International journal of obstetric anesthesia最新文献

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IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-01-01

引用次数: 0

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-01-01

引用次数: 0

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-01-01

引用次数: 0

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-01-01

引用次数: 0

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-01-01

引用次数: 0

Cardiac ultrasound-guided crystalloid preloading before spinal anesthesia vs. standard coloading for scheduled cesarean delivery: a randomized controlled trial 在脊髓麻醉前心脏超声引导下的晶体预负荷与计划剖宫产的标准负荷：一项随机对照试验

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-12-29 DOI: 10.1016/j.ijoa.2025.104840

S. Ben Marzouk, B. Fouzai, N. Dhraief, F. Ben Amor, T. Hkiri, H. Hamdi, S. Trablesi, A. Kalai, H. Maghrebi

Backgrounds

Spinal anesthesia for cesarean delivery commonly causes maternal hypotension (60–80%), leading to adverse maternal and fetal outcomes. Standard crystalloid coloading is preferred over preloading, but individualized fluid strategies based on preload dependence remain untested.

Methods

In this randomized controlled trial (NCT07108881) conducted at the Tunis Maternity Center, 96 ASA II women with singleton pregnancies scheduled for elective cesarean under spinal anesthesia and preload dependent (ΔLVOT VTI ≥ 12% after passive leg raising via cardiac ultrasound) were enrolled (n=96) and randomized to one of two groups. The active group (A, n=48) received titrated crystalloid preloading (250 mL increments guided by serial LVOT VTI until < 12%) plus standard coloading (10 mL/kg) and the control group (C, n=48) received coloading alone. The primary outcome was the hypotension incidence (SBP decrease > 20% baseline). Secondary outcomes were hypotension duration, rescue fluids, ephedrine use, nausea/vomiting, Apgar scores, and umbilical pH.

Results

Groups were comparable at baseline. Hypotension incidence was lower in group A vs C (37.5% vs. 62.5%; P < 0.001; RR = 0.6, 95% CI 0.39–0.91). Hypotension duration was shorter (2.9 ± 1.4 vs. 5.2 ± 1.6 min; P = 0.012), lowest SBP higher (88 ± 7 vs. 82 ± 9 mmHg; P < 0.001), rescue crystalloids reduced (365 ± 130 vs. 482 ± 116 mL; P = 0.04), and nausea/vomiting lower (21% vs. 53%; P = 0.01). Ephedrine use and cardiac output were similar; umbilical pH was better in group A (7.34 ± 0.06 vs. 7.28 ± 0.06; P = 0.02).

Conclusion

Ultrasound-guided preload correction plus coloading reduces hypotension incidence, duration, rescue fluids, and maternal side effects in preload-dependent patients. Multicenter trials should validate integration into obstetric point of care ultrasounds protocols.

背景剖宫产脊髓麻醉通常会导致母体低血压（60-80%），导致母体和胎儿的不良结局。标准晶体加载优于预压，但基于预压依赖性的个性化流体策略仍未经过测试。方法在突尼斯产科中心进行的这项随机对照试验（NCT07108881）中，纳入96名ASA II期单胎孕妇，她们计划在脊髓麻醉下择期剖宫产，且预负荷依赖（通过心脏超声被动抬腿后ΔLVOT VTI≥12%）（n=96），并随机分为两组之一。活性组（A, n=48）在连续LVOT VTI引导下，滴加晶体预压（250 mL/kg），加标准上样（10 mL/kg），对照组（C, n=48）单独上样。主要终点是低血压发生率（基线收缩压降低20%）。次要结局是低血压持续时间、补液、麻黄素使用、恶心/呕吐、Apgar评分和脐带ph。结果两组基线比较具有可比性。A组低血压发生率低于C组（37.5%比62.5%;P < 0.001; RR = 0.6, 95% CI 0.39-0.91）。低血压持续时间较短（2.9±1.4 vs 5.2±1.6 min, P = 0.012），最低收缩压升高（88±7 vs 82±9 mmHg, P < 0.001），抢救晶体减少（365±130 vs 482±116 mL, P = 0.04），恶心/呕吐降低（21% vs 53%, P = 0.01）。麻黄碱的使用和心输出量相似；A组脐带pH值较低（7.34±0.06 vs. 7.28±0.06;P = 0.02）。结论超声引导下预负荷矫正加负荷可降低预负荷依赖患者低血压的发生率、持续时间、补液量及母体副作用。多中心试验应验证产科护理点超声方案的整合。

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引用次数: 0

In response to: "Obstetric anaesthesia in Japan-beyond provider identity to system design". 回应：“日本的产科麻醉——从提供者身份到系统设计”。

