Anesthetic Management Of Labor Research Articles

The Most Influential Publications in Obstetric Anesthesiology, 1998-2017: Utilizing the Delphi Method for Expert Consensus.

There have been many advances in obstetric anesthesiology in the past 2 decades. We sought to create a list of highly influential publications in the field using the Delphi method among a group of obstetric anesthesiology experts to create an important educational, clinical, and research resource. Experts in the field, defined as obstetric anesthesiologists selected to present the Gerard W. Ostheimer Lecture at the Society for Obstetric Anesthesia and Perinatology (SOAP) annual meeting within the past 20 years, were recruited to participate. The Delphi technique was used by administering 3 rounds of surveys. Participants were initially asked to identify the highly influential publications from the year they presented the Ostheimer lecture, in addition to the most influential publications from the time period overall. Highly influential publications were defined as those that changed traditional views, invoked meaningful practices, catalyzed additional research, and fostered ideas or practices that had durability over time. After each round of surveys, responses were collected and used as choices for subsequent surveys with the goal of obtaining group consensus. We determined expert consensus on 22 highly influential publications from 1998 to 2017. The focus of these publications ranged from disease entities, interventions, treatment methodologies, and complications. Key themes in the publications chosen included the reduction of maternal morbidity and mortality and refinements in the analgesic and anesthetic management of labor and delivery.

Anesthetic Considerations for Labor and Delivery in Women With Cerebrospinal Fluid Shunts

Abstract Background The anesthetic management of labor and delivery in pregnant women with cerebrospinal fluid shunts can be challenging. We conducted a literature review to understand the anesthetic implications in pregnant women with cerebrospinal fluid shunts. Methods We searched PubMed, EMBASE, and Medline databases to identify reports of pregnant women with cerebrospinal fluid shunts during the 30-year period from 1985 to 2015. Twenty-four studies reporting anesthetic techniques for labor and delivery were included in the analyses. Results A total of 97 women with 130 pregnancies were included. Ventriculo-peritoneal shunts (77%) were the most common type of shunt. Twenty-eight (29%) women had shunt malfunction during pregnancy, with 20 (71%) requiring shunt revision. Overall, 73 women (56%) delivered vaginally and 23 (40%) received epidural analgesia. Fifty-seven women (44%) underwent cesarean delivery and general anesthesia was used in 45% of cases. Conclusion This review suggests that shunt malfunctions occurred commonly during pregnancy. The presence of neurological symptoms warrants careful evaluation of shunt function. Anesthetic management for labor and delivery varied and was dependent on shunt function. Epidural analgesia appears to be safe in women with functional shunts.

Parturients with hypertrophic cardiomyopathy: case series and review of pregnancy outcomes and anesthetic management of labor and delivery

BackgroundAdvances in understanding the pathogenesis, diagnosis and management of hypertrophic cardiomyopathy have resulted in increased longevity and a better quality of life of affected patients considering pregnancy. Several case series which focused predominantly on obstetric details have reported generally good outcomes. However, there remains a paucity of data on the specifics of obstetric anesthesia in women with hypertrophic cardiomyopathy. MethodsAfter Institutional Review Board approval, we reviewed antepartum transthoracic echocardiograms, cardiology, obstetric, anesthetic, and nursing labor records with a focus on anesthesia for labor and delivery and early postpartum complications in patients with hypertrophic cardiomyopathy who delivered between January 1993 and December 2013. ResultsThere were 23 completed pregnancies in 14 patients: 12 parturients (52%) delivered vaginally, of whom seven (30%) required assistance (forceps, vacuum), and 11 (48%) had a cesarean delivery. In 17 cases (74%) delivery was uneventful, but six patients (26%) had complications including congestive heart failure (n=3) and postpartum hemorrhage (n=3). All patients had neuraxial labor anesthesia/analgesia, and none received general anesthesia. No hemodynamic instability or fetal distress directly related to anesthesia was documented. ConclusionThe database search of approximately 160000 deliveries over 20years revealed only a small number of hypertrophic cardiomyopathy patients with completed pregnancies. No maternal or neonatal deaths were documented. Overall morbidity rate was 26% with a 13% incidence of peripartum congestive heart failure. In patients with mild to moderate disease, neuraxial anesthesia was safe, effective and well tolerated with no hemodynamic instability related to administration of local anesthetics.

