International journal of obstetric anesthesia最新文献

{"title":"“This is how we do it” Maternal and fetal anesthetic management for fetoscopic myelomeningocele repairs: the Texas Children's Fetal Center protocol","authors":"Claire A. Naus ,&nbsp;David G. Mann ,&nbsp;Dean B. Andropoulos ,&nbsp;Michael A. Belfort ,&nbsp;Magdalena Sanz-Cortes ,&nbsp;William E. Whitehead ,&nbsp;Caitlin D. Sutton","doi":"10.1016/j.ijoa.2024.104316","DOIUrl":"10.1016/j.ijoa.2024.104316","url":null,"abstract":"<div><div>Prenatal repair of myelomeningocele (MMC) is associated with lower rates of hydrocephalus requiring ventriculoperitoneal shunt and improved motor function when compared with postnatal repair. Efforts aiming to develop less invasive surgical techniques to decrease the risk for the pregnant patient while achieving similar benefits for the fetus have led to the implementation of fetoscopic surgical techniques. While no ideal anesthetic technique for fetoscopic MMC repair has been demonstrated, we present our anesthetic approach for these repairs, including considerations for both the pregnant patient and the fetus. We emphasize the importance of the preoperative consultation to optimize any medical conditions and to set expectations for the perioperative course. Our preferred anesthetic technique for the pregnant patient includes general anesthesia with an epidural for postoperative analgesia. Intraoperative anesthetic considerations for patients undergoing fetoscopic surgery include tocolysis, meticulous control of hemodynamics, judicious fluid administration, and maternal temperature regulation. We also avoid long-acting neuromuscular blocking agents due to significant weakness observed when given in combination with magnesium sulfate. While the maternal anesthetic crosses the placenta, direct administration of anesthesia to the fetus is required to reliably blunt the stress response. Additional considerations for the fetus include monitoring, fetal resuscitation strategies, and the theoretical risk of anesthetic neurotoxicity. Postoperatively, we use a multi-modal, opioid sparing regimen for analgesia. As advances in fetal surgery aiming to minimize risk to the pregnant patient alter the surgical approach, maternal-fetal anesthesiologists must adapt and incorporate the unique considerations of fetoscopy into their anesthetic management.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104316"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894481","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":"Novel bimanual haptic simulator for epidural loss-of-resistance detection: a pilot study assessing movement strategies and performance across anesthesiologist experience levels","authors":"Yair Binyamin ,&nbsp;Nitsan Davidor ,&nbsp;Sharon Orbach-Zinger ,&nbsp;Tamar Hayuni ,&nbsp;Ilana Nisky","doi":"10.1016/j.ijoa.2024.104321","DOIUrl":"10.1016/j.ijoa.2024.104321","url":null,"abstract":"<div><h3>Background</h3><div>Correct identification of the epidural space requires extensive training for technical proficiency. This study explores a novel bimanual haptic simulator designed for the precise insertion of an epidural needle based on loss-of-resistance (LOR) detection, providing realistic dual-hand force feedback.</div></div><div><h3>Methods</h3><div>The simulator, equipped with two haptic devices connected to a Tuohy needle and an LOR syringe, was designed to simulate the tissues’ resistive forces felt by the user during the procedure, offer anatomical variability and record detailed performance metrics for personalized feedback. We assessed the simulator’s validity through attempts conducted by anesthesiologists of varying experience levels, analyzing success rates, error sizes, the impact of patient weight, and movement strategies.</div></div><div><h3>Results</h3><div>Performance varied significantly with the expertise level of the anesthesiologists. Experts achieved higher success rates and smaller errors, demonstrating the simulator’s construct validity. Patient weight influenced outcomes, with higher weights leading to more failed epidurals and lower weights resulting in increased accidental dural punctures. Successful attempts typically involved more probing movements, particularly near the epidural space.</div></div><div><h3>Conclusions</h3><div>The innovative bimanual haptic simulator shows significant potential as a tool for assessing epidural skills and differentiating expertise levels. Its ability to provide realistic, concurrent feedback for both hands, adapt to patient anatomical variations, and generate precise metrics for performance evaluation distinguishes it from existing simulators. However, further research is necessary to establish its value as a training tool. Planned studies will focus on developing an effective training protocol and evaluating the long-term educational impact of the simulator, determining whether its integration into residency programs can improve patient outcomes.