International journal of obstetric anesthesia最新文献

{"title":"Patient perspectives in obstetric anaesthesia reports and invaluable learning for clinicians – In response to “A decade of obstetric anaesthetic case reports publications: a focused review”","authors":"M. Mostafa , A. Impiumi , R. Howle , R. Kearsley","doi":"10.1016/j.ijoa.2025.104346","DOIUrl":"10.1016/j.ijoa.2025.104346","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104346"},"PeriodicalIF":2.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704122","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":"Erratum to \"Pre-oxygenation using high flow nasal oxygen or face mask oxygen in pregnant people - A prospective randomised controlled crossover non-inferiority study (The HINOP2 study)\" [Int J Obstet Anesth 60 (2024) 104236].","authors":"P C F Tan, P J Peyton, A Deane, J Unterscheider, A T Dennis","doi":"10.1016/j.ijoa.2025.104333","DOIUrl":"https://doi.org/10.1016/j.ijoa.2025.104333","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":" ","pages":"104333"},"PeriodicalIF":2.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633899","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":"Neonatal acid-base status before and after discontinuing routine left uterine displacement for elective cesarean delivery: a retrospective cohort study (2014–2017)","authors":"Keyanna L. Jackson ,&nbsp;Richard M. Smiley ,&nbsp;Allison J. Lee","doi":"10.1016/j.ijoa.2025.104350","DOIUrl":"10.1016/j.ijoa.2025.104350","url":null,"abstract":"<div><h3>Background</h3><div>Maintaining left uterine displacement during cesarean delivery has been a decades-long recommendation to mitigate aortocaval compression. We abandoned the practice at our institution following the publication in 2017 of our study showing that maternal supine position did not impair neonatal acid-base status compared with 15 degrees left tilt, when maternal systolic blood pressure was maintained with a crystalloid coload and prophylactic phenylephrine infusion. We hypothesized that there would be no difference in mean umbilical artery base excess between neonates delivered by elective cesarean section with spinal anesthesia during the periods before and after our change in practice.</div></div><div><h3>Methods</h3><div>Maternal demographics and neonatal outcomes were obtained by retrospective review of electronic health records in 2014 (‘with tilt’) and 2017 (‘no tilt’). Cases with elective cesarean delivery of singleton pregnancies at term with spinal anesthesia were selected consecutively in each year. Routine practice included crystalloid coloading and prophylactic phenylephrine infusion targeted at maintaining maternal baseline systolic blood pressure. The primary outcome was mean umbilical artery base excess, analyzed using an unpaired <em>t</em>-test for two groups.</div></div><div><h3>Results</h3><div>There were no differences in umbilical artery or vein base excess or pH ‘with tilt’ (n=201) vs. ‘no tilt’ (n=202). There was also no significant difference between groups in the number of outliers with respect to neonatal umbilical artery base excess, pH, Apgar scores or need for resuscitation.</div></div><div><h3>Conclusion</h3><div>No tilt of surgical table in elective cesarean delivery cases with spinal anesthesia did not affect neonatal acid-base status compared with a historical cohort when maternal tilt was routine.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104350"},"PeriodicalIF":2.6,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143642299","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":"Intrathecal morphine 100 µg versus 150 µg for post-cesarean delivery analgesia: a retrospective cohort study (2020–2022)","authors":"M. Kim ,&nbsp;S.M. Rubright ,&nbsp;T. Pham ,&nbsp;M. Fuller ,&nbsp;A.S. Habib","doi":"10.1016/j.ijoa.2025.104348","DOIUrl":"10.1016/j.ijoa.2025.104348","url":null,"abstract":"<div><h3>Background</h3><div>In the context of multimodal analgesia, the optimal dose of intrathecal morphine (ITM) for post-cesarean analgesia remains unclear. In January 2022, the dose of ITM was reduced from 150 µg to 100 µg without other changes in our analgesic regimen with the assumption that ITM 100 µg provides comparable analgesia to ITM 150 µg with fewer opioid-related side effects.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study including cases from January 2020 through October 2022, we identified all cesarean delivery cases with a neuraxial technique with ITM. The primary outcome was oral opioid use in the first 24 hours. Opioid use in oral morphine equivalents (OME) was compared using zero-inflated negative binomial models, and antiemetic and antipruritic use was compared using logistic regression models.</div></div><div><h3>Results</h3><div>There were 3293 cases included in the analysis (1689 with ITM 150 µg and 1604 with ITM 100 µg). There was no significant difference between the groups in the primary outcome of opioid consumption in the first 24 hours in both the unadjusted and adjusted analysis [mean ratio (95% CI) = 1.03 (0.96 to 1.11); <em>P</em> = 0.373]. With ITM 100 µg, antiemetic use was less likely [OR = 0.65 (0.55 to 0.76)] and so was treatment for pruritus [OR = 0.16 (0.12 to 0.21)] compared with ITM 150 µg.