International journal of obstetric anesthesia最新文献

{"title":"Pain during caesarean delivery: what gets measured, gets managed","authors":"","doi":"10.1016/j.ijoa.2024.104281","DOIUrl":"10.1016/j.ijoa.2024.104281","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142358087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstetric hemorrhage risk assessment using the maximum allowable blood loss calculation: are we on the right track?","authors":"","doi":"10.1016/j.ijoa.2024.104277","DOIUrl":"10.1016/j.ijoa.2024.104277","url":null,"abstract":"<div><div>The clinical guidelines on postpartum hemorrhage from the Society of Obstetricians and Gynaecologists of Canada (SOGC) provide evidence-based recommendations structured around the 6Rs framework: Risk Assessment, Risk Reduction, Recognition and Evaluation, Reaction, Resuscitation, and Review. Since its publication, our institution has begun implementing all the guideline recommendations. One key recommendation is to calculate the Maximum Allowable Blood Loss (MABL) to reach a hemoglobin level of 70 g/L for every obstetric patient. This practice was introduced to promote an individualized approach to hemorrhage risk assessment, accounting for variations in patients’ anthropometric characteristics. However, there is currently a lack of evidence supporting the use of MABL calculation in the obstetric population. In this commentary, we highlight the limitations of the MABL calculation through specific examples and propose areas for further research.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anaesthetic considerations for impacted fetal head at caesarean delivery: a focused review","authors":"","doi":"10.1016/j.ijoa.2024.104268","DOIUrl":"10.1016/j.ijoa.2024.104268","url":null,"abstract":"<div><h3>Background</h3><div>Impacted fetal head occurs when the fetal head is deeply engaged within the maternal pelvis and difficult to deliver during caesarean delivery. In order to deliver the fetal head, additional surgical manoeuvres and/or pharmacological tocolysis are needed. The aim of this focused review is to outline the incidence, risk factors, management and complications of this obstetric emergency from the perspective of the anaesthetist.</div></div><div><h3>Methods</h3><div>Databases were searched for free text headings and subject headings associated with different permutations of terms related to impacted fetal head and caesarean delivery.</div></div><div><h3>Results</h3><div>Impacted fetal head has been estimated to occur in 1.5 % of elective caesarean deliveries and 2.9–18.4% of all emergency caesarean deliveries at any cervical dilatation. Risk factors include advanced cervical dilatation, labour augmentation with oxytocin, prolonged second stage of labour, fetal malposition and junior grade of operating obstetrician. If impacted fetal head occurs, the anaesthetist in conjunction with the multidisciplinary team should consider decreasing the height of the operating table, providing a step for the obstetrician to stand on, placing the patient in the head down position, providing pharmacological tocolysis with glyceryl trinitrate (or nitroglycerin), beta-2 adrenoreceptor agonists or volatile anaesthetic agents, and managing complications such as postpartum haemorrhage.</div></div><div><h3>Conclusion</h3><div>Impacted fetal head is an obstetric emergency that the anaesthetist should be familiar with and has a vital role in managing. We propose an algorithm for management that may serve as a clinical decision aid.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of an interdisciplinary process to increase utilization of neuraxial anesthesia for cesarean delivery: A retrospective database analysis","authors":"","doi":"10.1016/j.ijoa.2024.104267","DOIUrl":"10.1016/j.ijoa.2024.104267","url":null,"abstract":"<div><h3>Background</h3><div>Neuraxial anesthesia is the preferred anesthesia mode for cesarean delivery (CD). The primary study aim was to study the rate of neuraxial anesthesia for cesarean delivery before and after educational strategies were implemented, focusing on neuraxial anesthesia use for CD.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of the mode of anesthesia for CD. Educational strategies to inform about neuraxial anesthesia for CD included interdisciplinary daily handovers and ward rounds, and interdisciplinary academic meetings and simulation sessions. We retrieved data from the hospital electronic record for mode of anesthesia for CD, intravenous supplementation, to assess the impact of our strategies on neuraxial anesthesia use for CD (2014–2023).</div></div><div><h3>Results</h3><div>The rate of neuraxial anesthesia increased from 89.8% in 2014 to 96.3% in 2023, with corresponding decrease in general anesthesia from 10.2% to 4.5% for all CD. The use of labor epidural augmentation for unplanned CD increased from 31.9% to 55.1%. Intravenous supplementation with spinal anesthesia for unplanned CD increased from 18.1% to 32.1%.