Society For Obstetric Anesthesia And Perinatology Research Articles

Respiratory Depression After Administration of Single-dose Neuraxial Morphine for Postcesarean Delivery Analgesia: A Retrospective Cohort Study

(Int J Obstet Anesth. 2022;52:103592) Neuraxial anesthesia is the analgesia of choice during cesarean delivery which frequently includes long‐acting morphine. While the standard practice, neuraxial morphine poses an increased risk of delayed respiratory depression. While the risk is low at 1.08 to 1.63 per 10,000 cases, patient comorbidities can increase occurrence. In 2019, the Society for Obstetric Anesthesia and Perinatology (SOAP) gave guidelines for patient surveillance following cesarean delivery (CD) with morphine though evidence-based research is lacking and is rather a result of expert opinion. The aim of this retrospective study was to determine the occurrence of respiratory depression in CD patients who received neuraxial morphine for pain management.

Sugammadex Use for Reversal in Nonobstetric Surgery During Pregnancy: A Reexamination of the Evidence.

Sugammadex Use for Reversal in Nonobstetric Surgery During Pregnancy: A Reexamination of the Evidence.

Quantifying the Incidence of Clinically Significant Respiratory Depression in Women With and Without Obesity Class III Receiving Neuraxial Morphine for Postcesarean Analgesia: A Retrospective Cohort Study

(Int J Obstet Anesth. 2021;47:103187) Although neuraxial morphine is commonly administered to patients for analgesia following cesarean delivery (CD), one recognized side effect is respiratory depression. According to The Society for Obstetric Anesthesia and Perinatology (SOAP), obesity [body mass index (BMI) ≥40 kg/m2] is a condition which increases the odds for respiratory depression and therefore necessitates enhanced respiratory monitoring for patients receiving neuraxial morphine. However, limited research has been carried out on the relationship between respiratory depression and obesity. To improve guidelines for respiratory monitoring for this patient population, the authors compared rates of respiratory depression in postpartum women with BMI ≥40 kg/m2 to those of BMI <40 kg/m2. Specifically, the authors investigated the hypothesis that clinically significant respiratory depression following neuraxial morphine occurs more commonly in obese patients.

The Society for Obstetric Anesthesia and Perinatology Coronavirus Disease 2019 Registry: An Analysis of Outcomes Among Pregnant Women Delivering During the Initial Severe Acute Respiratory Syndrome Coronavirus-2 Outbreak in the United States

(Anesth Analg. 2021;133:462–473. doi: 10.1213/ANE.0000000000005592) From the beginning of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) outbreak to January 17, 2021, there was an interest concerning and growing research on pregnancy and SARS-CoV-2, but little data had been gathered and analyzed comparing obstetric patients with and without the virus with regards to anesthetic management. The Society for Obstetric Anesthesia and Perinatology (SOAP) coronavirus disease 2019 (COVID-19) registry was made primarily to better understand anesthetic management and obstetric outcomes in women with and without SARS-CoV-2 during hospital delivery at widespread-testing institutions.

Enhanced Recovery after Surgery: Cesarean Delivery.

This review summarizes the importance of enhanced recovery after surgery (ERAS) implementation for cesarean deliveries (CDs) and explores ERAS elements shared with the non-obstetric surgical population. The Society for Obstetric Anesthesia and Perinatology (SOAP) consensus statement on ERAS for CD is used as a template for the discussion. Suggested areas for research to improve our understanding of ERAS in the obstetric population are delineated. Strategies and examples of anesthesia-specific protocol elements are included.

Neuraxial Anesthesia and the Ubiquitous Platelet Count Question: How Low Is Too Low?

(Anesth Analg. 2021;132:1527–1530) Recently, the Society for Obstetric Anesthesia and Perinatology (SOAP) issued a consensus statement regarding neuraxial procedures in patients with thrombocytopenia. When considering the cutoff platelet count for providing neuraxial labor analgesia or neuraxial anesthesia for cesarean, this statement might not provide clinicians with all the answers.

Society for Obstetric Anesthesia and Perinatology: Consensus Statement and Recommendations for Enhanced Recovery After Cesarean.

The purpose of this article is to provide a summary of the Enhanced Recovery After Cesarean delivery (ERAC) protocol written by a Society for Obstetric Anesthesia and Perinatology (SOAP) committee and approved by the SOAP Board of Directors in May 2019. The goal of the consensus statement is to provide both practical and where available, evidence-based recommendations regarding ERAC. These recommendations focus on optimizing maternal recovery, maternal-infant bonding, and perioperative outcomes after cesarean delivery. They also incorporate management strategies for this patient cohort, including recommendations from existing guidelines issued by professional organizations such as the American College of Obstetricians and Gynecologists and the American Society of Anesthesiologists. This consensus statement focuses on anesthesia-related and perioperative components of an enhanced recovery pathway for cesarean delivery and provides the level of evidence for each recommendation.

