International journal of obstetric anesthesia
-
Int J Obstet Anesth · Nov 2024
ReviewExtracorporeal membrane oxygenation (ECMO) in pregnancy and peripartum: a focused review.
As the medical complexity of pregnant patients increases, the rate of maternal morbidity has risen. Maternal cardiovascular disease is a leading cause of maternal morbidity and mortality followed closely by sepsis and infection, both of which may be associated with respiratory failure. ⋯ Obstetricians and anesthesiologists who care for women on the labor floor must strive to recognize at-risk and deteriorating patients, facilitate escalation of care when appropriate, and engage consultant teams to consider the need for extracorporeal support in high-risk circumstances. This article reviews the epidemiology, indications, specific considerations, potential complications, and outcomes of extracorporeal life support in pregnant and peripartum patients.
-
Int J Obstet Anesth · Nov 2024
ReviewAnaesthetic management of obstetric patients with Chiari type I malformation: a retrospective case series and literature review.
The peripartum management of obstetric patients with Chiari type I malformation remains a challenge due to the degree of cerebellar tonsillar herniation and a paucity of published evidence. There is concern about neuraxial anaesthetic blocks and uncertainty regarding the optimum mode of delivery. We systematically searched the literature for the obstetric management of patients with Chiari type I malformation, independent of publication date and language. ⋯ Our review reveals the use of a variety of modes of delivery and anaesthetic techniques and that most patients suffered no neurological complication. We conclude there is no of evidence to avoid any one approach to labour analgesia, delivery and anaesthesia. We propose a holistic, individualised and patient-centred approach with an appraisal of the risks and benefits to support shared-decision making.
-
Int J Obstet Anesth · Nov 2024
Randomized Controlled Trial Comparative StudyComparison of erector spinae plane and transversus abdominis plane block for postoperative analgesia after caesarean delivery under spinal anaesthesia: A randomised controlled trial.
Truncal blocks contribute to multimodal analgesia that enhances early recovery after caesarean delivery. The transversus abdominis plane (TAP) block is an established technique that offers somatic abdominal wall analgesia. The erector spinae plane (ESP) block is a fascial plane technique that may offer additional visceral analgesic effects. This study hypothesized that ESP block would offer superior analgesic efficacy to TAP block in women undergoing caesarean delivery under spinal anaesthesia. ⋯ This study found similar postoperative opioid use and analgesic efficacy between ESP and TAP block after caesarean delivery performed under spinal anaesthesia.
-
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
Randomized Controlled TrialSacral sensory blockade from 27-gauge pencil-point dural puncture epidural analgesia or epidural analgesia in laboring nulliparous parturients: a randomized controlled trial.
The dural puncture epidural (DPE) technique has been associated with better sacral analgesia compared with a traditional epidural (EPL) technique in laboring parturients. The aim of this study was to investigate whether DPE with a 27-gauge pencil-point needle compared with a traditional EPL technique produces more rapid bilateral sacral blockade in nulliparous parturients. ⋯ The DPE technique with a 27-gauge pencil-point spinal needle more often provides bilateral sacral blockade at 20 min following block initiation compared with the EPL technique. The time to adequate analgesia and need for supplemental analgesia did not appear to differ between techniques.