International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2019
Observational StudyIncidence of respiratory depression after epidural administration of morphine for cesarean delivery: findings using a continuous respiratory rate monitoring system.
Epidural morphine is widely used for postoperative analgesia after cesarean delivery. However, respiratory depression can occur after neuraxial administration of morphine. Previous reports describing respiratory depression in obstetric patients have relied on intermittent visual counting of the respiratory rate. In this study, we estimated the incidence of respiratory depression in patients who had received epidural morphine after cesarean delivery, using a continuous respiratory rate monitoring system with a finger sensor. ⋯ Approximately half the women experienced mild respiratory depression, but only one developed moderate respiratory depression. Continuous respiratory rate monitoring until ambulation may assist in early identification of respiratory depression after neuraxial administration of morphine.
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Int J Obstet Anesth · May 2019
Observational StudyObservational study evaluating obstetric anesthesiologist residents' wellbeing, anxiety and stress in a North American academic program.
The obstetric work environment has a unique set of stressors that may be associated with burnout. We investigated how well-being during the obstetric anesthesia (ObA) rotation compared to other rotations; which workplace environment characteristics precipitated the greatest stress; and whether anxiety and stress levels changed in trainees before and after an ObA rotation. ⋯ We provide the first example of tools for assessing work environment stressors in ObA. Our study illustrates that beyond excessive workload, lack of fairness and community values are areas that impact physician well-being. Use of these tools can guide initiatives to address work environment concerns, and presents a need for a validated well-being instrument to gauge physician well-being, in order to create a cultural shift from burnout to one of well-being.
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Int J Obstet Anesth · May 2019
Case ReportsSyncope after administration of epidural analgesia in an obstetric patient with a vagus nerve stimulator.
Vagus nerve stimulation (VNS) is an adjunctive therapy for medically refractory epilepsy and depression. Vagus nerve stimulation is generally well-tolerated, but cardiac arrhythmias or asystole are rare complications that have been reported. ⋯ These resolved after deactivating the device. This is the first report of a suspected arrhythmia during VNS in the setting of epidural analgesia.
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Int J Obstet Anesth · May 2019
A 10-year update: national survey questionnaire of obstetric anesthesia units in Israel.
This nationwide survey was conducted to provide data about the obstetric anesthesia services in Israeli labor and delivery units in 2016. ⋯ No new labor units have opened since 2005, despite huge increases in delivery volume in many units. These units manage increased numbers of epidurals and cesarean deliveries. Use of intrathecal morphine for spinal anesthesia has become more widespread. Future efforts should focus on availability of emergency equipment, separate obstetric anesthesia staffing, and establishing emergency protocols.
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Int J Obstet Anesth · May 2019
Randomized Controlled TrialEffect of companion presence on maternal satisfaction during neuraxial catheter placement for labor analgesia: a randomized clinical trial.
Companion presence during labour epidural placement reduces maternal anxiety and improves maternal satisfaction.
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