The Society for Obstetric Anesthesia and Perinatology Coronavirus Disease 2019 Registry: An Analysis of Outcomes Among Pregnant Women Delivering During the Initial Severe Acute Respiratory Syndrome Coronavirus-2 Outbreak in the United States.

Early reports associating severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection with adverse pregnancy outcomes were biased by including only women with severe disease without controls. The Society for Obstetric Anesthesia and Perinatology (SOAP) coronavirus disease 2019 (COVID-19) registry was created to compare peripartum outcomes and anesthetic utilization in women with and without SARS-CoV-2 infection delivering at institutions with widespread testing. Deliveries from 14 US medical centers, from March 19 to May 31, 2020, were included. Peripartum infection was defined as a positive SARS-CoV-2 polymerase chain reaction test within 14 days of delivery. Consecutive SARS-CoV-2-infected patients with randomly selected control patients were sampled (1:2 ratio) with controls delivering during the same day without a positive test. Outcomes were obstetric (eg, delivery mode, hypertensive disorders of pregnancy, and delivery <37 weeks), an adverse neonatal outcome composite measure (primary), and anesthetic utilization (eg, neuraxial labor analgesia and anesthesia). Outcomes were analyzed using generalized estimating equations to account for clustering within centers. Sensitivity analyses compared symptomatic and asymptomatic patients to controls. One thousand four hundred fifty four peripartum women were included: 490 with SARS-CoV-2 infection (176 [35.9%] symptomatic) and 964 were controls. SARS-CoV-2 patients were slightly younger, more likely nonnulliparous, nonwhite, and Hispanic than controls. They were more likely to have diabetes, obesity, or cardiac disease and less likely to have autoimmune disease. After adjustment for confounders, individuals experiencing SARS-CoV-2 infection exhibited an increased risk for delivery <37 weeks of gestation compared to controls, 73 (14.8%) vs 98 (10.2%) (adjusted odds ratio [aOR], 1.47; 95% confidence interval [CI], 1.03-2.09). Effect estimates for other obstetric outcomes and the neonatal composite outcome measure were not meaningfully different between SARS-CoV-2 patients versus controls. In sensitivity analyses, compared to controls, symptomatic SARS-CoV-2 patients exhibited increases in cesarean delivery (aOR, 1.57; 95% CI, 1.09-2.27), postpartum length of stay (aOR, 1.89; 95% CI, 1.18-2.60), and delivery <37 weeks of gestation (aOR, 2.08; 95% CI, 1.29-3.36). These adverse outcomes were not found in asymptomatic women versus controls. SARS-CoV-2 patients (asymptomatic and symptomatic) were less likely to receive neuraxial labor analgesia (aOR, 0.52; 95% CI, 0.35-0.75) and more likely to receive general anesthesia for cesarean delivery (aOR, 3.69; 95% CI, 1.40-9.74) due to maternal respiratory failure. In this large, multicenter US cohort study of women with and without peripartum SARS-CoV-2 infection, differences in obstetric and neonatal outcomes seem to be mostly driven by symptomatic patients. Lower utilization of neuraxial analgesia in laboring patients with asymptomatic or symptomatic infection compared to patients without infection requires further investigation.

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.

Cesarean section thromboprophylaxis in the context of the modern ERAC rapid recovery concept

This article outlines the main guidelines of the European Society of Anesthesiologists for Perioperative Venous Thromboembolism Prevention and the basic guidelines of the Society for Obstetric Anesthesia and Perinatology (SOAP) for Enhanced Recovery After Cesarean (ERAC). The search for effective methods of recovery after caesarean section, the desire to reduce the risks of postoperative complications, to shorten the length of the hospital stay led us to the introduction of the modern concept of rapid recovery. The concept of Enhanced Recovery After Cesarean is already used in the “Leleka” maternity hospital. The positive results of the implementation of the ERAC concept in obstetric practice make it necessary to modernize the traditional approach to the postoperative period.

Society for Obstetric Anesthesia and Perinatology Consensus Statement: Monitoring Recommendations for Prevention and Detection of Respiratory Depression Associated With Administration of Neuraxial Morphine for Cesarean Delivery Analgesia.

