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Obstetric Anesthesia

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101 papers 100 to 500 followers Articles of interest for anesthesiologist who work with obstetrics either general or subspecialized
By Ron George Anesthesiologist with special interests in Obstetrics, Pain, and Global Health
J S Berger, A Gonzalez, A Hopkins, T Alshaeri, D Jeon, S Wang, R L Amdur, R Smiley
BACKGROUND: The appropriate dose of intrathecal morphine for post-cesarean analgesia is unclear. With the inclusion of routine non-steroidal anti-inflammatory drugs, the required dose of morphine may be significantly less than the 200-300μg common a decade ago. We performed a two-center, prospective, randomized, blinded trial comparing three doses of intrathecal morphine, combined with routine intravenous ketorolac, in 144 healthy women undergoing elective cesarean delivery. METHODS: Patients received an intrathecal injection of hyperbaric bupivacaine 12mg, fentanyl 15μg and a randomized dose of 50, 100, or 150μg morphine in a volume of 2...
August 28, 2016: International Journal of Obstetric Anesthesia
Naola Austin, Sara Goldhaber-Fiebert, Kay Daniels, Julie Arafeh, Veronique Grenon, Dana Welle, Steven Lipman
As pioneers in the field of patient safety, anesthesiologists are uniquely suited to help develop and implement safety strategies to minimize preventable harm on the labor and delivery unit. Most existing obstetric safety strategies are not comprehensive, lack input from anesthesiologists, are designed with a relatively narrow focus, or lack implementation details to allow customization for different units. This article attempts to address these gaps and build more comprehensive strategies by discussing the available evidence and multidisciplinary authors' local experience with obstetric simulation drills and optimization of team communication...
October 3, 2016: Anesthesia and Analgesia
Lynn M Yee, Grecio Sandoval, Jennifer Bailit, Uma M Reddy, Ronald J Wapner, Michael W Varner, Steve N Caritis, Mona Prasad, Alan T N Tita, George Saade, Yoram Sorokin, Dwight J Rouse, Sean C Blackwell, Jorge E Tolosa
OBJECTIVE: To describe factors associated with delayed pushing and evaluate the relationship between delayed pushing and perinatal outcomes in nulliparous women with singleton term gestations. METHODS: This was a secondary analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Assessment of Perinatal Excellence cohort of 115,502 women and their neonates born in 25 U.S. hospitals from 2008 to 2011. Nulliparous women with singleton, cephalic, nonanomalous term births who achieved 10-cm cervical dilation were included...
October 6, 2016: Obstetrics and Gynecology
Pamela Angle, Christine Kurtz Landy, Jasmine Djordjevic, Jon Barrett, Alanna Kibbe, Saiena Sriparamananthan, Yuna Lee, Lydia Hamata, Alex Kiss
OBJECTIVES: The Angle Labor Pain Questionnaire (A-LPQ) is a new, condition-specific, multidimensional psychometric instrument which measures the most important dimensions of women's childbirth pain experiences using 5 subscales: The Enormity of the Pain, Fear/Anxiety, Uterine Contraction Pain, Birthing Pain and Back Pain/Long Haul. This study assessed the A-LPQ's test-retest reliability during early active labor without pain relief. METHODS: Two versions of the A-LPQ were randomly administered during 2 test sessions separated by a 20 minute window...
September 28, 2016: Clinical Journal of Pain
H Virgin, E Oddby, J G Jakobsson
INTRODUCTION: Epidural analgesia is commonly used for management of pain during childbirth. Need for emergent Caesarean section e.g. because of signs of foetal distress or lack of progress is however not an uncommon event. In females having an established epidural; general anaesthesia, top-up of the epidural or putting a spinal are all possible options. Dosing of the spinal anaesthesia in females having epidural is a matter of discussion. PRESENTATION OF CASE: We describe a healthy 32 years, 0 para mother in gestation week 36 having labour epidural analgesia but due to foetal distress scheduled for an emergent Caesarean section category 2 that developed upper extremity weakness and respiratory depression after administration of standard dose high density bupivacaine/morphine/fentanyl intrathecal anaesthesia...
