International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2024
Labor epidural analgesia among Han and Uyghur parturients: a prospective observational study in China.
Disparities in pain sensitivity and tolerance have been described, however little is known about variability in the experience of labor pain and childbirth in China. ⋯ Our findings suggest that Uyghur women experience labor pain with higher levels of pain and with higher use of epidural analgesics than Han women. Further studies are needed to evaluate whether these differences are clinically relevant.
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Int J Obstet Anesth · Nov 2024
Upper back, neck, and shoulder pain during labor epidural analgesia: a quality improvement initiative.
Severe upper back/interscapular, neck and shoulder pain during labor epidural analgesia (PLEA) is not uncommon. The objective of this quality initiative was to evaluate the incidence, demographic associations and management of PLEA. ⋯ The incidence of PLEA was higher than previously reported. Patients with PLEA were younger, more commonly nulliparous, had higher BMI, longer epidural infusion times and higher CD rates. A three-step treatment protocol was successful in managing PLEA.
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Int J Obstet Anesth · Nov 2024
Randomized Controlled Trial Comparative StudyP6 acupressure versus sham acupressure for prevention of intraoperative nausea and vomiting during cesarean delivery under neuraxial anesthesia: a randomized controlled trial.
Intraoperative and postoperative nausea and vomiting (IONV and PONV) are common during cesarean delivery (CD) with neuraxial anesthesia. Limited information exists on the antiemetic benefit of combined P6 acupoint stimulation with acupressure (P6 acupressure) and pharmacologic antiemetics on preventing IONV and PONV after CD. This study assessed the antiemetic efficacy of P6 acupressure compared to a non-P6 acupoint stimulation with acupressure (sham acupressure) in preventing IONV during CD. ⋯ P6 acupressure did not reduce the incidence of IONV or PONV when combined with antiemetic therapy per enhanced recovery recommendations. There does not appear to be sufficient evidence to support using P6 acupressure for IONV prevention.
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Int J Obstet Anesth · Nov 2024
ReviewObstetric anesthesia management of dilated cardiomyopathies and heart failure: a narrative review.
Pregnancy in patients with dilated cardiomyopathy carries a significantly increased risk of maternal mortality or severe morbidity, and pregnancy is typically considered contraindicated for patients with severely reduced ventricular function. Nonetheless, anesthesiologists will still encounter patients with cardiomyopathy requiring delivery or termination care. ⋯ Vaginal delivery, with effective neuraxial anesthesia is the preferred mode of delivery in most patients with cardiomyopathy, with cesarean delivery reserved for maternal or fetal indications. The Pregnancy Heart Team is vital in coordinating the multidisciplinary care necessary to safely support these patients through pregnancy.
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Int J Obstet Anesth · Nov 2024
ReviewObstetric anesthesia considerations in pregnancy-associated myocardial infarction: a focused review.
Pregnancy-associated myocardial infarction (PAMI) is a rare but serious complication that can occur either during pregnancy or postpartum. The etiologies of PAMI are atherosclerosis, spontaneous coronary artery dissection, coronary thrombosis, coronary embolism, and coronary vasospasm. ⋯ Anesthetic management during delivery in patients with PAMI should consist of early and carefully titrated neuraxial analgesia and anesthesia, maintenance of normal sinus rhythm, preservation of afterload, and monitoring for and avoiding myocardial ischemia. To improve the care of women with PAMI, a multidisciplinary team of cardiologists, maternal fetal medicine specialists, obstetric providers, neonatologists, and anesthesiologists must work collectively to manage these complex patients.