International journal of obstetric anesthesia
-
Int J Obstet Anesth · Nov 2024
Randomized Controlled TrialEffect of pneumatic leg compression on phenylephrine dose for hypotension prophylaxis via variable rate infusion at cesarean delivery: an unblinded randomized controlled trial.
Phenylephrine infusion is recommended to prevent spinal hypotension during cesarean delivery (CD) but may be associated with dose-dependent side effects. We hypothesized that adding intermittent pneumatic compression (IPC) of the lower legs to a variable-rate phenylephrine infusion will reduce the dose of phenylephrine required during CD. ⋯ Intermittent pneumatic compression combined with a variable-rate phenylephrine infusion reduced the phenylephrine dose per minute and the incidence of hypotension during CD under spinal anesthesia.
-
Int J Obstet Anesth · Nov 2024
Comparative StudyProphylactic phenylephrine infusion versus treatment with vasopressor bolus as needed during non-urgent cesarean delivery and neonatal acidemia: a retrospective cohort study (2016-2021).
Prophylactic vasopressor administration reduces spinal hypotension during cesarean delivery, however the effects of vasopressor administration on neonatal acidemia remain uncertain. We examined the occurrence of neonatal acidemia in the setting of non-urgent cesarean delivery and compared outcomes between cases receiving prophylactic phenylephrine infusion versus cases treated with boluses of phenylephrine. ⋯ In this pragmatic study, prophylactic phenylephrine infusion was associated with a reduction in maternal spinal hypotension, but not reduced neonatal acidemia.
-
Int J Obstet Anesth · Nov 2024
Quality of recovery and maternal satisfaction after caesarean delivery: a mixed-methods prospective cohort study.
Patient satisfaction and quality of recovery (QoR) are important patient-reported outcomes and quality metrics. The relationship between these two outcomes is complex, with studies showing a weak correlation between them in the non-obstetric population. We sought to evaluate the correlation between patient satisfaction and QoR scores in the obstetric population after caesarean delivery. As secondary aims, we aimed to determine the influence of urgency of procedure and mode of anaesthetic on patient satisfaction and QoR scores as well as determining drivers of satisfaction and dissatisfaction. ⋯ Maternal satisfaction and obstetric QoR are distinct entities with a weak correlation between the two variables. Urgency of procedure and mode of anaesthesia are significant predictors of the correlation between satisfaction and quality of recovery scores. Many of the drivers of satisfaction were modifiable including quality of communication and a comfortable physical space for postpartum recovery.
-
Int J Obstet Anesth · Nov 2024
Impact of the 2017 revised Japanese obstetric hemorrhage management guidelines on tranexamic acid use in patients undergoing cesarean delivery: an interrupted time series analysis.
Tranexamic acid is one component of a complex management algorithm for postpartum hemorrhage. In Japan, the 2010 obstetric hemorrhage management guidelines was revised in 2017, adding the recommendation for the administration of tranexamic acid for postpartum hemorrhage. This research aims to delineate the temporal trends in tranexamic acid administration in patients undergoing cesarean deliveries and to examine the impact of the obstetric hemorrhage management guidelines implementation. ⋯ This interrupted time series analysis demonstrated a significant increase in the rate of tranexamic acid administration following the implementation of the revised guidelines, reversing the previously observed downward trend. Our findings could reflect the impact of the revised guideline on the use of tranexamic acid for postpartum hemorrhage, but this did not translate to fewer blood transfusions.
-
Int J Obstet Anesth · Nov 2024
Case ReportsNovel approaches facilitating neuraxial anesthesia placement in pregnant women with morbid obesity: case descriptions.
Clinical management of pregnant women with morbid obesity poses challenges in performing neuraxial anesthesia as well as positioning for cesarean delivery. Occupational injuries are also known to occur while caring for patients with morbid obesity. We describe two novel approaches to assist neuraxial anesthesia administration and positioning for cesarean delivery. ⋯ This is particularly useful when the traditional taping of fat folds away from the site is inadequate. The pannus retractor results in a flatter surface facilitating epidural placement. We have introduced these two approaches into our clinical practice for pregnant women with morbid obesity requiring cesarean delivery under neuraxial anesthesia.