The University of Western Australia

UWA Staff Profile


Michael Paech

W/Prof Michael Paech

Chair of Obstetric Anaesthesia

Contact details

Address Division of Anaesthesiology
The University of Western Australia (M510)
35 Stirling Highway
CRAWLEY WA 6009
Australia
Phone 9340 2200

Biography

Professor Mike Paech has a Chair of Obstetric Anaesthesia in the Pharmacology and Anaesthesiology Unit of the School of Medicine and Pharmacology, the University of Western Australia. He trained in South Australia and the UK and has longstanding interests in obstetric anaesthesia, pain medicine, undergraduate and postgraduate teaching and clinical research, having directed departmental research at Royal Perth and King Edward Memorial Hospitals.
He is an editor of the journal Anaesthesia and Intensive Care and on the editorial boards of two international obstetric anaesthesia journals. He has represented the Australian and New Zealand College of Anaesthetists a member of the Research, Examinations and WA Regional Committees, various working parties and the National Advisory Committee on Maternal Mortality. He has represented the Australian Society of Anaesthetists on the National Scientific Congress sub-committee and was scientific program convenor for the 2007 annual congress; and on the World Federation of Societies of Anaesthesiology Obstetric Committee. He is currently past-President of the Asian and Oceanic Society of Regional Anaesthesia and Pain Medicine.

Key research

  • My research interests are predominantly in clinical anaesthesia and analgesia, with a focus on clinical pharmacology but including applied basic research. Research at King Edward Memorial Hospital for Women relates especially to regional (spinal and epidural) anaesthesia during pregnancy and to acute pain management, with special interests in the application of patient-controlled epidural analgesia and innovative drug delivery technologies; the efficacy and safety of intraspinal analgesic drugs; the complications of central neural block; consumer satisfaction; and the pharmacology of drugs administered during lactation (in collaboration with Emeritus Professor Ken Ilett).
  • Other research areas of interest (also at Royal Perth Hosiptal) include day-care anaesthesia, postoperative pain relief and perioperative outcome, for example the impact of anaesthesia on postoperative morbidity and the prevention of postoperative nausea and vomiting. I have collaborations with the Australian and New Zealand College of Anaesthetists Trials Group and with colleagues in Australasia and overseas.

Major research interests

  • Acute pain management
  • Obstetric anaesthesia and analgesia
  • Perioperative outcome

Qualifications

MB BS Adel., DA, DRCOG, FRCA, FANZCA, FFPMANZCA

Publications

Books (n=1)Handbook of Obstetric Anesthesia. Palmer C, D’Angelo R, Paech M (eds) 2002 Bios Publishers, Oxford
Book Chapters & Gazetted Materials (n=15)
Review Articles, Clinical Practice Guidelines and Editorials (n=22)
Letters (n=17)
Peer-reviewed Journal Articles (n=106)
Last 12-
Paech MJ, Ilett KF, Hackett LP, Page -Sharp M. Disposition and clinical outcome after intraperitoneal meperidine and ropivacaine administration during laparoscopic surgery. Anesth Analg 2008; 106:278-286
Ilett KF, Paech MJ, Page-Sharp M et al. Use of a sparse sampling study design to assess transfer of tramadol and its O-desmethyl metabolite into transitional breast milk. Br J Clin Pharm 2008;65:661-6
Myles PS, Chan MTV, Leslie K, Peyton P, Paech M, Forbes A. Effect of nitrous oxide on plasma homocysteine and folate in patients undergoing major surgery. Br J Anaesth 2008;100:780-786
POISE Study Group. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomized controlled trial. Lancet. 2008; 371: 1839-1847.
MJ Paech, KL Scott, OM Clavisi, S Chua, N McDonnell and the ANZCA Trials Group. A prospective study of awareness and recall associated with general anaesthesia for caesarean section. Int J Obstet Anesth 2008; 17:298-303
NJ McDonnell, MJ Paech, OM Clavisi, KL Scott and the ANZCA Trials Group. Difficult and failed intubation in obstetric anaesthesia: an observational study of airway management and complications associated with general anaesthesia for caesarean section. Int J Obstet Anesth 2008; 17:292-297
Leslie K, Myles PS, Chan MTV, Paech MJ, Peyton P, Forbes A. McKenzie D and the ENIGMA Trial Group. Risk factors for severe post-operative nausea and vomiting in a randomized trial of nitrous oxide-based vs nitrous oxide-free anaesthesia. Br J Anaesth 2008;101:498-505
Lim SCB, Paech MJ, Goy R, Liu Y, Zhang G, Yao M, Doherty DA. Pharmacokinetics and bioavailability of hydromorphone nasal spray. J Pharm Prac Research 2008;38:191-195
Tan L-H, Cokis CJ, Weightman WM, Manopas AR, Paech MJ, Nazir HS, Hackett LP. The effect of open-chest surgery in the lateral position on blood propofol concentration during target-controlled infusion of propofol. Anaesth Intensive Care 2008;36:798-801
Flisberg P, Paech MJ, Shah T, Ledowski T, Kurowski I, Parsons R. Induction dose of propofol in patients using cannabis. Euro J Anaesthesiol 2009; 26:192-195.
Myles PS, Leslie K, Peyton P, Paech M, Forbes A, Chan MTV, Sessler D, Devereaux PJ, Silbert BS, Jamrozik K, Beattie S, Badner N, Tomlinson J, Wallace S, and the ANZCA Trials Group. Nitrous oxide and perioperative cardiac morbidity (ENIGMA-II) trial: rationale and design. Am Heart J 2009;157:488-494.e1
McDonnell NJ, Paech MJ, Browning R, Nathan EA. Oral oxycodone versus intrathecal morphine for post caesarean analgesia; a randomised controlled trial. Int J Obstet Anesth 2009, doi:10.1016/j.ijoa.2009.03.004