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-12-27 DOI: 10.1016/j.ijoa.2025.104841

A Maeda, W Camann

引用次数: 0

In response to “Ten plus ten equals twenty: a prospective crossover study evaluating syringe size and speed of epidural injection” 回应“十加十等于二十：评估硬膜外注射注射器大小和速度的前瞻性交叉研究”

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-12-24 DOI: 10.1016/j.ijoa.2025.104843

Daniel F. Berenson, Sharon C. Reale

引用次数: 0

Factors associated with severe pain during the active phase of pushing despite labor epidural analgesia: a secondary analysis on a prospective cohort study 尽管分娩时采用硬膜外镇痛，但产程中与剧烈疼痛相关的因素：一项前瞻性队列研究的二次分析

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-12-23 DOI: 10.1016/j.ijoa.2025.104842

K. Sassi , M. Mari , S. Denisi , M. Ciccarli , E. Cambon , L. Ysard , L. Martin , M. Noly , P. Guerby , V. Minville

Background

A subset of women experience severe pain during vaginal delivery, even with labor epidural analgesia. The objective of this analysis was to identify factors associated with severe pain during the active phase of pushing with analgesia delivered via programmed intermittent epidural bolus (PIEB) and patient-controlled epidural analgesia (PCEA).

Methods

This pre-specified secondary analysis of a prospective cohort study included 210 women who delivered vaginally with labor epidural analgesia (levobupivacaine 1.25 mg/mL with sufentanil 0.25 μg/mL) at Toulouse University Hospital between February and April 2025. The primary outcome was severe pain during the active phase of pushing, defined as a numeric rating scale (NRS) score ≥ 7. Multivariable logistic regression was used to identify independent associations.

Results

Twenty women (9.5%) experienced severe pain during the active phase of pushing. Factors independently associated with this outcome were rapid cervical change (adjusted OR 4.58, 95% CI 1.59, 13.18, P = 0.005) and fetal macrosomia > 4000 g (adjusted OR 5.23, 95% CI 1.22, 22.41, P = 0.026). Women with severe pain during the active phase of pushing reported lower satisfaction with labor epidural analgesia (median 4.0 vs. 5.0, P < 0.001) and overall pain management (median 4.5 vs. 5.0, P < 0.001).

Conclusions

In this cohort, 9.5% of women experienced severe pain during the active phase of pushing despite labor epidural analgesia (PIEB and PCEA), which was associated with rapid cervical change and fetal macrosomia. These findings suggest potential roles of incomplete sacral analgesia and enhanced somatic nociception, but require confirmation in future studies.

一部分妇女在阴道分娩时经历剧烈疼痛，即使分娩时使用硬膜外镇痛。本分析的目的是确定通过程序性间歇硬膜外小丸（PIEB）和患者控制的硬膜外镇痛（PCEA）给予镇痛的活动期与剧烈疼痛相关的因素。方法对2025年2月至4月在图卢兹大学医院接受硬膜外镇痛（左布比卡因1.25 mg/mL和舒芬太尼0.25 μg/mL）阴道分娩的210名妇女进行前瞻性队列研究的预先指定的二次分析。主要结局是推术活动期的严重疼痛，以数字评定量表（NRS）评分≥7来定义。多变量逻辑回归用于确定独立关联。结果20例（9.5%）患者在推挤活动期出现剧烈疼痛。与该结果独立相关的因素是宫颈快速改变（调整后OR为4.58,95% CI为1.59,13.18,P = 0.005）和胎儿巨大儿（调整后OR为5.23,95% CI为1.22,22.41,P = 0.026）。在产程活动期出现剧烈疼痛的妇女报告对分娩硬膜外镇痛的满意度较低（中位数4.0比5.0,P < 0.001）和整体疼痛管理的满意度较低（中位数4.5比5.0,P < 0.001）。结论在该队列中，9.5%的产妇在产程中尽管有硬膜外镇痛（PIEB和PCEA），但仍经历了剧烈疼痛，这与宫颈快速改变和胎儿巨大儿有关。这些发现提示了不完全骶部镇痛和增强躯体痛觉的潜在作用，但需要在未来的研究中得到证实。

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引用次数: 0

Unexpected spinal needle resistance and upward deflection when using NRFit Pajunk Tuohy needles for combined spinal–epidural procedures 当使用NRFit Pajunk - Tuohy针进行脊髓-硬膜外联合手术时，意外的脊髓阻力和向上偏斜

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-12-16 DOI: 10.1016/j.ijoa.2025.104839

Calum Craig, Adrian Dabrowicz

引用次数: 0

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