International journal of obstetric anesthesia最新文献

英文中文

“This is how we do it” Maternal and fetal anesthetic management for fetoscopic myelomeningocele repairs: the Texas Children's Fetal Center protocol “我们就是这样做的”胎儿镜下脊髓脊膜膨出修复的母婴麻醉管理：德克萨斯儿童胎儿中心协议。

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-02-01 DOI: 10.1016/j.ijoa.2024.104316

Claire A. Naus , David G. Mann , Dean B. Andropoulos , Michael A. Belfort , Magdalena Sanz-Cortes , William E. Whitehead , Caitlin D. Sutton

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.

与产后修复相比，脊髓脊膜突出（MMC）的产前修复与脑室-腹膜分流术所需的脑积水发生率较低以及运动功能改善有关。为了开发侵入性更小的手术技术，以降低孕妇的风险，同时为胎儿带来类似的好处，已经导致了胎儿镜手术技术的实施。虽然没有理想的麻醉技术用于胎儿镜下MMC修复，但我们提出了我们的麻醉方法用于这些修复，包括对孕妇和胎儿的考虑。我们强调术前咨询的重要性，以优化任何医疗条件和设定围手术期的期望。我们对孕妇的首选麻醉技术包括全身麻醉加硬膜外麻醉用于术后镇痛。胎儿镜手术患者术中麻醉应注意的事项包括：胎儿溶解、细致的血流动力学控制、明智的液体给药和产妇体温调节。我们也避免长效神经肌肉阻滞剂，因为与硫酸镁联合使用时观察到明显的虚弱。当母体麻醉通过胎盘时，需要直接给胎儿麻醉以可靠地减弱应激反应。对胎儿的其他考虑包括监测、胎儿复苏策略和麻醉神经毒性的理论风险。术后，我们使用多模式，阿片类药物节约方案进行镇痛。随着胎儿手术技术的进步，旨在将妊娠患者的风险降至最低，改变手术方法，母胎麻醉师必须适应并将胎儿镜检查的独特考虑纳入其麻醉管理。

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引用次数: 0

Novel bimanual haptic simulator for epidural loss-of-resistance detection: a pilot study assessing movement strategies and performance across anesthesiologist experience levels 用于硬膜外失阻检测的新型双手触觉模拟器：一项评估麻醉医生经验水平的运动策略和表现的试点研究。

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-02-01 DOI: 10.1016/j.ijoa.2024.104321

Yair Binyamin , Nitsan Davidor , Sharon Orbach-Zinger , Tamar Hayuni , Ilana Nisky

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.

背景：硬膜外腔的正确识别需要广泛的技术熟练训练。本研究探索了一种基于阻力损失（LOR）检测的新型双手触觉模拟器，用于硬膜外针的精确插入，提供真实的双手力反馈。方法：该模拟器配备两个触觉装置，连接到Tuohy针和LOR注射器，旨在模拟用户在手术过程中感受到的组织阻力，提供解剖变异性并记录详细的性能指标，以供个性化反馈。我们通过不同经验水平的麻醉师进行的尝试来评估模拟器的有效性，分析成功率、错误大小、患者体重的影响和运动策略。结果：不同麻醉医师的专业水平对麻醉效果有显著影响。专家们取得了较高的成功率和较小的错误，证明了模拟器的构造有效性。患者体重影响结果，体重高导致更多硬膜外穿刺失败，体重低导致意外硬膜穿刺增加。成功的尝试通常涉及更多的探查动作，特别是在硬膜外间隙附近。结论：创新的双手触觉模拟器显示了作为评估硬膜外技能和区分专业水平的工具的巨大潜力。它能够为双手提供真实的、同步的反馈，适应病人的解剖变化，并产生精确的性能评估指标，这使它与现有的模拟器区别开来。然而，需要进一步的研究来确定其作为一种培训工具的价值。计划中的研究将侧重于制定有效的培训方案，评估模拟器的长期教育影响，确定将其整合到住院医师项目中是否可以改善患者的治疗效果。

