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Neuraxial anesthesia

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https://www.readbyqxmd.com/read/29135590/the-analgesic-effect-of-ultrasound-guided-quadratus-lumborum-block-after-cesarean-delivery-a-randomized-clinical-trial
#1
Anders Krohg, Kyrre Ullensvang, Leiv Arne Rosseland, Eldrid Langesæter, Axel R Sauter
BACKGROUND: Landmark and ultrasound-guided transversus abdominis plane blocks have demonstrated an opioid-sparing effect postoperatively after cesarean delivery. The more posterior quadratus lumborum (QL) might provide superior local anesthetic spread to the thoracolumbar fascia and paravertebral space. The aim of our study was to evaluate the efficacy of the QL block after cesarean delivery. METHODS: A randomized, double-blind, controlled trial was performed. Forty parturients undergoing cesarean delivery received bilateral ultrasound-guided QL blocks with either 2 mg/mL ropivacaine or saline postoperatively...
November 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29135475/using-activity-trackers-to-quantify-postpartum-ambulation-a-prospective-observational-study-of-ambulation-after-regional-anesthesia-and-analgesia-interventions
#2
Julia Ma, Rachel Martin, Bokman Chan, Michael Gofeld, Michael P Geary, John G Laffey, Faraj W Abdallah
BACKGROUND: Early postoperative ambulation is associated with enhanced functional recovery, particularly in the postpartum population, but ambulation questionnaires are limited by recall bias. This observational study aims to objectively quantify ambulation after neuraxial anesthesia and analgesia for cesarean delivery and vaginal delivery, respectively, by using activity tracker technology. The hypothesis was that vaginal delivery is associated with greater ambulation during the first 24 h postdelivery, compared to cesarean delivery...
November 14, 2017: Anesthesiology
https://www.readbyqxmd.com/read/29108403/epidemiology-of-septic-meningitis-associated-with-neuraxial-anesthesia-a-historical-review-and-meta-analysis
#3
Andres Zorrilla-Vaca, Ryan J Healy, Lucia Rivera-Lara, Michael C Grant, Lisa L Maragakis, Kevin Escandón-Vargas, Marek A Mirski
BACKGROUND: Neuraxial anesthesia in the form of spinal and epidural are two of the most frequent forms of regional anesthesia. We aimed to describe and compare the relevant epidemiological, clinical and microbiological characteristics of all reported cases of septic meningitis associated with the use of spinal and epidural anesthetics. METHODS: We performed a systematic review of septic meningitis associated with neuraxial anesthesia. We included all relevant case-reports and observational studies in which authors described septic meningitis in association with spinal, epidural or combined neuraxial anesthesia using local anesthetics...
November 6, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29107311/the-use-of-remifentanil-as-the-primary-agent-for-analgesia-in-parturients
#4
REVIEW
Bryan Anderson
Pain control in parturients can be particularly challenging for the hospital staff. To achieve optimal outcomes in anesthesia patients, it is important to consider multiple options for pain control, especially when traditional options pose a problem or are not options. In particular, there are parturient clients for whom the use of neuraxial anesthesia (epidural and spinal blockade) is not an option. One option that warrants consideration for patient centered anesthesia practice is the use of remifentanil.
December 2017: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/29107309/pain-management-in-obstetrics
#5
REVIEW
Jennifer G Hensley, Michelle R Collins, Claire L Leezer
Critical care clinicians may be called on to care for a laboring woman. Comprehension of the anatomic changes associated with pregnancy, and labor and birth, is essential. A working knowledge of the current options for pain management in labor, both pharmacologic and nonpharmacologic, is necessary to facilitate patient-centered care. Pharmacologic options include intravenous or intramuscular agents, inhalational agents, and neuraxial anesthesia. Each modality has contraindications, risks, and benefits that must be considered when choosing the most appropriate method...
