International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2019
Randomized Controlled TrialUltrasound guided L5-S1 placement of labor epidural does not improve dermatomal block in parturients.
Based on their experience or training, anesthesiologists typically use the iliac crest as a landmark to choose the L3-4 or L2-3 interspace for labor epidural catheter placement. There is no evidence-based recommendation to guide the exact placement. We hypothesized that lower placement of the catheter would lead to a higher incidence of S2 dermatomal block and improved analgesia in late labor and at delivery. ⋯ Placement of an epidural catheter at the L5-S1 interspace using ultrasound did not improve sacral sensory block coverage when compared with an epidural catheter placed at a higher lumbar interspace, without using ultrasound guidance.
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Int J Obstet Anesth · May 2019
ReviewTreatment of obstetric post-dural puncture headache. Part 1: conservative and pharmacological management.
The 2009-12 MBRRACE-UK report highlighted the deaths of two women in whom dural puncture had occurred during insertion of a labour epidural catheter. One woman received an epidural blood patch, the other did not, but both suffered with chronic headaches following discharge from hospital. Neither woman was adequately followed-up. ⋯ Surveys of clinical practice in the UK have revealed significant variation in anaesthetic practice in the management of obstetric post-dural puncture headache. To help provide guidance on treatment, the Obstetric Anaesthetists' Association set up a working group to review the literature and produce evidence-based guidelines for management of obstetric post-dural puncture headache. These guidelines have been condensed into two review articles, the first of which covers conservative and pharmacological treatment.
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Int J Obstet Anesth · May 2019
Observational StudyObservational study evaluating obstetric anesthesiologist residents' wellbeing, anxiety and stress in a North American academic program.
The obstetric work environment has a unique set of stressors that may be associated with burnout. We investigated how well-being during the obstetric anesthesia (ObA) rotation compared to other rotations; which workplace environment characteristics precipitated the greatest stress; and whether anxiety and stress levels changed in trainees before and after an ObA rotation. ⋯ We provide the first example of tools for assessing work environment stressors in ObA. Our study illustrates that beyond excessive workload, lack of fairness and community values are areas that impact physician well-being. Use of these tools can guide initiatives to address work environment concerns, and presents a need for a validated well-being instrument to gauge physician well-being, in order to create a cultural shift from burnout to one of well-being.
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Int J Obstet Anesth · May 2019
Letter Randomized Controlled TrialIn vitro intravenous fluid co-load rates with and without an intravenous fluid warming device.
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Int J Obstet Anesth · May 2019
Massive hemorrhage protocol activation in obstetrics: a 5-year quality performance review.
A structured approach to hemorrhagic emergencies in obstetrics has gained popularity with the implementation of massive hemorrhage protocols. The trauma literature suggests that routine quality reviews should be in place to improve patient outcomes. The aim of this study was to develop quality indicators and assess compliance by the clinical team. ⋯ Suboptimal compliance was found in multiple areas, which may be attributable to the low frequency of activation of our massive haemorrhage protocol in obstetrics. The quality targets identified in this report can act as a basis for other institutions developing quality indicators to evaluate performance.