International journal of obstetric anesthesia最新文献

{"title":"Management of a vagus nerve stimulator in a patient undergoing an emergency caesarean delivery: a case report","authors":"Eanna Mulvihill, Sabrina Hoesni","doi":"10.1016/j.ijoa.2024.104244","DOIUrl":"10.1016/j.ijoa.2024.104244","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141940827","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":"Peripartum anesthesia management and outcomes of patients with congenital heart disease: a single-center retrospective analysis (2009–2023)","authors":"D. Iluz-Freundlich ,&nbsp;Y. Vikhorova ,&nbsp;K. Azem ,&nbsp;S. Fein ,&nbsp;P. Chernov ,&nbsp;N. Schamroth-Pravda ,&nbsp;A. Shmueli ,&nbsp;O. Houri ,&nbsp;P. Heesen ,&nbsp;M. Garren-Tam ,&nbsp;Y. Binyamin ,&nbsp;S. Orbach-Zinger","doi":"10.1016/j.ijoa.2024.104241","DOIUrl":"10.1016/j.ijoa.2024.104241","url":null,"abstract":"<div><h3>Background</h3><div>Advances in medicine have enabled more patients with congenital heart disease (CHD) to become pregnant. However, these patients face significant challenges during the peripartum period. Current peripartum anesthesia guidelines for CHD patients mainly rely on case reports and small series.</div></div><div><h3>Methods</h3><div>In this retrospective study at a high-volume tertiary care center, we analyzed peripartum anesthetic approaches, postpartum hemorrhage (PPH) incidence, and maternal outcomes in CHD patients stratified by the modified World Health Organization (mWHO) classification.</div></div><div><h3>Results</h3><div>Among 85 473 deliveries between 2009 and 2023, 409 occurred in 282 patients with CHD. Cesarean deliveries were significantly more frequent in mWHO class III, <em>p</em>=0.005. Labor epidural analgesia was the most common analgesic modality for vaginal deliveries (epidural rate was 71.1% with no differences between mWHO classes). Anesthesia management for cesarean deliveries varied significantly by class <em>p</em>&lt;0.001. While spinal anesthesia was predominant in classes I and II, combined spinal-epidural anesthesia was more common in class III. PPH incidence was 6.4%, with no significant difference across classes, and no association was found between mWHO class severity and PPH risk (OR 0.97; 95% CI; 0.93 to 1.02, <em>p</em>=0.2). Higher mWHO classes correlated with significantly higher intensive care unit (ICU) admission rates, longer hospital stays, and one-year cardiac hospitalizations.</div></div><div><h3>Conclusion</h3><div>In this retrospective study on the peripartum anesthetic management and outcomes of CHD patients stratified by mWHO class, cases with greater mWHO class were more likely to deliver preterm, by cesarean delivery, with a combined spinal-epidural anesthetic and an arterial line placement for that cesarean delivery. They overall had a longer hospital stay and were more likely to be admitted to the ICU. However, the overall risk of PPH did not increase with mWHO class severity.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141969073","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":"Felicity Reynolds (1935 – 2024)","authors":"Robin Russell","doi":"10.1016/j.ijoa.2024.104240","DOIUrl":"10.1016/j.ijoa.2024.104240","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0959289X24002528/pdfft?md5=c573f95f76ef8b6c5cd1607139e69747&pid=1-s2.0-S0959289X24002528-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141847079","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":"AI-augmented vs. conventional cardiac POCUS training: a pilot study among obstetric anesthesiologists","authors":"S. Johnson ,&nbsp;S. Feldman ,&nbsp;R. Gessouroun ,&nbsp;M. Fuller ,&nbsp;M. Stafford-Smith ,&nbsp;Y.S. Bronshteyn ,&nbsp;M.L. Meng","doi":"10.1016/j.ijoa.2024.104238","DOIUrl":"10.1016/j.ijoa.2024.104238","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853848","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":"Do essential oil diffusers during labor pose a contamination risk to sterile neuraxial procedures?","authors":"N. Lemoine,&nbsp;B. Wakefield,&nbsp;W. Agee,&nbsp;J. Bauchat,&nbsp;H. Ende,&nbsp;B. Raymond","doi":"10.1016/j.ijoa.2024.104237","DOIUrl":"10.1016/j.ijoa.2024.104237","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141848485","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":"Pre-oxygenation