December 2017: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/29099429/the-society-for-obstetric-anesthesia-and-perinatology-consensus-statement-on-the-anesthetic-management-of-pregnant-and-postpartum-women-receiving-thromboprophylaxis-or-higher-dose-anticoagulants
#6
Lisa Leffert, Alexander Butwick, Brendan Carvalho, Katherine Arendt, Shannon M Bates, Alex Friedman, Terese Horlocker, Timothy Houle, Ruth Landau, Heloise Dubois, Roshan Fernando, Tim Houle, Sandra Kopp, Douglas Montgomery, Joseph Pellegrini, Richard Smiley, Paloma Toledo
Venous thromboembolism is recognized as a leading cause of maternal death in the United States. Thromboprophylaxis has been highlighted as a key preventive measure to reduce venous thromboembolism-related maternal deaths. However, the expanded use of thromboprophylaxis in obstetrics will have a major impact on the use and timing of neuraxial analgesia and anesthesia for women undergoing vaginal or cesarean delivery and other obstetric surgeries. Experts from the Society of Obstetric Anesthesia and Perinatology, the American Society of Regional Anesthesia, and hematology have collaborated to develop this comprehensive, pregnancy-specific consensus statement on neuraxial procedures in obstetric patients receiving thromboprophylaxis or higher dose anticoagulants...
November 1, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29095750/the-use-of-regional-or-neuraxial-anesthesia-for-below-knee-amputations-may-reduce-the-need-for-perioperative-blood-transfusions
#7
Obaid Malik, Ethan Y Brovman, Richard D Urman
BACKGROUND AND OBJECTIVES: Amputations of the lower extremity remain a common procedure in a high-risk population. Perioperative morbidity and mortality reach as high as 14.1% in below-knee amputations. We aimed to determine whether regional, or neuraxial, anesthesia, when compared with general anesthesia (GA), would be associated with reduced perioperative morbidity and mortality. METHODS: We queried the American College of Surgeons National Surgical Quality Improvement Program data set...
November 1, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29082228/a-pregnant-woman-with-spina-bifida-need-for-a-multidisciplinary-labor-plan
#8
Mary Angela O'Neal
Women with spina bifida present both obstetrical and anesthesia challenges. They are more likely to require a caesarian delivery and traditionally neuraxial anesthesia has been avoided due to concerns of worsening neurologic disability. The case of a pregnant woman with a history of a surgically corrected lipomeningocele and tethered cord is presented to illustrate the need for a comprehensive labor plan.
2017: Frontiers in Medicine
https://www.readbyqxmd.com/read/29073508/lower-limbs-venous-compression-reduces-the-incidence-of-maternal-hypotension-following-epidural-analgesia-during-term-labor
#9
Violaine Peyronnet, Arnaud Roses, Aude Girault, Marie Pierre Bonnet, Francois Goffinet, Vassilis Tsatsaris, Edouard Lecarpentier
OBJECTIVE(S): Every year in France, 10% to 20% of the 600 000 women given epidural analgesia during labor experience hypotension, which in 15% of cases is associated with fetal heart rate abnormalities. The efficiency of lower limbs venous compression in preventing the occurrence of maternal hypotension after neuraxial anesthesia has already been demonstrated, but only in the context of scheduled cesarean section. We assessed the preventive effect of medical lower limbs venous compression on the incidence of maternal hypotension after epidural analgesia during spontaneous term labor...
October 16, 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/29046933/-regional-anesthesia-are-the-standards-changing
#10
REVIEW
T Volk, C Kubulus
Regional anesthesia has undergone many changes over the years and the increasing use of ultrasound has certainly played an important role in this. Apart from individual case reports in the literature of very different blocking options, some new procedures seem to have become established and can be broadly applied. Among these are blockades, by which ultrasound-guided injection of local anesthetics is carried out in fascial or muscular layers rather than around target nerves (e.g. cervical plexus blocks and truncal blocks)...
