International journal of obstetric anesthesia最新文献

{"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}

{"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 ,&nbsp;A. Impiumi ,&nbsp;R. Howle ,&nbsp;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":"Blood pressure management for caesarean delivery under spinal anaesthesia: a UK multi-centre audit (2023)","authors":"J Blackburn ,&nbsp;EJ Yates ,&nbsp;MS Jarvis ,&nbsp;CL Small ,&nbsp;J Kerr ,&nbsp;J Patel ,&nbsp;J Yeung ,&nbsp;on behalf of West Midlands Trainee Research in Anaesthesia and Intensive Care Network (WMTRAIN) Collaborators","doi":"10.1016/j.ijoa.2025.104352","DOIUrl":"10.1016/j.ijoa.2025.104352","url":null,"abstract":"<div><h3>Background</h3><div>Untreated sympathetic blockade after spinal anaesthesia for caesarean delivery can cause profound maternal hypotension. National Institute for Health and Care Excellence (NICE) guidance recommends systolic blood pressure (SBP) should be maintained ≥90% of the baseline. This multi-centre audit assessed compliance with guidance regarding choice and administration method of vasopressors during caesarean delivery under spinal anaesthesia.</div></div><div><h3>Methods</h3><div>A multi-centre prospective audit of adult patients undergoing caesarean delivery under spinal anaesthesia was undertaken across the West Midlands, UK. Anonymised patient data was obtained during routine peri-operative care and audited across primary, process and clinical outcomes. The primary audit outcome was maintenance of intra-operative SBP at ≥90% baseline.</div></div><div><h3>Results</h3><div>Five-hundred-and-twenty-six patients were included. The primary outcome was achieved in 9.1% of cases. SBP was maintained within 80–90% of baseline in 65.0%, and below 80% of baseline in 25.9%. Phenylephrine was the first-line vasopressor in 91% of cases, administered via a rate-controlled device in 73.8%. Compliance with the international consensus recommendation for prophylactic phenylephrine via a rate-controlled device at 25–50 μg/min was 37.6%. Clinician-reported incidence of intra-operative nausea and vomiting were 24.9% and 8.4% respectively. Secondary analysis found that use of rate-controlled pump devices to administer prophylactic vasopressors was associated with reduced incidence of SBP decrease to &lt;80% of baseline (<em>P</em> &lt;0.01).</div></div><div><h3>Conclusions</h3><div>Intraoperative hypotension is common, and there is lack of adherence to guidance, including variation in choice and administration method of prophylactic vasopressors. Optimal management of hypotension should be incorporated into departmental guidance for enhanced recovery.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104352"},"PeriodicalIF":2.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760983","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":"Online patient information on labour epidural analgesia provided by UK NHS hospitals: assessment of readability and improvement of readability standards using ChatGPT","authors":"Valentin Weber ,&nbsp;Adam Truelove ,&nbsp;Shireen S. Gohari ,&nbsp;Luke A. Wynne ,&nbsp;Rachel J. Kearns ,&nbsp;James E. O’Carroll","doi":"10.1016/j.ijoa.2025.104344","DOIUrl":"10.1016/j.ijoa.2025.104344","url":null,"abstract":"<div><h3>Background</h3><div>Labour epidurals are considered the gold standard for labour analgesia in pregnant patients. Inequities in health literacy levels can negatively impact understanding of online patient education materials, potentially affecting uptake of labour epidural analgesia. Generative artificial technology such as ChatGPT may be able to improve readability of patient information materials.</div></div><div><h3>Objectives</h3><div>Firstly, to assess the readability of available online materials on labour epidurals in the United Kingdom (UK). Secondly, to evaluate the ability of generative artificial technology to improve readability.</div></div><div><h3>Methods</h3><div>All UK public hospitals' websites performing obstetric anaesthesia were searched for patient education materials relating to labour epidurals. A readability assessment was conducted using three readability scoring systems. ChatGPT was used to rewrite content of online patient information material on labour epidural analgesia to be understandable by an individual with the health literacy level of an 11-year-old (sixth grade).</div></div><div><h3>Results</h3><div>A total of 61.6% of UK hospitals provided some form of online patient education materials on labour analgesia and epidurals, 14.5% and 23.2% of the texts, met the target readability in two commonly used readability scores, respectively. The mean grade (8.4 ± 2.1) did not meet target readability levels. After AI-modification, 24.6% and 27.5% of the texts met targets using the same metrics, with the mean grade (7.7 ± 1.2) decreasing significantly (<em>P</em> &lt;0.001), but still not meeting the target level.</div></div><div><h3>Conclusion</h3><div>Online patient-information on labour epidural analgesia frequently exceeds the recommended sixth grade reading level. ChatGPT can be used to enhance readability but also fails to meet recommended health literacy standards.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104344"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739092","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}