Obstetric Anesthesia Research Articles

The new S1 guidelines "Obstetric analgesia and anesthesia"-Presentation and comments

The new S1 guidelines "Obstetric analgesia and anesthesia"-Presentation and comments

Obstetric Anesthesia: A Case Based and Visual Approach.

Obstetric Anesthesia: A Case Based and Visual Approach.

Incidence of accidental awareness during general anaesthesia in obstetrics: a multicentre, prospective cohort study.

General anaesthesia for obstetric surgery has distinct characteristics that may contribute towards a higher risk of accidental awareness during general anaesthesia. The primary aim of this study was to investigate the incidence, experience and psychological implications of unintended conscious awareness during general anaesthesia in obstetric patients. From May 2017 to August 2018, 3115 consenting patients receiving general anaesthesia for obstetric surgery in 72 hospitals in England were recruited to the study. Patients received three repetitions of standardised questioning over 30days, with responses indicating memories during general anaesthesia that were verified using interviews and record interrogation. A total of 12 patients had certain/probable or possible awareness, an incidence of 1 in 256 (95%CI 149-500) for all obstetric surgery. The incidence was 1 in 212 (95%CI 122-417) for caesarean section surgery. Distressing experiences were reported by seven (58.3%) patients, paralysis by five (41.7%) and paralysis with pain by two (16.7%). Accidental awareness occurred during induction and emergence in nine (75%) of the patients who reported awareness. Factors associated with accidental awareness during general anaesthesia were: high BMI (25-30kg.m-2 ); low BMI (<18.5kg.m-2 ); out-of-hours surgery; and use of ketamine or thiopental for induction. Standardised psychological impact scores at 30days were significantly higher in awareness patients (median (IQR [range]) 15 (2.7-52.0 [2-56]) than in patients without awareness 3 (1-9 [0-64]), p=0.010. Four patients had a provisional diagnosis of post-traumatic stress disorder. We conclude that direct postoperative questioning reveals high rates of accidental awareness during general anaesthesia for obstetric surgery, which has implications for anaesthetic practice, consent and follow-up.

Perioperative mobile application for mothers undergoing Cesarean delivery: a prospective cohort study on patient engagement.

PurposeGiving birth is the most common reason for hospital admission, with Cesarean delivery being the most frequently performed inpatient surgery. Through a needs assessment and iterative design process involving patients and obstetric anesthesiologists, we previously developed a mobile application, C-Care, for patients undergoing Cesarean delivery. The focus of C-Care is perioperative education and self-monitoring of potential anesthetic complications. This study aimed to obtain feedback on patient engagement with C-Care.MethodWe conducted a prospective cohort study of patients ≥ 18 yr (n = 36) undergoing elective Cesarean delivery. Anonymous usage data were recorded for 30 days. On postoperative days 1–5, participants received daily self-monitoring questionnaires within C-Care. Fourteen days after surgery, participants received an online survey regarding satisfaction and use of C-Care.ResultsThirty-five out of 36 participants visited the application after orientation, with a median [interquartile range (IQR)] age of 32 [31–36] yr. Each participant visited the application a median of 15 [9–31] times over 30 days and completed a median of 3 [2–4] out of five self-monitoring questionnaires. Each participant viewed a median of 4 [2–7] out of eight education topics, with the most viewed patient education topics being “Controlling Pain” and “The First Few Days”. Visits to the application were highest in the first week postpartum. Of the 18 respondents who completed the day 14 survey, 83% (n = 15) participants would recommend C-Care to other women, and the median participant satisfaction score was 7.5 out of 10 (range, 2–10).ConclusionMost participants used this mobile application for patient education and self-monitoring after elective Cesarean delivery. Insights into patient engagement with C-Care after Cesarean delivery could help design more effective perioperative mobile telehealth programs.Trial registrationwww.ClinicalTrials.gov (NCT03746678); registered 5 November 2018.Supplementary InformationThe online version of this article (10.1007/s12630-020-01907-x) contains supplementary material, which is available to authorized users.

Obstetric anaesthesia as a career.

