Journal of Obstetric Anaesthesia and Critical Care最新文献

{"title":"Enhanced recovery after cesarean delivery & role of anesthesiologists: A narrative review","authors":"S. Ismail, Malika Hameed","doi":"10.4103/JOACC.JOACC_74_22","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_74_22","url":null,"abstract":"Enhanced recovery after cesarean delivery (ERAC) is an evidence-based interdisciplinary protocol with an aim to improve quality of care and patient satisfaction while lowering health care cost by reducing length of hospital stay. It is an approach that combines several evidence-based perioperative care components to hasten patient recovery. ERAC uses multidisciplinary approach with inclusion of all stakeholders including anesthesiologists, obstetricians, pediatricians, nurses, pharmacists, patients, and hospital administration. Therefore, institutional support, local infrastructure, and compliance of all supporting systems are necessary for the successful implementation of ERAC. The role of anesthesiologists in implementation of standardized care cannot be disregarded as they are involved in the provision of perioperative services to improve maternal outcomes and healthcare quality. The purpose of this narrative review is to explore the components and guidelines from the enhanced recovery after surgery for caesarean delivery, highlight the responsibility of anesthesiologists in the existing and emerging ERAC programs and the difficulties associated with implementing the ERAC in resource-constrained environments.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41756152","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 ultrasound measured gastric volume in term-pregnant patients posted for elective cesarean section with nonpregnant elective surgery patients---An observational study","authors":"Snigdha Bellapukonda, S. Podder, Kamal Kajal, G. Prasad","doi":"10.4103/JOACC.JOACC_25_22","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_25_22","url":null,"abstract":"Background: The pregnant patients undergoing anesthesia are at increased risk of aspiration due to decreased lower esophageal sphincter tone and mass effect of gravid uterus on gastric antrum. Ultrasound used as a noninvasive bedside imaging tool to measure gastric volume in term pregnant patients immediately before elective caesarian section (CS) may help in reducing aspiration induced morbidity and mortality. Methods: This observational prospective case--control study was conducted in 33 nonlaboring term pregnant patients immediately before elective CS and 30 nonpregnant patients immediately before elective surgeries, enrolled according to inclusion and exclusion criteria. A 2-5 MHz curvilinear probe was used to scan the participants in supine and right lateral decubitus (RLD) position in pre-recovery room. Visibility, qualitative grading (0,1, 2), anteroposterior (AP), and craniocaudal (CC) diameter, and cross-sectional area (CSA) of gastric antrum was measured. Gastric volume was derived from CSA using equations formulated by previous investigators. Results: Gastric antrum was visible in 27 (82%) of pregnant and 30 (100%) of nonpregnant patients in supine position (P = 0.014). In RLD position, 25 (75.7%) pregnant and 29 (96.7%) nonpregnant patients had antrum visible (P = 0.018). The qualitative grading was comparable (P = 0.064) in both the groups. In supine position, (P = 0.615), CSA in cm2 was 3.37 ± 1.31 and 3.54 ± 1.33, while in RLD position (P = 0.012), CSA was 3.98 ± 1.13 and 5.09 ± 1.85, in pregnant and nonpregnant patients, respectively. Conclusion: Gravid uterus sometimes impedes visualization of antrum by ultrasound in term pregnant patients immediately before elective CS and shows clinically similar gastric CSA when compared to nonpregnant patients, though statistically different in RLD position. Trial registration number- NCT03380637","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44465786","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":"Effect of intra-abdominal pressure on maximum level of intrathecal sensory block: A preliminary randomized controlled trial","authors":"Jubin Jakhar, Michell Gulabani, A. Tyagi, A. Sethi","doi":"10.4103/JOACC.JOACC_41_22","DOIUrl":"https://doi.org/10.4103/JOACC.JOACC_41_22","url":null,"abstract":"Objectives: Increase in Intra-Abdominal Pressure (IAP) is commonly accepted as a cause for intrathecal dose sparing and consequently higher level of sensory block during pregnancy. There is however very little actual data evaluating the relationship. Thus, we aimed to evaluate association between IAP and maximum level of sensory block following intrathecal injection of hyperbaric bupivacaine as well as plain levobupivacaine for cesarean section. Methods: Preliminary randomized controlled blinded trial included females aged 18-40 years, scheduled for elective