International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2023
Controlled Clinical TrialCalculation of effective dose of phenylephrine bolus for treatment of post-spinal hypotension in pre-eclamptic patients undergoing caesarean section - a non-randomised controlled trial.
Patients with pre-eclampsia require smaller vasopressor doses compared with those with normotension for management of post-spinal hypotension during caesarean section. However, the literature has little evidence as to the phenylephrine dose required for patients with pre-eclampsia. ⋯ Patients with pre-eclampsia may need a 33% to 40% reduction in the first phenylephrine bolus dose, compared with patients with normotension, for the treatment of the first episode of post-spinal hypotension.
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Int J Obstet Anesth · Nov 2023
Role of cosyntropin in the prevention of post-dural puncture headache: a propensity-matched retrospective analysis.
Post-dural puncture headache (PDPH) is a well-documented complication of accidental dural puncture in obstetric patients. Reports have shown successful treatment with adrenocorticotropic hormone (ACTH) but evidence remains low and limited. In this retrospective analysis, we assessed whether prophylactic administration of cosyntropin, a synthetic derivative of ACTH, reduced the incidence of PDPH after accidental dural puncture in parturients. ⋯ Prophylactic administration of cosyntropin is not associated with a reduced incidence of PDPH.
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Int J Obstet Anesth · Nov 2023
Anesthesiology resident preferences regarding learning to perform epidural anesthesia procedures in obstetrics: a qualitative phenomenological study.
Learning to perform neuraxial techniques in obstetrics is considered one of the most difficult skills for anesthesiology trainees to acquire and no consensus exists regarding the best practices for teaching these procedures. Utilizing a qualitative, phenomenological approach, we aimed to explore what trainees perceive as the best approaches to teaching epidural anesthesia techniques; identify how these perceptions align or differ from those of faculty anesthesiologists; and examine how these approaches fit into the cognitive apprenticeship framework, which describes a process of reflection on how learning occurs in the authentic environment. ⋯ Trainee and instructor preferences for teaching epidural procedures in obstetrics aligned with the cognitive apprenticeship framework. These concepts may be applied to curriculum design, evaluation, feedback, self-assessment and faculty development.
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Int J Obstet Anesth · Nov 2023
Review Meta AnalysisFactors associated with epidural-related maternal fever in low-risk term women: a systematic review.
The underlying mechanism of epidural-related maternal fever (ERMF) is not fully understood. This systematic review aimed to identify factors associated with ERMF in low-risk, full-term women using neuraxial analgesia. ⋯ Many factors are associated with ERMF but may not be independent or causal. Further study is needed to clarify the interactions of these factors in ERMF development and whether modification of these factors might influence risk of ERMF.