using high flow humidified nasal oxygen or face mask oxygen in pregnant people – a prospective randomised controlled crossover non-inferiority study (The HINOP2 study)","authors":"P.C.F. Tan ,&nbsp;P.J. Peyton ,&nbsp;A. Deane ,&nbsp;J. Unterscheider ,&nbsp;A.T. Dennis","doi":"10.1016/j.ijoa.2024.104236","DOIUrl":"10.1016/j.ijoa.2024.104236","url":null,"abstract":"<div><h3>Background</h3><div>Airway guidelines recommend pre-oxygenation of obstetric patients to an end tidal oxygen concentration (etO₂) ≥90%. High flow nasal oxygen (HFNO) achieves this in 60% of pregnant people. However face mask (FM) pre-oxygenation also may not achieve this target in all patients. In this study we determined whether HFNO pre-oxygenation is non-inferior to FM pre-oxygenation.</div></div><div><h3>Methods</h3><div>This randomised controlled crossover non-inferiority trial was conducted on healthy participants of gestational age ≥37 weeks in a simulated environment. Participants underwent pre-oxygenation for three minutes with HFNO and FM oxygen in randomised order. HFNO was delivered at a maximal flow of 70 l.min^-1 and FM oxygen at 10 l.min^-1. The primary outcome was etO₂ on first expired breath after pre-oxygenation. Non-inferiority was defined as a mean difference in first etO₂ between groups of ≤5%.</div></div><div><h3>Results</h3><div>Seventy participants were randomised with 62 analysed. Age (mean (SD)), gestation (median (IQR)), and body mass index (median (IQR)), were 34.7 (4.6) years, 39 (38.4, 39.4) weeks, 29 (26.6, 32.4) kg.m^-2 respectively. First etO₂ after HFNO pre-oxygenation was greater than after FM pre-oxygenation (HFNO pre-oxygenation mean (SD) 90.2 (3.9)% versus FM pre-oxygenation 88.7 (3.0)%; mean difference = 1.45%, 95% CI 0.19 to 2.72%; p = 0.025. Forty-four (71%) participants achieved ≥90% first etO₂ concentration after HFNO pre-oxygenation versus 27 (44%) after FM pre-oxygenation (p = 0.002).</div></div><div><h3>Conclusions</h3><div>In this cohort of pregnant people at term in a simulated environment, pre-oxygenation with HFNO was not inferior to FM pre-oxygenation. FM pre-oxygenation did not achieve pre-oxygenation targets in over 50% of participants.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141851021","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":"Postpartum neurological deficits following neuraxial intervention: a retrospective analysis in a tertiary obstetric centre (2021-2023)","authors":"A.M. Brumby,&nbsp;M. Bright,&nbsp;S. Maffey,&nbsp;E. Schulz","doi":"10.1016/j.ijoa.2024.104234","DOIUrl":"10.1016/j.ijoa.2024.104234","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141841682","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":"Pain during caesarean delivery in a tertiary maternity hospital: a retrospective cohort study (2022–2023)","authors":"Ciara Luke,&nbsp;Lorcan O’ Carroll,&nbsp;Roger McMorrow","doi":"10.1016/j.ijoa.2024.104235","DOIUrl":"10.1016/j.ijoa.2024.104235","url":null,"abstract":"<div><h3>Background</h3><p>Intra-operative pain during Caesarean delivery (PDCD) is the leading cause of successful litigation against obstetric anaesthesiologists. PDCD may require conversion to general anaesthesia (GA). The aim of this analysis is to assess our incidence of PDCD and associated GA conversion.</p></div><div><h3>Methods</h3><p>Data were collected from electronic patient records. Data included baseline demographics, incidence of PDCD and rates of GA conversion, proportion of PDCD cases attributable to failed epidural (EA) or spinal anaesthesia (SA), and level of sensory and motor blockade in cases of PDCD. Results were audited against current standards set by the Royal College of Anaesthetists ‘rates of PDCD should be &lt;5% for category 4, &lt;15% for categories 2-3, and &lt;20 % for category 1 CD ’ and that ‘rates of conversion to GA due to neuraxial complications should be &lt;1% for category 4, &lt;5% for categories 2-3 and &lt;15% for category 1 patients’.