Hairmyres Hospital (1999) UK
  • Internship:Royal Alexandra Hospital (1999) UK

Research & Scholarship

Clinical Trials


  • Temperature Study in Cesarean Section Recruiting

    During surgery body temperature can decrease which can adversely affect how people recover from surgery. This is a common problem. We aim to reduce the incidence of this drop in body temperature during surgery by testing the effectiveness of two active body warming devices. One method is to warm the intravenous fluids that the patients will receive, as they are being infused. The other method is to use a forced-air warmer. This is a device that is similar to a blanket that the patient has laid over their upper body during the surgery which has warm air blown into it. The control group will not have any active warming methods. Study group 1 will have the intravenous fluid warmer in the pre- and intraoperative period. Study group 2 will have a forced-air warmer in the intra-operative period as well as the fluid warmer in the pre- and intraoperative period. We will also observe the neonates' vital signs following delivery.

    View full details

Teaching

Graduate and Fellowship Programs


Publications

Journal Articles


  • The impact of breastfeeding on postpartum pain after vaginal and cesarean delivery. Journal of clinical anesthesia Wen, L., Hilton, G., Carvalho, B. 2015; 27 (1): 33-38

    Abstract

    Oxytocin may play a role in pain modulation. The analgesic effects of breastfeeding with its associated endogenous oxytocin release have not been well investigated. To determine the impact of breastfeeding on incisional, perineal, and cramping pain after cesarean and vaginal delivery.Institutional review board-approved prospective observational study.Labor and delivery and maternity wards.Healthy (American Society of Anesthesiology physical statuses 1 and 2) multiparous women who had cesarean (n = 40) and vaginal (n = 43) deliveries of singleton term infants and who were breastfeeding were enrolled.Women completed diaries to record incisional, perineal, or cramping pain scores 5 minutes before, during, and 5 minutes after breastfeeding.Demographic, obstetric, and neonatal variables, as well as analgesic use, were recorded.There was no difference in incisional pain before, during, and after breastfeeding in women post-cesarean delivery. Cramping pain was significantly increased during, as compared with before or after breastfeeding in both the vaginal (P < .001) and cesarean (P < .001) delivery cohorts.There was no analgesic effect on incisional pain during breastfeeding, indicating that endogenous oxytocin associated with breastfeeding may not play a significant role in postpartum cesarean wound pain modulation. Breastfeeding increased cramping pain after vaginal and cesarean delivery. The increase in cramping pain is most likely due to the breastfeeding-associated oxytocin surge increasing uterine tone.

    View details for DOI 10.1016/j.jclinane.2014.06.010

    View details for PubMedID 25468582

  • Prospective longitudinal cohort questionnaire assessment of labouring women's preference both pre- and post-delivery for either reduced pain intensity for a longer duration or greater pain intensity for a shorter duration. British journal of anaesthesia Carvalho, B., Hilton, G., Wen, L., Weiniger, C. F. 2014; 113 (3): 468-473

    Abstract

    Assessments of labour pain focus on pain intensity, not on duration. We aimed to assess the importance labouring women apply to pain intensity and duration before labour and post-delivery.Forty healthy women scheduled for labour induction were enrolled in this institutional review board-approved, prospective cohort study. Participants completed a pain preference questionnaire before active labour and within 24-h of delivery. The questionnaire consisted of seven stem questions that evaluated preference for pain intensity or duration. The pain preference ratio was determined by dividing the percentage of women who preferred reduced pain intensity for longer duration by that of those who preferred greater pain intensity for shorter duration (estimate of the odds). The overall hypothetical pain burden was determined by multiplying intensity by time. All questions presented the same overall hypothetical pain burden.Pain preference questionnaire scores demonstrated preference for low intensity pain for a longer duration rather than higher intensity for a shorter duration, both pre-labour (P<0.001) and post-delivery (P<0.001): the null median imputed as 3 of 6 (i.e. no preference for pain intensity over pain duration). This preference for pain duration over intensity was greater post-delivery compared with before labour (P=0.03). There was a significant correlation (r=0.83; P=0.04) between the pain preference ratio vs overall hypothetical pain burden before labour but not after delivery (r=0.28; P=0.59).In this preliminary labour assessment, women preferred lower pain intensity at the cost of longer pain duration. This suggests that pain intensity is the primary driver of hypothetical pain burden-a preference reinforced post-delivery.

