International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2018
Observational StudyUltrasonographic evaluation of gastric contents in term pregnant women fasted for six hours.
Current fasting guidelines suggest six hours are adequate to minimise the aspiration risk after a light meal consumed by pregnant women undergoing elective caesarean section. We assessed gastric contents in non-labouring pregnant women, using ultrasonographic analysis. ⋯ Our cohort of pregnant women fasted for six hours had no solid food visible in the antrum, but many had both qualitative and quantitative ultrasonographic evidence of gastric volumes potentially associated with aspiration risk. This suggests that pregnancy-specific fasting guidelines may be required.
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Int J Obstet Anesth · May 2018
A retrospective analysis of factors associated with anesthetic case duration for cesarean deliveries.
Accurately predicting cesarean delivery case duration is an integral component of designing appropriate workflow protocols and ensuring adequate provider availability. Our primary objective was to describe the variability of case duration, based on factors that we hypothesized would be influential, such as hospital facility type, United States region, time of day, case volume, and patient and provider characteristics. ⋯ This study analyzed national cesarean delivery data and determined factors associated with cesarean delivery duration. We showed that case durations varied in meaningful ways according to facility type, United States region, presence of a Certified Registered Nurse Anesthetist, and anesthesia type. Our work contributes to a small but growing body of research on optimal staffing models for anesthesia practices.
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Int J Obstet Anesth · May 2018
Risk-stratification, resource availability, and choice of surgical location for the management of parturients with abnormal placentation: a survey of United States-based obstetric anesthesiologists.
Parturients with abnormally adherent placentas present anesthetic challenges that include risk-stratification, management planning and resource utilization. The labor and delivery unit may be remote from the main operating room services. ⋯ Obstetric anesthesia leaders identified patients at lower clinical risk and those less likely to require greater resources. Additional resources were available in institutions where all abnormal placentation cases were managed on the labor and delivery unit. Practitioners should consider risk-stratification and resource availability when planning high-risk cases.
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Int J Obstet Anesth · May 2018
Case ReportsAnesthetic management of two parturients with cerebral palsy and prior selective dorsal rhizotomy.
Selective dorsal rhizotomy is a surgical spine procedure used to reduce spasticity in patients with upper motor neuron dysfunction caused by conditions such as cerebral palsy. The optimal anesthetic approach for obstetric patients who have undergone a selective dorsal rhizotomy is unknown. ⋯ We describe the use of neuraxial anesthesia in two patients with prior selective dorsal rhizotomy. Unless contraindicated for other reasons, a neuraxial anesthetic approach appears to be an effective option in patients with a history of a selective dorsal rhizotomy.
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Int J Obstet Anesth · May 2018
A study of factors influencing surgical cesarean delivery times in an academic tertiary center.
Knowledge of hospital-specific average cesarean delivery operative times, and factors influencing length of surgery, can serve as a guide for anesthesiologists when choosing the optimal anesthetic technique. The aim of this study was to determine operative times and the factors influencing those times for cesarean delivery. ⋯ Third and fourth cesarean delivery or the presence of other factors that could increase operative time may warrant catheter-based anesthetic techniques or the addition of adjunctive medications to prolong spinal anesthetic block. Institutional and individual surgeon factors may play an even more important role in determining surgical time.