International journal of obstetric anesthesia最新文献

{"title":"Failed epidural analgesia in a childhood cancer survivor who received intrathecal chemotherapy: a case report","authors":"J.A. Francke ,&nbsp;T.J. Guidugli ,&nbsp;B.W. Taha ,&nbsp;L.C. Tsen ,&nbsp;M.K. Farber ,&nbsp;A. Monroe ,&nbsp;A.R. Woytash","doi":"10.1016/j.ijoa.2025.104685","DOIUrl":"10.1016/j.ijoa.2025.104685","url":null,"abstract":"<div><div>The incidences of childhood leukemia and non-Hodgkin lymphoma (NHL) in the United States have steadily risen in the past two decades. Many patients with hematopoietic and lymphoid malignancies will receive both systemic and intrathecal chemotherapy to treat primary leptomeningeal cancer or secondary metastatic disease. Female survivors of childhood cancers may eventually desire parenthood, and the impact of intrathecal chemotherapy on neuraxial analgesia and anesthesia is unclear. We report a case of a primigravid parturient who, as a survivor of adolescent NHL, was treated with systemic and intrathecal methotrexate and cytarabine. Upon presenting for induction of labor in the setting of preeclampsia, the patient requested labor epidural analgesia. A dural puncture epidural (DPE) technique was performed by an experienced anesthesiologist, and though the procedure was straightforward, it resulted in minimal analgesic effect. Subsequently, a combined spinal epidural (CSE) analgesia was performed, with approximately two hours of analgesia followed by no epidural analgesia. An intentional dural puncture (17G) with an intrathecal catheter (20G) was discussed and accepted by the patient, and despite CSF confirmation, the technique was aborted due to significant catheter resistance. Our case of failed analgesia with multiple neuraxial techniques in a parturient who had previously received intrathecal chemotherapy raises a management dilemma. Future investigations into the impact of type, dose, duration, and cycles of intrathecal chemotherapy; the possible value of antepartum imaging; and the success of epidural or spinal analgesia and anesthesia are warranted.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104685"},"PeriodicalIF":2.6,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124690","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":"Maternal physiological parameters and routine laboratory tests to screen for maternal sepsis: an observational cohort study","authors":"T. Culling ,&nbsp;C. Bertorelli ,&nbsp;A. Strang ,&nbsp;S. Oram ,&nbsp;F. Faggian ,&nbsp;S. Sharma ,&nbsp;A. Ridgeway ,&nbsp;Summia Zaher ,&nbsp;Mario Labeta ,&nbsp;Simon A. Jones ,&nbsp;Luke C. Davies ,&nbsp;John Watkins ,&nbsp;Kate Siddall ,&nbsp;Vikki Keeping ,&nbsp;Kathryn Simpson ,&nbsp;Maryanne Bray ,&nbsp;Peter Ghazal ,&nbsp;Sarah F. Bell ,&nbsp;Rachel E. Collis","doi":"10.1016/j.ijoa.2025.104683","DOIUrl":"10.1016/j.ijoa.2025.104683","url":null,"abstract":"<div><h3>Background</h3><div>Maternal sepsis can lead to poor outcomes for the mother and neonate, and early diagnosis and treatment of infection is important to prevent sepsis. Current guidance to recognise maternal sepsis includes assessment of physiological markers, however normal physiological changes of pregnancy can hinder the diagnosis of sepsis. This study investigated the utility of routine clinical variables, including laboratory tests, in screening for maternal sepsis.</div></div><div><h3>Methods</h3><div>Patients considered at risk of obstetric sepsis were recruited into a single centre cohort study. Microbiological, histological and clinical data categorised patients into three diagnostic groups: ‘infection confirmed’, ‘infection unknown’ and ‘infection unlikely’. Differences in physiological and routine laboratory variables were investigated.</div></div><div><h3>Results</h3><div>Between November 2020 and December 2022, 154 pregnant patients were recruited. Comparison between ‘infection confirmed’ (n=58) and ‘infection unlikely’ (n=17) showed statistical differences in temperature (<em>P</em> &lt;0.001), neutrophil count (<em>P</em> =0.003) and leukocyte count (<em>P</em> =0.004) at the time of recruitment. Temperature was the best discriminator with an area under the receiver operating characteristic curve (AUC-ROC) of 0.82 (95% CI 0.70 to 0.94, <em>P</em> &lt;0.0001) with an optimal threshold of ≥37.5°C.