Roles, responsibilities and expertise

With my colleagues Professor Stephan Schug and Professor Thomas Ledowski I am responsible for undergraduate teaching and training of 4th, 5th and 6th year medical students. I mentor several medical students. I am actively involved in the Australian and New Zealand College of Anaesthetists postgraduate training in areas such as teaching and training; simulation; curriculum development and assessment. I supervise students and colleagues completing various postgraduate degrees.
I am frequently called on to teach at local, national and international meetings and scientific congresses. I regularly peer-review for more than a dozen medical journals, am on the editorial board of two international obstetric anaesthesia journals and am an editor of the sole Australasian anaesthetic journal. Administratively I have been the chair of international obstetric and regional anaesthesia groups and on the committee of other similar organisations.
My research responsibilities include directorship of a small but active research team based at King Edward Memorial Hospital for Women and in the past a similar role at Royal Perth Hospital. I have been on several hospital research and ethics committees and am a long-standing member of the College of Anaesthetists Research and Trials Committees.
My clinical expertise lies in anaesthesia and analgesia for the pregnant woman and in acute pain management. I am viewed as an international expert in specific topics within these fields of practice.

Future research

My current and planned research trials are listed -
Effect on recovery of bowel function of tramadol and morphine after bowel resection

The efficacy of volume for epidural blood patch

The safety of parecoxib in breast milk

The effect of PressureRight acupressure wrist bands on nausea and vomiting during labour and delivery

Nitrous oxide anaesthesia and cardiac events after major surgery (ENIGMA II)

The transversus abdominis plane block, alone and in combination with intrathecal morphine, for post caesarean pain: A randomised controlled trial.

Are neuroprostanes detectable in the cerebrospinal fluid of pregnant women and are they elevated in those with pre-eclampsia?; a cohort study
Comparison of the EpiSure™ Autodetect™ syringe with the Portex loss-of-resistance syringe: a randomised controlled trial

The influence of antiemetic doses of dexamethasone on postoperative lymphocyte sub-populations after abdominal surgery

Determination of equipotent infusion doses of metaraminol and phenylephrine to prevent hypotension at spinal anaesthesia for caesarean section

An evaluation of a new ambulatory patient-controlled analgesia pump

The pharmacokinetics of a new formulation of fentanyl wafer

The effect of epidural pethidine after caesarean on human lactation and infant breast-feeding

A randomised trial of parecoxib/celecoxib, paracetamol or both in combination, with patient-controlled epidural analgesia after caesrean section

Funding received

In total I have attracted research grant funding to the tune of several million dollars.
My grants in the past 5 years are listed -
National Health & Medical Reseach Council of Australia 2003-5
Evaluation of nitrous oxide in the gas mixture for anaesthesia: a randomised controlled trial (The ENIGMA Trial).
$465,000

Women and Infants Research Foundation 2003
Randomised evaluation of single-use laryngeal masks
$9,645

Women and Infants Research Foundation 2003
Beta trace protein in the cerebrospinal fluid and serum of pregnant women
$9,935

2004 Abbott / ASA Research Grant
Epidural blood patch: volume and efficacy
$40,000 2003

Australian and New Zealand College of Anaesthetists 2003
Safety of tramadol during breast feeding
$55,793

Australian and New Zealand College of Anaesthetists 2003
Intranasal hydromorphone; pharmacokinetics and clinical effect
$27,979

National Health & Medical Reseach Council of Australia 2003-6
Perioperative beta-blockade to prevent cardiac morbidity in high-risk patients undergoing surgery (the POISE study).
$601,000

Australian and New Zealand College of Anaesthetists 2004
Nasal versus epidural fentanyl for patient controlled analgesia after caesarean section
$41,653

Pfizer 2005
Single dose pregabalin for postoperative analgesia after minor gynaecological surgery.
$25,000

Australian and New Zealand College of Anaesthetists
Australasian survey of obstetric general anaesthesia for caesarean section 2006
$ 5,144