    View details for DOI 10.1093/bja/aeu149

    View details for PubMedID 24907280

  • Steps toward a national disaster plan for obstetrics. Obstetrics and gynecology Daniels, K., Oakeson, A. M., Hilton, G. 2014; 124 (1): 154-158

    Abstract

    Hospitals play a central role in disasters by receiving an influx of casualties and coordinating medical efforts to manage resources. However, plans have not been fully developed in the event the hospital itself is severely damaged, either from natural disasters like earthquakes or tornados or manmade events such as a massive electrical failure or terrorist attacks. Of particular concern is the limited awareness of the obstetric units' specialized needs in the world of disaster planning. Within the same footprint of any obstetric unit, there exists a large variety of patient acuity and needs including laboring women, postoperative patients, and healthy postpartum patients with their newborns. An obstetric-specific triage method is paramount to accurately assess and rapidly triage patients during a disaster. An example is presented here called OB TRAIN (Obstetric Triage by Resource Allocation for Inpatient). To accomplish a comprehensive obstetric disaster plan, there must be 1) national adoption of a common triage and evacuation language including an effective patient tracking system to avoid maternal-neonatal separation; 2) a stratification of maternity hospital levels of care; and 3) a collaborative network of obstetric hospitals, both regionally and nationally. However, obstetric disaster planning goes beyond evacuation and must include plans for shelter-in-place and surge capacity, all uniquely designed for the obstetric patient. Disasters, manmade or natural, are neither predictable nor preventable, but we can and should prepare for them.

    View details for DOI 10.1097/AOG.0000000000000326

    View details for PubMedID 24901273

  • On-time scheduled cesarean delivery start time process-improvement initiative. Obstetrics and gynecology Blumenfeld, Y. J., Riley, E., Hilton, G., Lee, H. C., El-Sayed, Y. Y., Druzin, M. L. 2014; 123: 138S-9S

    Abstract

    Cesarean deliveries comprise approximately 30% of all births, many of which are scheduled. Given the labile nature of labor and delivery units, scheduled cesarean deliveries are often delayed. Our aim was to improve on-time scheduled cesarean delivery start times.A multidisciplinary team (obstetrician-gynecologist, nursing, anesthesia, and hospital administration) met to review scheduled cesarean delivery data, identify logistic barriers to on-time starts, and develop a plan to improve cesarean delivery start times. After identifying possible barriers to on-time starts, the following process was instituted: planned preoperative visit 1-2 days before scheduled cesarean delivery, mandatory submission of History & Physical and consent forms by the time of the preoperative visit, and initial preparation of the first scheduled patient for cesaren delivery by nighttime nursing before morning change of shift. The process launched on March 1, 2013. Data from scheduled cesarean deliveries 6 months before and 3 months after the initiative were reviewed and analyzed.Of 1,298 total cesarean deliveries, 423 were scheduled, defined as cesarean delivery scheduled at least 24 hours in advance (300 before and 123 after the initiative). Sixty-four of 300 scheduled cesarean deliveries (21.3%) were on time before compared with 67 of 123 (54.5%) after the initiative began (P<.001). Among delayed cases, there was no difference in the average delay time between those before and after the initiative (55.7 compared with 54.4 minutes P=.93); however, 50.7% of cases were either on time or delayed by 15 minutes or less before the initiative compared with 69.9% of cases after (P<.001).A multidisciplinary initiative significantly increased scheduled cesarean delivery on-time start times.

