International journal of obstetric anesthesia
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Int J Obstet Anesth · Aug 2020
Review Comparative StudyEnhanced recovery after caesarean delivery versus standard care studies: a systematic review of interventions and outcomes.
This systematic review aimed to determine whether enhanced recovery after caesarean delivery (ERAC) protocols should be adopted. ⋯ Studies evaluating ERAC used heterogeneous interventions and outcomes. Although there is currently low- or very low-level evidence supporting all outcomes evaluated, the majority of studies showed some benefits and none reported harm. On balance, we recommend the use of ERAC. Future studies are needed to strengthen ERAC recommendations by standardising interventions and reported outcomes.
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Int J Obstet Anesth · Aug 2020
Case ReportsPermanent hearing loss and tinnitus following epidural analgesia complicated by accidental dural puncture.
We report a case of permanent high-frequency hearing loss and tinnitus in a 38-year-old woman following an unrecognised dural puncture during epidural placement. The patient reported subjective unilateral hearing loss and tinnitus, along with a post-dural puncture headache, four hours post-delivery. The patient's headache resolved following two epidural blood patches, however, hearing loss and tinnitus persisted longer than two years. Long-term auditory symptoms following epidural analgesia in labour are very unusual findings.
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Int J Obstet Anesth · Aug 2020
Impact of an enhanced recovery program for cesarean delivery on postoperative opioid use.
Cesarean delivery is one of the most common surgeries performed worldwide and the adoption of enhanced recovery programs for cesarean delivery is gaining popularity. We tested the hypothesis that implementation of an enhanced recovery program for cesarean delivery would be associated with a decrease in postoperative opioid consumption. ⋯ The implementation of an enhanced recovery program for cesarean delivery was associated with a significant reduction in postoperative opioid consumption throughout hospitalization, with average pain scores remaining <2. Implementation of this program was also associated with an increase in the number of patients who were opioid-free 24 h prior to discharge.
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Int J Obstet Anesth · Aug 2020
Case ReportsInhalational induction of general anaesthesia for elective caesarean: ethical acceptability in treatment-resistant needle-phobia?
We describe the anaesthetic management of a parturient who, due to a severe needle phobia, requested an inhalational induction of general anaesthesia for an elective caesarean section. If general anaesthesia is indicated, conventional practice in the UK is to perform a rapid sequence induction via an intravenous route of drug administration to allow rapid intubation of the trachea. ⋯ Despite a thorough consent process highlighting these significant risks, the patient insisted on an inhalational induction of anaesthesia. We present the case and discuss the ethical dilemma (relating to patient care) in situations in which decisions made by patients deviate from medical recommendations.