International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2020
Multicenter StudyProtocol for direct reporting of awareness in maternity patients (DREAMY): a prospective, multicentre cohort study of accidental awareness during general anaesthesia.
Accidental awareness during general anaesthesia (AAGA) is a complex and rare outcome to investigate in surgical patient populations, particularly obstetric patients. We report the protocol of the Direct Reporting of Awareness in Maternity patients (DREAMY) study, illustrating how the research was designed to address practical and methodological challenges for investigating AAGA in an obstetric cohort. ⋯ The DREAMY study will provide data on incidence, experience and implications of AAGA for obstetric patients, using a robust methodology that will reliably detect and translate subjective AAGA reports into objective outcomes. In addition, the study is expected to improve vigilance for AAGA in participating hospitals and encourage adoption of recommendations for support of patients experiencing AAGA.
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The Gerard W. Ostheimer Lecture presented at the annual meeting of the Society of Obstetric Anesthesia and Perinatology (SOAP) is a one-year summary of the literature published in domains of interest to anesthesiologists who manage and care for obstetric patients. ⋯ Ostheimer Lecture presented at the 2019 SOAP meeting; the relevant literature from 2018 was summarized. The topics included in this review are maternal morbidity, antibiotic prophylaxis, anaphylaxis, the Lancet series on increasing cesarean delivery rates, the Robson Ten-Group Classification System, pelvic floor disorders, timing of delivery in nulliparous women, placenta accreta disorders, anesthesia for cesarean delivery, labor analgesia (including parturients with thrombocytopenia and tattoos, and epidural maintenance with the programmed intermittent epidural bolus technique), ultrasound use in obstetric anesthesia, and drugs in pregnancy.
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Int J Obstet Anesth · May 2020
Observational StudyThe association between the introduction of quantitative assessment of postpartum blood loss and institutional changes in clinical practice: an observational study.
Imprecise visual estimates of blood loss contribute to morbidity from postpartum hemorrhage. We examined the impact of quantitative assessment of postpartum blood loss on clinical practice and outcomes. ⋯ Quantifying blood loss may result in increased vigilance for vaginal and cesarean delivery. We identified an association between quantifying blood loss and improved identification of postpartum hemorrhage, patient management steps and cost savings.
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Int J Obstet Anesth · May 2020
Inadvertent neuraxial block placement at or above the L1-L2 interspace in the super-obese parturient: a retrospective study.
Increasing body mass index (BMI) increases the difficulty of neuraxial procedures. We hypothesized that it may put patients at risk for inappropriately high dural puncture. The accuracy of anesthesiologists' estimates of the interspinous level in super-obese parturients has not been studied. We evaluated the frequency of inadvertently high epidural and/or intrathecal catheter placement (at or above the L1/L2 interspace) in parturients of BMI ≥50 kg/m2. ⋯ A high rate of inadvertently high epidural or intrathecal catheter placement occurs in super-obese parturients. Ultrasound did not prevent this.
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Int J Obstet Anesth · May 2020
Fentanyl concentration in maternal and umbilical cord plasma following intranasal or subcutaneous administration in labour.
The effect that the route of maternal fentanyl administration has on placental transfer of drug to the neonate is not well studied. Plasma concentration ratios are an indicator of fetal exposure, relative to the mother. ⋯ This study is the first to examine fetal and maternal fentanyl concentrations after subcutaneous administration. This research supports the safe use of fentanyl for labour analgesia for women.