Anesthetic Management During Labor and Delivery

Abstract Study Objective To describe the anesthetic management of labor and delivery in patients presenting with cancer during pregnancy at one institution. Design Retrospective data collection of pregnant cancer patients who delivered between January 1988 and December 2009. Setting University-affiliated teaching hospital. Measurements Clinical data on cancer diagnosis and treatment and obstetric, neonatal, and anesthetic management of the study patients were compiled. Analysis was done based on whether the cancer was diagnosed before or during pregnancy. Main Results The incidence of cancer during pregnancy at our institution was 0.1%. No difference was noted in the incidence of cancer diagnosed before and during pregnancy was noted. Women with a cancer diagnosis during pregnancy had more clinical symptoms, a higher rate of inductions (37% vs 11%; P = 0.0002) and premature deliveries (48% vs 20%; P = 0.0003) than those with a cancer diagnosis before delivery. No differences between groups in neonatal outcome were noted. Most patients received regional anesthesia for labor and delivery (75%); a significant number (22%) also received general anesthesia for cesarean section. Life-threatening complications were seen in those with mediastinal tumors or metastases. Conclusion Women with cancer diagnosed during pregnancy are likely to require prompt therapeutic intervention and have a potential for premature delivery. Anesthetic management should be tailored to the individual type of cancer, depending on the severity of symptoms, stage of cancer, and associated systemic involvement.

Anesthetic management of labor in a patient with congenitally corrected transposition of the great arteries

Laboring patients with congenitally corrected transposition of the great arteries present an interesting challenge to anesthesiologists because of the physiological changes that take place during pregnancy and the stress induced by labor. This paper describes the detailed management of a symptomatic parturient with congenitally corrected transposition of the great arteries. The patient was managed with epidural analgesia instituted early in labor with a continuous low-concentration infusion of local anesthetic and opioid but without an initial bolus. She underwent uneventful forceps-assisted vaginal delivery.

Anaesthetic management of labour and caesarean delivery of a patient with hyperkalaemic periodic paralysis

We describe a parturient with hyperkalaemic periodic paralysis who presented for induction of labour and subsequently, caesarean section. Epidural analgesia and anaesthesia were used successfully in a multidisciplinary plan aimed at avoiding a peripartum attack and providing safe delivery. Management of this rare condition is discussed along with a review of the available literature.

Continuous spinal anesthesia for cesarean section in a parturient with severe recurrent peripartum cardiomyopathy

The anesthetic management of labor and delivery in patients with peripartum cardiomyopathy is not well defined. Using continuous spinal anesthesia in such a rare clinical situation has not been previously reported. A patient with recurrent peripartum cardiomyopathy presented in congestive heart failure for emergent cesarean section. Continuous spinal anesthesia was successfully employed as the anesthetic technique for the procedure. In addition, it also markedly reduced the patient’s symptoms. Continuous spinal anesthesia is a reliable, rapidly titratable technique, which provides excellent analgesia with minimal undesirable hemodynamic changes for patients with peripartum cardiomyopathy undergoing cesarean delivery.

Patient-controlled epidural analgesia for labor and delivery in a parturient with chronic inflammatory demyelinating polyneuropathy

Objective: The anesthetic management of labor and delivery in patients with any form of chronic inflammatory demyelinating polyneuropathy (CIDP) is not well defined. Using patient-controlled epidural analgesia (PCEA), or epidural analgesia, in such a rare clinical situation has not been previously reported. Case Report: A 32-year-old, gravida 3, para 2, woman with a 2[frac12] year history of CIDP was admitted for labor and delivery at 38 weeks of pregnancy. At the time she presented for labor analgesia, she complained of bilateral hand and foot weakness and tingling. PCEA with 0.1% ropivacaine and fentanyl 2 [mu ]g/mL was used for labor analgesia. The patient was pain free during labor and delivery and had an uneventful postpartum course. Conclusion: PCEA had no apparent detrimental affect on the patient's disease and may be a reasonable option for patients with CIDP presenting for labor and delivery. Reg Anesth Pain Med 2002;27:217-219.