Obstetric anaesthesia is emerging as one of the most demanding subspecialities of anaesthesia. Obstetric anaesthesiologists are now an integral part of the multidisciplinary team managing the high-risk obstetrics. It has been recognised that targeted training in obstetric anaesthesia helps to recognise the mothers who need special care and formulate specific plan for delivery. Among the subspecialties of anaesthesia, obstetric anaesthesia has the potential to get established early. Obstetric anaesthesiologists have the prospect of choosing either a team or an independent practice. Group practice with a multidisciplinary team can mitigate some of the constraints and allows professional fulfilment and enough time for personal, family and societal commitments. Obstetric anaesthesia is a well-paid and sought-after speciality, and a dynamic field that demands excellent clinical and interpretative skills in a rapidly changing environment.

Relapsing polychondritis in a primiparous women for elective lower segment caesarean section

Relapsing polychondritis is a rare multisystem autoimmune disorder characterized by recurrent, progressive inflammation and destruction of cartilaginous tissue. Respiratory involvement is the major cause of morbidity and mortality. Airway management during anaesthesia in these patients can be challenging and may result in failed oxygenation and death. Increased physiological demand during pregnancy further complicates anaesthesia planning. Collaborative management under a multidisciplinary team of obstetricians, obstetric anaesthetists, rheumatologist, and pulmonologist is essential. We report a case of a parturient with relapsing polychondritis and severe respiratory involvement for caesarean section under combined epidural-spinal anaesthesia and discuss the anaesthetic management based on current literature.

How does the obstetric anesthesia in cesarean section affect the wellbeing of the newborn?

How does the obstetric anesthesia in cesarean section affect the wellbeing of the newborn?

Pulmonary Emblosim during Obstetric anaesthesia

Pulmonary Emblosim during Obstetric anaesthesia

Cardiac Anesthesia

Ask the Expert| January 2021 Cardiac Anesthesia Zachary Deutch, MD, FASA; Zachary Deutch, MD, FASA Search for other works by this author on: This Site PubMed Google Scholar Tiffany M. Williams, MD, PhD Tiffany M. Williams, MD, PhD Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor January 2021, Vol. 85, 14–15. https://doi.org/10.1097/01.ASM.0000725828.93598.84 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Search Site Citation Zachary Deutch, Tiffany M. Williams; Cardiac Anesthesia. ASA Monitor 2021; 85:14–15 doi: https://doi.org/10.1097/01.ASM.0000725828.93598.84 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu nav search search input Search input auto suggest search filter All ContentAll PublicationsASA Monitor Search Advanced Search Welcome to another edition of “Ask the Expert!” When this column is printed, we will be well into the holiday season. As I write this, I am hoping that the public health situation will allow most of us to travel as we see fit and spend that time with family and friends. I personally am fortunate to have obtained time off around the Christmas Holiday but have been hesitant in booking any arrangements for fear that some aspect of the pandemic might throw a monkey wrench into any family plans. For readers' information, potential upcoming topics for this column (in no particular order) include obstetric anesthesia, critical care, international medicine, practice management, and medical ethics. These topics are all off the top of my head, but there are of course plenty more out there. Experts in any of these fields (or others) are invited to contact me. Also, any... You do not currently have access to this content.

Obstetrik Anestezi Pratiğindeki Kritik Konularda Güncel Öneriler

Obstetrik Anestezi Pratiğindeki Kritik Konularda Güncel Öneriler

A ten-year-old obstetric anaesthesia journal: Musings of an editor

A ten-year-old obstetric anaesthesia journal: Musings of an editor

Antibiotic Prophylaxis for Cesarean Delivery: A Survey of Anesthesiologists.

Background The most common complication after cesarean delivery is surgical site infection. Antibiotic prophylaxis reduces infectious morbidity and current anesthetic quality metrics include preincision antibiotic prophylaxis. Recently, studies suggest reductions in infectious morbidity with the addition of azithromycin for unscheduled cesarean delivery. Larger doses of cefazolin are recommended for morbidly obese women, but evidence is conflicting. The aim of this study was to survey anesthesiologists to assess current practice for antibiotic prophylaxis for cesarean delivery. Methods We invited a random sample of 10,000 current members of the American Society of Anesthesiologists to complete an online survey about their current practice of antibiotic prophylaxis for cesarean delivery in November 2017. The survey included questions similar to a previous survey on this topic in 2012. Results The response rate was 12.2% (n = 1223). Most respondents had at least 15 years of experience (684, 55.9%), work at a nonteaching or community hospital (729, 59.6%), with >500 cesarean deliveries annually (619, 50.6%), and administer obstetric anesthesia several times a week (690, 56.4%). Routine preincision antibiotic prophylaxis was reported by 1162 (95.0%) of the 1223 respondents, a substantial improvement versus the 63.5% reported in the previous study in 2012. For intrapartum cesarean deliveries, 141 (11.5%) administer azithromycin for unscheduled cesarean deliveries. Those who use cefazolin, 509 (42.5%) administer 3 g for morbidly obese women. Conclusion Adherence to preincision antibiotic prophylaxis for cesarean delivery is very high, a significant improvement within 5 years. A minority of anesthesiologists utilize azithromycin for intrapartum cesarean deliveries. The dose of cefazolin for morbidly obese women varies widely.

