International journal of obstetric anesthesia最新文献

英文中文

Erratum to "Pre-oxygenation using high flow nasal oxygen or face mask oxygen in pregnant people - A prospective randomised controlled crossover non-inferiority study (The HINOP2 study)" [Int J Obstet Anesth 60 (2024) 104236].

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-03-14 DOI: 10.1016/j.ijoa.2025.104333

P C F Tan, P J Peyton, A Deane, J Unterscheider, A T Dennis

引用次数: 0

Neonatal acid-base status before and after discontinuing routine left uterine displacement for elective cesarean delivery: a retrospective cohort study (2014–2017)

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-03-08 DOI: 10.1016/j.ijoa.2025.104350

Keyanna L. Jackson , Richard M. Smiley , Allison J. Lee

Background

Maintaining left uterine displacement during cesarean delivery has been a decades-long recommendation to mitigate aortocaval compression. We abandoned the practice at our institution following the publication in 2017 of our study showing that maternal supine position did not impair neonatal acid-base status compared with 15 degrees left tilt, when maternal systolic blood pressure was maintained with a crystalloid coload and prophylactic phenylephrine infusion. We hypothesized that there would be no difference in mean umbilical artery base excess between neonates delivered by elective cesarean section with spinal anesthesia during the periods before and after our change in practice.

Methods

Maternal demographics and neonatal outcomes were obtained by retrospective review of electronic health records in 2014 (‘with tilt’) and 2017 (‘no tilt’). Cases with elective cesarean delivery of singleton pregnancies at term with spinal anesthesia were selected consecutively in each year. Routine practice included crystalloid coloading and prophylactic phenylephrine infusion targeted at maintaining maternal baseline systolic blood pressure. The primary outcome was mean umbilical artery base excess, analyzed using an unpaired t-test for two groups.

Results

There were no differences in umbilical artery or vein base excess or pH ‘with tilt’ (n=201) vs. ‘no tilt’ (n=202). There was also no significant difference between groups in the number of outliers with respect to neonatal umbilical artery base excess, pH, Apgar scores or need for resuscitation.

Conclusion

No tilt of surgical table in elective cesarean delivery cases with spinal anesthesia did not affect neonatal acid-base status compared with a historical cohort when maternal tilt was routine.

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引用次数: 0

Intrathecal morphine 100 µg versus 150 µg for post-cesarean delivery analgesia: a retrospective cohort study (2020–2022)

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-03-05 DOI: 10.1016/j.ijoa.2025.104348

M. Kim , S.M. Rubright , T. Pham , M. Fuller , A.S. Habib

Background

In the context of multimodal analgesia, the optimal dose of intrathecal morphine (ITM) for post-cesarean analgesia remains unclear. In January 2022, the dose of ITM was reduced from 150 µg to 100 µg without other changes in our analgesic regimen with the assumption that ITM 100 µg provides comparable analgesia to ITM 150 µg with fewer opioid-related side effects.

Methods

In this retrospective cohort study including cases from January 2020 through October 2022, we identified all cesarean delivery cases with a neuraxial technique with ITM. The primary outcome was oral opioid use in the first 24 hours. Opioid use in oral morphine equivalents (OME) was compared using zero-inflated negative binomial models, and antiemetic and antipruritic use was compared using logistic regression models.

Results

There were 3293 cases included in the analysis (1689 with ITM 150 µg and 1604 with ITM 100 µg). There was no significant difference between the groups in the primary outcome of opioid consumption in the first 24 hours in both the unadjusted and adjusted analysis [mean ratio (95% CI) = 1.03 (0.96 to 1.11); P = 0.373]. With ITM 100 µg, antiemetic use was less likely [OR = 0.65 (0.55 to 0.76)] and so was treatment for pruritus [OR = 0.16 (0.12 to 0.21)] compared with ITM 150 µg.

Conclusions

When used with multimodal analgesia, a lower ITM dose of 100 µg provided comparable analgesia with lower incidence of opioid-related side effects compared with an ITM dose of 150 µg.

