International journal of obstetric anesthesia最新文献

英文中文

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

Availability and use of fibrinogen concentrate in labor and delivery units in North America with the Society for Obstetric Anesthesia and Perinatology (SOAP) center of excellence designation: a study survey (2023) 浓缩纤维蛋白原在北美产房和分娩单位的可用性和使用，并获得产科麻醉和围产期学会（SOAP）卓越中心的指定：一项研究调查（2023）

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-12-08 DOI: 10.1016/j.ijoa.2025.104833

A.G. Samworth , J.R. Battrell , E.M. Lange , A.D. Bhat , R.J. McCarthy , F.M. Peralta

Background

Postpartum hemorrhage is the leading cause of maternal mortality worldwide and is often complicated by hypofibrinogenemia, increasing the risk of severe hemorrhage. Fibrinogen concentrate may offer several advantages over cryoprecipitate for rapid fibrinogen replacement, but data on its availability and use in obstetric units are limited.

Methods

An IRB-approved electronic survey was distributed to all 70 Society for Obstetric Anesthesia and Perinatology (SOAP) Centers of Excellence (COE) in the United States and Canada. Responses were collected over six weeks, with three reminders.

Results

Twenty-eight centers (40%) responded. Annual delivery volumes ranged from <2,500 (14%) to >6,000 (26%). Fibrinogen concentrate was available in 75% of the centers, but only 17 (61%) had it on the Labor and Delivery Unit. Delivery volume did not correlate with institutional (ρ = –0.11, P = 0.56) or Labor and Delivery Unit (ρ = 0.03, P = 0.89) availability of fibrinogen concentrate. In centers with availability on the Labor and delivery Unit, 94% incorporated it in their obstetric hemorrhage protocols. Preparation was most often performed by the anesthesia care team (82%), with 76% achieving readiness within 10 min. Barriers to its use included cost and unfamiliarity with reconstitution.

Discussion

Although three-quarters of the SOAP COE responding institutions reported availability of fibrinogen concentrate, only 61% had it on the Labor and Delivery Unit. Availability of fibrinogen concentrate allows for a more rapid management of hypofibrinogenemia compared to cryoprecipitate in the setting of postpartum hemorrhage. Despite evidence of its effectiveness, inconsistent societal recommendations, dosing variability and educational gaps remain, highlighting the need for wider availability, greater awareness and training of personnel in its use in obstetrics.

背景产后出血是全世界孕产妇死亡的主要原因，并常伴有低纤维蛋白原血症，增加了严重出血的风险。纤维蛋白原浓缩物在快速替代纤维蛋白原方面可能比低温沉淀物有几个优势，但其在产科单位的可用性和使用数据有限。方法在美国和加拿大的70个产科麻醉和围产期学会（SOAP）卓越中心（COE）分发了一份经irb批准的电子调查。在六周的时间里收集了反馈，其中有三次提醒。结果有28个中心（40%）回应。年交付量从2,500英镑（14%）到6,000英镑（26%）不等。75%的中心提供纤维蛋白原浓缩物，但只有17个（61%）的产房提供。产生量与机构（ρ = -0.11, P = 0.56）或分娩单位（ρ = 0.03, P = 0.89）纤维蛋白原浓缩物的可得性无关。在有劳动和分娩部门的中心，94%的人将其纳入产科出血方案。准备工作通常由麻醉护理小组完成（82%），76%的人在10分钟内完成准备工作。使用它的障碍包括成本和对重组的不熟悉。尽管四分之三的SOAP COE响应机构报告了纤维蛋白原浓缩物的可用性，但只有61%的分娩单位有。与产后出血的低温沉淀相比，纤维蛋白原浓缩物的可用性允许更快速地管理低纤维蛋白原血症。尽管有证据表明其有效性，但社会建议不一致，剂量变化和教育差距仍然存在，突出表明需要扩大其在产科使用方面的可获得性，提高对人员的认识和培训。

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引用次数: 0

Reframing obstetric anesthesia workforce surveys for regional and global impact. 重塑产科麻醉劳动力调查的区域和全球影响。

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-12-08 DOI: 10.1016/j.ijoa.2025.104831

Anjan K Saha, Ronald B George

引用次数: 0

Platelet parameters in preeclampsia: comparing rotational thromboelastometry and platelet aggregometry with standard laboratory tests 血小板参数在先兆子痫：比较旋转血栓弹性测量和血小板聚集与标准实验室测试

