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Obstetric anesthesia

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https://www.readbyqxmd.com/read/28319475/advances-in-obstetric-anesthesia
#1
Joy L Hawkins
No abstract text is available yet for this article.
March 17, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28306682/training-future-anesthesiologists-in-obstetric-care
#2
Mauricio Vasco Ramírez
PURPOSE OF REVIEW: In order for the obstetric anesthesiologist to become a true perioperative / peripartum physician, a change in formative programs and certification process in anesthesia are needed. RECENT FINDINGS: Anesthesia training programs are migrating to competency based medical education (CBME) worldwide. The traditional model of attending lectures, grand rounds, reading textbooks and journal papers should be complemented by virtual modalities such as massive open online courses or online teaching tools...
March 16, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28291128/the-use-of-ultrasound-in-obstetric-anesthesia
#3
Carolyn F Weiniger, Limor Sharoni
PURPOSE OF REVIEW: The current review considers an array of recent applications for point-of-care ultrasound in clinical practice including diagnostic and therapeutic procedures that may be relevant for the obstetric anesthesiologist. The rapid advancement of technology and clinical applications for bedside ultrasound in obstetric anesthesiology requires an appraisal of the limitations and uses. RECENT FINDINGS: The review presents the most recent literature describing ultrasound-guided airway assessments, airway management, cricothyroidotomy, transthoracic echocardiography, gastric volume assessments, point-of-care lung ultrasound diagnoses, intracranial pressure assessments, vascular access, neuraxial blocks, and transversus abdominis plane blocks...
March 11, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28290956/multidisciplinary-in-situ-simulation-based-training-as-a-postpartum-hemorrhage-quality-improvement-project
#4
Monica A Lutgendorf, Carmen Spalding, Elizabeth Drake, Dennis Spence, Jason O Heaton, Kristina V Morocco
BACKGROUND: Postpartum hemorrhage is a common obstetric emergency affecting 3 to 5% of deliveries, with significant maternal morbidity and mortality. Effective management of postpartum hemorrhage requires strong teamwork and collaboration. We completed a multidisciplinary in situ postpartum hemorrhage simulation training exercise with structured team debriefing to evaluate hospital protocols, team performance, operational readiness, and real-time identification of system improvements...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28279665/multiple-sevoflurane-anesthesia-in-pregnant-mice-inhibits-neurogenesis-of-fetal-hippocampus-via-repressing-transcription-factor-pax6
#5
Fang Fang, Ruixue Song, Xiaomim Ling, Mengyuan Peng, Zhanggang Xue, Jing Cang
Sevoflurane is widely used in non-obstetric surgeries of pregnant women, but its influences on fetal brain are still not fully known. We set out to assess the effects of multiple maternal sevoflurane exposure on neurogenesis and cognitive dysfunction in fetus and offspring. Pregnant mice (gestational day 15.5) and cultured mouse neural stem cells (NSCs) received daily sevoflurane exposure (2.5%×2h and 4.1%×2h respectively) for three consecutive days. Cognitive function of the offspring was determined with the Morris water maze...
March 6, 2017: Life Sciences
https://www.readbyqxmd.com/read/28277382/current-applications-of-big-data-in-obstetric-anesthesiology
#6
Thomas T Klumpner, Melissa E Bauer, Sachin Kheterpal
PURPOSE OF REVIEW: The narrative review aims to highlight several recently published 'big data' studies pertinent to the field of obstetric anesthesiology. RECENT FINDINGS: Big data has been used to study rare outcomes, to identify trends within the healthcare system, to identify variations in practice patterns, and to highlight potential inequalities in obstetric anesthesia care. Big data studies have helped define the risk of rare complications of obstetric anesthesia, such as the risk of neuraxial hematoma in thrombocytopenic parturients...
March 8, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28277381/working-toward-quality-in-obstetric-anesthesia-a-business-approach
#7
Grant C Lynde
PURPOSE OF REVIEW: Physicians are increasingly required to demonstrate that they provide quality care. How does one define quality? A significant body of literature in industries outside of health care provides guidance on how to define appropriate metrics, create teams to troubleshoot problem areas, and sustain those improvements. RECENT FINDINGS: The modern quality movement in the United States began in response to revolutionary gains in both quality and productivity in Japanese manufacturing in the 1980's...
March 8, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28277324/risk-factors-for-severe-postpartum-hemorrhage-after-cesarean-delivery-case-control-studies
#8
Alexander J Butwick, Bharathi Ramachandran, Priya Hegde, Edward T Riley, Yasser Y El-Sayed, Lorene M Nelson
BACKGROUND: Women who undergo intrapartum caesarean delivery (CD) are at increased risk of postpartum hemorrhage (PPH) compared with those undergoing prelabor CD. To determine whether the presence and strength of the associations between individual risk factors and severe PPH vary among women undergoing prelabor CD or intrapartum CD, stratified analyses are needed according to CD subtype. METHODS: To identify risk factors for severe PPH within 2 distinct CD populations, prelabor CD and intrapartum CD, we performed 2 case-control studies...
