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
Observational StudyClinical and ultrasonographic assessment of airway indices among non-pregnant, normotensive pregnant and pre-eclamptic patients: a prospective observational study.
Prediction of a difficult airway is of paramount importance for an anaesthesiologist. Various anatomical and physiological factors contribute to a difficult airway in pregnant females, especially those with pre-eclampsia. The aim of the study was to assess airway indices using both routinely used clinical methods and ultrasound. ⋯ Routinely used clinical methods of airway assessment lack sensitivity and specificity. Ultrasound can visualise anatomical structures in the supraglottic and subglottic views and is encouraging as an airway assessment tool.
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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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Int J Obstet Anesth · May 2023
ReviewThe use of processed electroencephalography (pEEG) in obstetric anaesthesia: a narrative review.
Accidental awareness under general anaesthesia (AAGA) remains a major complication of anaesthesia. The incidence of AAGA during obstetric anaesthesia is high relative to other specialities. The use of processed electroencephalography (pEEG) in the form of "depth of anaesthesia" monitoring has been shown to reduce the incidence of AAGA in the non-obstetric population. ⋯ In addition, pEEG acts as a surrogate marker of cerebral perfusion, and thus as an additional monitor for impending cardiovascular collapse, as seen in amniotic fluid embolism. The subtle physiological and pathological changes in EEG activity that may occur during pregnancy are an unexplored research area in the context of anaesthetic pEEG monitors. We believe that the direction of clinical practice is moving towards greater use of pEEG monitoring and individualisation of anaesthesia.
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Int J Obstet Anesth · May 2023
Global issues in obstetric anaesthesia: perspectives from South Africa, Japan, China, Latin America and North America.
South Africa is classified as a low- and middle-income country, with a complex mixture of resource-rich and resource-limited settings. In the major referral hospitals, the necessary skill level exists for the management of complex challenges. However, this contrasts with the frequently-inadequate skill levels of anaesthesia practitioners in resource-limited environments. ⋯ Anaesthesia workforce challenges, exacerbated by coronavirus disease 2019, beset North American healthcare. Pre-existing struggles by governments and decision-makers to improve health care access remain, partly due to unfamiliarity with the role of the anaesthesiologist. In addition to weaknesses in work environments and dated standards of work culture, the work-life balance demanded by new generations of anaesthesiologists must be acknowledged.