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-12-06 DOI: 10.1016/j.ijoa.2025.104832

A. Malin, G. Garvey, H. McNamara

Background

Preeclampsia is a multisystem hypertensive disorder of pregnancy associated with coagulation abnormalities. Haemostatic testing aids decision making about mode of anaesthesia. Current UK guidelines consider the risk of neuraxial anaesthesia is increased if laboratory platelet count is < 100,000/μL. However, laboratory tests are limited by turnaround time and do not evaluate platelet function. This prospective case-control study investigated the utility of point-of-care testing with rotational thromboelastometry and platelet aggregometry to predict laboratory results in patients with preeclampsia.

Method

Seventy-one patients with preeclampsia and 57 pregnant control patients were included. Thromboelastometry and platelet aggregometry parameters were compared with laboratory tests. Repeat tests were performed at a median of 11 h in 55 patients with preeclampsia.

Results

Four point of care-derived parameters were significantly lower in preeclampsia patients with platelet count < 100,000/μL than those > 100,000/μL; EXTEM A5, clot elasticity from platelets (CE_platelet), PLTEM (EXTEM A5-FIBTEM A5) and ADP-induced platelet aggregation. These parameters showed high negative but low positive predictive values for platelet count < 100,000/μL, with the highest negative predictive value of 1.0 (95% CI 0.96, 1.0; P < 0.0001) for PLTEM. Serial testing in 55 patients with preeclampsia showed reclassification of neuraxial anaesthesia risk in two cases according to platelet count.

Conclusion

This study has identified thromboelastometry and aggregometry parameters that may be useful in rapidly ruling out a platelet count < 100,000/μL in patients with preeclampsia, a threshold associated with increased risk of neuraxial haematoma. However, a limited positive predictive ability and relatively small sample size warrants further research before routine implementation.

背景子痫前期是一种与凝血异常相关的妊娠多系统高血压疾病。止血试验有助于决定麻醉方式。目前的英国指南认为，如果实验室血小板计数为10万/μL，则神经轴麻醉的风险增加。然而，实验室测试受周转时间的限制，不能评估血小板功能。这项前瞻性病例对照研究调查了旋转血栓弹性测定法和血小板聚集法在预测子痫前期患者实验室结果中的应用。方法选取71例先兆子痫患者和57例妊娠对照。将血栓弹性测量和血小板聚集参数与实验室测试进行比较。在55例先兆子痫患者中，平均11小时进行重复试验。结果血小板计数≥10万/μL的子痫前期患者4项监护指标均低于血小板计数≥10万/μL的子痫前期患者；EXTEM A5，血小板凝块弹性（ce血小板），PLTEM （EXTEM A5- fitem A5）和adp诱导的血小板聚集。这些参数对血小板计数（10万/μL）的阴性预测值高，阳性预测值低，对PLTEM的阴性预测值最高为1.0 （95% CI 0.96, 1.0; P < 0.0001）。55例先兆子痫患者的系列试验显示，根据血小板计数，两例患者的轴向麻醉风险被重新分类。结论：本研究确定了血小板弹性测量和聚集参数，可用于快速排除先兆子痫患者血小板计数（10万/μL），这一阈值与轴状血肿风险增加有关。然而，有限的阳性预测能力和相对较小的样本量值得在常规实施前进一步研究。

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引用次数: 0

Anaesthesia for caesarean delivery in patients with placenta accreta spectrum: a retrospective cohort study in two referral centres in Ireland (2017–2024) 增胎性胎盘患者剖宫产麻醉：爱尔兰两家转诊中心的回顾性队列研究（2017-2024）

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-12-06 DOI: 10.1016/j.ijoa.2025.104830

O. Elabbasy , S. Ahmed , D. Walsh , H. Bartels , D. Brennan , M. Wilkinson , S. MacColgain , A. Doherty , R. Ffrench-O’Carroll

Background

Placenta accreta spectrum disorders represent a major anaesthetic and surgical challenge, yet there are limited published data describing anaesthetic management in Ireland. This study examined anaesthetic practices and maternal and neonatal outcomes in patients with placenta accreta spectrum undergoing caesarean delivery in two tertiary referral maternity hospitals in Ireland.