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引用次数: 0

Artificial intelligence chatbots versus traditional medical resources for patient education on “Labor Epidurals”: an evaluation of accuracy, emotional tone, and readability 人工智能聊天机器人与传统医疗资源对患者进行“硬膜外分娩”教育：准确性、情绪基调和可读性的评估。

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-02-01 DOI: 10.1016/j.ijoa.2024.104302

Prakash Gyandev Gondode, Ram Singh, Swati Mehta, Sneha Singh, Subodh Kumar, Sudhansu Sekhar Nayak

引用次数: 0

Quality of recovery after cesarean delivery in patients with Class III obesity: a prospective observational cohort study III级肥胖患者剖宫产后恢复质量：一项前瞻性观察队列研究

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-02-01 DOI: 10.1016/j.ijoa.2024.104312

Khader Zimmo , Justin Ching-Johnson , Philip M Jones , Sudha I Singh , Aldo Dobrowlanski , Yahui T Symons , Barbra de Vrijer , Pervez Sultan , Brendan Carvalho , Ilana Sebbag

引用次数: 0

Urinary retention during and after labor with programmed intermittent epidural bolus (PIEB) analgesia: a prospective observational study 分娩期间和分娩后尿潴留与计划性间歇硬膜外丸（PIEB）镇痛：一项前瞻性观察研究。

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-02-01 DOI: 10.1016/j.ijoa.2024.104326

Willemijn Lips , Corina S. Sie , Liv M. Freeman

Background

This study investigates the incidence and risk factors for urinary retention during and after labor in women receiving programmed intermittent epidural bolus (PIEB) analgesia and evaluates the optimal bladder management strategy.

Methods

This prospective observational study assessed urinary retention during voiding attempts every two to three hours during labor and postpartum, among women with labor epidural analgesia using PIEB. Urinary retention was defined as a post-void residual volume >150 mL, determined by catheterization after spontaneous voiding.

Results

Among 137 women included, with 277 voiding attempts during labor, the urinary retention rate was 20.6%, occurring in 48 women (35%). When the spontaneously voided volume was >50 mL, urinary retention was observed in less than 10% of attempts. Postpartum urinary retention occurred in nine women (6.7%) with a mean post-void residual volume of 1133 ± 447 mL; all were nulliparous, seven had induced labor, and five had an episiotomy.

Conclusions

Women who are able to successfully void during labor have a low risk of intrapartum urinary retention. We would recommend considering catheterization every 3 to 4 hours for women who are unable to urinate spontaneously, void less than 50 ml, or experience complete motor blockade during labor.

背景：本研究调查了接受程序间歇硬膜外小丸（PIEB）镇痛的妇女分娩期间和分娩后尿潴留的发生率和危险因素，并评估了最佳膀胱管理策略。方法：这项前瞻性观察性研究评估了分娩和产后每2 - 3小时排尿时的尿潴留，在分娩时使用PIEB硬膜外镇痛的妇女中。尿潴留定义为自然排尿后尿潴留量> 150ml，通过导尿确定。结果：137例产妇277次产程排尿，尿潴留率为20.6%，48例（35%）。当自然排尿量为50 mL时，尿潴留的发生率不到10%。产后尿潴留9例（6.7%），平均尿后残留1133±447 mL；所有人都没有分娩，7人引产，5人外阴切开术。结论：在分娩过程中成功排尿的妇女产时尿潴留的风险较低。我们建议对于不能自主排尿、排尿量小于50毫升或在分娩过程中经历完全运动阻滞的妇女，每3 - 4小时导尿一次。

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引用次数: 0

Maternal exposure to general anesthesia and labor epidural analgesia during pregnancy and delivery, and subsequent neurodevelopmental outcomes in children 孕妇在妊娠和分娩期间接受全麻和硬膜外镇痛，以及随后的儿童神经发育结局。

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-02-01 DOI: 10.1016/j.ijoa.2024.104318

