International journal of obstetric anesthesia
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Int J Obstet Anesth · Feb 2020
Infrared thermography to assess dermatomal levels of labor epidural analgesia with 1 mg/mL ropivacaine plus 0.5 µg/mL sufentanil: a prospective cohort study.
Assessment of the effectiveness of obstetric epidural analgesia may be difficult and techniques for objective assessment of epidural spread of local anesthetic would be useful. In this prospective cohort study we assessed whether obstetric epidural analgesia from a low concentration of ropivacaine led to significant change in cutaneous temperature, related to sympathetic block detected by infrared thermography, at dermatomes C4, T4, T10, L2 and L5. ⋯ These results suggest that infrared thermography might be useful for the early diagnosis of successful obstetric epidural analgesia.
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Int J Obstet Anesth · Feb 2020
An educational intervention about the classification of penicillin allergies: effect on the appropriate choice of antibiotic therapy in pregnant women.
Most pregnant women who self-report penicillin allergy are not truly penicillin-allergic and this misunderstanding often leads to administration of inappropriate antibiotic therapy. Decision algorithms have been developed to guide antibiotic selection but major discrepancies have been reported between guidelines and clinical practice. We aimed to optimize the prescription of antibiotics for pregnant women who self-reported penicillin allergy, using an educational intervention about the classification of penicillin allergies that targeted gynecologists, anesthesiologists and midwives. ⋯ An educational intervention about penicillin allergy classification was associated with an improvement in the choice of appropriate antibiotic therapy among women who had reported penicillin allergy.
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Int J Obstet Anesth · Feb 2020
Efficacy of the Epidural Positioning Device® in optimizing the acoustic target window for neuraxial needle placement in term pregnancy.
Neuraxial anesthesia can be challenging in obstetric patients due to the gravid uterus interfering with patient positioning. Ultrasound is commonly used in obstetric anesthesia to facilitate neuraxial needle placement. Some positioning maneuvers facilitate the ultrasound visualization of structures and the placement of neuraxial needles, but the Epidural Positioning Device (EPD) has yet to be evaluated. ⋯ Although the application of an EPD did not improve the paramedian acoustic target area in term parturients, greater patient comfort might facilitate needle placement.
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Int J Obstet Anesth · Feb 2020
Maternal and neonatal characteristics in obstetric intensive care unit admissions.
The objective of this study was to evaluate the course of pregnancy and delivery of obstetric patients admitted for intensive care, and determine the health status of their infants. ⋯ Advanced maternal age, nulliparity and multiple pregnancy were more common among intensive care unit-admitted women than in the general obstetric population. The main causes for admission were hypertensive complications and obstetric haemorrhage. Compared with the general obstetric population, neonates of intensive care unit-admitted mothers were eight times more likely to require treatment on a neonatal ward and their risk of neonatal death was also eight times greater.
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Int J Obstet Anesth · Feb 2020
Observational StudyGastric emptying of carbohydrate drinks in term parturients before elective caesarean delivery: an observational study.
Pre-operative carbohydrate (CHO) drinks have shown some benefits peri-operatively and have been incorporated into many Enhanced Recovery after Surgery (ERAS) programmes. We assessed the gastric emptying of pre-operative CHO drinks prior to elective caesarean delivery using ultrasonography. ⋯ The gastric emptying of this cohort of pregnant women suggests that 400 mL of a CHO drink can be safely consumed up to two hours before elective surgery. This study can help inform future peri-operative fasting guidelines for pregnant patients.