Modern anesthesia in obstetrics as a component of the concept of safe anesthesia

Background. Anesthesia should be selected individually for each labor. Systemic analgesia of labor includes suggestive analgesia, narcotic analgesics, local infiltration and regional blockade, inhalation analgesia. It should be noted that there is no analgesic, sedative or local anesthetic that does not penetrate the placenta, affecting the fetus in any way.&#x0D; Objective. To describe modern anesthesia in obstetrics.&#x0D; Materials and methods. Analysis of literature sources on this issue.&#x0D; Results and discussion. Three groups of antispasmodics are used for analgesia: neurotropic (atropine, scopolamine), myotropic (papaverine, drotaverine) and neuromyotropic (baralgin). The main non-steroidal anti-inflammatory drugs used for this purpose include metamizole sodium, ketorolac tromethamine, diclofenac sodium. Inhalation autoanalgesia with nitrous oxide (N2O) is effective only in 30-50 % of women. When the concentration of N2O exceeds 50 %, the sedative effect increases and oxygenation decreases, which leads to the loss of consciousness and protective laryngeal reflexes. Such analgesia is indicated for low-risk patients who have refused from regional anesthesia. Epidural anesthesia (EDA) is the gold standard of labor anesthesia. The advantages of EDA include the option to change the degree of analgesia, the ability to continue pain relief until the end of labor and the minimal impact on the condition of both child and mother. Before manipulation, be sure to determine the platelet count and heart rate of the fetus. It is recommended to start EDA in the latent stage of labor. In patients with uterine scarring, early EDA is a mandatory component of medical care. The woman’s wish is the main indication for EDA. Indications for early catheterization of the epidural space include the presence of twins, preeclampsia, obesity, respiratory tract with special features. Headache is the most common complication of EDA. The use of pencil-point spinal needles minimizes the frequency of this complication. Adequate analgesia for uncomplicated labor should be performed with minimal concentrations of anesthetics with the least possible motor block. Local anesthetics (lidocaine, bupivacaine (Longocaine, “Yuria-Pharm”), ropivacaine) are used for EDA). Combined spinal-epidural anesthesia provides a rapid effect and long-term analgesia. For this purpose, 0.25 % Longocaine heavy (“Yuria-Pharm”) 2 mg and fentanyl 20 μg are administered intrathecally, followed by 0.225 % Longocaine 10 mg and fentanyl 20 μg epidurally. The technique of epidural dural puncture is a modification of combined spinal-epidural anesthesia. This technique improves the caudal spread of analgesia compared to the epidural technique without the side effects seen with spinal-epidural anesthesia. The ideal local anesthetic should be safe for both mother and fetus, provide sufficient analgesia with minimal motor block, and not affect labor process. A single spinal injection of opioids may be effective, but it should be limited in time. The use of systemic opioids during labor increases the need for resuscitation of newborns and worsens the condition of their acid-base balance compared to basic regional anesthesia. Catheter techniques can be used in case of the increased labor duration. Nalbuphine (“Yuria-Pharm”), which eliminates the side effects of regional anesthesia, can also be successfully used. Analgesic effect of paracetamol (Infulgan, “Yuria-Pharm”) in case of intravenous administration exceeds the analgetic effect of tramadol, and the effect on the newborn condition according to the Apgar scale does not differ (Meenakshi et al., 2015). Paracetamol (Infulgan) is moderately effective for perineal pain on the first day after delivery. The possibility of use during lactation is an another advantage of paracetamol.&#x0D; Conclusions. 1. Pain during labor is an extremely stressful factor, so women should have access to quality analgesia and anesthesia. 2. There is no analgesic, sedative or local anesthetic that does not penetrate the placenta, affecting the fetus. 3. EDA is the gold standard of labor anesthesia. 4. Combined spinal-epidural anesthesia provides rapid effect and long-term analgesia. 5. The use of systemic opioids during labor increases the need for resuscitation of newborns and worsens the condition of their acid-base balance. 6. Nalbuphine and Infulgan have been used successfully for labor pain relief.

