Journal of Obstetric Anaesthesia and Critical Care最新文献

{"title":"Fahr and beyond: Anesthesia for obstetric emergency in a patient with fahr's syndrome","authors":"Swati Taneja, Bhavya Krishna","doi":"10.4103/JOACC.JOACC_34_23","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_34_23","url":null,"abstract":"","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":"13 1","pages":"223 - 224"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46137580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amniotic fluid embolism: A narrative review","authors":"Frederick Baxter","doi":"10.4103/JOACC.JOACC_12_23","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_12_23","url":null,"abstract":"Amniotic fluid embolism (AFE) is a rare but deadly complication of pregnancy. First described in 1926, it remains a diagnosis of exclusion, without clear etiology or a specific test to confirm the diagnosis. Mortality remains high and neurological injury is common among survivors, although reported case fatality rates are decreasing over time. Hemodynamic instability appears to be caused by severe pulmonary vasospasm and subsequent right heart failure, followed by severe left ventricular failure. Presentation is often sudden with loss of consciousness and circulatory arrest, requiring immediate cardiopulmonary resuscitation, vasopressor and inotropic support, and endotracheal intubation. Disseminated intravascular coagulation commonly follows with severe coagulopathy and postpartum hemorrhage and may in some cases be the primary presenting feature. Management remains largely supportive, with the use of extracorporeal membrane oxygenation and inhaled pulmonary vasodilators assuming an increased role, in addition to advanced life support methods. Blood products and coagulation factor replacement are frequently required, sometimes in the form of a massive transfusion. This narrative review summarizes the past and current literature, emphasizing rapid identification of AFE and therapeutic options for its immediate management.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":"74 1","pages":"130 - 141"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139365152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To compare the efficacy of two different bolus doses of phenylephrine in combination with oxytocin in preventing oxytocin-induced hypotension during cesarean section under spinal anesthesia: A randomized comparative study","authors":"S. Kumari, Ratindra Barman, Pranab Kalita, Peter Engti","doi":"10.4103/JOACC.JOACC_72_22","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_72_22","url":null,"abstract":"Background: A randomized comparative study was conducted to assess the effectiveness of two different bolus doses of phenylephrine to obtund the hypotensive effects of bolus oxytocin injection in patients undergoing cesarean section under spinal anesthesia. Methods: The study involved 180 parturients belonging to the ASAI and II, undergoing CS under SA were randomized into three groups, group A: oxytocin 3U and phenylephrine 50 μg; group B: oxytocin 3U and phenylephrine 75 μg; group C: oxytocin 3U and normal saline, administered intravenously over 5 min after delivery of anterior shoulder. The incidence of hypotension being the primary objective and hemodynamic changes, the incidence of nausea and vomiting, and other complications, such as total rescue vasopressor requirement, adequacy of uterine contraction, and the number of patients requiring additional uterotonics, were our secondary objectives. Results: The incidence of hypotension was highest in group C (83.3%) followed by group A (80%) and lowest in group B (11.6%). The total rescue doses of PE after T0 between the three groups showed that group A required (61.32 ± 41.19) μg, group B required (10.19 ± 29.75) μg, and group C required (113.21 ± 47.18) μg of PE. The uterine contraction was comparable between the groups. Incidence of nausea and vomiting and other complications were comparable between the groups. Conclusion: Co-administration of PE 75 μg with OT 3 IU after delivery reduces the incidence of OT-induced hypotension and rescue vasopressor requirement compared to co-administration of 50 μg PE during CS under spinal anesthesia.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":"13 1","pages":"172 - 179"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45596626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carbetocin: Are we ready for a paradigm shift?","authors":"Anjeleena Gupta","doi":"10.4103/JOACC.JOACC_55_23","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_55_23","url":null,"abstract":"","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":"13 1","pages":"127 - 129"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44557220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To study maternal hypotension, side-effects and fetal acid-base balance during cesarean delivery under spinal anesthesia using prophylactic infusion doses of 25 and 50 μg/Min phenylephrine","authors":"R. Akshay, J. Bajaj","doi":"10.4103/JOACC.JOACC_67_22","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_67_22","url":null,"abstract":"Objectives: To study maternal hypotension, side effects, and fetal acid-base balance during cesarean delivery under spinal anesthesia using prophylactic infusion doses of 25 and 50 μg/min phenylephrine. Methods: This prospective randomized study was carried out at a tertiary care hospital on 100 pregnant women who underwent caesarean section under subarachnoid block. The participants were randomized into: Group P1 (n = 50): who received phenylephrine 25 μg/min infusion prophylactically