National Health & Medical Reseach Council of Australia 2006-2007
Perioperative beta-blockade to prevent cardiac morbidity in high-risk patients undergoing surgery (the POISE study).
$374,000

Australian and New Zealand College of Anaesthetists 2007
Skin conductance monitoring to predict hypotension after spinal anaesthesia for elective caesarean section
$15,149

Australian and New Zealand College of Anaesthetists 2007
Transfer of parecoxib into breast milk: a study of postoperative use after caesarean section
$45,549

National Health & Medical Reseach Council of Australia 2007-2011
Nitrous oxide anaesthesia and cardiac morbidity after major surgery. A randomised controlled trial (ENIGMA II)l
$2.7 million

Australian and New Zealand College of Anaesthetists
Regular oral analgesia compared with intrathecal morphine for postoperative analgesia after caesarean section 2007
$34,986

The Australian Society fo Anaesthetists/ Abbott Australia 2008
Comparison of the EpiSure™ Autodetect™ syringe with the Portex loss-of-resistance syringe: a randomised controlled trial
$40,000

Women and Infants Research Foundation 2008
Epidural Pethidine after Caesarean Section. A Pilot Study of Initiation of lactation, Plasma and Milk Levels of Pethidine and Norpethidine and the Behaviour of Breast-fed Infants (The EPACS Study)
$15,000

Neurotrauma Research Program (NRP) 2009
Neuroprostanes Reflect Ongoing Neurological Injury
$89,944.

Pfizer Pharmaceuticals 2009
Celecoxib, paracetamol or their combination for analgesia after caesarean section
$25,000

Women and Infants Research Foundation 2008
Determination of equipotent infusion doses of metaraminol and phenylephrine to prevent hypotension at spinal anaesthesia for caesarean section
$13,000

Western Australian Department of Health (SHRAC) 2009
Electronic support systems for preoperative assessment and management – improved quality and reduced cost
$150,000

The Jackson Rees Research Grant, Australian Society of Anaesthetists 2010
Pre-Epidural Rapid Ultra Sound Assessment of Anatomical Landmarks, Observational Pilot Study
$15,000

Industrial relevance

I am involved in research of innovative approaches to analgesic drug delivery although to date this has not been commercialised. I have been or am a consultant to a number of pharmaceutical and medical equipment companies.

Languages

I am English speaking only.

Memberships

Australian and New Zealand College of Anaesthetists 1986-

Faculty of Pain Medicine, Australian and New Zealand College of Anaesthetists 1999-

Australian Society of Anaesthetists 1988-

Society of Obstetric Anesthesia and Perinatology 1996-

Perinatal Society of Australian and New Zealand 1998-

Obstetric Anaesthetists’ Association 2005-

Australian Medical Association 1998-

Society of Obstetric Medicine of Austalia and New Zealand 2004-

Asian and Oceanic Society of Regional Anaesthesia and Pain Medicine 1999-

Honours and awards

The Boots / Australian Society of Anaesthetists Young Investigator Award 1988

The Dr. John Boyd Craig / College of Anaesthetists Annual Award 1991 & 2003

Honorary Research Fellow, Women and Infants Research Foundation, WA 1996-

The Australian Society of Anaesthetists “Australasian Visitor”
and the 2nd Kester Brown Lecturer, Dunedin NZ 1998

Clinical Associate Professor, University of Western Australia 1999-

Honorary Fellowship of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists 2006

Lennard Travers Professor, ANZCA 2007

Previous positions

Visiting Specialist Anaesthetist
Royal Perth Hospital, Perth, Western Australia 2000-

Head, Department of Anaesthesia
King Edward Memorial Hospital for Women, Perth, Western Australia 1993-1996

Staff Specialist Anaesthetist
King Edward Memorial Hospital for Women, Perth, Western Australia 1988-2002

Part-time Clinical Lecturer in Anaesthesia
Department of Surgery, University of Western Australia 1988-1999

Staff Specialist Anaesthetist
National Womens' and Auckland Hospitals, Auckland, New Zealand 1986-87

Patents

Nil

Teaching

The topics I am most frequently asked to teach are any aspect of obstetric anaesthesia; pain relief in labour and pregnancy; postoperative pain relief; complications of epidural and spinal anaesthesia; intraspinal analgesics; management of obstetric haemorrhage and preeclampsia; postoperative nausea and vomiting; anaesthesia and perioperative outcome and clinical research.

Current external positions

Nil

New and noteworthy

I have just assumed a number of administrative positions as head of the UWA anaesthesiology unit in WA during the absence of Professor Stephan Schug who is on study leave. I will commence sabbatical myself in February 2010 and be overseas until November 2010.

Current projects

In addition to my research projects listed above, I am currently co-writing a new obstetric anaesthesia textbook (a previous book was published in 2002).

Research profile