cesarean section under single-shot subarachnoid block. After randomization, they received either intrathecal hyperbaric bupivacaine (group H) or plain (isobaric) levobupivacaine (group P) in a dose of 12.5 mg (n = 40 each). IAP was measured before and after the spinal block, using the recommended intravesical technique. The maximum level of sensory block and the IAPs were measured in each patient. Results: There was no significant correlation of IAPprespinal with maximum level of sensory block for group H (P = 0.334; rs = -0.157) or group P (P = 0.637; rs = -0.078). Similarly, there was no significant correlation of the IAPpostspinal: group H (P = 0.370; rs = -0.145); and group P (P = 0.714; rs = -0.061). Both group H and group P had similar IAPprespinal (15.9 [14.3-18.2] and 15.3 [14.3-17.4] mmHg, respectively) (P = 0.474); as well as IAPpostspinal (15.2 [13.8-17.2] and 14.6 [13.4-16.0] mmH, g respectively) (P = 0.239). Among ancillary observations, duration of sensory block was significantly longer for group P versus group H (133.6 ± 24.2 and 103 ± 23.4 mins; P < 0.000). However, the maximum levels of sensory and motor block, respective times required to achieve them, as well as incidences of intraoperative hypotension and bradycardia were statistically similar between group H and group P (P > 0.05). Conclusions: The IAP was raised to the level of conventionally defined intra-abdominal hypertension (>12 mmHg) in patients scheduled for elective cesarean section. However, despite being increased, the IAPprespinal or IAPpostspinal did not show any significant association with the maximum level of sensory block (P > 0.05).","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45705068","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":"Rotational thromboelastometry reference range during pregnancy, labor and postpartum period: A systematic review with meta-analysis","authors":"A. Ronenson, E. Shifman, Aleksandr L. Kulikov, Y. Raspopin, Klaus Görlinger, AlexanderM Ioscovich, G. Tikhova","doi":"10.4103/joacc.joacc_21_22","DOIUrl":"https://doi.org/10.4103/joacc.joacc_21_22","url":null,"abstract":"Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) have become increasingly popular for urgent assessment of the hemostasis system. Accordingly, TEG and ROTEM algorithms and their corresponding cut-off values are not interchangeable. ROTEM provides fast results (including validated early clot firmness parameters [A5 and A10]), that are easy to use, and the graphical display of the results is easy to interpret. ROTEM manufacturer, Tem Innovations GmbH (Munich, Germany), mentions in the user manual that the manufacturer has not set any strict reference values for INTEM, EXTEM, FIBTEM, APTEM, and NATEM in any patient population (including pregnant women) and that these values are highly variable in healthy subjects. To date, no systematic review assessing ROTEM parameters in pregnant, parturient, and postpartum women is available. With the increasing usage of ROTEM, we conducted this systematic review and meta-analysis to determine the reference values of ROTEM parameters in pregnant, parturient, and postpartum women compared with non-pregnant population.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46157778","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":"Hysterotomy repair during cesarean delivery – In or out, does it really matter?","authors":"Adithya Bhat, Preet M. Singh","doi":"10.4103/joacc.joacc_46_22","DOIUrl":"https://doi.org/10.4103/joacc.joacc_46_22","url":null,"abstract":"","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46999456","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":"Psychogenic non-epileptic seizures: Why anaesthesiologist should know?","authors":"P. Dammalapati","doi":"10.4103/joacc.joacc_80_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_80_21","url":null,"abstract":"A 19-year-old primigravida underwent caesarean section under spinal anaesthesia. She presented with seizures on 7th post-operative day. All the common etiological factors for seizures were ruled out. We found out that the seizures were due to a psychiatric condition called 'psychogenic non-epileptic seizure (PNES)'. There were previous case reports of PNES that were documented on known patients of seizures, followed by general anaesthesia. Here is a case of PNES without any previous history of functional or organic seizures followed by spinal anaesthesia.