    View details for DOI 10.1097/01.AOG.0000447113.07157.f3

    View details for PubMedID 24770007

  • Anesthetic management of a parturient with VACTERL association undergoing Cesarean delivery CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE Hilton, G., Mihm, F., Butwick, A. 2013; 60 (6): 570-576
  • Continuous spinal anesthesia for Cesarean hysterectomy and massive hemorrhage in a parturient with placenta increta CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE Sultan, P., Hilton, G., Butwick, A., Carvalho, B. 2012; 59 (5): 473-477

    Abstract

    We present anesthetic management using a continuous spinal anesthesia (CSA) technique in a patient with placenta increta who underwent elective Cesarean hysterectomy with massive postpartum hemorrhage.A 34-yr-old parturient (G3P2) was scheduled for Cesarean delivery and possible hysterectomy at 35(+3) weeks due to suspected placenta accreta. Her body mass index was 21 kg·m(-2) and she had a reassuring airway. Inadvertent dural puncture occurred during combined spinal-epidural (CSE) placement, and a decision was made to thread the epidural catheter and utilize a CSA technique. Following delivery of a healthy infant, morbid adherence of the placenta to the myometrium was confirmed, and a supracervical hysterectomy was performed. Eight litres of blood loss occurred postpartum requiring resuscitation with crystalloid 3,800 mL, colloid 1,500 mL, red blood cells 16 units, fresh frozen plasma 16 units, platelets 4 units, and cryoprecipitate 1 unit. The patient developed pulmonary edema requiring conversion to general anesthesia. The patient's cardiovascular status was stable throughout surgery, and her lungs were mechanically ventilated for 18 hr postoperatively in the intensive care unit. The intrathecal catheter was removed 24 hr after placement. She developed no adverse neurological sequelae and reported no postdural puncture headache. The pathology report confirmed placenta increta.A CSA technique may be a viable option in the event of inadvertent dural puncture during planned CSE or epidural placement in patients with a reassuring airway undergoing Cesarean delivery. Although a catheter-based neuraxial technique is appropriate for Cesarean hysterectomy for abnormal placentation, conversion to general anesthesia may be required in the event of massive perioperative hemorrhage and fluid resuscitation.

    View details for DOI 10.1007/s12630-012-9681-0

    View details for Web of Science ID 000302574200007

    View details for PubMedID 22395824

  • Non-invasive haemoglobin measurement in patients undergoing elective Caesarean section BRITISH JOURNAL OF ANAESTHESIA Butwick, A., Hilton, G., Carvalho, B. 2012; 108 (2): 271-277

    Abstract

    The ability to measure haemoglobin (Hb) real-time and non-invasively offers important clinical value in the assessment of acute changes in maternal Hb during the peripartum period. This study evaluates the Masimo Rainbow SET(®) Radical-7 Pulse CO-Oximeter in a pregnant population undergoing Caesarean section (CS).Fifty patients undergoing elective CS were enrolled in this prospective, controlled study and followed for 48 h after surgery. Non-invasive Masimo Hb (SpHb) values were compared with laboratory Hb values from venous blood samples drawn at baseline, immediately post-CS, and 24 h post-CS using the Bland-Altman plots. Longitudinal analysis of SpHb changes over time was performed using mixed-effects regression modelling.For the comparison between SpHb and laboratory Hb, SpHb displayed a significant positive bias at baseline {1.22 g dl(-1) [95% confidence interval (CI): 0.89-1.54]} and at 24 h post-CS [1.36 g dl(-1) (95% CI: 1.04-1.68)]. The bias immediately post-CS was 0.14 g dl(-1) (95% CI: -0.18 to 0.46). The limits of agreement at baseline, immediately post-CS, and at 24 h post-CS were: -0.9 and 3.33, -2.35 and 2.56, and -0.55 and 3.27 g dl(-1), respectively. The mean decrease in SpHb from baseline to 48 h post-CS was ?1 g dl(-1).The variability in bias and limits of agreements of the Rainbow SET(®) Radical-7 Pulse CO-Oximeter SpHb may limit its clinical utility for assessing Hb concentration in patients undergoing elective CS. Modifications are needed in the calibration of the device to improve accuracy and precision in an obstetric setting. The study was registered at clinicaltrials.gov (NCT01108471) before participant enrolment: URL=http://clinicaltrials.gov/ct2/show/NCT01108471?term=butwick&rank=1.