</div></div><div><h3>Conclusions</h3><div>This study demonstrates the utility of educational strategies to increase neuraxial anesthesia use and highlights the importance of proactive interdisciplinary labor management.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcutaneous electrical acupuncture point stimulation and quality of recovery following cesarean delivery: A randomized controlled trial.","authors":"A Polat, B Kozanhan, M Yildiz, O Gunenc, M S Tutar","doi":"10.1016/j.ijoa.2024.104266","DOIUrl":"https://doi.org/10.1016/j.ijoa.2024.104266","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Avoidable general anesthesia for nonobstetric surgery during pregnancy: A retrospective cohort pilot study (2011-2020).","authors":"J-P Salaün, A Baron, T Simonet, A Chagnot, A Alves, R Fauvet, S Albadri, E Villeneuve, L J Salomon, M-P Bonnet, G Orliaguet, J-L Hanouz, L Bouvet, H Keita","doi":"10.1016/j.ijoa.2024.104265","DOIUrl":"https://doi.org/10.1016/j.ijoa.2024.104265","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rate of difficult intubation during caesarean delivery: A single centre before/after standardised airway management implementation study.","authors":"Yitzhak Brzezinski Sinai, Eleni Anna Papadimitraki, Victor Rabkin, Chen Arviv, Boris Aptekman, Idit Matot, Carolyn Fiona Weiniger","doi":"10.1016/j.ijoa.2024.104264","DOIUrl":"https://doi.org/10.1016/j.ijoa.2024.104264","url":null,"abstract":"<p><strong>Background: </strong>The use of general anaesthesia (GA) for caesarean delivery (CD) introduces the risk of both difficult and failed intubation. Various strategies may be utilised to reduce this risk; however, not all are supported by evidence. We analysed the rate of difficult intubation following implementation of three recommendations specific to airway management in CD.</p><p><strong>Methods: </strong>This was a retrospective single-center study of CD cases performed under GA at a tertiary care center between January 2013 and December 2022. Cases with GA induced after delivery or with incomplete airway management records were not included in the analysis. We compared outcomes for cases before (2013-2018) versus after (2019-2022) implementation of three specific recommendations: (1) video laryngoscopy (VL) for the first intubation attempt; (2) the presence of a second anesthetist; (3) use of endotracheal tube size 6.5 mm. The primary outcome was difficult intubation, defined as a composite variable (> 1 intubation attempt, use of a rescue device, SpO₂ < 90%). We conducted univariable and adjusted analyses of plausible variables associated with difficult intubation, including age, body mass index, predicted difficult airway, and each of three recommendations.</p><p><strong>Results: </strong>We identified 1462 cases, 922 before and 540 after implementation. The frequency of difficult intubation was similar with 239 (25.9%) before versus 135 (25.0%) after implementation (p = 0.71; 95% CI -0.03 to 0.05). The recommendations were not associated with a decreased likelihood of difficult intubation in the univariable and adjusted models. Adoption of all three recommendations was significantly more frequent in the post-implementation period.</p><p><strong>Conclusion: </strong>Implementation of standardised airway management recommendations had no significant impact on difficult intubation rate, though adoption of all three recommendations was not universal.</p>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the 2017 revised Japanese obstetric hemorrhage management guidelines on tranexamic acid use in patients undergoing cesarean delivery: an interrupted time series analysis","authors":"","doi":"10.1016/j.ijoa.2024.104258","DOIUrl":"10.1016/j.ijoa.2024.104258","url":null,"abstract":"<div><h3>Background</h3><p>Tranexamic acid is one component of a complex management algorithm for postpartum hemorrhage. In Japan, the 2010 obstetric hemorrhage management guidelines was revised in 2017, adding the recommendation for the administration of tranexamic acid for postpartum hemorrhage. This research aims to delineate the temporal trends in tranexamic acid administration in patients undergoing cesarean deliveries and to examine the impact of the obstetric hemorrhage management guidelines implementation.</p></div><div><h3>Methods</h3><p>An interrupted time series analysis was conducted on data from patients who underwent cesarean deliveries from April 2012 to August 2021, sourced from Japan’s nationwide health insurance claims database. We examined the trends of tranexamic acid usage and blood transfusion use before and after the implementation of the revised guidelines in 2017.