International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2023
Persistent opioid use after cesarean delivery in the United States of America: a systematic review.
This systematic review assessed the incidence of persistent opioid use after cesarean delivery in opioid-naïve individuals in the United States of America (USA). ⋯ Findings emphasize the importance of developing a standardized definition of persistent opioid use to accurately assess the risk, rate, and trends for persistent opioid use among opioid-naïve individuals undergoing cesarean delivery.
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Int J Obstet Anesth · May 2023
Meta AnalysisSystematic review of the effectiveness of remifentanil in term breech pregnancies undergoing external cephalic version.
External cephalic version (ECV) is a moderately painful procedure used to turn a fetus from a non-vertex to cephalic position. This systematic review and meta-analysis compared intravenous remifentanil with other analgesia or no analgesia or placebo on the success rate and associated pain of ECV. ⋯ Remifentanil increases the procedural success of ECV and reduces pain compared with placebo. Trials were at low risk of bias and contained a sufficient number of participants to have reasonable confidence in this finding.
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In this update we explore the current applications of simulation in obstetric anesthesia, describe what is known regarding its impacts on care and consider the different settings in which simulation programs are required. We will introduce practical strategies, such as cognitive aids and communication tools, that can be applied in the obstetric setting and share ways in which a program might apply these tools. Finally, we provide a list of common obstetric emergencies essential for a program's curriculum and common teamwork pitfalls to address within a comprehensive obstetric anesthesia simulation program.
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Int J Obstet Anesth · May 2023
Observational StudyMaternal heart rate variability patterns associated with maternal hypotension and non-reassuring fetal heart rate patterns following initiation of combined spinal-epidural labor analgesia: a prospective observational trial.
We evaluated whether baseline maternal heart rate variability (HRV), including the Analgesia Nociception Index (ANI), is associated with maternal hypotension and fetal heart rate (FHR) abnormalities following combined spinal-epidural (CSE) labor analgesia. ⋯ The ANI can predict the propensity for maternal hypotension and non-reassuring FHR patterns following CSE.