{"title":"Intrathecal morphine 100 µg versus 150 µg for post-cesarean delivery analgesia: a retrospective cohort study (2020–2022)","authors":"M. Kim , S.M. Rubright , T. Pham , M. Fuller , A.S. Habib","doi":"10.1016/j.ijoa.2025.104348","DOIUrl":"10.1016/j.ijoa.2025.104348","url":null,"abstract":"<div><h3>Background</h3><div>In the context of multimodal analgesia, the optimal dose of intrathecal morphine (ITM) for post-cesarean analgesia remains unclear. In January 2022, the dose of ITM was reduced from 150 µg to 100 µg without other changes in our analgesic regimen with the assumption that ITM 100 µg provides comparable analgesia to ITM 150 µg with fewer opioid-related side effects.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study including cases from January 2020 through October 2022, we identified all cesarean delivery cases with a neuraxial technique with ITM. The primary outcome was oral opioid use in the first 24 hours. Opioid use in oral morphine equivalents (OME) was compared using zero-inflated negative binomial models, and antiemetic and antipruritic use was compared using logistic regression models.</div></div><div><h3>Results</h3><div>There were 3293 cases included in the analysis (1689 with ITM 150 µg and 1604 with ITM 100 µg). There was no significant difference between the groups in the primary outcome of opioid consumption in the first 24 hours in both the unadjusted and adjusted analysis [mean ratio (95% CI) = 1.03 (0.96 to 1.11); <em>P</em> = 0.373]. With ITM 100 µg, antiemetic use was less likely [OR = 0.65 (0.55 to 0.76)] and so was treatment for pruritus [OR = 0.16 (0.12 to 0.21)] compared with ITM 150 µg.</div></div><div><h3>Conclusions</h3><div>When used with multimodal analgesia, a lower ITM dose of 100 µg provided comparable analgesia with lower incidence of opioid-related side effects compared with an ITM dose of 150 µg.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104348"},"PeriodicalIF":2.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impaired diaphragmatic excursion following magnesium sulfate administration in patients with preeclampsia with severe features: a prospective observational study

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-02-28 DOI: 10.1016/j.ijoa.2025.104347

Mina Adolf Helmy, Lama Mostafa, Nashwa S. El-zayyat, Mai A. Ali, Rabab Sabry

Magnesium sulfate is recognized for its muscular relaxant properties on both smooth and skeletal muscles; nevertheless, there are no prior studies examining the impact of magnesium administration on diaphragmatic movement, namely diaphragmatic excursion. Therefore, we aimed to evaluate diaphragmatic excursion as assessed by ultrasound before and after magnesium sulfate administration. Patients with a diagnosis of preeclampsia with severe features were screened for eligibility. Forty-seven patients with preeclampsia with severe features were included and available for final analysis. There was a significant reduction in diaphragmatic excursion 20 minutes after magnesium sulfate administration. Additionally, this study provides new insight into the dose effect between serum magnesium level and diaphragmatic excursion characterized by a negative correlation between serum magnesium level and diaphragmatic excursion, demonstrating that increased serum magnesium level is associated with increased diaphragmatic weakness.

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引用次数: 0

Intravenous dexmedetomidine use in obstetric anesthesia: a focused review

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-02-13 DOI: 10.1016/j.ijoa.2025.104345

M.S. Douglas , L.J. Soloniuk , J. Jones , R. Derderian , C. Baker , G. Stier

Dexmedetomidine is an alpha-₂ adrenergic receptor agonist with analgesic properties. Dexmedetomidine is currently U.S. Food and Drug Administration (FDA) approved for intravenous (IV) administration in non-pregnant patients. However, it has shown promise for various off-label indications in obstetric anesthesia. This review focuses on reported uses for IV dexmedetomidine in obstetric anesthesia. Intravenous dexmedetomidine has reported efficacy for producing light sedation, analgesia, and anxiolysis in the parturient. In addition, the use of IV dexmedetomidine during cesarean delivery has been reported to alleviate symptoms of postpartum depression and reduce the incidence of shivering and postoperative nausea and vomiting. In the setting of trauma, IV dexmedetomidine may reduce the risk of post-traumatic stress disorder. Further understanding of IV dexmedetomidine’s benefits and the recent advances in its clinical use allows clinicians to leverage its versatility to improve patient outcomes.