</p></div><div><h3>Results</h3><p>The study cohort comprised 91 166 cesarean deliveries. Prior to the guideline implementation, the rate of tranexamic acid usage decreased. Post-guidelines implementation, there was a statistically significant increase in the rate of tranexamic acid use, with a quarterly percentage change of 0.48% (95% confidence interval: 0.36 to 0.60; P &lt; 0.001). The guidelines implementation in 2017 was not significantly associated with a change in the rate of transfusions.</p></div><div><h3>Conclusions</h3><p>This interrupted time series analysis demonstrated a significant increase in the rate of tranexamic acid administration following the implementation of the revised guidelines, reversing the previously observed downward trend. Our findings could reflect the impact of the revised guideline on the use of tranexamic acid for postpartum hemorrhage, but this did not translate to fewer blood transfusions.</p></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as a strategy for postpartum haemorrhage management: A narrative review.","authors":"Michele Salvagno, Marta Grinza, Giacomo Coppalini, Alessandro de Cassai, Rossana Soloperto, Alessia Degrassi, Andrew Carlin, Filippo Annoni, Fabrizia Calabrese, Fabio Silvio Taccone","doi":"10.1016/j.ijoa.2024.104260","DOIUrl":"https://doi.org/10.1016/j.ijoa.2024.104260","url":null,"abstract":"<p><p>Postpartum hemorrhage (PPH) remains one of the leading causes of maternal mortality worldwide, with a significant impact on global health. Optimal management of PPH involves distinct steps executed simultaneously by a multidisciplinary approach, with anesthesiologists playing a key role in hemodynamic control and patient resuscitation. In this context, an aortic blood flow interruption through an internal balloon should be considered a rescue option among the various opportunities, to treat or prevent abdominal hemorrhages. Given this perspective, there is increasing interest in the role of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), originally used in trauma and military medicine, which has emerged as a novel strategy for managing PPH. Indeed, this technique has shown promise in managing severe cases of PPH, especially where traditional measures are insufficient. It also offers potential as a prophylactic measure in pregnancies with high risk for PPH, such as in the case of placenta accrete spectrum. This review aims to examine the efficacy, safety, and potential applications of REBOA in PPH management and prevention. At the same time, challenges such as the need for skilled operators, potential complications, costs, and the consideration of fetal safety were also discussed. REBOA presents as a promising tool against PPH, with efficacy in reducing blood loss, preserving fertility, and potentially decreasing maternal mortality and improving outcomes. However, its implementation requires careful consideration, training, and further research to establish clear guidelines for its use in obstetric care.</p>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prophylactic cosyntropin after unintentional dural puncture and incidence of post-dural puncture headache and epidural blood patch use: A retrospective cohort study (2019-2022).","authors":"E Ellis, J Salloum, M Hire, R J McCarthy, N Higgins","doi":"10.1016/j.ijoa.2024.104262","DOIUrl":"https://doi.org/10.1016/j.ijoa.2024.104262","url":null,"abstract":"<p><strong>Background: </strong>Cosyntropin has been suggested to decrease the incidence of post-dural puncture headache (PDPH) by increasing the production of cerebrospinal fluid. This study examined the association of prophylactic cosyntropin administration with the incidence of PDPH and its management with an epidural blood patch after an unintentional dural puncture (UDP).</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of cases with UDP during placement of neuraxial labor analgesia. Per institutional practice and at the discretion of the anesthesiologist, intravenous cosyntropin 1 mg may be administered for PDPH prophylaxis. PDPH, time from UDP to cosyntropin administration, time to development of PDPH, and management with epidural blood patch(es) were recorded.</p><p><strong>Results: </strong>Cosyntropin was administered in 164 of 234 (70%) cases with UDP. PDPH occurred 98/164 (60%) with cosyntropin and 45/70 (64%) without cosyntropin (p = 0.66). The PDPH adjusted incidence was 53% with cosyntropin and 62% without cosyntropin, difference 9% (95% CI -6% to 24%, p = 0.25). The adjusted epidural blood patch rate was 66% with cosyntropin and 78% without cosyntropin, difference of 12% (95% CI -5% to 28%, p = 0.17).</p><p><strong>Conclusions: </strong>Prophylactic cosyntropin following UDP was not associated with a significant decrease in PDPH rate or use of epidural blood patch for management of PDPH. There was no significant difference in the rate of adverse hyperglycemic or hypertensive events amongst those who did or did not receive cosyntropin.</p>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}