The majority of women undergoing cesarean delivery in the United States receive neuraxial morphine, the most effective form of postoperative analgesia for this surgery. Current American Society of Anesthesiologists (ASA) and American Society of Regional Anesthesia and Pain Medicine (ASRA) recommend respiratory monitoring standards following neuraxial morphine administration in the general surgical population that may be too frequent and intensive when applied to the healthy obstetric population receiving a single dose of neuraxial morphine at the time of surgery. There is limited evidence to support or guide the optimal modality, frequency, and duration of respiratory monitoring in the postoperative cesarean delivery patient receiving a single dose of neuraxial morphine. Consistent with the mission of the Society for Obstetric Anesthesia and Perinatology (SOAP) to improve outcomes in pregnancy for women and neonates, the purpose of this consensus statement is to encourage the use of this highly effective analgesic technique while promoting safe practice and patient-centered care. The document aims to reduce unnecessary interruptions from respiratory monitoring in healthy mothers while focusing vigilance on monitoring in those women at highest risk for respiratory depression following neuraxial morphine administration. This consensus statement promotes the use of low-dose neuraxial morphine and multimodal analgesia after cesarean delivery, gives perspective on the safety of this analgesic technique in healthy women, and promotes patient risk stratification and perioperative risk assessment to determine and adjust the intensity, frequency, and duration of respiratory monitoring.

Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-based Guidelines (Fourth Edition)

(Reg Anesth Pain Med. 2018;43:263–309) The American Society of Regional Anesthesia and Pain Medicine (ASRA) convened its Fourth Consensus Conference on Regional Anesthesia and Anticoagulation in conjunction with the European Society of Anesthesiology (ESA) in response to emerging patient safety issues. Among these are the heightened risk of neuraxial bleeding due to increasingly potent antithrombotic medications, changing standards for venous thromboembolism (VTE) prevention, and conflicting recommendations by various bodies and societies. Spinal hematoma is an uncommon and catastrophic complication of epidural or spinal anesthesia. Previous versions of this report have been published in 1998, 2003 and 2010 as ASRA Consensus Documents. For this update, authors performed a systematic and general review of relevant literature published between 2010 and 2017. The members represented ASRA, ESA, and the Society for Obstetric Anesthesia and Perinatology (SOAP).

Maternal Salvage With Extracorporeal Life Support: Lessons Learned in a Single Center

(Anesth Analg. 2017;125(4):1275–1280) Extracorporeal life support (ECLS) has been used in severe cases of maternal H1N1 infection, cardiogenic shock, massive pulmonary embolism, and peripartum hemorrhage. However, although the Society for Obstetric Anesthesia and Perinatology (SOAP) suggested ECLS as an appropriate therapy for maternal salvage, the American Heart Association did not endorse the SOAP recommendation at that time due to the lack of cohort data on maternal outcome. Currently, cohort data are available. The authors of the present study contributed to this data and described a consecutive cohort of 11 women placed on ECLS for salvage due to maternal death/near-demise during pregnancy and the peripartum period.

Publication Rate of Abstracts Presented at the Society for Obstetric Anesthesia and Perinatology Annual Meetings 2010-2014.

The Society for Obstetric Anesthesia and Perinatology (SOAP) annual meeting provides a forum to present new scientific work with the goal of broader dissemination of knowledge. The objective of this study was to evaluate the proportion of research abstracts presented at SOAP meetings, from 2010 to 2014, which resulted in peer-reviewed publications. The abstract-to-publication rate was compared with the percent of abstracts presented at biomedical meetings resulting in publication, as estimated by a 2007 Cochrane Review. The SOAP abstract-to-publication rate was lower than that of the Cochrane Review (26.8% vs 44.5%, P < .0001). Future work should identify barriers to publication.

The Management of Accidental Dural Puncture and Postdural Puncture Headache

Abstract Study Objective To evaluate the management of accidental dural puncture (ADP) and postdural puncture headache (PDPH) among obstetric anesthesiologists practicing in North America. Design Questionnaire survey of individual members of the Society for Obstetric Anesthesia and Perinatology (SOAP). Setting University hospital. Measurements In June 2008, a 4-part, 83-item electronic survey was distributed to all North American members of SOAP. It contained questions about respondent demographics, epidural catheter and intrathecal catheter management after ADP, PDPH management, epidural blood patch (EBP) management, and patient follow-up. Main Results Of the 843 United States and Canadian members of SOAP who were surveyed, 160 responses were collected. Respondents reported placing an epidural 75% of the time and an intrathecal catheter 25% of the time following ADP. Common prophylactic and conservative treatment strategies included hydration, caffeine, and opioids by mouth; 76% of respondents leave an intrathecal catheter in place for 24 hours to reduce the frequency of headache. Epidural blood patches are placed by 81% of practitioners less than 24 hours after headache onset. Conclusions Protocols for ADP management are rare. There is wide variation in catheter management after dural puncture, measures used to prevent and treat a resultant headache, and EBP management.