引用次数: 0

POCUS and pre-eclampsia: bedside echocardiography to guide resuscitation in cardiogenic shock with pre-eclampsia with severe features – a case report from a low and middle income country

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-02-10 DOI: 10.1016/j.ijoa.2025.104342

M. Schram , F. Uys , J. Purcell-Jones , C.L. Pfister

Pre-eclampsia is the second leading cause of maternal mortality worldwide, with over 99% of deaths occurring in low and middle income countries (LMICs). In South Africa, pre-eclampsia and obstetric haemorrhage are among the three primary causes of maternal mortality. These conditions pose significant challenges for even the most experienced healthcare providers with regular exposure to obstetric patients. Pre-eclampsia with severe features, in its most extreme form, can present with diastolic and systolic dysfunction and cardiogenic shock. This, in combination with a hypocoagulable state and hypovolemic shock from postpartum haemorrhage (PPH), can present a resuscitation conundrum for the anaesthetist. Point-of-care-ultrasonography (POCUS) is a useful tool to guide management of these complicated obstetric resuscitations.

引用次数: 0

A decade of obstetric anaesthetic case reports publications: a focused review

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-02-04 DOI: 10.1016/j.ijoa.2025.104341

R. Eshel , A. Berman , C.F. Weiniger

引用次数: 0

Beyond the puncture: new guidelines for intrathecal catheter management in obstetric anesthesia 超越穿刺：产科麻醉鞘内导管管理新指南。

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-02-01 DOI: 10.1016/j.ijoa.2024.104311

Yair Binyamin, Sharon Orbach-Zinger, Michael Heesen

引用次数: 0

Readability, quality and accuracy of generative artificial intelligence chatbots for commonly asked questions about labor epidurals: a comparison of ChatGPT and Bard 生成式人工智能聊天机器人对硬膜外分娩常见问题的可读性、质量和准确性：ChatGPT和Bard的比较

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-02-01 DOI: 10.1016/j.ijoa.2024.104317

D. Lee, M. Brown, J. Hammond, M. Zakowski

Introduction

Over 90% of pregnant women and 76% expectant fathers search for pregnancy health information. We examined readability, accuracy and quality of answers to common obstetric anesthesia questions from the popular generative artificial intelligence (AI) chatbots ChatGPT and Bard.

Methods

Twenty questions for generative AI chatbots were derived from frequently asked questions based on professional society, hospital and consumer websites. ChatGPT and Bard were queried in November 2023. Answers were graded for accuracy by four obstetric anesthesiologists. Quality was measured using Patient Education Materials Assessment Tool for Print (PEMAT). Readability was measured using six readability indices. Accuracy, quality and readability were compared using independent t-test.

Results

Bard readability scores were high school level, significantly easier than ChatGPT’s college level by all scoring metrics (P <0.001). Bard had significantly longer answers (P <0.001), yet with similar accuracy of Bard (85 % ± 10) and ChatGPT (87 % ± 14) (P = 0.5). PEMAT understandability scores were no statistically significantly different (P = 0.06). Actionability by PEMAT scores for Bard was significantly higher (22% vs. 9%) than ChatGPT (P = 0.007)

Conclusion

Answers to questions about “labor epidurals” should be accurate, high quality, and easy to read. Bard at high school reading level, was well above the goal 4^th to 6^th grade level suggested for patient materials. Consumers, health care providers, hospitals and governmental agencies should be aware of the quality of information generated by chatbots. Chatbots should meet the standards for readability and understandability of health-related questions, to aid public understanding and enhance shared decision-making.

