International journal of obstetric anesthesia最新文献

英文中文

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

Anaesthetic considerations for delivery in an obstetric patient with a RYR1 gene variant: a case report RYR1基因变异产科患者分娩时的麻醉考虑：1例报告

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-12-16 DOI: 10.1016/j.ijoa.2025.104838

C. Murphy, M. Melvin

Malignant hyperthermia (MH) is a rare, potentially life-threatening pharmacogenetic disorder most commonly associated with variants in the ryanodine receptor 1 gene (RYR1). Obstetric patients with undetermined risk of MH present distinct challenges, as the potential need for urgent delivery limits opportunities for anaesthetic preparation and necessitates a high level of multidisciplinary readiness.

We describe the perioperative management of a 32-year-old woman heterozygous for a RYR1 splicing variant who underwent an elective caesarean delivery at 39 weeks’ gestation following an in vitro fertilisation pregnancy. Her partner is a heterozygous carrier of the same pathogenic RYR1 variant, giving the fetus a 25% risk of severe autosomal-recessive myopathy, 50% chance of being an asymptomatic carrier, and an undetermined risk of malignant hyperthermia susceptibility. The patient had an undetermined risk of MH, in the absence of confirmatory testing. Early antenatal anaesthetic assessment enabled comprehensive risk evaluation and multidisciplinary planning. A detailed perioperative management strategy was implemented, incorporating early communication pathways, preparation of a trigger-free theatre, and development of a patient-specific MH prevention pack. Simulation-based multidisciplinary training was undertaken to enhance team preparedness and streamline trigger-free anaesthetic setup. An uncomplicated caesarean delivery was performed under spinal anaesthesia in a pre-prepared trigger-free environment. The patient was discharged home on the third post-operative day with a baby boy.

This case underscores the importance of early antenatal identification, multidisciplinary collaboration, and simulation-based training in developing structured emergency and personalised anaesthetic strategies. Given the rarity of such cases, and the absence of obstetric specific UK or Irish guidelines, proactive institutional preparedness remains essential to ensure safe obstetric outcomes in patients with undetermined risk of MH.

恶性高热症（MH）是一种罕见的、可能危及生命的药物遗传疾病，最常见的是与ryanodine受体1基因（RYR1）的变异有关。由于紧急分娩的潜在需求限制了麻醉药制备的机会，需要高水平的多学科准备，因此无法确定MH风险的产科患者面临着明显的挑战。我们描述了一名32岁的RYR1剪接变异杂合的女性，她在体外受精妊娠后的妊娠39周接受了选择性剖腹产手术。她的伴侣是同一致病性RYR1变异的杂合携带者，胎儿患严重常染色体隐性肌病的风险为25%，无症状携带者的风险为50%，恶性高热易感性风险未定。由于缺乏确证性检测，该患者患MH的风险尚未确定。早期产前麻醉评估可以进行全面的风险评估和多学科规划。实施了详细的围手术期管理策略，包括早期沟通途径，准备无触发器手术室，以及开发针对患者的MH预防包。进行了基于模拟的多学科培训，以加强团队准备和简化无触发麻醉设置。在脊髓麻醉下，在预先准备的无触发环境中进行了简单的剖宫产。术后第三天，患者带着一名男婴出院回家。该病例强调了早期产前识别、多学科合作和基于模拟的培训在制定结构化紧急和个性化麻醉策略中的重要性。鉴于此类病例的罕见性，以及英国或爱尔兰缺乏具体的产科指南，积极的机构准备对于确保MH风险未确定的患者的安全产科结果仍然至关重要。

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引用次数: 0

Letter to the Editor: Obstetric anaesthesia in Japan - beyond provider identity to system design. 致编辑的信：日本的产科麻醉-超越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 : 2025-12-14 DOI: 10.1016/j.ijoa.2025.104837

Kentaro Iga

引用次数: 0

Nitrous oxide in labor and neonatal hyperbilirubinemia: a retrospective propensity score–matched study (2012–2023) 分娩和新生儿高胆红素血症中的氧化亚氮：一项回顾性倾向评分匹配研究（2012-2023）

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-12-13 DOI: 10.1016/j.ijoa.2025.104836

P. Vovk Racman , T. Stopar Pintaric , I. Verdenik , M. Lucovnik

Background

We aimed to evaluate the association between intrapartum nitrous oxide analgesia and neonatal hyperbilirubinemia compared with other analgesic methods, and to assess additional short-term neonatal outcomes.