October 3, 2016: International Journal of Surgery Case Reports
Ema Hrešanová
This paper explores the history of the 'psychoprophylactic method of painless childbirth' in socialist Czechoslovakia, in particular, in the Czech and Moravian regions of the country, showing that it substantially differs from the course that the method took in other countries. This non-pharmacological method of pain relief originated in the USSR and became well known as the Lamaze method in western English-speaking countries. Use of the method in Czechoslovakia, however, followed a very different path from both the West, where its use was refined mainly outside the biomedical frame, and the USSR, where it ceased to be pursued as a scientific method in the 1950s after Stalin's death...
October 2016: Medical History
J L Booth, P H Pan, J A Thomas, L C Harris, R D'Angelo
BACKGROUND: The optimal volume of blood required to treat post-dural puncture headache remains in question. In our institution a target volume of 30mL is used for an epidural blood patch unless the patient experiences pain during injection. METHODS: The institutional database was retrospectively reviewed for epidural blood patch and delivery statistics over a 15-year period to determine if the volume of blood administered during the procedure directly correlated with the number of epidural blood patches administered...
June 3, 2016: International Journal of Obstetric Anesthesia
Michael P Leovic, Hailey N Robbins, Michael R Foley, Roman Starikov
Management of the critically-ill pregnant patient presents a clinical dilemma in which there is sparse objective data to determine the optimal setting for provision of high-quality care to these patients. This clinical scenario will continue to present a challenge for providers as the chronic illness and comorbid conditions continue to become more commonly encountered in the obstetric population. Various care models exist across a broad spectrum of facilities that are characterized by differing levels of resources; however, no studies have identified which model provides the highest level of care and patient safety while maintaining a reasonable degree of cost-effectiveness...
August 20, 2016: American Journal of Obstetrics and Gynecology
Agnes M Lamon, Ashraf S Habib
Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients...
2016: Local and Regional Anesthesia
Carla Silveira, Mary A Parpinelli, Rodolfo C Pacagnella, Carla B Andreucci, Elton C Ferreira, Carina R Angelini, Jamile C Bussadori, Juliana P Santos, Dulce M Zanardi, Gustavo N Cecchino, Renato T Souza, Maria L Costa, Rodrigo S Camargo, Jose G Cecatti
OBJECTIVE: To assess functioning and disability related to severe maternal morbidity (SMM) via the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). METHODS: In a retrospective cohort study, women with or without a history of SMM who delivered at a tertiary public hospital in Brazil between July 2008 and June 2012, completed the WHODAS 2.0 questionnaire by individual interview between August 2012 and November 2013. General WHODAS scores were evaluated by maternal and neonatal characteristics, and specific domain scores according to SMM event...
July 2016: International Journal of Gynaecology and Obstetrics
Sharon Einav, Hen Y Sela, Carolyn F Weiniger
Approximately 1% to 4% of pregnant women are evaluated in emergency/delivery room because of traumatic injury, yet there are few educational strategies targeted toward prevention/management of maternal trauma. Use of illicit drugs and alcohol, domestic abuse, and depression contribute to maternal trauma; thus a high index of suspicion should be maintained when treating injured young women. Treating the mother appropriately is beneficial for both the mother and the fetus. Fetal viability should be assessed after maternal stabilization...
March 2013: Anesthesiology Clinics
Emir Battaloglu, Declan McDonnell, Justin Chu, Fiona Lecky, Keith Porter
OBJECTIVE: To understand the epidemiology of pregnancy and obstetric complications encountered in the management of pregnant trauma patients. METHODS AND DESIGN: Retrospective analysis of national trauma registry for recording of pregnancy status or obstetric complication in cases of trauma. Sub-division of patient cohort by severity of trauma and stage of pregnancy. Comparison of data sets between pregnant trauma patients and age-matched non-pregnant female trauma patients to determine patterns of injury and impact upon clinical outcomes...