March 8, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28270765/cafedrine-theodrenaline-20-1-is-an-established-alternative-for-the-management-of-arterial-hypotension-in-germany-a-review-based-on-a-systematic-literature-search
#9
REVIEW
Berthold Bein, Torsten Christ, Leopold H J Eberhart
A 20:1 combination of cafedrine:theodrenaline (Akrinor®) is widely used in Germany for the treatment of hypotensive states during anesthesia and in emergency medicine. Although this drug formulation has been available since 1963, there are few studies relating to its use and many of the data are only available in German. In this article, we summarize the available data and propose mechanisms for the effects of cafedrine/theodrenaline on cardiac muscle cells and vascular smooth muscle cells. Cafedrine/theodrenaline leads to a rapid increase in mean arterial pressure that is characterized by increased cardiac preload, stroke volume, and cardiac output...
2017: Frontiers in Pharmacology
https://www.readbyqxmd.com/read/28256306/clinical-follow-up-of-pregnancy-in-myasthenia-gravis-patients
#10
Renata D Ducci, Paulo J Lorenzoni, Claudia S K Kay, Lineu C Werneck, Rosana H Scola
This study aimed to analyze the outcome and impact of pregnancy in women with myasthenia gravis (MG). Obstetric and clinical data were retrospectively analyzed before, during and after pregnancy. Predictors of outcome were studied. We included 35 pregnancies from 21 MG patients. In the course of MG symptoms in 30 pregnancies with live births, 50% deteriorated (mainly during the second trimester, p = 0.028), 30% improved, and 20% remained unchanged. The deterioration group had more frequent abnormal repetitive nerve stimulation (RNS) (p = 0...
February 1, 2017: Neuromuscular Disorders: NMD
https://www.readbyqxmd.com/read/28244952/prophylactic-phenylephrine-infusions-to-reduce-severe-spinal-anesthesia-hypotension-during-cesarean-delivery-in-a-resource-constrained-environment
#11
David G Bishop, Carel Cairns, Mariette Grobbelaar, Reitze N Rodseth
Phenylephrine infusions are considered as standard management for obstetric spinal hypotension, but there remains reluctance to implement them in resource-limited contexts. This prospective, alternating intervention study of patients undergoing elective or urgent cesarean delivery under spinal anesthesia compared a vasopressor bolus strategy to fixed-rate, low-dose prophylactic phenylephrine infusion with supplemental boluses. The primary outcome was the incidence of severe hypotension (mean arterial pressure <70% baseline or systolic blood pressure <80 mm Hg)...
February 24, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28244949/cross-disciplinary-perceptions-of-structured-interprofessional-rounds-in-promoting-teamwork-within-an-academic-tertiary-care-obstetric-unit
#12
Anthony Chau, Mary A Vijjeswarapu, Margaret Hickey, David Acker, Chuan-Chin Huang, Lawrence C Tsen
BACKGROUND: In 2005, physician and nursing leaders at Brigham and Women's Hospital initiated structured interprofessional rounds (SIPRs) on the labor and delivery (L&D) suite to improve team communication. We performed a cross-sectional analysis of providers' perceptions of SIPRs and their effectiveness in improving teamwork. We hypothesized that on average, providers would perceive SIPRs as being effective in promoting teamwork, but ratings would differ among professional groups. METHODS: After a factor analysis and internal consistency assessment, a 19-item paper-based questionnaire was used to evaluate providers' perceptions using a 5-point Likert scale...
February 24, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28238025/anesthetic-management-of-abdominal-radical-trachelectomy-for-uterine-cervical-cancer-during-pregnancy
#13
Jun Terukina, Misako Takamatsu, Takayuki Enomoto, Hiroshi Baba
Abdominal radical trachelectomy has been identified as a surgical option for fertility preservation in cervical cancer patients, particularly in pregnant women who strongly desire to continue their pregnancy. Since this procedure requires operating in the uterus, the hardness of the uterus can affect the ease of surgery. Generally, sevoflurane is used for anesthesia in non-obstetric surgery for pregnant women because uterine relaxation is advantageous for uterine blood flow maintenance. However, the use of sevoflurane during radical trachelectomy has not been thoroughly evaluated...
