International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2024
Randomized Controlled TrialPre-oxygenation using high flow humidified nasal oxygen or face mask oxygen in pregnant people - a prospective randomised controlled crossover non-inferiority study (The HINOP2 study).
Airway guidelines recommend pre-oxygenation of obstetric patients to an end tidal oxygen concentration (etO2) ≥90%. High flow nasal oxygen (HFNO) achieves this in 60% of pregnant people. However face mask (FM) pre-oxygenation also may not achieve this target in all patients. In this study we determined whether HFNO pre-oxygenation is non-inferior to FM pre-oxygenation. ⋯ In this cohort of pregnant people at term in a simulated environment, pre-oxygenation with HFNO was not inferior to FM pre-oxygenation. FM pre-oxygenation did not achieve pre-oxygenation targets in over 50% of participants.
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Int J Obstet Anesth · Nov 2024
Comparative StudyProphylactic phenylephrine infusion versus treatment with vasopressor bolus as needed during non-urgent cesarean delivery and neonatal acidemia: a retrospective cohort study (2016-2021).
Prophylactic vasopressor administration reduces spinal hypotension during cesarean delivery, however the effects of vasopressor administration on neonatal acidemia remain uncertain. We examined the occurrence of neonatal acidemia in the setting of non-urgent cesarean delivery and compared outcomes between cases receiving prophylactic phenylephrine infusion versus cases treated with boluses of phenylephrine. ⋯ In this pragmatic study, prophylactic phenylephrine infusion was associated with a reduction in maternal spinal hypotension, but not reduced neonatal acidemia.
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Int J Obstet Anesth · Nov 2024
Case ReportsNeuraxial labor analgesia in a parturient with carnitine palmitoyl transferase type II deficiency: a case report.
Carnitine Palmitoyl Transferase Type II (CPT II) deficiency is a disorder of fatty acid beta oxidation that causes decreased adenosine triphosphate (ATP) and ketone production during periods of fasting or high energy requirements. Labor and delivery can precipitate attacks for parturients with this disorder, causing hypoglycemia, muscle weakness, rhabdomyolysis, and kidney failure. Anesthetic management considers the delivery mode and anesthetic medications available to reduce these risks. We present the case of a pregnant patient with CPT II deficiency with labor epidural analgesia and a vaginal delivery, with alternative plans had a different delivery mode been required.