Journal of Obstetric Anaesthesia and Critical Care最新文献

{"title":"Retrospective observational case series of management of placenta accreta at tertiary care institution","authors":"Y. Patil, Abhilasha D Motghare, Dhwani Walavalkar, I. Chincholi","doi":"10.4103/JOACC.JOACC_4_22","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_4_22","url":null,"abstract":"Introduction: Placenta accreta is a general term, when part of the placenta or the entire placenta invades and is inseparable from the uterine wall. The incidence is considerably higher in women with both a previous caesarean delivery and placenta praevia, occurring in around 1 in every 20 such women. Resorption of the retained, poorly perfused placenta can be augmented by concurrent treatment with methotrexate when fertility is desired. In cases where operative measures are required, placement of Internal Iliac artery (IIA) balloons preoperatively and their inflation intraoperatively, reduces maternal morbidity and mortality. Materials and Methodology: We present a case series of 14 patients with placenta accreta diagnosed preoperatively, 7 of whom had IIA balloons placed before undergoing Caesarean section and 7 did not have such an intervention. The maternal and foetal morbidity and mortality were studied, including the need for blood and blood product transfusions. Results: Internal Iliac Balloon placements did not change the requirement for blood and blood product transfudion in both groups. The group who had IIA balloon placed preoperatively had better maternal and fetal outcome as compared to the group who had no such intervention.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":"13 1","pages":"71 - 74"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47364253","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":"Ultrasound-guided subarachnoid block in kyphoscoliotic parturient posted for urgent caesarean section","authors":"R. Jain, K. Bansal, Kanupriya Jain, M. Singh, A. Grewal","doi":"10.4103/JOACC.JOACC_42_22","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_42_22","url":null,"abstract":"Parturient with kyphoscoliosis poses a major challenge in the administration of spinal anaesthesia owing to changes in the anatomy of the spine and physiological changes associated with pregnancy. Recently, ultrasound guidance has proved to be a boon for regional anaesthesia techniques. We report the successful anaesthetic management of a 43 year-old primigravida with kyphoscoliosis who was posted for emergency caesarean section using an ultrasound-guided subarachnoid block.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":"13 1","pages":"112 - 115"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47418583","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":"Walking epidural in labor analgesia: A comparative study of ropivacaine with fentanyl and without fentanyl","authors":"Avni Thacker, Divya Kheskani, D. Panchal, H. Chhanwal","doi":"10.4103/JOACC.JOACC_32_22","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_32_22","url":null,"abstract":"Background: Labor pain and child birth entail a number of physiological consequences that may lead to deleterious effects on the mother and fetus. Implication of a neuraxial technique is being appreciated in labor. Fetal prognosis and maternal consent and its satisfaction are key to labor analgesia. Method: The primary objectives were to determine the visual analog scale (VAS), total duration of labor analgesia, patient-controlled analgesia demand, sensory and motor block, and hemodynamics. The secondary objectives were to determine obstetrics parameters such as maternal satisfaction, cervical dilation, membrane, APGAR score, and complications such as hypotension, bradycardia, and vomiting. A randomized prospective comparative, interventional study including 50 parturients was conducted, where they were divided into two equal groups of 25 each, and epidural analgesia was given by 0.2% ropivacaine with 2 mcg/ml fentanyl and 0.2% ropivacaine without fentanyl. Observation and Results: Analgesia was more in the RF group compared to the R group. The maternal satisfaction was more in the RF group than in the R group. Clinical hemodyamics, VAS score, Bromage score, and APGAR score were appreciable in the RF group as compared to the R group. Conclusion: We concluded that 0.2% ropivacine with fentanyl gives more analgesia and maternal satisfaction than ropivacine alone.