    View details for DOI 10.1093/bja/aer373

    View details for Web of Science ID 000299414800015

    View details for PubMedID 22116296

  • Non-invasive measurement of hemoglobin during cesarean hysterectomy: a case series INTERNATIONAL JOURNAL OF OBSTETRIC ANESTHESIA Butwick, A. J., Hilton, G., Riley, E. T., Carvalho, B. 2011; 20 (3): 240-245

    Abstract

    Obstetric patients diagnosed with abnormal placentation (placenta accreta, increta or percreta) are at increased risk of major postpartum hemorrhage and cesarean hysterectomy. Obstetric anesthesiologists are primarily involved in intraoperative transfusion management in these cases. Hemoglobin assessment is invaluable for assisting transfusion decision-making during the acute period of obstetric hemorrhage. However, laboratory and point-of-care tests of hemoglobin concentration are time-dependent and intermittent, and do not provide a real-time assessment of change during the acute phase of blood loss. A new non-invasive hemoglobin monitor has been introduced recently, which provides real-time measurement of hemoglobin values (SpHb) using multi-wavelength pulse co-oximetry. We present a review of five patients with suspected abnormal placentation who received SpHb monitoring during cesarean hysterectomy at our institution. We discuss the potential clinical utility of non-invasive hemoglobin monitoring for pregnant patients at high risk of obstetric hemorrhage, and the potential role of SpHb in guiding transfusion therapy.

    View details for DOI 10.1016/j.ijoa.2011.03.009

    View details for Web of Science ID 000293042800009

    View details for PubMedID 21640577

  • What were the perceptions of primary care teams on learning from a single multidisciplinary simulation-based training intervention? Education for primary care : an official publication of the Association of Course Organisers, National Association of GP Tutors, World Organisation of Family Doctors Strachan, A. N., Graham, A. C., Hormis, A. P., Hilton, G. 2011; 22 (4): 229-234

    Abstract

    Medical emergencies in general practice are uncommon and their management requires good teamwork, communication and effective use of the available resources by the whole primary care team. To address this need the Montagu Clinical Simulation Centre developed and delivered a half-day simulation-based medical emergencies course for primary care teams (GPs, practice nurses and administrative staff). Each half-day course comprises two simulated medical emergencies, which are video-taped and then debriefed. The course was evaluated using a multi-level approach by seeking the staff's reactions to the course, their learning, the behaviour changes produced and the results for the organisation. We gained this information through self-reporting using end-of-course and follow-up questionnaires. The immediate feedback was very positive, showing they had learnt the objectives set. We then surveyed all those who had attended training between 2003 and 2007. A follow-up questionnaire was developed and sent to the practice managers who then co-ordinated their completion and return using a pre-paid return envelope. The survey was carried out in two cohorts. The first set of follow-up questionnaires was sent out in September 2004 to all those that had attended up to the end of May 2004 and the second set sent out in May 2008 to those who had attended between June 2004 and May 2007. Of the 338 available to complete the follow-up questionnaire, 208 responded, giving a response rate of 62%. Eighty percent of practices had made changes to equipment, emergency protocols or training and 20% of the participants had been involved in managing a medical emergency since attending the course. Of those, 86% indicated that their management and confidence had improved, that they were better able to take a lead role, give instruction and delegate tasks as required. Based on the self-reported perceptions of learning, we believe that the lessons learnt have been translated into positive changes at a personal and practice level for all members of the primary care team. The participants valued the chance to train as a complete unit. We plan to evaluate simulation-based training in the workplace to see if this has a greater impact.

    View details for PubMedID 21781389

  • Failure to Ventilate with the Drager Apollo (R) Anesthesia Workstation ANESTHESIOLOGY Hilton, G., Moll, V., Zumaran, A. A., Jaffe, R. A., Brock-Utne, J. G. 2011; 114 (5): 1238-1240

    View details for Web of Science ID 000289980200029

    View details for PubMedID 21430517

  • Kinked Perifix® FX Springwound epidural catheters Canadian Journal of Anesthesia Hilton, G., Jette, C. G., Ouyang, Y., Riley, E. T. 2011; 58 (4): 413-14

Stanford Medicine Resources: