International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2022
ReviewThe venous system during pregnancy. Part 2: clinical implications of the venous system.
Maternal positioning, medications, and other modulations to the venous system can affect maternal and fetal well-being. The venous system is a dynamic reservoir for blood volume, in which a virtual point of conversion between unstressed volume (Vu) and stressed volume (Vs) exists. The anatomic and physiologic changes associated with hypotension (e.g. supine and neuraxial technique-induced), hypertension (e.g. preeclampsia), and fluid management (e.g. early recovery after cesarean delivery protocols) are opportunities to consider the important role of the venous system in pregnancy.
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Int J Obstet Anesth · May 2022
Review Meta AnalysisUterine externalization versus in situ repair of hysterotomy during cesarean delivery: a systematic review, equivalence meta-analysis, and trial sequential analysis.
Uterine positioning during hysterotomy repair is controversial, with both in situ and externalized approaches commonly performed. Despite many published trials, clinical equipoise remains. This meta-analysis and trial sequential analysis (TSA) summarizes studies comparing both techniques. ⋯ This analysis revealed equivalence between methods for EBL and surgical duration. While the small reduction in EBL with externalized repair was not clinically or statistically significant, TSA analysis revealed an unmet information size, suggesting a potentially inconclusive result. In situ repair may be associated with less breakthrough postoperative analgesia requirement and faster return of bowel function.
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Int J Obstet Anesth · May 2022
Meta AnalysisThe effect of two groups of intrathecal fentanyl doses on analgesic outcomes and adverse effects in parturients undergoing cesarean delivery: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis.
Variable doses of intrathecal fentanyl (ITF) have been used for peri-operative analgesia during cesarean delivery (CD). We conducted a systematic review and meta-analysis to compare lower doses (LD; ≤12.5 µg) and higher doses (HD; >12.5 µg) of ITF in parturients undergoing CD. ⋯ In women undergoing CD, doses of ITF >12.5 µg reduced the requirement for intra-operative analgesic supplementation and prolonged the time to first rescue analgesia compared with smaller doses, but increased pruritus. On revising the cut-off to 15 µg, no significant difference was found.