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":"13 1","pages":"45 - 50"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48390453","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":"Anaesthetic management of parturient posted for elective caesarean section with cerebral arteriovenous malformation","authors":"N. Puthenveettil, Amal Ashok, Sobha S. Nair, J. Paul","doi":"10.4103/JOACC.JOACC_3_22","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_3_22","url":null,"abstract":"","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":"13 1","pages":"125 - 126"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42058946","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":"Opioid-sparing post-cesarean analgesia using intravenous diclofenac-acetaminophen combination: A prospective, randomized clinical trial","authors":"N. Bhatia, K. Jain, K. Kumari, V. Ashok, A. Dhir, Mandeep Kumar","doi":"10.4103/JOACC.JOACC_49_22","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_49_22","url":null,"abstract":"Background: Current research promotes opioid-sparing analgesia as an approach to enhanced recovery after cesarean (ERAC). In developing countries, non-opioid-based analgesia is routinely practiced in obstetric settings, as opioids are not freely accessible. There are no randomized trials evaluating intravenous diclofenac and acetaminophen for postoperative analgesia following elective cesarean section. Methods: Women scheduled for elective cesarean delivery under subarachnoid block were enrolled if they fulfilled the inclusion criteria. They were randomized to receive either intravenous diclofenac or intravenous diclofenac-acetaminophen combination at the end of surgery and at predefined time intervals during the 24-hour postoperative period. The primary outcome measure of our study was 24-hour rescue analgesic (tramadol) consumption. Secondary outcome measures included time to first request for rescue analgesia, postoperative pain at rest and on movement, episodes of nausea, retching, and vomiting during the 24-hour postoperative period and overall patient satisfaction. Results: The 24-hour rescue analgesic consumption was significantly lesser in the diclofenac-acetaminophen group compared to the diclofenac group (56.25 ± 47.73 mg vs. 92.86 ± 50.83 mg; P = 0.00). Time to first request for rescue analgesia was earlier in the diclofenac group compared to the diclofenac-acetaminophen group (3.96 ± 2.40 h vs. 5.64 ± 3.58 h, P = 0.01). Parturients given a combination of intravenous diclofenac and acetaminophen used 40% less tramadol in the first 24 hours following cesarean section and were more satisfied with their pain management when compared to those given intravenous diclofenac alone. Conclusion: Following cesarean section, intravenous diclofenac-acetaminophen combination provides superior analgesia with significantly lesser opioid consumption and higher patient satisfaction when compared to intravenous diclofenac alone. This combination is effective, easy to administer, opioid-sparing and is compatible with ERAC regimens.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":"13 1","pages":"65 - 70"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48955611","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":"Labour analgesia-epidural/combined spinal epidural/dural puncture epidural/entonox - A cafeteria choice for the patient or just research!","authors":"Manpreet Kaur, A. Trikha","doi":"10.4103/JOACC.JOACC_9_23","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_9_23","url":null,"abstract":"","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":"13 1","pages":"1 - 2"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43701968","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":"Combined spinal-epidural anesthetic management of delivery for marfan syndrome: Case report","authors":"M. Malinovic, Kimberly Babiash, F. Newton","doi":"10.4103/JOACC.JOACC_31_22","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_31_22","url":null,"abstract":"Pregnancy in a patient with Marfan syndrome is associated with risks, including cardiovascular complications. The hemodynamic changes of pregnancy during delivery are deleterious to Marfan syndrome patients. This case describes a Marfan syndrome parturient with dilated aortic root >45 mm who underwent neuraxial anesthesia and cesarean delivery. Anesthetic management focused on reducing hypertension and shear forces on the ascending aorta. A combined spinal-epidural with a reduced dose of hyperbaric bupivacaine was utilized for cesarean delivery. Multidisciplinary approaches are vital in the management of Marfan syndrome pregnancy and cardiovascular complications must be considered when planning for delivery and postpartum management. Anesthetic management must consider the hemodynamic changes in pregnancy and severity of Marfan syndrome cardiovascular involvement in the parturient as well as neonatal risks. Guideline development concerning anesthetic management for both the timing of delivery and aortic repair postpartum would be beneficial to Marfan syndrome parturients.