International journal of obstetric anesthesia最新文献

{"title":"Remimazolam use in obstetric patients: a single-center retrospective study (2021–2024)","authors":"A. Goyal ,&nbsp;E.E. Sharpe ,&nbsp;M.T. Teixeira","doi":"10.1016/j.ijoa.2025.104750","DOIUrl":"10.1016/j.ijoa.2025.104750","url":null,"abstract":"<div><h3>Background</h3><div>Remimazolam is an ultra-short-acting intravenous benzodiazepine approved for procedural sedation and general anaesthesia. Its favourable pharmacokinetic profile, including rapid onset, short context-sensitive half-time, and minimal cardiovascular depression, makes it a potential agent for obstetric anaesthesia, where maternal stability and fetal safety are paramount.</div></div><div><h3>Methods</h3><div>This scoping review evaluates the pharmacologic profile, clinical applications, safety considerations, and emerging evidence for the use of remimazolam in obstetric settings. A comprehensive literature search was conducted using PubMed and Ovid databases (inception to April 1, 2025), for English-language manuscripts related to remimazolam use in obstetric contexts. Search terms included remimazolam during labour analgesia, caesarean delivery, termination of pregnancy, and procedural sedation during obstetric care. No restrictions were placed on study design or manuscript type; however, grey literature and non-peer-reviewed sources were excluded.</div></div><div><h3>Results</h3><div>The existing literature on remimazolam in obstetric anaesthesia consists primarily of case reports (n=), case series (n=) and randomised control trials (n=). These suggest that remimazolam may be safely used in high-risk obstetric populations including those with maternal cardiac disease, providing effective sedation, stable haemodynamic, high patient satisfaction and favourable maternal-fetal outcomes. The availability of flumazenil as a reversal agent adds a safety margin.</div></div><div><h3>Conclusion</h3><div>While preliminary findings are encouraging, the current evidence is limited by the small cohorts evaluated in studies. Larger prospective studies are needed to validate its efficacy, confirm maternal and neonatal safety, address fluid compatibility concerns, and support guideline development for obstetric use.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104750"},"PeriodicalIF":2.3,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145094881","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":"Chronic pain and long-term disability following postdural puncture headache in obstetric patients: a five-year prospective follow-up of a case-control cohort.","authors":"A Weiss, A Ioscovich, M Heesen, A Frenkel, D Shatalin, Y Gozal, S Orbach-Zinger, Y Binyamin","doi":"10.1016/j.ijoa.2025.104747","DOIUrl":"https://doi.org/10.1016/j.ijoa.2025.104747","url":null,"abstract":"<p><strong>Background: </strong>Unintended dural puncture is a recognized complication of neuraxial labor analgesia and has been associated with postdural puncture headache (PDPH). While short-term outcomes are well documented, long-term consequences remain poorly characterized. No previous study has reported follow-up beyond two years.</p><p><strong>Methods: </strong>This prospective case-control study followed 336 women up to five years after delivery. The cohort comprised 113 women who delivered without labor epidural analgesia, 113 women who delivered with uncomplicated labor epidural analgesia, 54 women with PDPH following an unintended dural puncture who were not treated with an epidural blood patch, and 56 women with PDPH following an unintended dural puncture who were treated with an epidural blood patch. Outcomes included the prevalence of chronic headache and backache assessed through standardized telephone questionnaires based on International Classification of Headache Disorders criteria, as well as functional impact over time evaluated using the Von Korff chronic pain grade questionnaire.</p><p><strong>Results: </strong>At five years, chronic headache was significantly more common in the two PDPH groups (20.4% with an epidural blood patch and 21.4% without) than in the control groups (5.3% with an uncomplicated epidural procedure and 0.9% without labor epidural; P <0.01). Chronic backache showed a similar pattern (20.8% and 16.1% vs. 5.3% and 0.9%, respectively; P <0.01). Most women reported persistent rather than resolving symptoms. Functional impairment increased over time, with high disability reported in 7 of 16 women (43.8%) with PDPH without an epidural blood patch and 4 of 14 women (28.6%) with PDPH with an epidural blood patch, who reported chronic pain at five years.</p><p><strong>Conclusions: </strong>This five-years follow-up study demonstrates that chronic pain (headache and backache) after an unintended dural puncture is a prolonged condition with substantial functional consequences, challenging its traditional characterization as a transient complication and underscoring the need for long-term follow-up and prevention.