Methods

A retrospective cohort study was conducted between 2017 and 2024, including 75 women with placenta accreta spectrum. Data collected included demographics, anaesthetic techniques, intraoperative management, and maternal and neonatal outcomes. Outcomes were compared across three groups: general anaesthesia only, combined neuraxial and general anaesthesia, and neuraxial anaesthesia only.

Results

Combined neuraxial and general anaesthesia was the most common anaesthetic approach used (50.7%), with 63 patients (84%) receiving a general anaesthetic at some point during surgery. Use of general anaesthesia was employed in all non-elective cases and was associated with performance of hysterectomy (OR 6.6, 95% CI 1.34, 32.9; P = 0.02), increased blood loss (OR 1.001, 95% CI 1.00, 1.00); P = 0.043), reduced Apgar scores at 5 and 10 min (P < 0.011) and greater need for neonatal intubation (P = 0.002).

Conclusions

General anaesthesia was performed in the majority of placenta accreta spectrum cases although in many patients this was combined with neuraxial anaesthesia. General anaesthesia was associated with greater maternal blood loss and poorer neonatal outcomes, although these findings should be interpreted with caution given the performance of general anaesthesia in all non-elective cases.

背景：胎盘增生谱系障碍是一个主要的麻醉和手术挑战，但在爱尔兰，描述麻醉管理的公开数据有限。本研究调查了在爱尔兰两家三级转诊妇产医院进行剖腹产的增胎性胎盘患者的麻醉做法和产妇和新生儿结局。方法采用回顾性队列研究方法，选取2017 - 2024年伴有胎盘增生谱的女性75例。收集的数据包括人口统计学、麻醉技术、术中管理、孕产妇和新生儿结局。结果在三组之间进行比较：仅全麻，神经轴和全身联合麻醉，以及仅神经轴麻醉。结果神经轴和全身麻醉是最常见的麻醉方式（50.7%），其中63例（84%）患者在手术过程中接受了全身麻醉。所有非选择性病例均采用全身麻醉，并与子宫切除术的实施（OR 6.6, 95% CI 1.34, 32.9; P = 0.02）、出血量增加（OR 1.001, 95% CI 1.00, 1.00）相关；P = 0.043)， 5分钟和10分钟Apgar评分降低（P < 0.011），新生儿插管需求增加（P = 0.002）。结论：尽管在许多患者中，全身麻醉与神经轴麻醉相结合，但大多数增生性胎盘病例均行全身麻醉。全身麻醉与更多的产妇失血和较差的新生儿结局有关，尽管考虑到所有非选择性病例的全身麻醉表现，这些发现应谨慎解释。

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引用次数: 0

Intraoperative pain during cesarean delivery: reflections and next steps 剖宫产术中疼痛：反思与下一步

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-12-05 DOI: 10.1016/j.ijoa.2025.104828

Pervez Sultan , Brendan Carvalho , Ruth Landau

引用次数: 0

Three initial prophylactic phenylephrine infusion rates and physician interventions in patients with preeclampsia undergoing caesarean delivery under spinal anaesthesia: a randomised double-blind trial 三种初始预防性苯肾上腺素输注率和医生干预在脊髓麻醉下剖腹产子痫前期患者：一项随机双盲试验

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-12-02 DOI: 10.1016/j.ijoa.2025.104825

M. Mohta, A. Jain, G.T. Chilkoti

Background

Patients with preeclampsia have greater sensitivity to vasopressors and require lower doses than patients without preeclampsia. The aim of the current study was to compare the number of required physician interventions using three initial prophylactic phenylephrine infusion rates titrated to maintain systolic blood pressure close to baseline values.

Methods

In this randomised, controlled, double-blind trial, 102 patients with preeclampsia undergoing caesarean delivery under spinal anaesthesia were randomised to one of three prophylactic phenylephrine infusion rates: 15 µg/min, 25 µg/min, or 35 µg/min. The rate was titrated to maintain systolic blood pressure within 10% of baseline values. The primary outcome was the number of physician interventions; secondary outcome measures included the incidence of hypertension, hypotension and bradycardia, total phenylephrine dose, neonatal outcomes, and maternal complications.

Results

The median [interquartile range] number of physician interventions was 6.5 [4–9], 6 [4–7.5] and 6.5 [4–9], respectively, for initial infusion rates of 15, 25, and 35 µg/min (P = 0.831). The total phenylephrine dose was greater with higher infusion doses (P < 0.001). No patient had bradycardia, and one patient had hypertension. Nineteen patients each in groups starting at 15 µg/min and 25 µg/min, and 22 patients starting at 35 µg/min developed hypotension (P = 0.695). Neonatal outcome and maternal complications were not different among groups.

