International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2020
Review Meta AnalysisQuadratus lumborum block for postoperative analgesia after cesarean delivery: a systematic review and meta-analysis.
Quadratus lumborum block (QLB) can reduce pain and opioid consumption after cesarean delivery. This systematic review investigated the effectiveness of QLB in reducing postoperative opioid use and its effect on pain scores compared with other analgesic methods after cesarean delivery. ⋯ The review findings show the superior analgesic effect of QLB when compared with systemic opioids in reducing postoperative opioid consumption, when intrathecal morphine is not administered.
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Int J Obstet Anesth · May 2020
ReviewRescue supraglottic airway devices at caesarean delivery: What are the options to consider?
Tracheal intubation is considered the gold standard means of securing the airway in obstetric general anaesthesia because of the increased risk of aspiration. Obstetric failed intubation is relatively rare. Difficult airway guidelines recommend the use of a supraglottic airway device to maintain the airway and to allow rescue ventilation. ⋯ However, after failed intubation via laryngoscopy, there is a lack of specific recommendations or indications for SAGFBI in current obstetric difficult airway guidelines in relation to achieving tracheal intubation. Our narrative review explores the issues pertaining to airway management in these cases: the use of supraglottic airway devices and the techniques of, and technical issues related to, SAGFBI. We also discuss the factors involved in the decision-making process as to whether to proceed with surgery with the airway maintained only with a supraglottic airway device, or to proceed only after SAGFBI.
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Int J Obstet Anesth · May 2020
Observational StudyHeterozygote carriers of mutations in the F11 gene, encoding Factor XI, have normal coagulation by thromboelastography during pregnancy.
Evidence to guide clinical decision-making in pregnant women who are usually asymptomatic, but identified as heterozygote carriers of F11 mutations, is lacking. We hypothesized that women identified on prenatal screening as heterozygous for a mutation in the F11 allele would have minimal evidence of an in vitro coagulation abnormality. ⋯ Despite lower FXI activity in the F11 mutation group, we found minimal differences in whole-blood measures of coagulation using thromboelastography. These findings support our hypothesis that a single copy of an F11 mutation does not produce significant evidence of an in vitro coagulation abnormality. Thromboelastography might be useful in determining the risk of neuraxial anesthesia in pregnant women, but additional work is required to establish the validity of this test.
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Int J Obstet Anesth · May 2020
Antisepsis for neuraxial procedures in Irish obstetric units and its possible impact on patient safety. A survey of national practice and associated complications.
The Association of Anaesthetists' guidelines recommend 0.5% chlorhexidine gluconate for skin antisepsis before obstetric neuraxial procedures. In this national survey, we identified the practice of all 19 obstetric units in Ireland. A secondary aim was to investigate complications in units not following guidelines. ⋯ Twenty-one percent of obstetric anaesthesia units in Ireland, catering for one-third of the total deliveries, use the ChloraPrep™ swab-stick and consider it the safest form of application. Chlorhexidine gluconate has been implicated in devastating neurological injury, however there is no evidence that a less concentrated solution such as 0.5% is safer. We suggest a meticulous application technique should be considered more important for patient safety than the concentration of solution.
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Int J Obstet Anesth · May 2020
Letter Case ReportsIsolated chronic tinnitus after neuraxial labor analgesia.