International journal of obstetric anesthesia
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Int J Obstet Anesth · Aug 2020
Considerations and strategies in the organisation of obstetric anaesthesia care during the 2019 COVID-19 outbreak in Singapore.
The provision of safe obstetric anaesthesia services is essential during the COVID-19 global outbreak. The identification of the 'high-infection risk' parturient can be challenging especially with the rapidly changing risk criteria for COVID-19 'cases'. ⋯ A constant review of such processes is needed to enhance efficiency and to optimise use of finite resources. Good communication between health officials, institutional leadership and ground staff is essential for the dissemination of information.
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Int J Obstet Anesth · Aug 2020
Observational StudyHand placement during chest compressions in parturients: a pilot study to identify the location of the left ventricle using transthoracic echocardiography.
Current guidelines for maternal cardiopulmonary resuscitation recommend the hands be placed on the lower half of the sternum for compressions. We sought to evaluate the effect of the gravid uterus and left uterine displacement on the position of the left ventricle (LV) using transthoracic echocardiography. ⋯ This pilot study used transthoracic echocardiography to document the position of the LV during the third trimester of pregnancy. The LV was located approximately 6 cm cranial to the distal tip of the xiphoid process. Further validation is required before recommending changes in hand placement during maternal cardiopulmonary resuscitation.
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Int J Obstet Anesth · Aug 2020
Case ReportsInhalational induction of general anaesthesia for elective caesarean: ethical acceptability in treatment-resistant needle-phobia?
We describe the anaesthetic management of a parturient who, due to a severe needle phobia, requested an inhalational induction of general anaesthesia for an elective caesarean section. If general anaesthesia is indicated, conventional practice in the UK is to perform a rapid sequence induction via an intravenous route of drug administration to allow rapid intubation of the trachea. ⋯ Despite a thorough consent process highlighting these significant risks, the patient insisted on an inhalational induction of anaesthesia. We present the case and discuss the ethical dilemma (relating to patient care) in situations in which decisions made by patients deviate from medical recommendations.
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Int J Obstet Anesth · Aug 2020
Review Comparative StudyEnhanced recovery after caesarean delivery versus standard care studies: a systematic review of interventions and outcomes.
This systematic review aimed to determine whether enhanced recovery after caesarean delivery (ERAC) protocols should be adopted. ⋯ Studies evaluating ERAC used heterogeneous interventions and outcomes. Although there is currently low- or very low-level evidence supporting all outcomes evaluated, the majority of studies showed some benefits and none reported harm. On balance, we recommend the use of ERAC. Future studies are needed to strengthen ERAC recommendations by standardising interventions and reported outcomes.