Best practice & research. Clinical anaesthesiology
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Maternal sepsis is a life-threatening condition defined as organ dysfunction resulting from infection that can arise during pregnancy, childbirth, postabortion, or in the postpartum period. Validated diagnostic criteria of maternal sepsis and septic shock may reduce the impact of this condition on maternal health worldwide, but the lack of consensus on adequate tools due to the overlap between physiological adaptations that occur during pregnancy and signs and symptoms of infection and sepsis can delay both diagnosis and treatment. ⋯ Interventions within the first hour from diagnosis have been proposed in 2021 to emphasize the state of emergency of a maternal sepsis. This review will highlight the utility of standardized diagnostic criteria, the implemented approaches for the prevention and treatment of maternal infections, and the strategies for early management of critically ill parturients.
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Best Pract Res Clin Anaesthesiol · May 2022
ReviewNeuraxial and general anaesthesia for caesarean section.
Caesarean section (CS) is one of the most performed operations worldwide. In many parts of the world, there has been a reduction in anaesthetic associated obstetric mortality, and this has been attributed to the increased use of neuraxial anaesthesia and improved safety of general anaesthesia, alongside improved training and organisational changes. In resource-limited countries, anaesthesia contributes disproportionately to maternal mortality, with one in seven deaths being due to anaesthesia. ⋯ For elective CS, spinal and combined-spinal anaesthesia predominate. General anaesthesia is mainly reserved for Category 1 CS where there is an immediate threat to the life of the mother or the baby. This review discusses the practical aspects of neuraxial and general anaesthesia for CS.
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Best Pract Res Clin Anaesthesiol · May 2022
ReviewEnhancing recovery after cesarean delivery - A narrative review.
Enhanced recovery after cesarean delivery (ERAC) is increasingly being implemented worldwide with the aim to improve patient care for women undergoing this procedure. ERAC is associated with superior maternal outcomes including decreased length of hospital stay, opioid consumption, pain scores, times to mobilization and urinary catheter removal and hospitalization costs, without increasing hospital readmission rates. A number of preoperative, intraoperative, and postoperative interventions have been incorporated into ERAC protocols. ⋯ Protocols rarely assess patient-reported outcome measures, patient satisfaction, or patient experience. The best measures of ERAC success are yet to be fully elucidated. Further work is required to evaluate protocols, interventions, and how best to measure the effect of ERAC.
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Best Pract Res Clin Anaesthesiol · May 2022
ReviewPlacenta accreta. A review of current anesthetic considerations.
Placenta accreta spectrum (PAS) is a potentially life-threatening disorder with unique anesthetic challenges, and its incidence has increased over the past decades. We review current guidelines and best practice evidence for antenatal diagnosis and preoperative evaluation, management pathways, multidisciplinary staff coordination, and surgery location. We address specific considerations for choice of anesthesia modality, the role of interventional radiology, and various techniques for minimizing hemorrhage for both planned and unplanned cases, as well as postoperative care for the PAS patient.
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Best Pract Res Clin Anaesthesiol · May 2022
ReviewSpinal hypotension in obstetrics: Context-sensitive prevention and management.
Spinal hypotension during caesarean section remains a common complication, with important attendant maternal and fetal adverse outcomes. Research elucidating the mechanisms of spinal hypotension has led to the development and refinement of effective management strategies, with a particular emphasis on prophylactic vasopressor administration. This has proved effective in well-resourced settings, with maternal comfort and the elimination of nausea now considered the primary aim of treatment. ⋯ Translational, context-sensitive research in resource-limited settings has shown promise in implementing pragmatic strategies based on research from resource-rich environments. We review the current best practice for the prevention and treatment of spinal hypotension, with a special emphasis on effective strategies in resource-limited settings. We further suggest a research agenda to address the knowledge gap in specific contexts.