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Obstetric anaesthesia emergencies

Matthew A R Stokes, Glenn D Guest, Perista Mamadi, Westin Seta, Noel Yaubihi, Grace Karawiga, Billy Naidi, David A K Watters
BACKGROUND: Timely access to emergency and essential surgical care (EESC) and anaesthesia in low- and middle-income countries (LMICs) prevents premature death, minimises lifelong disability and reduces their economic impact on families and communities. Papua New Guinea is one of the poorest countries in the Pacific region, and provides much of its surgical care at a district hospital level. We aimed to evaluate the surgical capacity of a district hospital in PNG and estimate the effectiveness of surgical interventions provided...
October 13, 2016: World Journal of Surgery
Asrar Ahmad, Monica Kohli, Anita Malik, Megha Kohli, Jaishri Bogra, Haider Abbas, Rajni Gupta, B B Kushwaha
PURPOSE: In this study, we aimed to correlate thromboelastography (TEG) variables versus conventional coagulation profile in all patients presenting with pre-eclampsia/eclampsia and to see whether TEG would be helpful for evaluating coagulation in parturients before regional anaesthesia. MATERIALS AND METHODS: This was a prospective study on 100 pre-eclampsia/eclampsia patients undergoing lower-segment caesarean section under regional anaesthesia. Two blood samples were collected...
October 2016: Journal of Obstetrics and Gynaecology of India
A Nyamtema, N Mwakatundu, S Dominico, H Mohamed, A Shayo, R Rumanyika, C Kairuki, C Nzabuhakwa, O Issa, C Lyimo, I Kasiga, J van Roosmalen
OBJECTIVE: To describe the results of increasing availability and quality of caesarean deliveries and anaesthesia in rural Tanzania. DESIGN: Before-after intervention study design. SETTINGS: Rural Tanzania. METHODS: Ten health centres located in rural areas were upgraded to provide comprehensive emergency obstetric care (CEmOC) and the four related district hospitals were supported. Upgrading entailed constructing and equipping maternity blocks, operation rooms and laboratories; installing solar systems, backup generators and water supply systems...
September 2016: BJOG: An International Journal of Obstetrics and Gynaecology
Lucille Jay, Laurent Zieleskiewicz, François-Pierrick Desgranges, Bérengère Cogniat, Marius Pop, Pierre Boucher, Amandine Bellon, Marc Léone, Dominique Chassard, Lionel Bouvet
BACKGROUND: Ultrasound measurement of the antral cross-sectional area of the stomach, performed in the supine position, has been described for preoperative assessment of gastric content in the adult, but, to date, no study has determined the cut-off value of the antral area for the diagnosis of an empty stomach in the parturient. Nevertheless, previous studies in parturients have reported that the use of a simple qualitative grading scale (0 to 2) was reliable for the estimation of the gastric fluid volume...
June 2, 2016: European Journal of Anaesthesiology
Angelo S Nyamtema, Nguke Mwakatundu, Sunday Dominico, Hamed Mohamed, Senga Pemba, Richard Rumanyika, Clementina Kairuki, Irene Kassiga, Allan Shayo, Omary Issa, Calist Nzabuhakwa, Chagi Lyimo, Jos van Roosmalen
BACKGROUND: In Tanzania, maternal mortality ratio (MMR), unmet need for emergency obstetric care and health inequities across the country are in a critical state, particularly in rural areas. This study was established to determine the feasibility and impact of decentralizing comprehensive emergency obstetric and neonatal care (CEmONC) services in underserved rural areas using associate clinicians. METHODS: Ten health centres (HCs) were upgraded by constructing and equipping maternity blocks, operating rooms, laboratories, staff houses and installing solar panels, standby generators and water supply systems...
2016: PloS One
Annettee Nakimuli, Sarah Nakubulwa, Othman Kakaire, Michael O Osinde, Scovia N Mbalinda, Rose C Nabirye, Nelson Kakande, Dan K Kaye
BACKGROUND: Maternal near misses occur more often than maternal deaths and could enable more comprehensive analysis of risk factors, short-term outcomes and prognostic factors of complications during pregnancy and childbirth. The study determined the incidence, determinants and prognostic factors of severe maternal outcomes (near miss or maternal death) in two referral hospitals in Uganda. METHODS: A prospective cohort study was conducted between March 1, 2013 and February 28, 2014, where cases of severe pregnancy and childbirth complications were included...