导读：超过90%的孕妇和76%的准爸爸会搜索孕期健康信息。我们检查了流行的生成式人工智能（AI）聊天机器人ChatGPT和Bard对常见产科麻醉问题的回答的可读性、准确性和质量。方法：从专业学会、医院和消费者网站的常见问题中抽取20个生成式AI聊天机器人的问题。ChatGPT和Bard于2023年11月进行了查询。答案的准确性由四位产科麻醉师评分。使用患者教育材料评估工具（PEMAT）测量质量。使用6个可读性指标来测量可读性。准确性、质量和可读性采用独立t检验比较。结果：巴德的可读性分数是高中水平，明显比ChatGPT的大学水平更容易，所有评分指标（P至6年级建议的患者材料水平）。消费者、医疗保健提供者、医院和政府机构应该意识到聊天机器人产生的信息的质量。聊天机器人应符合健康相关问题的可读性和可理解性标准，以帮助公众理解和加强共同决策。

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引用次数: 0

Factors affecting womens’ attitude towards labor epidural analgesia in a culturally diverse population: a prospective patient-reported outcome study 影响不同文化人群中妇女对分娩硬膜外镇痛态度的因素：一项前瞻性患者报告的结果研究

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-02-01 DOI: 10.1016/j.ijoa.2025.104329

Raneen Abu Shqara , Gabriela Goldinfeld , Sari Nahir Biderman , Tatiana Sher Brodsky , Asal Darwish , Nadir Ganem , Lior Lowenstein , Maya Frank Wolf

Background

To evaluate pregnant women’s intentions to deliver with labor epidural analgesia (LEA) and identify factors influencing decision-making in a diverse population in northern Israel.

Methods

A cross-sectional survey was conducted at Galilee Medical Center from February to July 2024. Women completed pre- and post-labor questionnaires assessing demographics, religiosity, prior experience, prenatal education, attitude towards LEA, reasons for not intending to deliver with and actual LEA use. Statistical analysis included multivariate logistic regression.

Results

The LEA rate among participants was 83.5% (380/455) (83.5%); 257 (56.5%) had indented to deliver with. Among those not intending to deliver with LEA, 66.7% (132/198) eventually delivered with. There were 297 (65.3%) Arab and 158 (34.7%) Jewish women; 180 (39.6%) identified as Muslim, 158 (34.7%) Jewish, 92 (20.2%) Druze, and 25 (5.5%) Christian. Factors associated with intention to deliver with LEA were nulliparity (P =0.024), childbirth preparation course (P =0.002), internet as source of information (P =0.016), and previous delivery with LEA (P <0.001). Factors associated with not intending to deliver with but ultimately delivering with LEA were nulliparity (P =0.033), partner presence (P <0.001), labor induction (P =0.044), and previous delivery with LEA (P <0.001).

Conclusion

Attitudes toward LEA are shaped by culture, knowledge, prior experiences, and social support. In our cohort, the most important factors for delivering with LEA when not intending to were previous delivery with LEA and partner presence. Factors associated with not delivering with LEA were preference for natural childbirth and fear of LEA-associated side effects. Promoting evidence-based information through language-adapted platforms can further improve informed decision-making about LEA.

背景：在以色列北部不同人群中评估孕妇使用硬膜外镇痛（LEA）分娩的意向，并确定影响决策的因素。方法：于2024年2月至7月在加利利医疗中心进行横断面调查。妇女完成了产前和产后问卷调查，评估人口统计、宗教信仰、先前经验、产前教育、对LEA的态度、不打算使用LEA分娩的原因和实际使用LEA。统计分析采用多元逻辑回归。结果：受试者LEA率为83.5% (380/455)；257人（56.5%）有凹痕。在不打算使用LEA分娩的患者中，66.7%（132/198）最终使用LEA分娩。其中阿拉伯女性297人（65.3%），犹太女性158人（34.7%）；180人（39.6%）为穆斯林，158人（34.7%）为犹太人，92人（20.2%）为德鲁兹派，25人（5.5%）为基督徒。未产（P =0.024）、分娩准备过程（P =0.002）、网络信息来源（P =0.016）、曾产(P)与预备分娩意愿相关。结论：预备分娩态度受文化、知识、经验和社会支持的影响。在我们的队列中，当不打算用LEA分娩时，最重要的因素是以前用LEA分娩和合作伙伴在场。不采用LEA分娩的相关因素是倾向于自然分娩和担心LEA相关的副作用。通过适应语言的平台推广基于证据的信息，可以进一步改善LEA的知情决策。

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引用次数: 0

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International journal of obstetric anesthesia

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