and Group P2 (n = 50) received phenylephrine 50 μg/min infusion prophylactically. The two groups were compared for heart rate, blood pressure, side effects, and fetal arterial and venous blood gas analysis. P value < 0.05 was considered statistically significant. Results: In group P1, 3 (6%) patients had episode of hypotension and in group P2, 1 (2%) patient had episode of hypotension. There was no incidence of hypertension in group P1 but in group P2, 5 (10%) patients had hypertension (p < 0.05). There was no episode of bradycardia or oxygen desaturation in any group. Side effects were Grade 1 in three patients each in both the groups, and Grade 2 in one patient of Group P1 and four patients in Group P2 (p = 0.842). Fetal acid-base balance was comparable in the two groups (p > 0.05). Conclusion: It can be concluded that 50 μg/min phenylephrine was able to better prevent maternal hypotension with comparable side-effects profile and fetal acid base balance.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":"13 1","pages":"166 - 171"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42068950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Airtraq as an alternative device for airway management for emergency cesarean section in a parturient with kyphoscoliosis and short stature – A case report","authors":"K. Narayanan, Geeta Bhandari, A. Nautiyal, Abha Tiwari","doi":"10.4103/JOACC.JOACC_65_22","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_65_22","url":null,"abstract":"Kyphoscoliosis is a spine abnormality identified by anterior flexion (kyphosis) and lateral curvature (scoliosis) and its causes can be multifactorial. A 24-year-old primigravida with short stature and severe thoracolumbar kyphoscoliosis was scheduled for emergency cesarean section due to non-progression of labor with fetal distress. After failed spinal and unsuccessful conventional laryngoscopy, the patient was intubated using an optical Airtraq (Prodol Meditec S.A., Vizcaya, Spain) laryngoscope and operated. The main purpose of an anesthesiologist is to perform safe and skilled anesthetic management to minimize risk to mother and baby. Kyphoscoliosis exacerbates an already compromised cardiopulmonary status due to pregnancy. The severity of pulmonary impairment depends upon the degree of Cobb's angle. None of the anesthetic techniques is said to be perfect as each technique has its own merits and demerits. General anesthesia may be indicated because of maternal preference or maternal cardiopulmonary disease or technical difficulties related to the regional block. Airtraq can be an alternative option for airway management as it provides a direct view of the glottis in a neutral neck position.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":"13 1","pages":"214 - 217"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70810510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthetic management of cesarean section in a patient with Léri-Weill dyschondrosteosis – A case report","authors":"Muizz Hussain, Nikhil Nair, Matthew Foss, James Paul","doi":"10.4103/JOACC.JOACC_75_22","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_75_22","url":null,"abstract":"When providing spinal anesthesia for patients with achondroplasia, a dose reduction is often recommended to prevent respiratory arrest and total spinal blocks as patients with achondroplasia present with spinal complications such as spinal cord stenosis, kyphoscoliosis, and lumbar lordosis. This case report describes why this dose reduction is unnecessary in patients with Léri–Weill dyschondrosteosis (LWD) dwarfism and how a regular spinal neuraxial approach is safe and efficacious. A 38-year-old pregnant woman with physical findings consistent with LWD and unremarkable past medical history presented for a repeat elective cesarean section. On examination, the patient was noted to have conserved spinal length and anatomy. In accordance with current recommendations, this patient received a 20% reduced spinal anesthetic dose for her cesarean section based on her height. The cesarean was uneventful. Additional dose reduction was found to be unnecessary due to normal spinal length and anatomy. This characteristic of LWD warrants a review of the clinical recommendations surrounding the anesthetic management of patients with LWD.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":"13 1","pages":"218 - 220"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48537140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative evaluation of two doses of phenylephrine infusion to prevent intra-operative nausea and vomiting during elective obstetric spinal anesthesia","authors":"Vikram Bedi, Anchal Jhawer, Santosh Choudhary, Sandeep Savitaprakash Sharma, Yadav Pratibha, Debbarma Sanghamitra","doi":"10.4103/JOACC.JOACC_58_22","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_58_22","url":null,"abstract":"Background and Aims: Hypotension is very common after obstetric spinal anesthesia. Maternal hypotension in turn leads to intra-operative nausea and/or vomiting (IONV). We planned this study to compare the effect of phenylephrine infusion of 25 μg/min and 50 μg/min for preventing IONV in patients undergoing elective lower segment cesarean section. Material and Methods: This prospective double-blind randomized placebo controlled trial was conducted on 195 parturients with singleton pregnancy undergoing elective cesarean section under subarachnoid block. Parturients were randomly allocated into three groups, groups C, P25, and P50, to receive normal saline at 15 ml/hour, 100 μg/ml phenylephrine as 15 ml/hour infusion (dose 25 μg/min), and 200 