</p>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"104747"},"PeriodicalIF":2.3,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799058","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":"Letter to the Editor: Mothers' experiences of category 1 caesarean delivery under general anaesthesia with the partner present: a prospective explorative study.","authors":"K Brosnan","doi":"10.1016/j.ijoa.2025.104746","DOIUrl":"https://doi.org/10.1016/j.ijoa.2025.104746","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"104746"},"PeriodicalIF":2.3,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799059","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 pain during cesarean delivery: a qualitative concept elicitation study","authors":"P. Callihan ,&nbsp;Z.J. Cottrell Bekemeyer ,&nbsp;R. Pedreira ,&nbsp;G. Michel ,&nbsp;H. Sukhdeo ,&nbsp;J. O’Carroll ,&nbsp;B. Carvalho ,&nbsp;E. Martinez ,&nbsp;P. Sultan","doi":"10.1016/j.ijoa.2025.104748","DOIUrl":"10.1016/j.ijoa.2025.104748","url":null,"abstract":"<div><h3>Background</h3><div>Qualitative studies surrounding patient experiences of intraoperative pain during cesarean delivery (PDCD) are lacking. The primary outcome of this study was to identify themes that describe experiences of PDCD performed under neuraxial anesthesia from the patients' perspective. Secondary outcomes were to provide exemplar quotations for themes identified and summarize patient experiences.</div></div><div><h3>Methods</h3><div>This prospective qualitative study included semi-structured interviews of patients who delivered at Lucille Packard Children’s Hospital, Stanford, California, between 2023 and 2024. Consenting participants were English-speaking, 18–50 years old, who received a primary neuraxial anesthetic for CD of a live infant with a gestational age at time of delivery ≥25 weeks and reported PDCD on postpartum day 1 to 3. Recorded interviews occurred on postpartum day 1, 2 or 3, and patients were screened for post-traumatic stress symptoms and depression with PCL-5 and EPDS questionnaires during inpatient admission and at 6-weeks postpartum and referred to psychiatry services if indicated.</div></div><div><h3>Results</h3><div>Ten interviews were completed. Seven participants delivered via scheduled CD and three via intrapartum CD. Nine domains were proposed for the construct of PDCD: patient expectations, anesthesia care on the labor and delivery unit, interactions with staff, obstetric variables, anesthesia care in the operating room, patient impression of the anesthesia provider, testing of the block, maternal psychological state, and sensations during surgery. Four patients were referred to psychiatry services for follow up care.</div></div><div><h3>Conclusions</h3><div>These findings can help guide future research efforts designed to improve counseling, prevention and management of PDCD, and highlight the need to determine the long-term psychological impact of PDCD.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104748"},"PeriodicalIF":2.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144813988","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":"Letter to the Editor: “Pain severity during infiltration of local anesthesia before spinal anesthesia as a predictor of post-cesarean pain and Obstetric Quality-of-Recovery scores (ObsQoR-11): a prospective observational study”","authors":"Rachana Mehta,&nbsp;Ranjana Sah","doi":"10.1016/j.ijoa.2025.104744","DOIUrl":"10.1016/j.ijoa.2025.104744","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104744"},"PeriodicalIF":2.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144829544","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":"Resuscitative hysterotomy and mechanical circulatory support for maternal cardiac arrest secondary to pulmonary embolism in a patient with known placenta accreta spectrum: a case report","authors":"T. Dorittke ,&nbsp;E. Prindl ,&nbsp;A. Farr ,&nbsp;J. Gratz","doi":"10.1016/j.ijoa.2025.104743","DOIUrl":"10.1016/j.ijoa.2025.104743","url":null,"abstract":"<div><div>Maternal cardiac arrest is a rare but severe event in obstetrics, with outcomes largely dependent on effective multidisciplinary management. We report the case of a 30-year-old pregnant woman with placenta accreta spectrum (PAS), a large placental hematoma, and uterine dehiscence. During her inpatient stay, she was conservatively managed until 24 + 6 weeks, when she suffered sudden cardiac arrest due to massive pulmonary embolism. Resuscitative hysterotomy and mechanical circulatory support was performed and venoarterial extracorporeal membrane oxygenation (VA-ECMO) was initiated following identification of intracardiac thrombus. The patient required emergency hysterectomy due to uncontrolled PAS bleeding, complicated by massive hemorrhage and coagulopathy. Despite the complexity and severity of the situation, both maternal and neonatal outcomes were ultimately favorable. The patient was discharged home without neurological deficits 26 days after cardiac arrest; the neonate was discharged in good health at term-equivalent age. This case highlights the need for individualized thromboprophylaxis and underscores the critical role of specialized centers in managing high-risk pregnancies. Multidisciplinary care, prompt emergency response, and advanced life support measures were key to the successful outcome in this life-threatening scenario.