Oliver G. Isik , Caleb Ing

引用次数: 0

“This is how we do it”: disseminating protocols for enhanced fetal safety and maternal recovery after fetoscopic myelomeningocele repairs

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-02-01 DOI: 10.1016/j.ijoa.2024.104319

David Berman , Ruth Landau

引用次数: 0

Recovery after cesarean delivery in patients with obesity: do we need to look beyond the body mass index? 肥胖患者剖宫产后的恢复：我们是否需要超越体重指数？

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-02-01 DOI: 10.1016/j.ijoa.2024.104314

A.S. Habib

引用次数: 0

Patient and clinical characteristics associated with pain during cesarean delivery: a prospective single-center patient-reported outcome study 与剖宫产疼痛相关的患者和临床特征：一项前瞻性单中心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.2024.104324

J. Litman , R. Bates , S.R. Lindheim , E.E. Sharpe , J.C. Ehrig , M.P. Hofkamp

Introduction

There are multiple variables known to be associated with pain during cesarean delivery (PDCD), including patient-related factors, obstetrical and surgical factors, and anesthetic technique. The primary aim of this prospective patient-reported outcome study was to evaluate patient-related factors, including expectations and anxiety, and clinical variables associated with PDCD.

Methods

Patients undergoing cesarean delivery from December 1, 2023 to March 31, 2024 were enrolled 24 to 72 hours postoperatively. They completed the STAI-6 anxiety survey, a 13-item catastrophizing survey, a question about expected PDCD, and reported PDCD on a 0–100 mm visual analog scale (VAS). We defined PDCD as a VAS score

\geq

30 mm. Demographic, physical, and clinical data were retrieved from the electronic medical record.

Results

There were 110 recruited patients with 40 (36%) reporting PDCD. Patients who had PDCD differed in race, surgical duration, and administration of supplemental systemic analgesic medication. A multivariate logistic regression identified that surgical duration, history of anxiety, intrapartum activation of epidural (versus spinal or combined spinal epidural) and Black race (versus White) were associated with PDCD. There were 33 (30%), 48 (44%), 14 (13%), 7 (6%), and 7 (6%) patients who reported no pain, pain less than expected, pain that was expected, more pain than expected, and much more pain than expected during their cesarean delivery, respectively.

Conclusions

In our cohort with a high reported PDCD rate, potentially modifiable variables associated with PDCD were initial anesthetic technique and surgical duration. A concerning finding was that most patients reported some level of PDCD.

导言：已知与剖宫产（PDCD）疼痛相关的变量有多种，包括患者相关因素、产科和外科因素以及麻醉技术。这项前瞻性患者报告结果研究的主要目的是评估与患者相关的因素，包括期望和焦虑，以及与PDCD相关的临床变量。方法：2023年12月1日至2024年3月31日行剖宫产的患者，术后24 ~ 72小时入组。他们完成了焦虑问卷（STAI-6）、灾难化问卷（13项）、预期PDCD问卷（0-100 mm视觉模拟量表）。我们将PDCD定义为VAS评分≥30 mm。从电子病历中检索人口统计、物理和临床数据。结果：110例患者中有40例（36%）报告PDCD。患有PDCD的患者在种族、手术时间和补充全身镇痛药物的管理方面存在差异。多因素logistic回归发现，手术时间、焦虑史、分娩时硬膜外激活（与脊髓或脊髓联合硬膜外激活）和黑人（与白人）与PDCD相关。分别有33例（30%）、48例（44%）、14例（13%）、7例（6%）和7例（6%）患者在剖宫产过程中报告无疼痛、疼痛小于预期、疼痛在预期范围内、疼痛大于预期和疼痛远远大于预期。结论：在我们报道的PDCD发生率较高的队列中，与PDCD相关的潜在可修改变量是初始麻醉技术和手术时间。一个令人担忧的发现是，大多数患者报告有一定程度的PDCD。