2016: BMC Pregnancy and Childbirth
Janet Martin, Goa Tau, Meena Nathan Cherian, Jennifer Vergel de Dios, David Mills, Jane Fitzpatrick, William Adu-Krow, Davy Cheng
OBJECTIVE: To assess capacity to provide essential surgical services including emergency, obstetric and anaesthesia care in Papua New Guinea (PNG) in order to support planning for relevant post-2015 sustainable development goals for PNG. DESIGN: Cross-sectional survey. SETTING: Hospitals and health facilities in PNG. PARTICIPANTS: 21 facilities including 3 national/provincial hospitals, 11 district/rural hospitals, and 7 health centres...
2015: BMJ Open
Miguel Trelles, Lynette Dominguez, Katie Tayler-Smith, Katrin Kisswani, Alberto Zerboni, Thierry Vandenborre, Silvia Dallatomasina, Alaa Rahmoun, Marie-Christine Ferir
BACKGROUND: Since 2011, civil war has crippled Syria leaving much of the population without access to healthcare. Various field hospitals have been clandestinely set up to provide basic healthcare but few have been able to provide quality surgical care. In 2012, Medecins Sans Frontieres (MSF) began providing surgical care in the Jabal al-Akrad region of north-western Syria. Based on the MSF experience, we describe, for the period 5th September 2012 to 1st January 2014: a) the volume and profile of surgical cases, b) the volume and type of anaesthetic and surgical procedures performed, and c) the intraoperative mortality rate...
2015: Conflict and Health
Angela Enright, Kate Grady, Faye Evans
Maternal mortality is high in many low- and middle-income countries. Unsafe anaesthesia contributes to this, especially for women requiring Caesarean section. Anaesthesia providers with limited skills and poor resources are often faced with complicated obstetric patients. A new course called SAFE-OB teaches a systematic approach to anticipating, preparing for, and dealing with obstetric anaesthetic emergencies. The course has now been taught in many African, Asian, and Latin countries. Initial follow-up suggests improvement in skills and knowledge, and effective translation of these to the workplace...
October 2015: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Jette Led Sørensen, Laura Emdal Navne, Helle Max Martin, Bent Ottesen, Charlotte Krebs Albrecthsen, Berit Woetmann Pedersen, Hanne Kjærgaard, Cees van der Vleuten
OBJECTIVE: To examine how the setting in in situ simulation (ISS) and off-site simulation (OSS) in simulation-based medical education affects the perceptions and learning experience of healthcare professionals. DESIGN: Qualitative study using focus groups and content analysis. PARTICIPANTS: Twenty-five healthcare professionals (obstetricians, midwives, auxiliary nurses, anaesthesiologists, a nurse anaesthetist and operating theatre nurse) participated in four focus groups and were recruited due to their exposure to either ISS or OSS in multidisciplinary obstetric emergencies in a randomised trial...
2015: BMJ Open
Jette Led Sørensen, Cees van der Vleuten, Susanne Rosthøj, Doris Østergaard, Vicki LeBlanc, Marianne Johansen, Kim Ekelund, Liis Starkopf, Jane Lindschou, Christian Gluud, Pia Weikop, Bent Ottesen
OBJECTIVE: To investigate the effect of in situ simulation (ISS) versus off-site simulation (OSS) on knowledge, patient safety attitude, stress, motivation, perceptions of simulation, team performance and organisational impact. DESIGN: Investigator-initiated single-centre randomised superiority educational trial. SETTING: Obstetrics and anaesthesiology departments, Rigshospitalet, University of Copenhagen, Denmark. PARTICIPANTS: 100 participants in teams of 10, comprising midwives, specialised midwives, auxiliary nurses, nurse anaesthetists, operating theatre nurses, and consultant doctors and trainees in obstetrics and anaesthesiology...
2015: BMJ Open
Lily A Gutnik, Joseph Dielman, Anna J Dare, Margarita S Ramos, Robert Riviello, John G Meara, Gavin Yamey, Mark G Shrime
BACKGROUND: In recent years, funds for global health have risen substantially, particularly for infectious diseases. Although conditions amenable to surgery account for 28% of the global burden of disease, the external funds directed towards global surgical delivery, capacity building, and research are currently unknown and presumed to be low. We aimed to describe external funds given to these efforts from the USA, the world's largest donor nation. METHODS: We searched the United States Agency for International Development (USAID), National Institute of Health (NIH), Foundation Center, and registered US charitable organisations databases for financial data on any giving exclusively to surgical care in low-income and middle-income countries (LMICs)...