</div></div><div><h3>Conclusion</h3><div>This observational cohort study demonstrated that maternal temperature ≥37.5°C (rather than the threshold of 38°C found in most screening tools) may be important in screening patients at risk of developing maternal sepsis. When temperature ≥37.5°C persists, medical care should be expedited and maternal infection considered.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104683"},"PeriodicalIF":2.6,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144147272","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":"Intraoperative fentanyl versus paracetamol for ultrasound-guided oocyte retrieval analgesia: a randomised clinical trial","authors":"E. Farladansky ,&nbsp;B. Cohen ,&nbsp;B. Almog ,&nbsp;C. Weiniger ,&nbsp;S. Hazan ,&nbsp;L. Barzilay ,&nbsp;S. Haim","doi":"10.1016/j.ijoa.2025.104681","DOIUrl":"10.1016/j.ijoa.2025.104681","url":null,"abstract":"<div><h3>Background</h3><div>Despite its brief duration, transvaginal ultrasound-guided oocyte retrieval is a potentially painful procedure often managed with opioid-based sedation. This study evaluated whether intravenous paracetamol could provide postoperative analgesia comparable to fentanyl.</div></div><div><h3>Methods</h3><div>We investigated two multimodal anaesthesia regimens, one including intravenous (IV) paracetamol and the other IV fentanyl, for postoperative analgesia in a single-center, single-blinded, randomised, non-inferiority trial. Healthy women with ≤15 follicles identified by ultrasound undergoing oocyte retrieval under general anaesthesia (propofol) were randomised to receive IV paracetamol 1000 mg vs IV fentanyl 100 μg. The primary outcome was median postoperative pain on an 11-point numerical rating scale (NRS) scores (0 = no pain, 10 = worst imaginable pain) at five predefined time points within the first two postoperative hours. Secondary outcome measures included sedation scale (Pasero), Aldrete scale, discharge time, patient satisfaction with anaesthesia (5-point Likert scale), administration of supplemental analgesia and antiemetics.</div></div><div><h3>Results</h3><div>In total, 100 patients were enrolled with 95 cases analysed. Median [IQR] NRS scores were 0 [0–1] in the paracetamol group and 0 [0–1] in the fentanyl group (<em>P</em> =0.31), indicating non-inferiority. There were no differences between groups in the rate of low Pasero score (84% with paracetamol vs 87% with fentanyl, <em>P</em> =0.98), Aldrete scores, use of postoperative analgesia, prolonged discharge time (&gt;60 minutes) or satisfaction scores (median 5 in both groups, <em>P</em> =0.90).</div></div><div><h3>Conclusion</h3><div>Intra-operative IV paracetamol 1000 mg was non-inferior to fentanyl 100 μg for post-procedure analgesia, suggesting opioid-free anaesthesia may be an acceptable approach for ≤15 follicles ultrasound-guided oocyte retrievals.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104681"},"PeriodicalIF":2.6,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184949","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":"Head elevating device and cricothyroid membrane position in pregnant women with obesity class 3: an observational study","authors":"F. Zasso ,&nbsp;A. Spring ,&nbsp;J.F. Casellato ,&nbsp;E. Wild ,&nbsp;E. You-Ten ,&nbsp;J.C.A. Carvalho ,&nbsp;J. Morales ,&nbsp;K. Downey ,&nbsp;X.Y. Ye ,&nbsp;N. Siddiqui","doi":"10.1016/j.ijoa.2025.104680","DOIUrl":"10.1016/j.ijoa.2025.104680","url":null,"abstract":"<div><h3>Background</h3><div> <!-->Obesity and pregnancy are risk factors for difficult intubation. A head-elevating positioning device increases functional residual capacity and improves direct laryngoscopy. It is unclear what effect such device has on the airway anatomy. The primary aim of this study was to determine the change in distance from the sternal notch to the cricothyroid membrane (CTM) mid-point among pregnant women with class 3 obesity, comparing the supine positioning and the head-elevated position.