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104321"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927084","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":"Artificial intelligence chatbots versus traditional medical resources for patient education on “Labor Epidurals”: an evaluation of accuracy, emotional tone, and readability","authors":"Prakash Gyandev Gondode,&nbsp;Ram Singh,&nbsp;Swati Mehta,&nbsp;Sneha Singh,&nbsp;Subodh Kumar,&nbsp;Sudhansu Sekhar Nayak","doi":"10.1016/j.ijoa.2024.104302","DOIUrl":"10.1016/j.ijoa.2024.104302","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104302"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806869","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":"Quality of recovery after cesarean delivery in patients with Class III obesity: a prospective observational cohort study","authors":"Khader Zimmo ,&nbsp;Justin Ching-Johnson ,&nbsp;Philip M Jones ,&nbsp;Sudha I Singh ,&nbsp;Aldo Dobrowlanski ,&nbsp;Yahui T Symons ,&nbsp;Barbra de Vrijer ,&nbsp;Pervez Sultan ,&nbsp;Brendan Carvalho ,&nbsp;Ilana Sebbag","doi":"10.1016/j.ijoa.2024.104312","DOIUrl":"10.1016/j.ijoa.2024.104312","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104312"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864169","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":"Urinary retention during and after labor with programmed intermittent epidural bolus (PIEB) analgesia: a prospective observational study","authors":"Willemijn Lips ,&nbsp;Corina S. Sie ,&nbsp;Liv M. Freeman","doi":"10.1016/j.ijoa.2024.104326","DOIUrl":"10.1016/j.ijoa.2024.104326","url":null,"abstract":"<div><h3>Background</h3><div>This study investigates the incidence and risk factors for urinary retention during and after labor in women receiving programmed intermittent epidural bolus (PIEB) analgesia and evaluates the optimal bladder management strategy.</div></div><div><h3>Methods</h3><div>This prospective observational study assessed urinary retention during voiding attempts every two to three hours during labor and postpartum, among women with labor epidural analgesia using PIEB. Urinary retention was defined as a post-void residual volume &gt;150 mL, determined by catheterization after spontaneous voiding.</div></div><div><h3>Results</h3><div>Among 137 women included, with 277 voiding attempts during labor, the urinary retention rate was 20.6%, occurring in 48 women (35%). When the spontaneously voided volume was &gt;50 mL, urinary retention was observed in less than 10% of attempts. Postpartum urinary retention occurred in nine women (6.7%) with a mean post-void residual volume of 1133 ± 447 mL; all were nulliparous, seven had induced labor, and five had an episiotomy.</div></div><div><h3>Conclusions</h3><div>Women who are able to successfully void during labor have a low risk of intrapartum urinary retention. We would recommend considering catheterization every 3 to 4 hours for women who are unable to urinate spontaneously, void less than 50 ml, or experience complete motor blockade during labor.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104326"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005315","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":"Maternal exposure to general anesthesia and labor epidural analgesia during pregnancy and delivery, and subsequent neurodevelopmental outcomes in children","authors":"Oliver G. Isik ,&nbsp;Caleb Ing","doi":"10.1016/j.ijoa.2024.104318","DOIUrl":"10.1016/j.ijoa.2024.104318","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104318"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927062","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":"“This is how we do it”: disseminating protocols for enhanced fetal safety and maternal recovery after fetoscopic myelomeningocele repairs","authors":"David Berman ,&nbsp;Ruth Landau","doi":"10.1016/j.ijoa.2024.104319","DOIUrl":"10.1016/j.ijoa.2024.104319","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104319"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143038836","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":"Recovery after cesarean delivery in patients with obesity: do we need to look beyond the body mass index?","authors":"A.S. Habib","doi":"10.1016/j.ijoa.2024.104314","DOIUrl":"10.1016/j.ijoa.2024.104314","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104314"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871976","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 and clinical characteristics associated with pain during cesarean delivery: a prospective single-center patient-reported outcome study","authors":"J. Litman ,&nbsp;R. Bates ,&nbsp;S.R. Lindheim ,&nbsp;E.E. Sharpe ,&nbsp;J.C. Ehrig ,&nbsp;M.P. Hofkamp","doi":"10.1016/j.ijoa.2024.104324","DOIUrl":"10.1016/j.ijoa.2024.104324","url":null,"abstract":"<div><h3>Introduction</h3><div>There are multiple variables known to be associated with pain during cesarean delivery (PDCD), including patient-related factors, obstetrical and surgical factors, and anesthetic technique. The primary aim of this prospective patient-reported outcome study was to evaluate patient-related factors, including expectations and anxiety, and clinical variables associated with PDCD.