April 27, 2015: Lancet
Sadic Kagwa, Mark A Hoeft, Paul G Firth, Stephen Ttendo, Vicki E Modest
BACKGROUND: Transversus abdominis plane (TAP) block provides 12-24 h of analgesia to the parietal peritoneum and abdominal wall, and are best used combined with oral or intravenous medications. Despite ease of use, a large margin of safety, and a high success rate, TAP blocks remain under used in settings where patients could most benefit from their use. Previous studies have used oral or intravenous narcotics for supplementation. However, the efficacy of TAP blocks in low-resourced settings where patients do not have dependable access to these medications is unknown...
April 27, 2015: Lancet
Victoria A Eley, Andre van Zundert, Leonie Callaway
BACKGROUND: Early utilisation of neuraxial anaesthesia has been recommended to reduce the need for general anaesthesia in obese parturients. The insertion and management of labour epidurals in obese women is not straight-forward. The aim of this pilot study was to compare the failure rate of extension of epidural analgesia for emergency caesarean section, in pregnant women with a body mass index (BMI) ≥ 40 kg/m(2), to those with a BMI < 30 kg/m(2). The results will be used to calculate the sample size of a planned prospective study...
2015: BMC Anesthesiology
P M Slater
Two obstetric patients presenting with post-traumatic stress disorder in the antenatal period are discussed. The first patient had previously had an unexpected stillborn delivered by emergency caesarean section under general anaesthesia. She developed post-traumatic stress disorder and presented for repeat caesarean section in her subsequent pregnancy, suffering flashbacks and severe anxiety. Following antenatal preparation with hypnosis and a psychological method called the rewind technique, she had a repeat caesarean section under spinal anaesthesia, successfully managing her anxiety...
August 2015: International Journal of Obstetric Anesthesia
Suyogi V Jigajinni, Baskar Rajala, Nadir El Sharawi
Rapid sequence induction of general anaesthesia (GA) is the fastest anaesthetic technique in a category-1 caesarean section (C1CS) for foetal distress. Recently rapid sequence spinal anaesthesia (RSS) has been explored as a technique to avoid the potential risks of GA in such cases. Out of hours, trainee anaesthetists are often required to provide anaesthesia for these emergencies. We surveyed their practices when performing a RSS. The aim of a RSS is to rapidly and safely achieve anaesthesia for C1CS, while optimising foetal oxygenation and preparing for possible GA...
January 2015: Journal of Perioperative Practice
A J Butwick, Y Y El-Sayed, Y J Blumenfeld, S S Osmundson, C F Weiniger
BACKGROUND: Preterm delivery is often performed by Caesarean section. We investigated modes of anaesthesia and risk factors for general anaesthesia among women undergoing preterm Caesarean delivery. METHODS: Women undergoing Caesarean delivery between 24(+0) and 36(+6) weeks' gestation were identified from a multicentre US registry. The mode of anaesthesia was classified as neuraxial anaesthesia (spinal, epidural, or combined spinal and epidural) or general anaesthesia...
August 2015: British Journal of Anaesthesia
P Howell, I Tennant, R Augier, G Gordon-Strachan, H Harding-Goldson
OBJECTIVE: To determine physicians' knowledge of cardiopulmonary resuscitation (CPR) guidelines at the University Hospital of the West Indies (UHWI), Jamaica, and their current certification status in basic life support (BLS), advanced cardiac life support (ACLS), paediatric advanced life support (PALS) and advanced trauma life support (ATLS). METHODS: This was a cross-sectional study. A 23-item self-administered questionnaire was used to assess physicians practising at the UHWI, from the Departments of Anaesthesia, Surgery, Internal Medicine, Accident and Emergency, Obstetrics and Gynaecology and Oncology...
December 2014: West Indian Medical Journal
Sarah Devroe, Marc Van de Velde, Steffen Rex
PURPOSE OF REVIEW: For most anaesthesiologists, the clinical experience with general anaesthesia for caesarean section is very low. General anaesthesia is mostly performed for emergency grade 1 caesarean section and due to a lack of time to apply a neuraxial anaesthesia technique. Unfortunately, the majority of anaesthesiologists rely on historical and partly outdated approaches in this stressful situation. We propose an evidence-based approach to general anaesthesia for caesarean section...
June 2015: Current Opinion in Anaesthesiology
H J Vansell, J J Schlesinger, A Harvey, J P Rohde, S Persaud, K A McQueen
The surgical and anaesthesia needs of low-income countries are mostly unknown due to the lack of data on surgical infrastructure and human resources. The goal of this study is to assess the surgical and anaesthesia capacity in Guyana. A survey tool adapted from the WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care was used to survey nine regional and district hospitals within the Ministry of Health system in Guyana. In nine hospitals across Guyana, there were an average of 0...
March 2015: Journal of Epidemiology and Global Health
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