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":"13 1","pages":"106 - 108"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43812323","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 high flow nasal oxygenation as a technique for preoxygenation in full term pregnant women","authors":"P. Ajeetha, N. Kachru, N. Saraswat","doi":"10.4103/JOACC.JOACC_24_22","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_24_22","url":null,"abstract":"Background and Aims: Obstetric airway guidelines recommend preoxygenation before the induction of general anesthesia to achieve an end tidal oxygen concentration of ≥90%. Recently, high flow nasal oxygenation (HFNO) has been evaluated as a technique for delivering a high concentration of oxygen using high flow rates to patients. We evaluated the use of HFNO as a technique for preoxygenation in full-term pregnant women. Methods: A cross-sectional observational study was conducted on 100 term pregnant women. They underwent preoxygenation using HFNO for 4 minutes (30 L/min for 30 secs followed by 50 L/min for 210 secs) and end tidal oxygen concentration (ETO2) was measured at the end of preoxygenation. The primary outcome was the percentage of women who achieved an expired oxygen concentration of ≥90% for the first expired breath. The secondary outcome was the acceptability and comfort of HFNO as compared to facemask preoxygenation using a 4-point Likert scale. Results: The percentage of women who achieved expired oxygen concentration of ≥90% after 4 minutes of HFNO preoxygenation was 32% [95% confidence interval (CI):22.7-41.3%] with the mean end tidal oxygen (SD) being 86.67 (3.4). 71% [mean (SD): 2.94 (0.92)] found nasal cannula and 56% [mean (SD): 2.67 (1.21)] found facemask comfortable and acceptable for preoxygenation (P value, 0.05). Conclusion: Although HFNO is a comfortable technique, when used for preoxygenation for 4 minutes, it did not achieve an acceptable level of preoxygenation (ETO2 ≥90% in 95% of individuals). Therefore, it is an inadequate technique for preoxygenation in term pregnant women.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":"13 1","pages":"35 - 39"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49661672","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 non-modifiable factors associated with post-dural puncture headache following subarachnoid block utilising 26 G quincke spinal needle: Prospective, observational study","authors":"Chander K Negi, S. Bhandari, Ravinder Kumar, S. Rana, Radhika Sharma, Nishita Kaushal","doi":"10.4103/JOACC.JOACC_23_22","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_23_22","url":null,"abstract":"Background and Aims: Post-dural puncture headache (PDPH) is one of the complications of the subarachnoid block (SAB), and the incidence of PDPH is influenced by various factors related to either patients or the type of spinal needle used. This study observed the incidence and severity of PDPH in relation to non-modifiable factors in the patients scheduled for surgeries under SAB. Methods: The study enrolled 302 obstetric and non-obstetric patients, aged 20–60 years, American Society of Anesthesiologists (ASA) I/II having body mass index (BMI) 18.5–29.9 kg.m-2 scheduled for surgeries under SAB utilizing 26 G Quincke spinal needle. Primary outcome was the incidence of PDPH in obstetric and non-obstetric patients. The secondary outcomes included onset, severity of PDPH, and association of age, BMI, and gender to PDPH. Results: The total incidence of PDPH was 5.6%, eight (7%) patients in obstetric and nine (4.8%) patients in non-obstetric group (P = 0.597). The onset of PDPH was comparable in obstetric 17.25 ± 3.69 and non-obstetric patients 18.0 ± 6.02 h (P = 0.663). None of the patient had severe PDPH. The BMI of the patients was not associated with the incidence of PDPH. The female patients among non-obstetric group had higher incidence of PDPH (P = 0.0002). The six patients having PDPH in non-obstetric group belonged to age-group of 31–40 yrs as compared to two above 40 years (P = 0.0173). Conclusion: Obstetric population had comparable incidence of PDPH to non-obstetric population. In the subgroup analysis of non-obstetric patients, the higher incidence of PDPH was observed in the female and younger patients.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":"13 1","pages":"30 - 34"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42651383","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":"Pregnancy-induced pituitary apoplexy: Two lives at stake","authors":"I. Faisal, T. Kaushik, Pragati Ganjoo, A. Jagetia","doi":"10.4103/JOACC.JOACC_53_22","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_53_22","url":null,"abstract":"Pituitary apoplexy in a pregnant woman is a devastating condition that develops secondary to a massive increase in the size of the pituitary gland and hyperplasia of lactotroph cells caused by high estrogen levels of pregnancy. The resultant sudden hemorrhage or infarction into the pituitary gland or a tumor leads to gland destruction with serious consequences like acute adrenal insufficiency, circulatory shock, neurological deterioration, and visual loss. Prompt handling of complications is necessary to prevent maternal and fetal mortality. Resuscitation is aimed at the early correction of hemodynamic instability, fluid-electrolyte abnormalities, hormone deficiencies, and intracranial hypertension. Urgent decompressive pituitary surgery may be required if the patient has rapidly declining vision and neurological status. Management of such patients is challenging and requires multi-disciplinary collaboration. We describe here the emergency handling of pituitary apoplexy in a pregnant woman.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":"13 1","pages":"119 - 121"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42637101","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}