</div></div><div><h3>Methods</h3><div>Patients undergoing cesarean delivery from December 1, 2023 to March 31, 2024 were enrolled 24 to 72 hours postoperatively. They completed the STAI-6 anxiety survey, a 13-item catastrophizing survey, a question about expected PDCD, and reported PDCD on a 0–100 mm visual analog scale (VAS). We defined PDCD as a VAS score <span><math><mo>≥</mo></math></span>30 mm. Demographic, physical, and clinical data were retrieved from the electronic medical record.</div></div><div><h3>Results</h3><div>There were 110 recruited patients with 40 (36%) reporting PDCD. Patients who had PDCD differed in race, surgical duration, and administration of supplemental systemic analgesic medication. A multivariate logistic regression identified that surgical duration, history of anxiety, intrapartum activation of epidural (versus spinal or combined spinal epidural) and Black race (versus White) were associated with PDCD. There were 33 (30%), 48 (44%), 14 (13%), 7 (6%), and 7 (6%) patients who reported no pain, pain less than expected, pain that was expected, more pain than expected, and much more pain than expected during their cesarean delivery, respectively.</div></div><div><h3>Conclusions</h3><div>In our cohort with a high reported PDCD rate, potentially modifiable variables associated with PDCD were initial anesthetic technique and surgical duration. A concerning finding was that most patients reported some level of PDCD.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104324"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005272","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":"Platelet aggregation and thromboelastometry monitoring in women with preeclampsia: a prospective observational study","authors":"Malin Andersson ,&nbsp;Peter Bengtsson ,&nbsp;Ove Karlsson ,&nbsp;Sven-Egron Thörn ,&nbsp;Lilja Thorgeirsdottir ,&nbsp;Lina Bergman ,&nbsp;Jonatan Oras ,&nbsp;Birgitta Romlin","doi":"10.1016/j.ijoa.2024.104297","DOIUrl":"10.1016/j.ijoa.2024.104297","url":null,"abstract":"<div><h3>Background</h3><div>Thrombocytopenia affects 12–20% of women with preeclampsia and a low platelet count impairs coagulation. Women with preeclampsia have an increased risk of both cerebral hemorrhage, thromboembolism, and postpartum hemorrhage. Studies of platelet function and coagulation in women with preeclampsia show conflicting results. Therefore, we aimed to study platelet aggregation and coagulation in women with preeclampsia.</div></div><div><h3>Method</h3><div>Women with preeclampsia and women with normotensive pregnancies were included prior to delivery in a prospective observational study as a part of the Gothenburg Preeclampsia Adverse Event (GoPROVE) Biobank and Database. Sampling and analyses were performed shortly before delivery. Platelet count was analyzed and impedance aggregometry was used for examining platelet adhesion and aggregation. Thromboelastometry was used to assess coagulation.</div></div><div><h3>Results</h3><div>Ninety-three women with preeclampsia and 45 normotensive pregnant control patients were included. There was no difference in platelet aggregation (adenosine diphosphate, ADP-test), (arachidonic acid, ASPI-test) or (thrombin receptor-activating peptide, TRAP-test) between women with preeclampsia and women with normotensive pregnancies. Women with preeclampsia had lower platelet counts, shorter clotting (EXTEM-CT and INTEM-CT) and clot formation (EXTEM-CFT and INTEM-CFT) times than women with normotensive pregnancies. Platelet aggregation and coagulation were hyperactivated in women with preeclampsia and normal platelet counts. In women with preeclampsia and thrombocytopenia, platelet aggregation and thromboelastic tests of coagulation were impaired compared with normotensive pregnancies.</div></div><div><h3>Conclusion</h3><div>Platelet aggregation and thromboelastic tests of coagulation are dependent on platelet counts in women with preeclampsia. At normal platelet counts, women with preeclampsia have hyperactivated tests of coagulation. In contrast, women with thrombocytopenia demonstrated lower coagulation test values.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104297"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005331","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}