February 25, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28235522/preprocedural-ultrasound-assessment-does-not-improve-trainee-performance-of-spinal-anesthesia-for-obstetrical-patients-a-randomized-controlled-trial
#14
Timothy P Turkstra, Kristine L Marmai, Kevin P Armstrong, Kamal Kumar, S Indu Singh
STUDY OBJECTIVE: This randomized controlled trial was designed to evaluate the efficacy of additional information from preprocedure ultrasound examination to aid anesthesiology trainees performing spinal anesthesia for obstetric patients. DESIGN: Trainee residents were randomly allocated to landmark technique and anatomy demonstration via ultrasound examination or landmark technique only for spinal anesthetic placement. SETTING: Obstetric delivery suite...
February 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28235511/increasing-body-mass-index-predicts-increasing-difficulty-failure-rate-and-time-to-discovery-of-failure-of-epidural-anesthesia-in-laboring-patients
#15
Ayse O Kula, Matthias L Riess, Elizabeth H Ellinas
STUDY OBJECTIVE: Obese parturients both greatly benefit from neuraxial techniques, and may represent a technical challenge to obstetric anesthesiologists. Several studies address the topic of obesity and neuraxial analgesia in general, but few offer well described definitions or rates of "difficulty" and "failure" of labor epidural analgesia. Providing those definitions, we hypothesized that increasing body mass index (BMI) is associated with negative outcomes in both categories and increased time needed for epidural placement...
February 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28224270/intrapartal-pelvic-floor-protection-a-pragmatic-and-interdisciplinary-approach-between-obstetrics-and-urogynecology
#16
Markus Huebner, Sara Y Brucker, Ralf Tunn, Gert Naumann, Christl Reisenauer, Harald Abele
Pelvic floor protection is an issue of increasing relevance. This article sought to summarize the session at last year's annual meeting of the German Society of Gynecology and Obstetrics (DGGG) in Stuttgart (10/2016) called "Urogynecology 2020-what is the optimal rate of cesarean section-does urogynecology have to deal with Obstetrics?". The main focus was set on the two important anatomical structures, the levator ani muscle and the anal sphincters. Operative vaginal delivery, epidural anesthesia, and episiotomy are subject to discussion...
February 21, 2017: Archives of Gynecology and Obstetrics
https://www.readbyqxmd.com/read/28218212/laryngeal-mask-airway-for-cesarean-delivery-a-5-year-retrospective-cohort-study
#17
Zhi-Yu Geng, Dong-Xin Wang
BACKGROUND: The laryngeal mask airway (LMA) is the most commonly used rescue airway in obstetric anesthesia. The aim of this retrospective cohort study was to evaluate the application of the LMA in parturients undergoing cesarean delivery (CD) for 5 years in our hospital. As a secondary objective, we investigated the incidence of airway-related complication in obstetric general anesthesia (GA). METHODS: We collected electronic data for all obstetric patients who received GA for CD between January 2010 and December 2014 in Peking University First Hospital...
2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/28217389/management-of-parturients-in-active-labor-with-arnold-chiari-malformation-tonsillar-herniation-and-syringomyelia
#18
Ramsis F Ghaly, Tatiana Tverdohleb, Kenneth D Candido, Nebojsa Nick Knezevic
BACKGROUND: Arnold-Chiari malformation Type 1 (ACM-1) in parturients is a topic of ongoing discussion between obstetricians and anesthesiologists. The primary unanswered question remains; How should the anesthesia provider proceed with labor analgesia and anesthesia for cesarean section when confronted with an advanced, asymptomatic, or minimally symptomatic case of ACM-1 during labor? CASE DESCRIPTION: A 24-year-old, ASA II, G1P0 full-term parturient presented to Labor and Delivery for vaginal delivery...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28215984/the-cost-of-nurse-midwifery-care-use-of-interventions-resources-and-associated-costs-in-the-hospital-setting
#19
Molly R Altman, Sean M Murphy, Cynthia E Fitzgerald, H Frank Andersen, Kenn B Daratha
INTRODUCTION: Obstetrical care often involves multiple expensive, and often elective, interventions that may increase costs to patients, payers and the health care system with little effect on patient outcomes. The objectives of this study were to examine the following hospital related outcomes: 1) use of labor and birth interventions, 2) inpatient duration of stay, and 3) total direct health care costs for patients attended by a certified nurse-midwife (CNM) compared with those attended by an obstetrician-gynecologist (OB-GYN), within an environment of safe and high-quality care...
February 15, 2017: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
https://www.readbyqxmd.com/read/28212182/what-s-new-in-obstetric-anesthesia-the-2016-gerard-w-ostheimer-lecture
#20
Philip E Hess
This special article presents potentially important trends and issues affecting the field of obstetric anesthesia drawn from publications in 2015. Both maternal mortality and morbidity in the United States have increased in recent years because, in part, of the changing demographics of the childbearing population. Pregnant women are older and have more pre-existing conditions and complex medical histories. Cardiovascular and noncardiovascular medical diseases now account for half of maternal deaths in the United States...
March 2017: Anesthesia and Analgesia
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