Methods

This retrospective epopulation-based, retrospective propensity score–matched cohort study used data from the Slovenian National Perinatal Database. Singleton pregnancies at ≥35 weeks’ gestation from 2012 to 2023 were included. Cases with intrapartum nitrous oxide analgesia, remifentanil, pethidine, or neuraxial analgesia were matched 1:1:1:1 based on maternal age, parity, body-mass-index, socioeconomic status, smoking, gestational age, and labor duration. The primary outcome was neonatal hyperbilirubinemia. Secondary outcomes included neonatal intensive care unit (NICU) admission, Apgar scores <7 at 1 and 5 min, neonatal hypoglycemia, and a composite of respiratory morbidity. Outcomes were compared using chi-square tests with Bonferroni-corrected pairwise comparisons.

Results

The study included 32,744 births (8,186 per group). Neonatal hyperbilirubinemia rate was 13.5% with nitrous oxide exposure, 14.9% with remifentanil, 15.8% with pethidine, and 14.2% with neuraxial analgesia (P = 0.0003). Hyperbilirubinemia rate was significantly higher after pethidine exposure compared with nitrous oxide (P = 0.0002) however NICU admission was more common after nitrous oxide exposure (n = 244; P < 0.001). Pethidine exposure was associated with more frequent Apgar <7 at 1 min (n = 245; P < 0.001), and remifentanil was associated with more frequent neonatal hypoglycemia (n = 222; P < 0.001). There were no significant differences in Apgar <7 at 5 min or respiratory morbidity between exposures.

Conclusions

Intrapartum nitrous oxide analgesia was not associated with increased neonatal hyperbilirubinemia compared with other labor analgesic modalities. However, the NICU admission rate after nitrous oxide exposure was significantly higher.

背景：我们的目的是评估分娩时一氧化氮镇痛与其他镇痛方法与新生儿高胆红素血症之间的关系，并评估额外的新生儿短期预后。方法：该回顾性人群为基础，回顾性倾向评分匹配队列研究使用来自斯洛文尼亚国家围产期数据库的数据。纳入2012 - 2023年妊娠≥35周的单胎妊娠。根据产妇年龄、胎次、体重指数、社会经济状况、是否吸烟、胎龄、分娩时间等因素，将分娩时使用一氧化二氮镇痛、瑞芬太尼、哌嗪或轴向镇痛的病例进行1:1:1:1的匹配。主要结局是新生儿高胆红素血症。次要结局包括新生儿重症监护病房（NICU）入院、Apgar评分。结果：该研究包括32,744例新生儿（每组8,186例）。氧化亚氮组新生儿高胆红素血症发生率为13.5%，瑞芬太尼组为14.9%，哌啶组为15.8%，轴向镇痛组为14.2% （P = 0.0003）。与氧化亚氮暴露后相比，哌啶暴露后高胆红素血症发生率显著升高（P = 0.0002），但氧化亚氮暴露后入住NICU的发生率更高（n = 244; P < 0.001）。结论：与其他分娩镇痛方式相比，产时氧化亚氮镇痛与新生儿高胆红素血症的增加无关。然而，一氧化二氮暴露后NICU入院率明显较高。

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引用次数: 0

Pushing the envelope: anesthesia for uterine transplantation 挑战极限：子宫移植的麻醉。

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-12-13 DOI: 10.1016/j.ijoa.2025.104835

David Berman , Caitlin D. Sutton

引用次数: 0

Caesarean delivery management in a patient with sickle cell disease and severe delayed haemolytic transfusion reaction and hyperhaemolysis: a case report. 镰状细胞病合并严重迟发性溶血输血反应和高溶血患者的剖宫产管理：1例报告。

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-12-10 DOI: 10.1016/j.ijoa.2025.104834

H Catton, V Prabhu, A Kale

引用次数: 0

Letter to the editor: Obstetric critical care admissions to a tertiary referral hospital from a level 1 obstetric unit in Ireland. 致编辑的信：爱尔兰一级产科病房到三级转诊医院接受产科重症护理。

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-12-08 DOI: 10.1016/j.ijoa.2025.104829

K Brosnan

引用次数: 0

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