Epidural analgesia in labour for a patient with hereditary neuropathy with liability to pressure palsy

Hereditary neuropathy with liability to pressure palsy (HNPP) is a rare but probably under-diagnosed disorder of peripheral nerves in which individuals suffer from repeated motor and sensory neuropathies (pressure palsies) following brief nerve compression or mild trauma. A seemingly trivial insult such as sitting or kneeling may result in a focal neurological deficit lasting for hours to months. Despite the growing recognition of this problem, information regarding the anaesthetic management of labour is sparse. We present a woman with HNPP who was provided with a modified epidural regimen (low concentration bupivacaine and fentanyl) for analgesia in labour and delivery. Labour progressed uneventfully and there were no neurological sequelae following delivery.

Combined spinal and epidural anesthesia for labor and cesarean delivery in a patient with Guillain-Barre syndrome

Background and Objectives: The anesthetic management of labor, delivery, and cesarean delivery in patients with active or resolving Guillain-Barre syndrome is not well defined. Using a combined spinal and epidural (CSE) technique in such a rare clinical situation has not been previously reported. Case Report: A 32-year-old woman gravida 2, para 0 was diagnosed with Guillain-Barre syndrome at 21 weeks of pregnancy. Paralysis spread up to the T4 level. Three months later, she was admitted for labor at term. She presented in severe labor pain and it was decided to proceed with CSE analgesia. No unusual hemodynamic instability, signs of autonomic dysfunction, or increased sensitivity to local anesthetics was noted. After several hours, delivery by cesarean section was required and epidural anesthesia was then used. The patient had an uncomplicated postpartum course. Conclusion: Careful evaluation and documentation of the patient's baseline neurological status, a thorough discussion with the patient regarding the risks and benefits of the technique for labor analgesia, and an appreciation of the limited experience with this kind of clinical situation are important. Reg Anesth Pain Med 2001;26:174-176.

Infarctus du myocarde, grossesse et anesthésie

Myocardial infarction is rare during pregnancy. We report the case of a 35-year-old woman at 38 weeks gestation who developed a non-Q wave myocardial infarction. She was successfully treated with percutaneous transluminal coronary angioplasty and stenting. Maternal and fetal outcome were good. We discuss cardiologic and anaesthetic management of labour and delivery.

Anaesthetic Management of Labour and Delivery in a Woman Taking Long-Term MAOI

Anaesthetic Management of Labour and Delivery in a Woman Taking Long-Term MAOI

Anaesthetic management of labour in two patients with Klippel-Feil syndrome

Two patients with Type I Klippel-Feil syndrome presented at the antenatal clinic. The first patient, who suffered from sleep apnoea, was delivered of a healthy infant by vacuum extraction. The second, who was profoundly deaf and had marked kyphoscoliosis, developed pregnancy-induced hypertension and urinary tract infection and was delivered at 38 weeks by vacuum extraction. In both cases epidural analgesia was employed to allow pain relief during labour. Anaesthetic management of Klippel-Feil syndrome is discussed and the benefits of early anaesthetic assessment and continued involvement of senior anaesthetic and obstetric staff emphasized.

Anesthetic Management of Labor in a Patient With Dextrocardia, Congenitally Corrected Transposition, Wolff-Parkinson-White Syndrome, and Congestive Heart Failure

Anesthetic Management of Labor in a Patient With Dextrocardia, Congenitally Corrected Transposition, Wolff-Parkinson-White Syndrome, and Congestive Heart Failure

Continuous Spinal Anesthesia With Combined Hyperbaric and Isobaric Bupivacaine in a Patient With Scoliosis

We describe the anesthetic management of labor and cesarean delivery after failed epidural anesthesia using a continuous spinal technique with a combination of hyperbaric and isobaric local anesthetic solutions in a patient with severe kyphoscoliosis and congenital heart disease.

Anesthetic management of labor in a patient with dextrocardia, congenitally corrected transposition, Wolff-Parkinson-White syndrome, and congestive heart failure

Labor and delivery greatly stress the cardiovascular system. In this patient with underlying congenital heart disease and congestive heart failure, hemodynamic stability was maintained with a combination of lumbar epidural and caudal epidural anesthesia.