International journal of obstetric anesthesia最新文献

{"title":"Preoperative gastric ultrasound guiding anesthetic management of a patient with cyclic vomiting syndrome: a case report","authors":"Saranya Lertkovit , Lauren Anderson , William Camann","doi":"10.1016/j.ijoa.2025.104365","DOIUrl":"10.1016/j.ijoa.2025.104365","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104365"},"PeriodicalIF":2.6,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143844936","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":"Shedding more light on the management of intraoperative pain during cesarean delivery: a review of the American Society of Anesthesiologists statements","authors":"Antonio Gonzalez-Fiol , Kristen L. Fardelmann , Ruth Landau","doi":"10.1016/j.ijoa.2025.104360","DOIUrl":"10.1016/j.ijoa.2025.104360","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104360"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792393","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":"Spinal morphine for cesarean delivery: a little goes a long way.","authors":"Philip E Hess, Richard Smiley","doi":"10.1016/j.ijoa.2025.104363","DOIUrl":"https://doi.org/10.1016/j.ijoa.2025.104363","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":" ","pages":"104363"},"PeriodicalIF":2.6,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811372","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":"Racial health disparities in severe maternal morbidity before and after implementation of an enhanced recovery after cesarean delivery protocol: a retrospective observational study at two NYC hospitals (2016–2020)","authors":"A.T. Gilman ,&nbsp;J. Kim ,&nbsp;S.Y. Jiang ,&nbsp;S.E. Abramovitz ,&nbsp;R.S. White","doi":"10.1016/j.ijoa.2025.104362","DOIUrl":"10.1016/j.ijoa.2025.104362","url":null,"abstract":"<div><h3>Background</h3><div>Enhanced recovery after cesarean delivery (ERAC) is an evidence-based pathway that aims to improve the quality of care for all patients. Standardization of care has been seen as a tool to promote equality and equity. Our goal was to evaluate racial differences in severe maternal morbidity (SMM) among patients before and after implementation of an ERAC program.</div></div><div><h3>Methods</h3><div>A retrospective study was performed among cesarean delivery patients pre- and post-ERAC implementation at two large academic hospitals in New York City from October 2016 to September 2020. Logistic regression models were created to compare peripartum SMM complications pre-ERAC, post-ERAC, and overall, by race.</div></div><div><h3>Results</h3><div>The sample consisted of 7,812 cesarean delivery patients, of which 4,640 were pre-ERAC (59.4%) and 3172 were post-ERAC (40.6%). Within the overall population, Black (aOR 1.57, 95% CI 1.07 to 2.28; <em>P</em>=0.018) and Asian (aOR 1.61, 95% CI 1.20 to 2.14; <em>P</em>=0.001) patients had higher odds of SMM compared to white patients. Pre-ERAC, Black (aOR 1.92, 95% CI 1.16 to 3.14; <em>P</em>=0.010) and Asian patients (aOR 1.86, 95% CI 1.26 to 2.74; <em>P</em>=0.002) had higher odds of SMM relative to white patients. Post-ERAC, this relationship was no longer statistically significant [Black (aOR 1.13, 95% CI 0.61 to 2.01; <em>P</em>=0.69) and Asian (aOR 1.39, 95% CI 0.88 to 2.17; <em>P</em>=0.15)].</div></div><div><h3>Conclusion</h3><div>Implementation of the ERAC protocol improved SMM outcomes by race. Standardization of practices in ERAC protocols can help address disparities by reducing variations in obstetrical care.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104362"},"PeriodicalIF":2.6,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143767654","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":"Low dose intrathecal morphine for post-cesarean analgesia with scheduled multimodal pain regimen: a prospective, randomized, open blinded end-point study","authors":"K.H. Hatter ,&nbsp;N.W. Shugart ,&nbsp;N. Paladugu ,&nbsp;H. Nitchie ,&nbsp;B. Wolf ,&nbsp;L. Hebbar","doi":"10.1016/j.ijoa.2025.104361","DOIUrl":"10.1016/j.ijoa.2025.104361","url":null,"abstract":"<div><h3>Background</h3><div>The intrathecal morphine dose in combination with multimodal analgesia providing optimal pain management post-cesarean delivery while minimizing side effects has not been determined. We performed a prospective, randomized, open blinded end-point study comparing intrathecal morphine 50 μg vs. 100 μg combined with scheduled intravenous ketorolac and oral acetaminophen for post-cesarean delivery analgesia.</div></div><div><h3>Methods</h3><div>Participants received intrathecal hyperbaric bupivacaine 12 mg, fentanyl 15 µg and a randomized dose of intrathecal morphine 50 μg vs. 100 μg followed by intravenous ketorolac 30 mg every six hours and oral acetaminophen 1000 mg every eight hours for the first 24 hours. Oral oxycodone and intravenous morphine were administered based on pain scores. The primary outcome was time to first analgesic request (opioid rescue dose) in the first 24 hours, analyzed using intent to treat and the hypothesis of non-inferiority using a log-rank testing approach and assuming a non-inferiority margin of a hazard ratio of 1.65.</div></div><div><h3>Results</h3><div>There were 201 participants randomized to intrathecal morphine 50 μg vs. 100 μg. The median time to first rescue dose was 23.5 hours postoperatively for the 50 μg cohort (95% CI 15.2, 28.3) and 22.9 hours postoperatively with the 100 μg cohort (95% CI 13.8, 28.2). The probability of requesting an opioid rescue dose was similar between the two treatment groups during the first 24 hours. Postoperative pruritus, nausea, vomiting, total opioids used, pain at rest and with ambulation, and time to first ambulation were not different between the two cohorts.</div></div><div><h3>Conclusion</h3><div>With ketorolac and acetaminophen, intrathecal morphine 50 μg was not inferior to 100 μg evaluating time to first opioid rescue dose and opioid use over time. There were no differences in secondary outcomes.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104361"},"PeriodicalIF":2.6,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776660","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":"Arterial bleed from an epidural puncture site: a case report","authors":"R. Cowden,&nbsp;R. Hignett","doi":"10.1016/j.ijoa.2025.104357","DOIUrl":"10.1016/j.ijoa.2025.104357","url":null,"abstract":"<div><div>This case highlights a rare complication of superficial arterial bleeding from an epidural puncture site.