Comparison of the level of sensory blockade achieved when spinal anaesthesia is performed for caesarean section before and after urinary bladder catheterisation: a randomised controlled study

Background: Spinal anaesthesia has a prominent place in obstetric anaesthesia. Factors affecting the sensory level and the depth of anaesthesia and associated complications have been topics for much discussion. One such topic is whether keeping the patient supine for bladder catheterisation after the spinal injection would enhance spread of the anaesthetic agents upwards in the subarachnoid space leading to grave complications. Objectives: To observe whether there was a clinically significant difference in the sensory levels achieved, changes in blood pressure and pulse rates when bladder catheterization was done before as opposed to after spinal anaesthesia, for caesarean section. . Method: 106 pregnant women undergoing cesarean section were randomised into two groups, with one group receiving spinal anaesthesia before bladder catheterisation and the other receiving spinal anaesthesia after catheterisation. Results: The initial sensory level of T4 was achieved by 76% and 53.4% women who were catheterized before and after spinal anaesthesia respectively. The systolic and diastolic blood pressure dropped, and the pulse rate increased in both groups. There was no significant difference in either the spinal sensory level achieved, or the blood pressure and pulse rate changes observed whether the bladder was catheterized before or after spinal anaesthesia. Conclusions: There was no difference in either the spinal sensory level achieved or the haemodynamic changes irrespective of whether the bladder was catheterized before or after spinal anaesthesia.

Perioperative Implications of Obstetric Anaesthesia Care during COVID-19 Crisis

This article reviews the WHO and CDC guidelines related to obstetrics keeping in view the current Covid-19 pandemic. We are currently facing an unprecedented healthcare crisis caused by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The infection is spread by human-to-human transmission through droplet and direct contact, causing mild symptoms in the majority of cases, but critical illness, bilateral viral pneumonia, and acute respiratory distress syndrome (ARDS) in a minority. We suggest how personal protective equipment’s (PPE’s) and specific infection control policies related to the risk of viral transmission to the anaesthetists, intensivists and other healthcare workers can be minimised particularly in obstetric patients. Although pregnancy doesn’t appear to exhibit higher susceptibility to COVID-19 than the general population but implementing strict infection control in the maternity department presents unique challenges. Particularly it necessitates decreasing the risk of postnatal transmission from mother to neonate and methods to accommodate emergency patients to labour ward and emergency care with a high patient turnover. Performing routine and emergency procedures for obstetric patients, such as neuraxial anaesthesia, is made more technically difficult and time consuming by wearing a PPE. These new challenges have anaesthetic implications and mandate a change in approach for team working, protocols for perioperative anaesthesia care and infection prevention policies. With limited evidence as of now but antenatal vertical transmission appears to be rare.Placental samples, amniotic fluid, cord blood, neonatal throat swabs and breast milk samples from COVID-19 infected mothers have all tested negative in various case series. There is currently no evidence concerning transmission through genital fluids. Pregnant patients presenting to the emergency room and labour ward should be risk stratified and then screened for covid-19 irrespective of being symptomatic or not before admission and subsequent care provided taking all the precautions. Aerosol generation during labour, particularly when coupled with symptoms secondary to COVID-19 lung sequelae, may increase airborne transmission. For these reasons, surgical facemasks should be worn by the parturient Proper donning and doffing of PPE is paramount for decreasing the risk of transmission of infection for labour epidural, OT’s and obstetric ICU’s and needs creation of space within the older system and newer guidelines and protocols to be implemented in letter and spirit.

General Versus Regional Anesthesia for Emergency Cesarean Delivery in a High-volume High-resource Referral Center: A Retrospective Cohort Study.