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42677210","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":"Inadvertent intravenous injection of carboprost in a COVID-19-positive patient: A case report","authors":"N. Nazir, D. Chopra","doi":"10.4103/joacc.joacc_82_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_82_21","url":null,"abstract":"We present a case report of an inadvertent administration of intravenous carboprost in a COVID-19-positive parturient who was taken up for an emergency caesarean section for meconi um-stained liquor. Unintentionally, the patient was administered intravenous carboprost instead of ondansetron. The patient developed breathlessness, uneasiness and hypertension. Despite the mishap, the patient fully recovered and was discharged after 15 days. Although the medical error in the present case was non-harmful, the treating doctor discussed the case with the patient. Conclusion: A case with inadvertent intravenous administration of carboprost in a COVID-19-positive parturient is reported with a good outcome.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43032318","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":"Retrospective analysis of the outcome of the anaesthetic procedures in COVID-19 parturient undergoing cesarean delivery in a tertiary care hospital in Delhi, India","authors":"B. Wadhwa, P. Gaba, K. Chaudhary, K. Saxena, K. Sharma, M. Saha, Saurabh Gaur, Pallavi Doda","doi":"10.4103/joacc.joacc_93_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_93_21","url":null,"abstract":"Context: The effect of coronavirus disease 2019 (COVID-19) on a parturient undergoing cesarean delivery (CD) is not fully understood. Aims: To evaluate anesthetic management of a COVID parturient undergoing CD. Settings and Design: Tertiary care hospital, retrospective analysis. Methodology: Hospital case record files of COVID-19 parturients who underwent CD were reviewed with respect to clinical presentation, anesthetic technique, peri-operative course, and maternal-fetal outcome. Data Analysis: Continuous variables are reported as mean ± SD or median (range) and categorical variables as numbers (percentages). Results: Hundred COVID-19 parturients underwent CD: Ninety-eight parturients had asymptomatic to mild clinical presentation, whereas two had a severe presentation. Raised liver enzymes, raised D-dimer, and thrombocytopenia were observed in 65, 34, and 11 parturients, respectively. Combined spinal-epidural anesthesia (CSEA), subarachnoid block (SAB), and general anesthesia were administered in 72, 26, and 2 parturients, respectively. Meantime to administration of SAB and CSEA were 23.5 ± 3.2 min and 28.4 ± 2.8 min, respectively. Adequate block height for CD was achieved in all parturients. Post-spinal hypotension that responded promptly to fluids and vasopressors was reported in six parturients. Postoperatively, two parturients required intensive care unit (ICU) care with one maternal mortality. None of the neonates tested positive for COVID-19. Three neonates had a low Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) at 5 min with one neonatal mortality. Conclusions: Neuraxial anesthesia seems to be a safe and preferred anesthetic technique for CD in a COVID-19 parturient. The incidence of post-spinal hypotension is low and responds promptly to treatment. The course of neuraxial anesthesia and the neonatal outcome is unaffected by the COVID-19 status of the patient.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42955724","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":"Role of high flow nasal cannula (HFNC) for pre-oxygenation among pregnant patients: Current evidence and review of literature","authors":"Ashutosh Kumar Singh, A. Dhir, K. Jain, A. Trikha","doi":"10.4103/joacc.joacc_18_22","DOIUrl":"https://doi.org/10.4103/joacc.joacc_18_22","url":null,"abstract":"With an increasing understanding of respiratory physiology and pathology, many new oxygen delivery devices have been introduced lately. Among them, high flow nasal cannula (HFNC) seems a promising modality that can deliver heated and humidified flows higher than the peak inspiratory flow at high FiO2 (fractional inspired oxygen), hence decreasing the work of breathing without causing discomfort to the patient. Applications of HFNC have escalated for use in multiple areas besides perioperative period over the last decade. The use of HFNC in obstetric population is particularly intriguing as this population is at risk of adverse airway related events. Hence, this narrative review focuses upon the role of HFNC for pre-oxyenation of pregnant patients in peripartum and in intensive care units. We have reviewed the current state of knowledge and the future prospects of HFNC use in obstetric setting.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44786963","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":"Erratum: Enhanced recovery after cesarean protocol versus traditional protocol in elective cesarean section: A prospective observational study","authors":"","doi":"10.4103/2249-4472.355359","DOIUrl":"https://doi.org/10.4103/2249-4472.355359","url":null,"abstract":"","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49149890","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}