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104743"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764028","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 bupivacaine dose in spinal anaesthesia for prevention of pain during caesarean delivery – the “white elephant” in the guidelines − in response to “Shedding more light on the management of intraoperative pain during cesarean delivery: a review of the American Society of Anesthesiologists statements.”","authors":"E. Waddell ,&nbsp;K. Bhatia","doi":"10.1016/j.ijoa.2025.104741","DOIUrl":"10.1016/j.ijoa.2025.104741","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104741"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908981","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":"Neuraxial procedures and time to recognition of postpartum lower limb sensorimotor deficit in an obstetric cohort: a retrospective cohort study (2013–2022)","authors":"T. Yang ,&nbsp;W.-S. Chan ,&nbsp;A. Chau","doi":"10.1016/j.ijoa.2025.104740","DOIUrl":"10.1016/j.ijoa.2025.104740","url":null,"abstract":"<div><h3>Introduction</h3><div>Peripheral nerve injuries after neuraxial anesthesia in obstetric patients are rare but can impact postpartum recovery. The anesthetic requirements for different modes of delivery may influence block density and the timing of neurologic deficit recognition. We hypothesized that the time to recognition of postpartum lower limb neurologic deficits would differ significantly by mode of delivery.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study over a 9-year period (2013–2022), identifying postpartum patients referred to anesthesiology and/or obstetric internal medicine consultation for lower limb sensorimotor deficit following neuraxial procedure. The primary outcome was time to first recognition of neurologic deficit, stratified by mode of delivery. Secondary outcomes included incidence, time to ambulation, duration of hospitalization, and recovery profile stratified by peripheral nerve injury subtype. Time data were compared between groups using one-way analysis of variance and post hoc pairwise comparisons adjusted for multiple comparisons. All other outcomes were analyzed using descriptive statistics.</div></div><div><h3>Results</h3><div>Among 61,044 deliveries and 43,861 neuraxial procedures, 74 cases of postpartum peripheral neuropathies were identified, yielding an incidence of 0.17% (1 in 588). The most common diagnoses were lumbosacral plexopathy (37.8%), femoral neuropathy (33.7%), and lateral femoral cutaneous neuropathy (16.2%). Mean ± standard deviation time to first recognition of postpartum deficit was 22.9 ± 18.7 hours, and mean time to first ambulation after delivery was 22.1 ± 18.3 hours. Significantly delayed recognition occurred after intrapartum cesarean compared with spontaneous vaginal delivery (33.6 vs. 15.9 hours; <em>P</em>=0.005). For 92% of patients, only one or two outpatient follow-up visits were needed. The median time to discharge from outpatient follow-up was 29 days.</div></div><div><h3>Discussion</h3><div>Postpartum peripheral nerve injuries following neuraxial anesthesia are uncommon and, when they occur, are most often associated with favorable recovery. Recognition of lower limb neurologic deficits was most delayed following intrapartum cesarean deliveries. Structured postpartum neuraxial block monitoring, combined with initiatives that encourage early ambulation and patient self-reporting tools may support timely diagnosis, patient counselling and management.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104740"},"PeriodicalIF":2.3,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842840","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":"Post-cesarean opioid consumption in patients on maintenance medication for opioid use disorder undergoing cesarean delivery with neuraxial anesthesia: a single-center retrospective propensity-matched cohort study (2016–2020)","authors":"S. Roy ,&nbsp;L. Chitty ,&nbsp;A. Mongan ,&nbsp;M. Kotova ,&nbsp;B. Johnson ,&nbsp;C. Ripat ,&nbsp;P. Mongan","doi":"10.1016/j.ijoa.2025.104742","DOIUrl":"10.1016/j.ijoa.2025.104742","url":null,"abstract":"<div><h3>Background</h3><div>Scheduled multimodal non-opioid analgesics after cesarean delivery are effective in reducing opioid consumption. However, there is limited information regarding the effectiveness of this practice for reducing opioid consumption in patients on opioid agonists (methadone or buprenorphine) for an opioid use disorder. We hypothesized that standardized neuraxial anesthesia with neuraxial morphine and multimodal non-opioid analgesics would result in similar postoperative opioid consumption between patients on opioid agonist therapy and opioid-naïve controls.