International journal of obstetric anesthesia最新文献

英文中文

Accuracy of Spanish and English-generated ChatGPT responses to commonly asked patient questions about labor epidurals 西班牙语和英语生成的ChatGPT回答关于硬膜外分娩的常见问题的准确性。

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-02-01 DOI: 10.1016/j.ijoa.2024.104308

Hinpetch Daungsupawong , Viroj Wiwanitkit

引用次数: 0

Anesthesia management for cesarean delivery in patients with an arterial switch operation: a single center case series (2015–2023) 剖宫产动脉切换手术患者的麻醉管理：单中心病例系列（2015-2023）

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-02-01 DOI: 10.1016/j.ijoa.2024.104299

S. Goto, Y. Suzuki, S. Kurokawa, Y. Nagasaka

Background

Arterial switch operation (ASO) for dextro-transposition of the great arteries was developed four decades ago, and women with ASO have reached childbearing age. Although over 40% of the pregnant women who received ASO gave birth via cesarean delivery, detailed information about anesthesia management has not been reported. This study aimed to evaluate anesthesia and perioperative outcomes in pregnant women with ASO undergoing cesarean delivery.

Methods

A retrospective chart review was conducted on pregnant women with a history of ASO with a cesarean delivery at Tokyo Women’s Medical University Hospital between January 1, 2015, and May 31, 2023. Obstetric and anesthetic management, as well as maternal outcomes, were analyzed.

Results

A total of 12 cesarean deliveries among 10 ASO patients were identified. The median maternal age at cesarean delivery was 29 years (range: 26–38) and median gestational age was 37 weeks and 1 day (33 weeks and 6 days – 37 weeks and 6 days). Two patients developed arrhythmia (paroxysmal supraventricular tachycardia, non-sustained ventricular tachycardia, and atrial tachyarrhythmia) during pregnancy. Five patients presented with moderate to severe valvular regurgitation, three of which worsened during pregnancy. All patients received neuraxial anesthesia for the cesarean delivery. Spinal induced hypotension occurred in four cases, which was immediately treated with vasopressors. No patient developed heart failure or arrhythmias postoperatively.

Conclusion

Neuraxial anesthesia for cesarean delivery in pregnant women with a history of ASO resulted in favorable maternal outcomes with no postoperative cardiac complications.

背景：动脉转换手术（ASO）治疗大动脉右转是40年前发展起来的，ASO患者已达到生育年龄。虽然接受ASO的孕妇中有40%以上通过剖宫产分娩，但关于麻醉管理的详细信息尚未报道。本研究的目的是评估麻醉和围手术期结局的孕妇ASO剖宫产。方法：回顾性分析2015年1月1日至2023年5月31日在东京女子医科大学医院剖宫产的有ASO病史的孕妇。分析了产科和麻醉管理以及产妇结局。结果：10例ASO患者共12例剖宫产。剖宫产时产妇年龄中位数为29岁（范围：26-38岁），胎龄中位数为37周零1天（33周零6天- 37周零6天）。2例患者在妊娠期间发生心律失常（阵发性室上性心动过速、非持续性室性心动过速和房性心动过速）。5例患者表现为中度至重度瓣膜反流，其中3例在妊娠期间恶化。所有患者均行剖宫产神经轴麻醉。4例发生脊柱性低血压，立即给予血管加压药物治疗。无患者术后出现心力衰竭或心律失常。结论：有ASO病史的孕妇行轴向麻醉剖宫产结局良好，无术后心脏并发症。

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引用次数: 0

Pregnancy revealing hereditary angioedema type III with factor XII mutation managed in a resource-limited setting with no C1-inhibitor concentrate availability: a case report 妊娠暴露遗传性血管性水肿III型与因子XII突变管理在资源有限的设置没有c1抑制剂浓缩可用性：一个病例报告。

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-02-01 DOI: 10.1016/j.ijoa.2024.104283

H. Saddouk , M. Tajir , H. Saadi , B. Housni , N. Zerrouki , N. Zizi , S. Dikhaye

引用次数: 0

Wildfires and obstetric anesthesia care: growing threats in a changing climate 致编辑的信：野火和产科麻醉护理：气候变化中日益增长的威胁。

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-02-01 DOI: 10.1016/j.ijoa.2024.104301

Fritzner Montalmant , W.Reed Cone Le Beaumont , Tabitha M. Benney , Deirdre C. Kelleher , Robert S. White , John F. Pearson

引用次数: 0

In response to: Accuracy of Spanish and English-generated ChatGPT responses to commonly asked patient questions about labor epidurals

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-02-01 DOI: 10.1016/j.ijoa.2024.104315

Antonio Gonzalez Fiol , Sharon C. Reale

引用次数: 0

On causal inferences from retrospective and observational studies and their implications for neuraxial labor analgesia: the CHRISTMAS* study 回顾性和观察性研究的因果推论及其对神经轴分娩镇痛的影响：CHRISTMAS*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.2024.104307

Yehuda Ginosar , Or Sandman , Aharon Tevet , Malka Boret , Riki Greenberger , Zipora Boim , Ibrahim Naffar , Esty Harpenas , Jacob Pe’er , Tali Bdolah-Abram , Ronit Calderon-Margalit , Hadas Ben-Eli , for the CHRISTMAS* study group

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.

背景：观察性研究不应用于推断因果关系，因为它们容易受到混杂因素、选择偏差和反向因果关系的影响。许多关于分娩镇痛的观察性研究将硬膜外麻醉作为一种独立暴露，并得出结论：硬膜外麻醉导致难产，尽管多个随机对照试验显示没有影响。我们用还原法和谬论来强调这个问题。我们探讨了当人们逐渐增加的焦距等于或超过他们的固定臂长时，他们是否要求戴老花镜。方法：我们设计了一项横断面回顾性和前瞻性观察性研究，以评估老花眼患者首次配戴老花镜时臂长与年龄之间是否存在关联。我们评估了38-55岁因老花眼第一次戴老花镜的人（目前或过去一年内）。我们记录了初次配戴老花镜时的年龄，每只眼睛的屈光矫正（增加），并测量了臂长。结果：共纳入70例受试者。臂长与要求佩戴老花镜时的年龄或老花眼的严重程度之间没有关联。结论：即使这项观察性研究已经证明了要求佩戴老花镜的年龄与手臂长度之间有很强的相关性，但得出眼镜在某种程度上导致我们的手臂缩小的结论也是荒谬的。同样，骨盆狭窄的难产妇女更有可能要求神经轴分娩镇痛，但“硬膜外麻醉”不会使骨盆缩小。根据回顾性或观察数据作出影响深远的因果推论是非常短视的。

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引用次数: 0

“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

Sacral erector spinae plane block for labor analgesia: a case report 骶竖肌脊柱平面阻滞用于分娩镇痛1例。

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-02-01 DOI: 10.1016/j.ijoa.2024.104322

Saverio Paventi , Francesco Marrone , Carmine Pullano

引用次数: 0

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