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引用次数: 0

Platelet aggregation and thromboelastometry monitoring in women with preeclampsia: a prospective observational study 先兆子痫妇女的血小板聚集和血栓弹性测量监测：一项前瞻性观察研究。

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-02-01 DOI: 10.1016/j.ijoa.2024.104297

Malin Andersson , Peter Bengtsson , Ove Karlsson , Sven-Egron Thörn , Lilja Thorgeirsdottir , Lina Bergman , Jonatan Oras , Birgitta Romlin

Background

Thrombocytopenia affects 12–20% of women with preeclampsia and a low platelet count impairs coagulation. Women with preeclampsia have an increased risk of both cerebral hemorrhage, thromboembolism, and postpartum hemorrhage. Studies of platelet function and coagulation in women with preeclampsia show conflicting results. Therefore, we aimed to study platelet aggregation and coagulation in women with preeclampsia.

Method

Women with preeclampsia and women with normotensive pregnancies were included prior to delivery in a prospective observational study as a part of the Gothenburg Preeclampsia Adverse Event (GoPROVE) Biobank and Database. Sampling and analyses were performed shortly before delivery. Platelet count was analyzed and impedance aggregometry was used for examining platelet adhesion and aggregation. Thromboelastometry was used to assess coagulation.

Results

Ninety-three women with preeclampsia and 45 normotensive pregnant control patients were included. There was no difference in platelet aggregation (adenosine diphosphate, ADP-test), (arachidonic acid, ASPI-test) or (thrombin receptor-activating peptide, TRAP-test) between women with preeclampsia and women with normotensive pregnancies. Women with preeclampsia had lower platelet counts, shorter clotting (EXTEM-CT and INTEM-CT) and clot formation (EXTEM-CFT and INTEM-CFT) times than women with normotensive pregnancies. Platelet aggregation and coagulation were hyperactivated in women with preeclampsia and normal platelet counts. In women with preeclampsia and thrombocytopenia, platelet aggregation and thromboelastic tests of coagulation were impaired compared with normotensive pregnancies.

Conclusion

Platelet aggregation and thromboelastic tests of coagulation are dependent on platelet counts in women with preeclampsia. At normal platelet counts, women with preeclampsia have hyperactivated tests of coagulation. In contrast, women with thrombocytopenia demonstrated lower coagulation test values.

背景：血小板减少症影响12-20%的先兆子痫妇女，低血小板计数损害凝血。患有先兆子痫的妇女患脑出血、血栓栓塞和产后出血的风险增加。对子痫前期妇女血小板功能和凝血的研究显示了相互矛盾的结果。因此，我们的目的是研究血小板聚集和凝血妇女先兆子痫。方法：作为哥德堡子痫前期不良事件(Gothenburg pre子痫不良事件（GoPROVE）生物银行和数据库的一部分，一项前瞻性观察研究纳入了分娩前患有子痫前期和妊娠正常的妇女。在交货前不久进行了抽样和分析。分析血小板计数，用阻抗聚集法检测血小板粘附和聚集。血栓弹性测定法评估凝血情况。结果：纳入93例先兆子痫患者和45例正常妊娠对照。子痫前期妇女与正常妊娠妇女的血小板聚集（二磷酸腺苷，adp试验）、（花生四烯酸，aspi试验）或（凝血酶受体激活肽，trap试验）无差异。与正常妊娠妇女相比，子痫前期妇女血小板计数较低，凝血（EXTEM-CT和intertem - ct）和凝块形成（EXTEM-CFT和intertem - cft）时间较短。在血小板计数正常的子痫前期妇女中，血小板聚集和凝血功能亢进。在妇女先兆子痫和血小板减少，血小板聚集和血栓弹性试验的凝血是受损与正常妊娠。结论：血小板聚集和凝血弹性试验依赖于血小板计数的先兆子痫妇女。在血小板计数正常的情况下，先兆子痫患者的凝血试验异常。相比之下，患有血小板减少症的女性凝血试验值较低。

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