</div></div><div><h3>Methods</h3><div>This was a single-center retrospective cohort study on patients undergoing cesarean delivery with intrathecal morphine (median 200 μg) between January 2016 and December 2020. We compared 48-hour postoperative opioid consumption (milligram morphine equivalents; MME) between patients on opioid agonist therapy and matched controls (median MME [25th-75th percentile]). Secondary outcomes included pain scores (numeric rating; 0–10) and postoperative length of stay. The MME consumption was adjusted for covariates (e.g. current tobacco use, mental health diagnosis – anxiety, depression, bipolar, schizophrenia) using logistic regression.</div></div><div><h3>Results</h3><div>We identified 125 patients on opioid agonist therapy (buprenorphine n = 30, methadone n = 95), who were propensity-matched 1:1 with opioid-naive controls. Patients on opioid agonists had significantly higher 48-hour opioid consumption (82.5 [45.0–124.5] vs. 25.0 [15.0–46.0] MME; <em>P</em> &lt; 0.001), higher average pain scores (4.6 [3.5–5.8] vs. 3.4 [2.1–4.7]; <em>P</em> &lt; 0.001), and higher peak pain scores (7.0 [5.0–9.0] vs. 4.8 [3.7–6.6]; <em>P</em> &lt; 0.001). Mental health diagnoses were associated with increased opioid consumption, and the differences between groups remained significant after covariate adjustments. The length of stay was similar between the two groups (2.0 [2.0–3.0] days; <em>P</em> = 0.44).</div></div><div><h3>Conclusions</h3><div>Pregnant women maintained on their pre-delivery dose of opioid agonists after cesarean delivery had opioid consumption and pain scores after undergoing cesarean delivery under neuraxial anesthesia with neuraxial morphine despite optimizing multimodal non-opioid analgesic medications than matched controls. Within both groups, the diagnosis of a mental health diagnosis was highly associated with increased MME consumption.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104742"},"PeriodicalIF":2.3,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908978","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 anesthesia for cesarean delivery resulting in postdural puncture headache and intracranial subdural hematoma − a case report","authors":"P. Kyrychenko ,&nbsp;M. O’Sullivan ,&nbsp;W. Pfeifer","doi":"10.1016/j.ijoa.2025.104739","DOIUrl":"10.1016/j.ijoa.2025.104739","url":null,"abstract":"<div><h3>Background</h3><div>Spinal anesthesia is routinely used for cesarean delivery. Intracranial subdural hematoma (SDH) is a potentially fatal complication of neuraxial anesthesia and is extremely uncommon. This report describes a case of SDH following uncomplicated spinal anesthesia for elective cesarean delivery and highlights the importance of timely intervention and patient follow-up.</div></div><div><h3>Case</h3><div>A 35-year-old patient with a history of hepatitis B underwent elective cesarean delivery under spinal anesthesia provided with a pencil-point 25G needle at the presumed L3-L4 interspace. She experienced a mild non-positional headache the next day managed with oral pain medications. After discharge, she presented twice for worsening headache symptoms. By the 12^th postpartum day, symptoms were suggestive of post-dural puncture headache, prompting imaging that revealed a left-sided subdural hematoma with mass effect. After multidisciplinary consultation with neurosurgery, an epidural blood patch (18 mL) was performed. Despite worsening radiological findings, the patient experienced symptomatic relief. The patient was discharged with follow-up arranged at the institution’s headache clinic.</div></div><div><h3>Conclusion</h3><div>While post-dural puncture headache after unintended dural puncture may be common, serious complications such as SDH are rare and require prompt diagnosis and intervention. This case illustrates a rare but serious complication of an uncomplicated spinal anesthesia, highlighting the need for thorough follow-up and prompt interventions. This report underscores the importance of revising discharge instructions after neuraxial anesthesia to include education on symptoms of post-dural puncture headache and the necessity of timely re-evaluation if symptoms worsen.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104739"},"PeriodicalIF":2.6,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144713382","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}