</div></div><div><h3>Conclusions</h3><div>When used with multimodal analgesia, a lower ITM dose of 100 µg provided comparable analgesia with lower incidence of opioid-related side effects compared with an ITM dose of 150 µg.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104348"},"PeriodicalIF":2.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628601","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":"Clinical, economic and environmental evaluation of CoolStick compared to ethyl chloride to assess neuraxial sensory block level for caesarean delivery: a prospective observational study","authors":"H. Bykar,&nbsp;R. Craig,&nbsp;J.E. O’Carroll,&nbsp;S. Bampoe,&nbsp;P.M. Odor","doi":"10.1016/j.ijoa.2025.104349","DOIUrl":"10.1016/j.ijoa.2025.104349","url":null,"abstract":"<div><h3>Background</h3><div>CoolStick is a steel cylindrical device designed to be refrigerated and provide a sustainable, cost efficient alternative to vapo-coolant sprays when assessing cold sensation of neuraxial anaesthesia. We compared sensory block level testing with ethyl chloride and CoolSticks. We aimed to investigate the clinical efficacy, economic, environmental and practical considerations of CoolStick use.</div></div><div><h3>Methods</h3><div>Assessments of sensory block height were made using ethyl chloride and CoolStick prior to caesarean delivery according to a standardised protocol. Block height to cold sensation was compared to light touch using cotton wool. Patient feedback was collected to determine ease of discrimination between testing methods. Statistical analysis of concordance were assessed using the Kappa test, and depicted using Bland-Altman plots.</div></div><div><h3>Results</h3><div>50 patients undergoing caesarean delivery were included. Block assessment using ethyl chloride and CoolStick showed good agreement bilaterally (κ = 0.77, 0.63) and good concordance on Bland-Altman plot. Block level agreement with cotton wool was poor with both CoolStick (κ = 0.086, κ = 0.044) and ethyl chloride (κ = 0.076, κ = 0.035). Switching to routine CoolStick use in a hospital with 5500 deliveries may save £9,500 annually while preventing 229.32 kg of potentially unnecessary CO₂ equivalent emissions in the first year, and 238.4 kg each year thereafter.</div></div><div><h3>Conclusions</h3><div>CoolStick offers clinical equivalency to ethyl chloride for sensory block level assessment. Switching to using CoolStick may represent a positive economic and environmental movement.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104349"},"PeriodicalIF":2.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704787","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":"Impaired diaphragmatic excursion following magnesium sulfate administration in patients with preeclampsia with severe features: a prospective observational study","authors":"Mina Adolf Helmy,&nbsp;Lama Mostafa,&nbsp;Nashwa S. El-zayyat,&nbsp;Mai A. Ali,&nbsp;Rabab Sabry","doi":"10.1016/j.ijoa.2025.104347","DOIUrl":"10.1016/j.ijoa.2025.104347","url":null,"abstract":"<div><div>Magnesium sulfate is recognized for its muscular relaxant properties on both smooth and skeletal muscles; nevertheless, there are no prior studies examining the impact of magnesium administration on diaphragmatic movement, namely diaphragmatic excursion. Therefore, we aimed to evaluate diaphragmatic excursion as assessed by ultrasound before and after magnesium sulfate administration. Patients with a diagnosis of preeclampsia with severe features were screened for eligibility. Forty-seven patients with preeclampsia with severe features were included and available for final analysis. There was a significant reduction in diaphragmatic excursion 20 minutes after magnesium sulfate administration. Additionally, this study provides new insight into the dose effect between serum magnesium level and diaphragmatic excursion characterized by a negative correlation between serum magnesium level and diaphragmatic excursion, demonstrating that increased serum magnesium level is associated with increased diaphragmatic weakness.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104347"},"PeriodicalIF":2.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631993","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":"Anaesthesia for caesarean delivery in women with class 3 obesity: a retrospective cohort study from the north-west of England (2022–2023)","authors":"K. Bhatia ,&nbsp;M. Columb ,&nbsp;B. Roberts ,&nbsp;K. Turner ,&nbsp;E. Coffey ,&nbsp;H. Moxon ,&nbsp;M. Baker ,&nbsp;C. Pollington ,&nbsp;J. Lie ,&nbsp;S. Dixon ,&nbsp;W. Musselbrook ,&nbsp;M. Hulgur ,&nbsp;T. Markey ,&nbsp;S. Kumari ,&nbsp;M. Burrow ,&nbsp;A. Sashankar ,&nbsp;on behalf of Group of Obstetric Anesthetists of Lancashire, Greater Manchester, Mersey GOAL-GM Study Collaborators","doi":"10.1016/j.ijoa.2025.104343","DOIUrl":"10.1016/j.ijoa.2025.104343","url":null,"abstract":"<div><h3>Background</h3><div>The Royal College of Anaesthetists (RCOA) and the Royal College of Obstetricians and Gynaecologists (RCOG) have recommended standards for pregnant women with a body mass index (BMI) ≥40 kg/m². These include achieving specified rates for neuraxial anaesthesia and conversion from neuraxial to general anaesthesia (GA) during caesarean delivery (CD), 100% attendance at the anaesthesia antenatal clinic, re-weighing in the third trimester, and anaesthesia provision by a specialty trainee year 6 (ST6) or above.