October 18, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29017742/preoperative-anterior-thigh-temperature-does-not-correlate-with-perioperative-temporal-hypothermia-during-cesarean-delivery-with-spinal-anesthesia-secondary-analysis-of-a-randomized-control-trial
#11
B Cobb, G Abir, B Carvalho
BACKGROUND: Core-to-peripheral redistribution of heat, secondary to sympathetic-mediated vasodilation, is the major mechanism leading to early perioperative hypothermia after neuraxial anesthesia. The study aim was to determine if preoperative anterior thigh (peripheral lower extremity) temperature predicted perioperative temporal (core) temperature decrease during cesarean delivery with spinal anesthesia. METHODS: Secondary analysis of data derived from a prospective, randomized study of 46 healthy women undergoing scheduled cesarean delivery with spinal anesthesia was performed...
August 24, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28971803/perioperative-risk-factors-for-postpartum-pulmonary-embolism-in-taiwanese-cesarean-section-women
#12
Hao-Chin Wang, Pei-Shan Tsai, Kuang-Yao Li, Yen-Chun Fan, Chun-Jen Huang
OBJECTIVE: To explore the perioperative risk factors for predicting postpartum pulmonary embolism (PE) in Taiwanese women with Cesarean section (CS) delivery. METHODS: Data from Taiwan Longitudinal Health Insurance Database were analyzed. All CS women (2002-2007) in Taiwan, according to Diagnosis-Related Group codes, were included. Women having postpartum PE were identified by the diagnosis codes of PE from the medical records within 40 days after CS. Risk factors were analyzed using multivariate logistic regression...
June 2017: Asian J Anesthesiol
https://www.readbyqxmd.com/read/28968282/recent-advances-of-simulation-in-obstetric-anesthesia
#13
Leslie A Schornack, Curtis L Baysinger, May C M Pian-Smith
PURPOSE OF REVIEW: Simulation training in obstetric anesthesia has become widespread in recent years. Simulations are used to train staff and trainees, assess and improve team performance, and evaluate the work environment. This review summarizes current research in these categories. RECENT FINDINGS: Simulation to improve individual technical skills has focused on induction of general anesthesia for emergent cesarean delivery, an infrequently encountered scenario by anesthesia trainees...
December 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28968275/association-of-hospital-level-neuraxial-anesthesia-use-for-hip-fracture-surgery-with-outcomes-a-population-based-cohort-study
#14
Daniel I McIsaac, Duminda N Wijeysundera, Allen Huang, Gregory L Bryson, Carl van Walraven
BACKGROUND: There is consistent and significant variation in neuraxial anesthesia use for hip fracture surgery across jurisdictions. We measured the association of hospital-level utilization of neuraxial anesthesia, independent of patient-level use, with 30-day survival (primary outcome) and length of stay and costs (secondary outcomes). METHODS: We conducted a population-based cohort study using linked administrative data in Ontario, Canada. We identified all hip fracture patients more than 65 yr of age from 2002 to 2014...
October 2, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28922227/incidence-and-risk-factors-of-coagulation-profile-derangement-after-liver-surgery-implications-for-the-use-of-epidural-analgesia-a-retrospective-cohort-study
#15
Pierre Jacquenod, Grégoire Wallon, Mathieu Gazon, Benjamin Darnis, Pierre Pradat, Victor Virlogeux, Olivier Farges, Frédéric Aubrun
BACKGROUND: Hepatic surgery is a major abdominal surgery. Epidural analgesia may decrease the incidence of postoperative morbidities. Hemostatic disorders frequently occur after hepatic resection. Insertion or withdrawal (whether accidental or not) of an epidural catheter during coagulopathic state may cause an epidural hematoma. The aim of the study is to determine the incidence of coagulopathy after hepatectomy, interfering with epidural catheter removal, and to identify the risk factors related to coagulopathy...