</div><div>A 27-year-old primigravida was admitted for induction of labour at 38 weeks' gestation due to obstetric cholestasis. An epidural for labour analgesia was inserted at spinal level L4-L5 with a 16G Tuohy needle. Blood-stained fluid was noted on aspiration, prompting its removal. Subsequently, there appeared to be arterial bleeding from the epidural site, which persisted despite prolonged pressure with epinephrine and tranexamic acid soaked swabs. The bleeding was ultimately controlled using a purse-string suture and subcutaneous epinephrine 20 μg on each side of the bleeding site, with a<!--> <!-->total estimated blood loss of 500 mL. There were no neurological concerns and no cardiovascular changes or evidence of formation of a superficial haematoma following the interventions.</div><div>Epidural related arterial bleeding is exceptionally rare and the primary concern is the risk of an epidural haematoma, especially if the source of the bleeding is unknown. There are only four case reports in the literature detailing superficial arterial bleeding following an epidural with differing management strategies including a purse-string suture or varying doses of subcutaneous epinephrine (30 μg−300 μg). Both techniques carry potential risks.<!--> <!-->In this case, a combination of a purse-string suture and low-dose subcutaneous epinephrine effectively controlled the bleeding, with no complications. We recommend using the lowest effective dose of subcutaneous epinephrine with vigilant maternal and fetal monitoring. Any lower limb neurological changes warrants urgent imaging and a neurosurgical evaluation to exclude an epidural haematoma.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104357"},"PeriodicalIF":2.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747029","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":"Is prophylactic tranexamic acid effective in preventing postpartum hemorrhage? almost certainly no","authors":"Anne-Sophie Bouthors ,&nbsp;Maxence Hureau ,&nbsp;Alexander Butwick","doi":"10.1016/j.ijoa.2025.104356","DOIUrl":"10.1016/j.ijoa.2025.104356","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104356"},"PeriodicalIF":2.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776779","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":"In response to “Patient perspectives in obstetric anaesthesia reports: invaluable learning for clinicians”","authors":"R. Eshel,&nbsp;A. Berman,&nbsp;C.F. Weiniger","doi":"10.1016/j.ijoa.2025.104358","DOIUrl":"10.1016/j.ijoa.2025.104358","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104358"},"PeriodicalIF":2.6,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747030","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":"Effectiveness of artificial intelligence (AI) chatbots in providing labor epidural analgesia information: are we there yet?","authors":"Paige M Keasler ,&nbsp;Joel Chee Yee Chan ,&nbsp;Ban Leong Sng","doi":"10.1016/j.ijoa.2025.104353","DOIUrl":"10.1016/j.ijoa.2025.104353","url":null,"abstract":"<div><div>Artificial intelligence (AI) chatbots have gained popularity in healthcare. Their ability to understand and respond to language queries make them suitable for many practical applications ranging from medical advice to counselling. However, AI chatbots’ ability to provide personalized complex medical information about labor epidural analgesia may be limited. In this Editorial, we highlight findings from four recent publications in our Journal related to the use of AI chatbots and their effectiveness to provide or enhance patient education on labor epidural analgesia. Effectiveness can be measured by evaluating AI chatbots’ accuracy, readability, completeness, sentiment, and overall quality. While AI chatbots are promising tools for patient education, studies show that they may provide incomplete or inaccurate responses. Based on existing anesthesia societies and associations' guidelines, developing standards to assess the medical rigor and users’ comprehension of chatbot-generated responses is needed to ensure optimized patient education.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104353"},"PeriodicalIF":2.6,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739091","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":"Environmental and occupational risks with use of nitrous oxide (Entonox®) for labour analgesia: a qualitative analysis of midwives’ attitudes in the United Kingdom","authors":"R. Craig ,&nbsp;J. O’Carroll ,&nbsp;S. Bampoe ,&nbsp;P.M. Odor ,&nbsp;D. Kamming","doi":"10.1016/j.ijoa.2025.104359","DOIUrl":"10.1016/j.ijoa.2025.104359","url":null,"abstract":"<div><h3>Background</h3><div>Nitrous oxide carries significant environmental impact and has been linked to harm related to occupational exposure. In the United Kingdom, midwives are primarily responsible for administering nitrous oxide in the form of Entonox®. The aim of this study was to understand midwives’ perceptions related to the effects of nitrous oxide and barriers to change in the pursuit of net zero emissions.</div></div><div><h3>Methods</h3><div>This qualitative study was conducted at a single teaching hospital. An interview guide was developed for the conduct of this study with thematic analysis conducted using an inductive approach to determine common themes. A total of 10 participants consented and participated in semi-structured interviews.</div></div><div><h3>Results</h3><div>Three themes were identified; mixed awareness of environmental and occupational risk; midwifery culture as a barrier to change; and the identification of drivers for innovation and change.</div></div><div><h3>Conclusions</h3><div>Efforts to mitigate the environmental and occupational effects of nitrous oxide may require focused early educational policies and engagement with midwives to co-design demand- and supply-side mitigations to reduce harmful emissions from Entonox® delivery.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104359"},"PeriodicalIF":2.6,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143724966","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}