</div></div><div><h3>Methods</h3><div>Records of 760 women with BMI ranging from 40.0-49.99 kg/m² (89.7%), 50.0–59.99 kg/m² (8.9%) and ≥ 60 kg/m² (1.4%) undergoing a CD were reviewed across nine maternity units in the north-west of England. We aimed to analyse the variations in anaesthetic technique across the BMI cohorts, assess adherence with the proposed standards and explore the documented incidence of pain during CD (PDCD).</div></div><div><h3>Results</h3><div>Neuraxial anaesthesia was successfully utilised in 92.6% women. Spinal anaesthesia rates declined as BMI increased from ≥40–49.99 kg/m² (81.1%) to ≥50–59.99 kg/m² (67.2%) to ≥60 kg/m² (45.5%), (<em>P</em> =0.0001), whilst combined spinal epidural (CSE) use increased (4% vs 19.4% vs 45.5%, <em>P</em> &lt;0.0001). No differences were observed in the primary GA (3.7%; <em>P</em> =0.12) or the neuraxial to GA conversion rates (3.8%; <em>P</em> =0.54) across the BMI cohorts. The neuraxial anaesthesia standards for all CD categories were met by at least 66.7% of all hospitals, whilst the neuraxial to GA conversion standards for elective CD were met by only 33.3%. PDCD was documented in 6.1% and only 24.9% of women were re-weighed in the third trimester. Anaesthetic clinic attendance was recorded in 57% whilst a ST6 or above provided anaesthesia to 87.1% of women.</div></div><div><h3>Conclusion</h3><div>As BMI increases, anaesthetists tend to favour a CSE technique over spinal anaesthesia. Maternity units found it challenging to comply with the specified RCOA/RCOG standards.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104343"},"PeriodicalIF":2.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143684531","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":"Intravenous dexmedetomidine use in obstetric anesthesia: a focused review","authors":"M.S. Douglas ,&nbsp;L.J. Soloniuk ,&nbsp;J. Jones ,&nbsp;R. Derderian ,&nbsp;C. Baker ,&nbsp;G. Stier","doi":"10.1016/j.ijoa.2025.104345","DOIUrl":"10.1016/j.ijoa.2025.104345","url":null,"abstract":"<div><div>Dexmedetomidine is an alpha-₂ adrenergic receptor agonist with analgesic properties. Dexmedetomidine is currently U.S. Food and Drug Administration (FDA) approved for intravenous (IV) administration in non-pregnant patients. However, it has shown promise for various off-label indications in obstetric anesthesia. This review focuses on reported uses for IV dexmedetomidine in obstetric anesthesia. Intravenous dexmedetomidine has reported efficacy for producing light sedation, analgesia, and anxiolysis in the parturient. In addition, the use of IV dexmedetomidine during cesarean delivery has been reported to alleviate symptoms of postpartum depression and reduce the incidence of shivering and postoperative nausea and vomiting. In the setting of trauma, IV dexmedetomidine may reduce the risk of post-traumatic stress disorder. Further understanding of IV dexmedetomidine’s benefits and the recent advances in its clinical use allows clinicians to leverage its versatility to improve patient outcomes.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104345"},"PeriodicalIF":2.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628603","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":"POCUS and pre-eclampsia: bedside echocardiography to guide resuscitation in cardiogenic shock with pre-eclampsia with severe features – a case report from a low and middle income country","authors":"M. Schram ,&nbsp;F. Uys ,&nbsp;J. Purcell-Jones ,&nbsp;C.L. Pfister","doi":"10.1016/j.ijoa.2025.104342","DOIUrl":"10.1016/j.ijoa.2025.104342","url":null,"abstract":"<div><div>Pre-eclampsia is the second leading cause of maternal mortality worldwide, with over 99% of deaths occurring in low and middle income countries (LMICs). In South Africa, pre-eclampsia and obstetric haemorrhage are among the three primary causes of maternal mortality. These conditions pose significant challenges for even the most experienced healthcare providers with regular exposure to obstetric patients. Pre-eclampsia with severe features, in its most extreme form, can present with diastolic and systolic dysfunction and cardiogenic shock. This, in combination with a hypocoagulable state and hypovolemic shock from postpartum haemorrhage (PPH), can present a resuscitation conundrum for the anaesthetist. Point-of-care-ultrasonography (POCUS) is a useful tool to guide management of these complicated obstetric resuscitations.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104342"},"PeriodicalIF":2.6,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394990","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":"A decade of obstetric anaesthetic case reports publications: a focused review","authors":"R. Eshel ,&nbsp;A. Berman ,&nbsp;C.F. Weiniger","doi":"10.1016/j.ijoa.2025.104341","DOIUrl":"10.1016/j.ijoa.2025.104341","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104341"},"PeriodicalIF":2.6,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386990","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}