ObjectiveThe choice of anesthesia for emergency cesarean delivery (CD) is one of the most important choices to make in obstetric anesthesia. In this study, we examine which type of anesthesia was used for emergency CD in our hospital, and how the choice affected the time from entry to the operation room until incision (TTI), time until delivery (TTD), and maternal/neonatal outcomes.MethodsRetrospectively, we examined all emergency CD’s performed in Shaare Zedek Medical Center between January–December 2018. Results: 1059 patients met the inclusion criteria, of which 7.7% underwent general anesthesia (GA), 36.2% – conversion from labor epidural analgesia to surgical anesthesia, 52% – spinal anesthesia and 4.1% – combined spinal epidural. We did not find a significant difference between the GA and conversion epidural groups in terms of TTI or TTD. Nevertheless, GA was found to be correlated to a high rate of blood-products requirement and ICU admission. The rate of newborns with an APGAR score of less than 7, in both first and fifth second after birth, was significantly higher in the GA group, as well as the need for NICU admission.ConclusionThis study clearly emphasizes that the TTI are shortest when using GA or conversion of labor epidural analgesia to surgical anesthesia. Meanwhile, GA is also linked to higher rates of admissions to ICU as well as poorer neonatal outcomes compared to the other groups. Additionally, our study uncovered a low rate of GA, and relatively low rate of regional anesthesia failure, which meets the accepted standards.

Management of spinal-induced hypotension for elective caesarean section: A survey of practices among anesthesiologists from a developing country.

In developing countries, more than half of the anesthesia-related maternal deaths are related to spinal hypotension. To explore the practices of management of spinal induced hypotension with respect to fluid and vasopressor administration among anesthesiologists from a developing country. After approval from institutional ethics committee, an online questionnaire was sent to anesthesiologists registered with Pakistan Society of Anesthesiologists between July and August 2018 to determine management strategies for prevention and treatment of spinal-induced hypotension. The response rate was 36% (156/433), majority from academic institution (62.8%) with equal representation from attending and trainee anesthesiologist. For prophylaxis 39.1% respondents did not use vasopressors, 32.7% used fluid preloading with crystalloids (54.7%) as fluid of choice followed by combination of co-loading and vasopressor(22.4%). Phenylephrine was the vasopressor of choice for both prophylaxis (33.1%) and treatment (57%). Attending anesthesiologist used a combination of fluid co-loading and vasopressors for prophylaxis as compared to trainee anesthesiologists (37.2% vs. 17.9%; P=0.035) and selected vasopressors according to patient's heart rate (33.3% vs. 19.5%; p=0.05). Prophylactic phenylephrine was used more by respondents from the academic institution (p=0.023). Fluid co-loading was used more by respondents with <30 % compared to those with > 30% of clinical responsibility to obstetric anesthesia (P<0.05). Phenylephrine as the vasopressor of choice indicates growing awareness of management strategies among anesthesiologists from developing countries but there is a need to increase its use for prophylaxis. Some variation in practice according to the level of anesthesiologist, practice type and responsibilities to obstetric anesthesia are evident.

Pregnancy and COVID-19: what anesthesiologists should know.

Anesthetic management of parturients with COVID-19 is a big challenge to anesthesiologists. Limited data are available about COVID-19 during pregnancy; however, information on illnesses associated with SARS and MERS might provide insights into COVID-19's effects during pregnancy. Evidence from previous reports from SARS and MERS, and from COVID-19 cases were reviewed. Concepts from guidelines from the government and academic societies were collected as well. The evidence was described and summarized. Principles to minimize the risk of infection as well as optimize patients' safety during obstetric anesthesia were found to include careful evaluation, tight protection, and multi-discipline-based strategy. Though vertical transmission of COVID-19 still needs more definitive evidence, strict isolation is necessary for the newborn of COVID-19 mothers. Psychological support for the parturients is also an important issue during COVID-19 pandemic.

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

(Anesth Analg. 2020;131:239–244) Obstetric anesthesiology has seen many advances in the past 20 years. Identifying publications that have substantially influenced not only the practice of obstetric anesthesiology but also that of medicine, have relied upon analyses of bibliometric data or cited references, or a nomination process by select experts or panelists. This study sought to use the Delphi method to identify the most influential publications in the field of obstetric anesthesiology.

Obstetric Anesthesia During the Coronavirus Disease 2019 Pandemic

(Anesth Analg. 2020;131:7–15) When caring for obstetric patients infected with coronavirus disease 2019 (COVID-19), there are a number of factors to consider to safeguard the pregnant or postpartum woman and health care workers. The goal of this review was to provide recommendations based on evidence or expert opinion for anesthesiologists caring for pregnant women in the age of COVID-19.