μg/ml phenylephrine as 15 ml/hour infusion (dose 50 μg/min), respectively. Groups were compared with regard to incidence of IONV, rescue mephentermin consumption, hemodynamic parameters, neonatal outcome, and adverse effects. Categorical data were presented as number and compared using Chi-square test. Continuous variables were presented as mean ± SD and compared using t-test or ANOVA. P < 0.05 was considered statistically significant. Results: Group PE50 experienced a significantly lesser number of episodes of IONV compared to group PE25 and group C (0.09 ± 0.29 versus 0.23 ± 0.42 and 0.55 ± 0.84, respectively; P < 0.05). Group PE50 also required a significantly lesser number of rescue mephentermine for hypotension when compared to groups PE25 and C (0.00 v/s 0.18 ± 1.04 v/s 3.13 ± 5.31, P < 0.001). No significant difference was observed in number of patients experiencing IONV between the three groups (32% in PE50, 23% in PE25, 9% in C). Conclusion: Infusion of 50 microgram/min phenylephrine is superior to 25 microgram/min infusion and placebo to control IONV with significantly reduced cumulative rescue vasopressor consumption in patients undergoing elective cesarean section under subarachnoid block (SAB).","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":"13 1","pages":"160 - 165"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43499933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of perfusion index as a screening tool for prediction of hypotension and shivering in cesarean section","authors":"Parita Gandhi, Divya Kheskani, H. Chhanwal, Rekha Solanki, M. Shah, Aayushi Singh","doi":"10.4103/JOACC.JOACC_76_22","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_76_22","url":null,"abstract":"Aim: The aim of this study was to determine whether a baseline perfusion index (PI) can predict hypotension and shivering after spinal anesthesia for cesarean section. Materials and Methods: In this prospective, observational study, 100 parturients were divided into two groups on the basis of baseline PI. Group I included parturients with PI of <3.5, and Group II included parturients with PI values ≥3.5. Spinal anesthesia was performed with hyperbaric 2 ml of 0.75% ropivacaine at L3–L4 or L2–L3 interspace. Hypotension was defined as mean arterial pressure <65 mmHg. PI and blood pressure were monitored at baseline, every 2 min for 12 min, and every 10 min until 120 min. Shivering was observed until 120 min according to the Crossley and Mahajan scale. Statistical analysis was performed using Chi-square test, independent sample t-test, and Mann–Whitney U-test. Results: Baseline PI significantly correlated with the number of episodes of hypotension. The overall incidence of hypotension was significantly higher in parturients with baseline PI ≥3.5 (79.16%) compared to those with PI <3.5 (33.33%), and parturients with preoperative PI <3.5 had a greater risk of post-anesthetic shivering. Conclusions: Perfusion Index serves as an excellent tool for predicting hypotension and shivering in pregnant patients.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":"13 1","pages":"204 - 207"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45517935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of haemodynamic effects of intravenous carbetocin and oxytocin during caesarean section under subarchanoid block","authors":"V. Jannu, Meghana Hanagandi, Raghavendra Kalal, C. Sabari","doi":"10.4103/JOACC.JOACC_28_23","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_28_23","url":null,"abstract":"Context: Uterine atony is the commonest cause for postpartum haemorrhage in majority of cases. Oxytocin remains the first-line uterotonic agent but, is associated with significant cardiovascular effects like hypotension and tachycardia after intravenous administration. Carbetocin, a synthetic heat-stable oxytocin analogue combines the safety and efficacy profile of oxytocin with the sustained uterotonic activity. Aims: The aim of this study was to compare intravenous oxytocin and carbetocin for haemodynamic responses during caesarean section under subarachnoid block. Settings and Design: Randomized controlled trial. Methods and Material: We performed a prospective randomized, controlled study on 142 pregnant patients undergoing elective cesarean section under subarachnoid block. Patients were randomly assigned to receive either 3U of intravenous oxytocin followed by infusion of 10U/hour for 4 hours or 100 μg intravenous carbetocin after the delivery of anterior shoulder. Heart rate and mean intra-arterial blood pressures were recorded at every 15 s during the study period of 5 min. Statistical Analysis Used: Data were analyzed using Student's unpaired test, Chi-squared test, and Fischer's exact test. A P < 0.05 was considered statistically significant. Results: Oxytocin produced clinically significant tachycardia (>20%) with peak effects over 180 s after injection (P < 0.0001). It also demonstrated a significant decrease in mean arterial pressure within 30 s of bolus injection and hypotension persisted throughout the study period (P < 0.0001). Carbetocin produced no significant changes in heart rate and mean blood pressure responses. The requirement of additional uterotonics and total intraoperative blood loss were similar among both the groups. Conclusions: Intravenous carbetocin is better tolerated without significant haemodynamic adverse effects in comparison to oxytocin during cesarean section.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":"13 1","pages":"193 - 197"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49222098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}