The management of accidental dural puncture and postdural puncture headache: a North American survey

Study Objective To evaluate the management of accidental dural puncture (ADP) and postdural puncture headache (PDPH) among obstetric anesthesiologists practicing in North America. Design Questionnaire survey of individual members of the Society for Obstetric Anesthesia and Perinatology (SOAP). Setting University hospital. Measurements In June 2008, a 4-part, 83-item electronic survey was distributed to all North American members of SOAP. It contained questions about respondent demographics, epidural catheter and intrathecal catheter management after ADP, PDPH management, epidural blood patch (EBP) management, and patient follow-up. Main Results Of the 843 United States and Canadian members of SOAP who were surveyed, 160 responses were collected. Respondents reported placing an epidural 75% of the time and an intrathecal catheter 25% of the time following ADP. Common prophylactic and conservative treatment strategies included hydration, caffeine, and opioids by mouth; 76% of respondents leave an intrathecal catheter in place for 24 hours to reduce the frequency of headache. Epidural blood patches are placed by 81% of practitioners less than 24 hours after headache onset. Conclusions Protocols for ADP management are rare. There is wide variation in catheter management after dural puncture, measures used to prevent and treat a resultant headache, and EBP management.

All parturients receiving neuraxial morphine should be monitored with continuous pulse oximetry

At the 2007 annual meeting of the Society for Obstetric Anesthesia and Perinatology (SOAP), the attendees were informed that an ASA Task Force was drafting “Guidelines” for the management of patients receiving neuraxial opioids for postoperative pain management. In the discussion that ensued, which was of interest to SOAP as it concerned women receiving neuraxial morphine after cesarean delivery, one of the most controversial issues was the suggestion that ALL patients who receive neuraxial morphine should be monitored with continuous pulse oximetry.

Society for Obstetric Anesthesia and Perinatology 39th Annual Meeting.

Society for Obstetric Anesthesia and Perinatology 39th Annual Meeting.

ANNOUNCEMENT AND CALL FOR ABSTRACTS:

Anesthesiology and the Society for Obstetric Anesthesia and Perinatology (SOAP) are dedicated to bringing forward new and innovative research in the field of Obstetric Anesthesia. We are jointly organizing a special session during the ASA's Annual Meeting, October 13–17, 2007, in San Francisco, California.This will be an oral presentation session (without posters). A committee consisting of Journal Editors and representatives of SOAP will select the abstracts and presenters for this session. The authors will be invited to prepare a formal 10-minute oral presentation of their work. After the oral presentation, experts will be invited to discuss each presentation. The aim of this session is to gather as many individuals as possible to participate in this session and to present the most current scientific papers.Abstracts should be submitted online to the ASA Annual Meeting using the standard online process (which can be accessed via the Web sites www.ASAhq.organd www.anesthesiology.org). Select Obstetric Anesthesia as the major subject area. In addition, authors should notify the Anesthesiology Editorial Office via e-mail (editorial-office@anesthesiology.org) regarding their interest in being considered for the specific session. The deadline for abstract submission is March 31, 2007. All selected authors will be invited to submit their work to Anesthesiology for inclusion in a special issue to be published in 2008.

ANNOUNCEMENT AND CALL FOR ABSTRACTS:

Anesthesiology and the Society for Obstetric Anesthesia and Perinatology (SOAP) are dedicated to bringing forward new and innovative research in the field of Obstetric Anesthesia. We are jointly organizing a special session during the ASA’s Annual Meeting, October 13–17, 2007, in San Francisco, California.This will be an oral presentation session (without posters). A committee consisting of Journal Editors and representatives of SOAP will select the abstracts and presenters for this session. The authors will be invited to prepare a formal 10-minute oral presentation of their work. After the oral presentation, experts will be invited to discuss each presentation. The aim of this session is to gather as many individuals as possible to participate in this session and to present the most current scientific papers.Abstracts should be submitted online to the ASA Annual Meeting using the standard online process (which can be accessed via the Web sites www.ASAhq.organd www.anesthesiology.org). Select Obstetric Anesthesia as the major subject area. In addition, authors should notify the Anesthesiology Editorial Office via e-mail (editorial-office@anesthesiology.org) regarding their interest in being considered for the specific session. The deadline for abstract submission is March 31, 2007. All selected authors will be invited to submit their work to Anesthesiology for inclusion in a special issue to be published in 2008.