Best practice & research. Clinical anaesthesiology
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Leadership is an infinite and tremendously complex journey along with paradoxes that cannot be captured comprehensively. Over the past decades, key dimensions of leadership have caught the attention of practitioners in the field of management sciences. Yet, leadership education in healthcare is still limited. This personal perspective aims to summarize key aspects of leadership, ranging from managing people to managing systems and oneself.
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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
ReviewBeyond the epidural: Alternatives to neuraxial labor analgesia.
Labor creates an intense pain experienced by women across the world. Although neuraxial analgesia is the most effective treatment of labor pain, in many cases, it may not be undesired, not available, or have contraindications. In addition, satisfaction with labor analgesia is not only determined by the efficacy of analgesia but a woman's sense of agency and involvement in the childbirth experience are also key contributors. ⋯ Healthcare provider knowledge of various nonneuraxial analgesic options, including efficacy, contraindications, safe clinical implementation, and side effects of various techniques is needed for optimal patient care and satisfaction. Future rigorous scientific studies addressing all of these labor analgesia options are needed to improve our understanding. This review summarizes the current published literature for commonly available non-neuraxial labor analgesic options.
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Uterotonics play an important role in the management of postpartum haemorrhage (PPH), often caused by uterine atony. The World Health Organization (WHO) recommends the application of uterotonics for all births. Oxytocin, considered the first-line uterotonic, binds to a G protein-coupled receptor which is subject to down sensitization upon repeated or prolonged administration of oxytocin. ⋯ Methylergometrine and carboprost should, therefore, be avoided in many cardiovascular pathologies. Carbetocin is a chemical modification of oxytocin with a longer half-time, and therefore one bolus of carbetocin is usually sufficient. Its heat stability makes it an ideal candidate in resource-restricted settings.