September 14, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28888583/food-and-drug-administration-warning-on-anesthesia-and-brain-development-implications-for-obstetric-and-fetal-surgery
#16
Olutoyin A Olutoye, Byron Wycke Baker, Michael A Belfort, Oluyinka O Olutoye
There has been growing concern about the detrimental effects of certain anesthetic agents on the developing brain. Preclinical studies in small animal models as well as nonhuman primates suggested loss or death of brain cells and consequent impaired neurocognitive function following anesthetic exposure in neonates and late gestation fetuses. Human studies in this area are limited and currently inconclusive. On Dec. 14, 2016, the US Food and Drug Administration issued a warning regarding impaired brain development in children following exposure to certain anesthetic agents used for general anesthesia, namely the inhalational anesthetics isoflurane, sevoflurane, and desflurane, and the intravenous agents propofol and midazolam, in the third trimester of pregnancy...
September 6, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28867599/the-postoperative-venous-thromboembolism-trevo-study-risk-and-case-mortality-by-surgical-specialty
#17
Cristina Amaral, Luís Guimarães Pereira, Ana Moreto, Ana Carolina Sá, Ana Azevedo
INTRODUCTION AND OBJECTIVES: Venous thromboembolism, risk of which is increased in surgical patients, is a preventable cause of morbidity and death. The primary objective of this study was to estimate the incidence of symptomatic postoperative venous thromboembolism in adults at a tertiary university hospital, overall and by surgical specialty. The secondary objective was to analyze severity of and mortality from thromboembolic events. METHODS: We performed a retrospective study to identify cases of in-hospital postoperative venous thromboembolism, encoded by the International Classification of Diseases, Ninth Revision, according to the Joint Commission International criteria...
August 31, 2017: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/28860857/preventing-nausea-and-vomiting-in-women-undergoing-regional-anesthesia-for-cesarean-section-challenges-and-solutions
#18
REVIEW
Yvonne Jelting, Christian Klein, Thomas Harlander, Leopold Eberhart, Norbert Roewer, Peter Kranke
BACKGROUND: Intraoperative nausea and vomiting (IONV) or postoperative nausea and vomiting (PONV) affecting women undergoing regional anesthesia for cesarean section is an important clinical problem since these techniques are used widely. There are burdens of literature about IONV/PONV and several in parturient and cesarean. However, it needs more attention. The underlying mechanisms of IONV and PONV in the obstetrical setting mainly include hypotension due to sympathicolysis during neuraxial anesthesia, bradycardia owing to an increased vagal tone, the visceral stimulation via the surgical procedure and intravenously administered opioids...
2017: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/28858899/patients-undergoing-cesarean-delivery-after-exposure-to-oxytocin-during-labor-require-higher-postpartum-oxytocin-doses
#19
Amanda Foley, Ashley Gunter, Kenneth J Nunes, Sajid Shahul, Barbara M Scavone
BACKGROUND: Experts recommend postpartum oxytocin to prevent uterine atony and hemorrhage, but oxytocin may be associated with dose-dependent adverse effects, and the correct dose of postpartum oxytocin has yet to be determined. The effective dose in 90% of patients (ED90) of oxytocin after cesarean delivery may be higher in patients exposed to oxytocin during labor compared to patients unexposed. We therefore undertook this study to compare postpartum oxytocin requirements in patients exposed to oxytocin prior to cesarean delivery versus those not exposed, when all were treated according to a specific institutional protocol...
August 30, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28828987/perioperative-management-of-anticoagulants
#20
Joan M Irizarry-Alvarado, Lynsey A Seim
BACKGROUND: The prevalence of anticoagulant use has increased in the United States. Medical providers have the responsibility to explain to patients the management of anticoagulant regimens before an invasive procedure. The pharmacologic characteristics of these medications-specifically, their half-lives-are important in timing an interruption of anticoagulant therapy. OBJECTIVE: The authors review the current guidelines and recommendations for therapeutic interruption of anticoagulants and the involved pharmacologic factors...
August 21, 2017: Current Clinical Pharmacology
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