January 2016: Injury
Venu Jain, Radha Chari, Sharon Maslovitz, Dan Farine, Emmanuel Bujold, Robert Gagnon, Melanie Basso, Hayley Bos, Richard Brown, Stephanie Cooper, Katy Gouin, N Lynne McLeod, Savas Menticoglou, William Mundle, Christy Pylypjuk, Anne Roggensack, Frank Sanderson
OBJECTIVE: Physical trauma affects 1 in 12 pregnant women and has a major impact on maternal mortality and morbidity and on pregnancy outcome. A multidisciplinary approach is warranted to optimize outcome for both the mother and her fetus. The aim of this document is to provide the obstetric care provider with an evidence-based systematic approach to the pregnant trauma patient. OUTCOMES: Significant health and economic outcomes considered in comparing alternative practices...
June 2015: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Raheel Ahmed, Joseph Dunford, Roxana Mehran, Stephen Robson, Vijay Kunadian
Cardiovascular disease continues to be the leading cause of death in the western world. Due to advancements in diagnosis, prevention, and treatment, cardiovascular mortality has fallen in recent years. Previous studies have evaluated the impact of traditional risk factors such as hypercholesterolemia and smoking. However, limited studies have been conducted to evaluate sex discrepancies among patients with cardiovascular disease. Pre-eclampsia is a multisystem placentally mediated disease, which usually arises after 32 weeks of gestation and classically presents with hypertension and proteinuria...
May 13, 2014: Journal of the American College of Cardiology
Theresa R Crowgey, Jennifer E Dominguez, Cathleen Peterson-Layne, Terrence K Allen, Holly A Muir, Ashraf S Habib
Respiratory depression can occur after neuraxial morphine administration. In the obstetric population, there are little data on respiratory depression after neuraxial morphine administration in women undergoing cesarean delivery. In this single-center, retrospective study in 5036 obstetric patients (mean body mass index = 34 kg/m) who underwent cesarean delivery and received neuraxial morphine, we did not identify any instances of respiratory depression requiring naloxone administration or rapid response team involvement...
December 2013: Anesthesia and Analgesia
M C Mushambi, S M Kinsella, M Popat, H Swales, K K Ramaswamy, A L Winton, A C Quinn
The Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered...
November 2015: Anaesthesia
W R Jonker, D Hanumanthiah, E P O'Sullivan, T M Cook, J J Pandit
As part of the 5th National Audit Project of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland concerning accidental awareness during general anaesthesia, we issued a questionnaire to every consultant anaesthetist in each of 46 public hospitals in Ireland, represented by 41 local co-ordinators. The survey ascertained the number of new cases of accidental awareness becoming known to them for patients under their care or supervision for a calendar year, as well as their career experience...
September 2014: Anaesthesia
Ma Belén Conesa Ferrer, Manuel Canteras Jordana, Carmen Ballesteros Meseguer, César Carrillo García, M Emilia Martínez Roche
OBJECTIVES: To describe the differences in obstetrical results and women's childbirth satisfaction across 2 different models of maternity care (biomedical model and humanised birth). SETTING: 2 university hospitals in south-eastern Spain from April to October 2013. DESIGN: A correlational descriptive study. PARTICIPANTS: A convenience sample of 406 women participated in the study, 204 of the biomedical model and 202 of the humanised model...
2016: BMJ Open
Melissa E Bauer, Jill M Mhyre
No abstract text is available yet for this article.
August 22, 2016: Anesthesia and Analgesia
Ignacio Macpherson, María V Roqué-Sánchez, Finola O Legget Bn, Ferran Fuertes, Ignacio Segarra
INTRODUCTION: personalised support provided to women by health professionals is one of the prime factors attaining women's satisfaction during pregnancy and childbirth. However the multifactorial nature of 'satisfaction' makes difficult to assess it. Statistical multivariate analysis may be an effective technique to obtain in depth quantitative evidence of the importance of this factor and its interaction with the other factors involved. This technique allows us to estimate the importance of overall satisfaction in its context and suggest actions for healthcare services...
October 2016: Midwifery
2016-08-25 16:24:27
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