International journal of obstetric anesthesia最新文献

Background: Correct identification of the epidural space requires extensive training for technical proficiency. This study explores a novel bimanual haptic simulator designed for the precise insertion of an epidural needle based on loss-of-resistance (LOR) detection, providing realistic dual-hand force feedback.

Methods: The simulator, equipped with two haptic devices connected to a Tuohy needle and an LOR syringe, was designed to simulate the tissues' resistive forces felt by the user during the procedure, offer anatomical variability and record detailed performance metrics for personalized feedback. We assessed the simulator's validity through attempts conducted by anesthesiologists of varying experience levels, analyzing success rates, error sizes, the impact of patient weight, and movement strategies.

Results: Performance varied significantly with the expertise level of the anesthesiologists. Experts achieved higher success rates and smaller errors, demonstrating the simulator's construct validity. Patient weight influenced outcomes, with higher weights leading to more failed epidurals and lower weights resulting in increased accidental dural punctures. Successful attempts typically involved more probing movements, particularly near the epidural space.

Conclusions: The innovative bimanual haptic simulator shows significant potential as a tool for assessing epidural skills and differentiating expertise levels. Its ability to provide realistic, concurrent feedback for both hands, adapt to patient anatomical variations, and generate precise metrics for performance evaluation distinguishes it from existing simulators. However, further research is necessary to establish its value as a training tool. Planned studies will focus on developing an effective training protocol and evaluating the long-term educational impact of the simulator, determining whether its integration into residency programs can improve patient outcomes.

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.

Prenatal repair of myelomeningocele (MMC) is associated with lower rates of hydrocephalus requiring ventriculoperitoneal shunt and improved motor function when compared with postnatal repair. Efforts aiming to develop less invasive surgical techniques to decrease the risk for the pregnant patient while achieving similar benefits for the fetus have led to the implementation of fetoscopic surgical techniques. While no ideal anesthetic technique for fetoscopic MMC repair has been demonstrated, we present our anesthetic approach for these repairs, including considerations for both the pregnant patient and the fetus. We emphasize the importance of the preoperative consultation to optimize any medical conditions and to set expectations for the perioperative course. Our preferred anesthetic technique for the pregnant patient includes general anesthesia with an epidural for postoperative analgesia. Intraoperative anesthetic considerations for patients undergoing fetoscopic surgery include tocolysis, meticulous control of hemodynamics, judicious fluid administration, and maternal temperature regulation. We also avoid long-acting neuromuscular blocking agents due to significant weakness observed when given in combination with magnesium sulfate. While the maternal anesthetic crosses the placenta, direct administration of anesthesia to the fetus is required to reliably blunt the stress response. Additional considerations for the fetus include monitoring, fetal resuscitation strategies, and the theoretical risk of anesthetic neurotoxicity. Postoperatively, we use a multi-modal, opioid sparing regimen for analgesia. As advances in fetal surgery aiming to minimize risk to the pregnant patient alter the surgical approach, maternal-fetal anesthesiologists must adapt and incorporate the unique considerations of fetoscopy into their anesthetic management.

Background: Observational studies should not be used to infer causation as they are prone to confounding factors, selection bias, and reverse causality. Many observational studies of labor analgesia treated epidurals as an independent exposure and concluded that "epidurals" cause dystocia, despite multiple randomized controlled trials showing no effect. We highlight this problem using reductio ad absurdum. We explore whether people request reading glasses when their progressively increasing focal length equals or exceeds their fixed arm length.

Methods: We designed a cross-sectional retrospective and prospective observational study to assess whether there is an association between arm length and age when first requesting reading glasses in presbyopia. We evaluated individuals aged 38-55 receiving their first reading glasses for presbyopia (either currently or within the past year). We recorded age at first request for reading glasses, the refractive correction (additions) in each eye, and we measured arm length.

Results: Seventy subjects were included in the study. No association was found between arm length and the age at request for reading glasses or the severity of presbyopia at presentation.

Conclusions: Even if this observational study had demonstrated a strong correlation between age at request for reading glasses and arm length, it would have been absurd to conclude that spectacles somehow cause our arms to shrink. Similarly, women in obstructed labor with a narrow pelvis are more likely to request neuraxial labor analgesia, but "epidurals" do not make their pelvis shrink. Making far-reaching causal inferences based on retrospective or observational data is very shortsighted.