International journal of obstetric anesthesia
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Int J Obstet Anesth · Aug 2019
Randomized Controlled Trial Comparative StudyA randomised comparison of C-MAC™ and King Vision® videolaryngoscopes with direct laryngoscopy in 180 obstetric patients.
Current evidence suggests that there is uncertainty about which videolaryngoscope performs best in obstetric anaesthesia. The aim of this study was to compare C-MAC and King Vision® videolaryngoscopes and direct laryngoscopy for tracheal intubation of patients undergoing caesarean section. ⋯ Compared to direct laryngoscopy, C-MAC and King Vision® did not prolong the time to intubation, supporting these videolaryngoscopes as primary intubation devices in obstetric anaesthesia. The C-MAC was easier to use and needed fewer additional manoeuvres than the King Vision®. The C-MAC may be better suited for tracheal intubation of obstetric patients undergoing caesarean section.
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Int J Obstet Anesth · Aug 2019
ReviewMonitoring, prevention and treatment of side effects of long-acting neuraxial opioids for post-cesarean analgesia.
Long-acting neuraxial opioids such as morphine and diamorphine, administered via spinal or epidural routes, are staple components of a multimodal approach to postoperative analgesia following cesarean delivery. The widespread use of neuraxial opioids is due largely to their significant analgesic efficacy and favorable safety profile. The most common side effects of neuraxial opioids are pruritus, nausea and vomiting. ⋯ The most serious complication of neuraxial opioids is respiratory depression, which occurs in 0-0.9% of cases. Hypothermia has also been reported in association with neuraxial morphine use at cesarean delivery. This article will review recent advances in prophylaxis, treatment and monitoring of the side effects of long-acting neuraxial opioids.
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Int J Obstet Anesth · Aug 2019
Exploring the challenges of task-centred training in obstetric anaesthesia in the operating theatre environment.
Task-centred learning forms the basis of procedural training in obstetric anaesthesia. We observed that our residents were not building their competence from experiential practice in the operating theatre. We used a broad-based framework to explore the challenges encountered by the residents and clinical supervisors in the learning and teaching of obstetric anaesthesia. ⋯ Our study described the challenges of obstetric anaesthesia training in the operating theatre environment in an Asian healthcare setting. Research is needed on the influence of supervisors' concern about maternal risks and their teaching behaviours.
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Int J Obstet Anesth · Aug 2019
ReviewPost-cesarean delivery pain. Management of the opioid-dependent patient before, during and after cesarean delivery.
The opioid crisis has reached an unprecedented magnitude in the United States and worldwide, and data on opioid use and misuse in the obstetric population are extremely concerning. Despite an abundant number of studies evaluating strategies to prevent neonatal opioid withdrawal syndrome in babies born to mothers who are chronic opioid users, in babies born to mothers using chronic opioids, numerous questions remain unanswered, including (1) how to optimally manage postpartum pain in opioid-dependent patients (2) how to reconcile buprenorphine and methadone use with intrapartum and post-partum analgesia, so as to avoid opioid withdrawal during and after delivery (3) how to safely and effectively provide a stepwise multimodal approach that incorporates systemic opioid-sparing approaches, such as neuraxial opioids, clonidine, ketamine, gabapentin, and regional anesthetic blocks, to ensure adequate pain relief while avoiding opioid withdrawal (4) how to optimally manage post-partum recovery and (5) how to avoid excessive opioid prescription and possibly leftover opioids that may promote persistent use, misuse and diversion. With the recognition that an increasing number of pregnant women are taking chronic opioids, the goals of this review article are to summarize the existing literature on post-cesarean pain management in the obstetric patient with an opioid-use disorder; and to provide clinicians with a stepwise approach for management before, as well as during and after, cesarean delivery of women who have been chronically using opioids during their pregnancy.
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Int J Obstet Anesth · Aug 2019
Comparative StudyThe comparative accuracy of a handheld and console ultrasound device for neuraxial depth and landmark assessment.
The study aimed to compare the accuracy of epidural depth estimation of a handheld ultrasound device, with an integrated algorithm that estimates epidural depth (AU; Accuro, Rivanna Medical), to that of a console ultrasound machine (GU; GE LOGICTM S8). ⋯ The AU and GU provided comparable epidural depth estimates. The AU device may be a reasonable alternative to more sophisticated ultrasound devices in determining the epidural space and depth in a non-obese obstetric population.