</div></div><div><h3>Methods</h3><div> <!-->In this prospective observational study, 50 pregnant women with class 3 obesity provided their consent for participation, and airway anatomy was assessed with ultrasound when presenting either for elective cesarean delivery or in early stages of labor. The CTM’s depth and height were measured in supine (Time 1) and head-elevated (Time 2) positions. The CTM midpoint was established and the distance from this point to the sternal notch was obtained. The primary outcome was change in distance from sternal notch to CTM midpoint. Secondary outcomes included changes in CTM depth and height.</div></div><div><h3>Results</h3><div>The median (± standard deviation) sternal notch to CTM midpoint distance increased significantly from 41.07 mm (± 8.35 at Time 1 to 45.40 mm ± 8.97) at Time 2 (mean difference 4.33 mm, 95% CI 3.06 to 5.61, <em>P</em> &lt;0.0001). No differences were observed in CTM depth (mean difference −0.15 mm, <em>P</em> =0.66) or height (mean difference 0.34 mm, <em>P</em> =0.20).</div></div><div><h3>Conclusion</h3><div> <!-->Head elevation increased the distance from the sternal notch to the CTM midpoint but did not affect CTM depth or height in pregnant women with class 3 obesity. Further research is needed to assess neck ultrasound anatomy in high-risk patients for difficult intubation.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104680"},"PeriodicalIF":2.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144185008","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":"O.010 Pre-operative carbohydrate drink loading versus ‘Sip til send’: A randomised controlled trial of two fasting protocols at elective caesarean delivery","authors":"Shoaib Sadiq,&nbsp;Caitriona Murphy,&nbsp;Thomas Drew","doi":"10.1016/j.ijoa.2025.104389","DOIUrl":"10.1016/j.ijoa.2025.104389","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104389"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143934638","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":"P.028 How are sites across the UK escalating care during a postpartum haemorrhage?","authors":"Amrit Dhadda,&nbsp;Alexander Johnson,&nbsp;Sarah Bell","doi":"10.1016/j.ijoa.2025.104407","DOIUrl":"10.1016/j.ijoa.2025.104407","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104407"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143935053","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":"P.055 An 11 Year Review of Maternity Admissions to the Intensive Care Unit, Ulster Hospital, Northern Ireland","authors":"Hannah Houston,&nbsp;Leanne Laverty,&nbsp;Claire Jamison","doi":"10.1016/j.ijoa.2025.104433","DOIUrl":"10.1016/j.ijoa.2025.104433","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104433"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143935324","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":"P.052 Capnography waveform variation in obstetric anaesthetic areas across the UK","authors":"Mathew Lyons,&nbsp;Jennifer Proc,&nbsp;Alistair Mcnarry,&nbsp;Patrick Ward,&nbsp;Andrew Shepherd","doi":"10.1016/j.ijoa.2025.104430","DOIUrl":"10.1016/j.ijoa.2025.104430","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104430"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937212","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":"O.001 RotemSigma Assay use in Obstetric Haemorrhage: Is it time to review the FIBTEM A5 threshold?","authors":"Sahil Gupta,&nbsp;Sophie Scutt,&nbsp;Donna Davis","doi":"10.1016/j.ijoa.2025.104380","DOIUrl":"10.1016/j.ijoa.2025.104380","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104380"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937543","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":"P.027 Intraoperative cell salvage in major obstetric haemorrhage- does it make a difference?","authors":"Swati Gupta,&nbsp;Lewis Powell,&nbsp;Donna Davis,&nbsp;Sophie Scutt","doi":"10.1016/j.ijoa.2025.104406","DOIUrl":"10.1016/j.ijoa.2025.104406","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104406"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143935100","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}