International journal of obstetric anesthesia
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Int J Obstet Anesth · Aug 2021
Quantifying the incidence of clinically significant respiratory depression in women with and without obesity class III receiving neuraxial morphine for post-cesarean analgesia: a retrospective cohort study.
Obesity is a suspected risk factor for respiratory depression following neuraxial morphine for post-cesarean analgesia, however monitoring guidelines for obese obstetric patients are based on small, limited studies. We tested the hypothesis that clinically significant respiratory depression following neuraxial morphine occurs more commonly in women with body mass index (BMI) ≥40 kg/m2 compared with BMI <40 kg/m2. ⋯ Respiratory depression in this population is rare. A larger sample (∼75 000) is required to determine whether the incidence is higher with BMI ≥40 kg/m2. Tracheal intubation was higher among the BMI ≥40 kg/m2 cohort, likely due to more comorbidities.
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Int J Obstet Anesth · Aug 2021
ReviewPrediction of spinal anesthesia-induced hypotension during elective cesarean section: a systematic review of prospective observational studies.
Spinal anesthesia is the standard for elective cesarean section but spinal anesthesia-induced hypotension remains an important problem. Accurate prediction of hypotension could enhance clinical decision-making, alter management, and facilitate early intervention. We performed a systematic review of predictors of spinal anesthesia-induced hypotension and their predictive value during cesarean section. ⋯ Environmental and individual factors increased outcome variability, which restricted the value of the autonomic nervous system and peripheral perfusion indices for prediction of spinal anesthesia-induced hypotension. Supine stress tests may reflect parturients' cardiovascular tolerance during hemodynamic fluctuations and may optimize the predictive value of static state predictors. Future research for predicting spinal anesthesia-induced hypotension should focus on composite and dynamic parameters during the supine stress tests.
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Int J Obstet Anesth · Aug 2021
Observational StudyAn observational pilot study of a novel loss of resistance syringe for locating the epidural space.
The EpiFaith® syringe is a novel loss-of-resistance syringe that utilizes a spring-loaded plunger that automatically moves forward within the syringe when there is a loss of resistance. We evaluated the syringe in a clinical setting among a cohort of pregnant women receiving neuraxial labor analgesia. ⋯ This feasibility study found that three of the four anesthesiologists scored the EpiFaith® syringe as better or the same as using their regular loss-of-resistance syringe. More extensive studies are required to determine if the EpiFaith® syringe reduces adverse outcomes such as unintentional dural punctures.
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Int J Obstet Anesth · Aug 2021
Patient race and racial composition of delivery unit associated with disparities in severe maternal morbidity: a multistate analysis 2007-2014.
High Black-serving delivery units and high hospital safety-net burden have been associated with poorer patient outcomes. We examine these hospital-level factors and their association with severe maternal morbidity (SMM), independently and as effect modifiers of patient-level factors. ⋯ The patient racial/ethnic composition of the delivery unit is associated with adjusted-odds of SMM, both independently and interactively with individual patient race.
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Int J Obstet Anesth · Aug 2021
Observational StudyUtility of viscoelastography with TEG 6s to direct management of haemostasis during obstetric haemorrhage: a prospective observational study.
The TEG 6s is an automated cartridge-based device with limited description of use in obstetric haemorrhage. The aim of this analysis was to describe the utility of TEG 6s in identifying abnormal laboratory results of coagulation and platelet count, and inform an interventional treatment algorithm for postpartum haemorrhage. ⋯ The TEG 6s CFF can be used to identify low fibrinogen during obstetric haemorrhage. A value to identify transfusion thresholds for PT/aPTT and platelets was not established, and laboratory results should continue to be used.