</p></div><div><h3>Results</h3><p>During the 12-month study period, 2,429 patients underwent CD, of whom 52 (2.1%) experienced PDCD. The incidence of PDCD was 3.1% (41/1,309) for category 1-3 patients, while 1% (11/1,120) of category 4 patients experienced PDS. Of the 52 patients with PDCD, 17 patients required GA (33%). SA was used in 24/52 (47%) cases and EA in 28/52 (53%) cases. The median level of sensory block in patients with PDCD was located at the T4 dermatome, the median level of motor block was Bromage level 2.</p></div><div><h3>Conclusions</h3><p>PDCD occurred in 2.1% of CD, one-third required conversion to GA. Most patients experiencing PDCD met current motor and sensory blockade criteria.</p></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141841647","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":"Anaesthetic management of obstetric patients with Chiari type I malformation: a retrospective case series and literature review","authors":"A. Simpson ,&nbsp;C. Ferguson","doi":"10.1016/j.ijoa.2024.104232","DOIUrl":"10.1016/j.ijoa.2024.104232","url":null,"abstract":"<div><p>The peripartum management of obstetric patients with Chiari type I malformation remains a challenge due to the degree of cerebellar tonsillar herniation and a paucity of published evidence. There is concern about neuraxial anaesthetic blocks and uncertainty regarding the optimum mode of delivery.</p><p>We systematically searched the literature for the obstetric management of patients with Chiari type I malformation, independent of publication date and language. We also searched our local hospital database from December 2009 to December 2022 for all deliveries to patients with this condition. We identified 137 cases comprising 103 deliveries described in 40 publications that met our inclusion criteria; 34 deliveries were identified in our local database. There were 84 spontaneous vaginal deliveries, 52 caesarean deliveries, and one delivery by unknown modality. Sixty neuraxial blocks were performed; approximately half of these were epidural procedures for labour analgesia. Six patients had new or worsened symptoms following delivery, but it is unclear whether these were related to their Chiari malformation. We identified no cases with brainstem herniation or severe symptoms.</p><p>We discuss our findings in relation to other published literature and address the concerns described. Our review reveals the use of a variety of modes of delivery and anaesthetic techniques and that most patients suffered no neurological complication. We conclude there is no of evidence to avoid any one approach to labour analgesia, delivery and anaesthesia. We propose a holistic, individualised and patient-centred approach with an appraisal of the risks and benefits to support shared-decision making.</p></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141838545","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":"Obstetric anesthesia considerations in pregnancy-associated myocardial infarction: a focused review","authors":"E.E. Sharpe ,&nbsp;C.H. Rose ,&nbsp;M.S. Tweet","doi":"10.1016/j.ijoa.2024.104233","DOIUrl":"10.1016/j.ijoa.2024.104233","url":null,"abstract":"<div><div>Pregnancy-associated myocardial infarction (PAMI) is a rare but serious complication that can occur either during pregnancy or postpartum. The etiologies of PAMI are atherosclerosis, spontaneous coronary artery dissection, coronary thrombosis, coronary embolism, and coronary vasospasm. Therapy of acute PAMI depends largely on the ECG presentation, hemodynamic stability, and suspected etiology of myocardial infarction. Anesthetic management during delivery in patients with PAMI should consist of early and carefully titrated neuraxial analgesia and anesthesia, maintenance of normal sinus rhythm, preservation of afterload, and monitoring for and avoiding myocardial ischemia. To improve the care of women with PAMI, a multidisciplinary team of cardiologists, maternal fetal medicine specialists, obstetric providers, neonatologists, and anesthesiologists must work collectively to manage these complex patients.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141852602","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}