International journal of obstetric anesthesia
-
Int J Obstet Anesth · May 2018
Risk-stratification, resource availability, and choice of surgical location for the management of parturients with abnormal placentation: a survey of United States-based obstetric anesthesiologists.
Parturients with abnormally adherent placentas present anesthetic challenges that include risk-stratification, management planning and resource utilization. The labor and delivery unit may be remote from the main operating room services. ⋯ Obstetric anesthesia leaders identified patients at lower clinical risk and those less likely to require greater resources. Additional resources were available in institutions where all abnormal placentation cases were managed on the labor and delivery unit. Practitioners should consider risk-stratification and resource availability when planning high-risk cases.
-
Int J Obstet Anesth · May 2018
Impact of epidural analgesia on cesarean and operative vaginal delivery rates classified by the Ten Groups Classification System.
The Ten Group Classification System (TGCS) allows critical analysis according to the obstetric characteristics of women in labor: singleton or multiple pregnancy, nulliparous, multiparous, or multiparous with a previous cesarean delivery, cephalic, breech presentation or other malpresentation, spontaneous or induced labor, and term or preterm births. Labor outcomes associated with epidural analgesia may be different among the different labor classification groups. The aim of this study was to explore associations between epidural analgesia and cesarean delivery, and epidural analgesia and assisted vaginal delivery, in women classified using the TGCS. ⋯ Epidural analgesia is associated with different effects on cesarean delivery and assisted vaginal delivery rates in different TGCS groups.
-
Int J Obstet Anesth · May 2018
Case ReportsAnesthetic management of two parturients with cerebral palsy and prior selective dorsal rhizotomy.
Selective dorsal rhizotomy is a surgical spine procedure used to reduce spasticity in patients with upper motor neuron dysfunction caused by conditions such as cerebral palsy. The optimal anesthetic approach for obstetric patients who have undergone a selective dorsal rhizotomy is unknown. ⋯ We describe the use of neuraxial anesthesia in two patients with prior selective dorsal rhizotomy. Unless contraindicated for other reasons, a neuraxial anesthetic approach appears to be an effective option in patients with a history of a selective dorsal rhizotomy.
-
Int J Obstet Anesth · May 2018
A study of factors influencing surgical cesarean delivery times in an academic tertiary center.
Knowledge of hospital-specific average cesarean delivery operative times, and factors influencing length of surgery, can serve as a guide for anesthesiologists when choosing the optimal anesthetic technique. The aim of this study was to determine operative times and the factors influencing those times for cesarean delivery. ⋯ Third and fourth cesarean delivery or the presence of other factors that could increase operative time may warrant catheter-based anesthetic techniques or the addition of adjunctive medications to prolong spinal anesthetic block. Institutional and individual surgeon factors may play an even more important role in determining surgical time.
-
Int J Obstet Anesth · May 2018
Observational StudyUse of epidural clonidine for the management of analgesia in the opioid addicted parturient on buprenorphine maintenance therapy: an observational study.
Management of labor analgesia and post-cesarean delivery pain is challenging in the patient taking buprenorphine as opioid addiction maintenance therapy. We observed whether substituting clonidine for fentanyl in an epidural solution would provide adequate analgesia for labor and after cesarean delivery. ⋯ The combination of clonidine and bupivacaine appears effective in parturients on buprenorphine therapy for opioid addiction maintenance. As study numbers were small and several factors were not examined, further confirmatory research is needed, including to determine the ideal dose of epidural clonidine in this setting.