International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2024
Impact of the 2017 revised Japanese obstetric hemorrhage management guidelines on tranexamic acid use in patients undergoing cesarean delivery: an interrupted time series analysis.
Tranexamic acid is one component of a complex management algorithm for postpartum hemorrhage. In Japan, the 2010 obstetric hemorrhage management guidelines was revised in 2017, adding the recommendation for the administration of tranexamic acid for postpartum hemorrhage. This research aims to delineate the temporal trends in tranexamic acid administration in patients undergoing cesarean deliveries and to examine the impact of the obstetric hemorrhage management guidelines implementation. ⋯ This interrupted time series analysis demonstrated a significant increase in the rate of tranexamic acid administration following the implementation of the revised guidelines, reversing the previously observed downward trend. Our findings could reflect the impact of the revised guideline on the use of tranexamic acid for postpartum hemorrhage, but this did not translate to fewer blood transfusions.
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Int J Obstet Anesth · Nov 2024
Prophylactic cosyntropin after unintentional dural puncture and incidence of post-dural puncture headache and epidural blood patch use: A retrospective cohort study (2019-2022).
Cosyntropin has been suggested to decrease the incidence of post-dural puncture headache (PDPH) by increasing the production of cerebrospinal fluid. This study examined the association of prophylactic cosyntropin administration with the incidence of PDPH and its management with an epidural blood patch after an unintentional dural puncture (UDP). ⋯ Prophylactic cosyntropin following UDP was not associated with a significant decrease in PDPH rate or use of epidural blood patch for management of PDPH. There was no significant difference in the rate of adverse hyperglycemic or hypertensive events amongst those who did or did not receive cosyntropin.
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Int J Obstet Anesth · Nov 2024
Case ReportsNovel approaches facilitating neuraxial anesthesia placement in pregnant women with morbid obesity: case descriptions.
Clinical management of pregnant women with morbid obesity poses challenges in performing neuraxial anesthesia as well as positioning for cesarean delivery. Occupational injuries are also known to occur while caring for patients with morbid obesity. We describe two novel approaches to assist neuraxial anesthesia administration and positioning for cesarean delivery. ⋯ This is particularly useful when the traditional taping of fat folds away from the site is inadequate. The pannus retractor results in a flatter surface facilitating epidural placement. We have introduced these two approaches into our clinical practice for pregnant women with morbid obesity requiring cesarean delivery under neuraxial anesthesia.
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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.
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Int J Obstet Anesth · Nov 2024
Rate of difficult intubation during caesarean delivery: A single centre before/after standardised airway management implementation study.
The use of general anaesthesia (GA) for caesarean delivery (CD) introduces the risk of both difficult and failed intubation. Various strategies may be utilised to reduce this risk; however, not all are supported by evidence. We analysed the rate of difficult intubation following implementation of three recommendations specific to airway management in CD. ⋯ Implementation of standardised airway management recommendations had no significant impact on difficult intubation rate, though adoption of all three recommendations was not universal.