Conclusions

All three infusion regimens required a similar number of physician interventions to maintain systolic blood pressure close to the baseline. A starting dose of 15 µg/min may be considered in this patient population.

Clinical Trial Registration number: CTRI/2023/08/055926; registered on 1st August 2023.

背景：与没有子痫前期的患者相比，子痫前期患者对血管加压药物更敏感，需要更低的剂量。当前研究的目的是比较使用三种初始预防性苯肾上腺素滴注率以维持收缩压接近基线值所需的医生干预次数。方法：在这项随机、对照、双盲试验中，102例在脊髓麻醉下剖腹产的先兆子痫患者被随机分配到三种预防性苯肾上腺素输注率中的一种：15µg/min、25µg/min或35µg/min。滴定速率以维持收缩压在基线值的10%以内。主要结局是医生干预的次数；次要结局指标包括高血压、低血压和心动过缓的发生率、苯肾上腺素总剂量、新生儿结局和产妇并发症。结果：在初始输液速率为15、25和35µg/min时，医生干预次数的中位数[四分位数范围]分别为6.5[4-9]、6[4-7.5]和6.5 [4-9]（P = 0.831）。结论：所有三种输注方案都需要相似数量的医生干预来维持收缩压接近基线。在这类患者中，可以考虑起始剂量为15µg/min。临床试验注册号：CTRI/2023/08/055926；于2023年8月1日注册。

{"title":"Three initial prophylactic phenylephrine infusion rates and physician interventions in patients with preeclampsia undergoing caesarean delivery under spinal anaesthesia: a randomised double-blind trial","authors":"M. Mohta, A. Jain, G.T. Chilkoti","doi":"10.1016/j.ijoa.2025.104825","DOIUrl":"10.1016/j.ijoa.2025.104825","url":null,"abstract":"<div><h3>Background</h3><div>Patients with preeclampsia have greater sensitivity to vasopressors and require lower doses than patients without preeclampsia. The aim of the current study was to compare the number of required physician interventions using three initial prophylactic phenylephrine infusion rates titrated to maintain systolic blood pressure close to baseline values.</div></div><div><h3>Methods</h3><div>In this randomised, controlled, double-blind trial, 102 patients with preeclampsia undergoing caesarean delivery under spinal anaesthesia were randomised to one of three prophylactic phenylephrine infusion rates: 15 µg/min, 25 µg/min, or 35 µg/min. The rate was titrated to maintain systolic blood pressure within 10% of baseline values. The primary outcome was the number of physician interventions; secondary outcome measures included the incidence of hypertension, hypotension and bradycardia, total phenylephrine dose, neonatal outcomes, and maternal complications.</div></div><div><h3>Results</h3><div>The median [interquartile range] number of physician interventions was 6.5 [4–9], 6 [4–7.5] and 6.5 [4–9], respectively, for initial infusion rates of 15, 25, and 35 µg/min (<em>P</em> = 0.831). The total phenylephrine dose was greater with higher infusion doses (<em>P</em> < 0.001). No patient had bradycardia, and one patient had hypertension. Nineteen patients each in groups starting at 15 µg/min and 25 µg/min, and 22 patients starting at 35 µg/min developed hypotension (<em>P</em> = 0.695). Neonatal outcome and maternal complications were not different among groups.</div></div><div><h3>Conclusions</h3><div>All three infusion regimens required a similar number of physician interventions to maintain systolic blood pressure close to the baseline. A starting dose of 15 µg/min may be considered in this patient population.</div><div><strong>Clinical Trial Registration number:</strong> CTRI/2023/08/055926; registered on 1st August 2023.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104825"},"PeriodicalIF":2.3,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Intravenous lidocaine infusion reduces intrathecal opioid-induced pruritus after cesarean delivery: a randomized controlled trial and proof-of-concept 静脉输注利多卡因减少剖宫产后鞘内阿片类药物引起的瘙痒：一项随机对照试验和概念证明。

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-12-02 DOI: 10.1016/j.ijoa.2025.104826

Ayman Mohamady Eldemrdash, Mohamed A. Alazhary, Soudy S. Hammad, Tarek S. Hemaida, Ahmed Mohamed Reda Ragheb, Gamal Hendawy Shams, Taha Tairy Dardeer, Zaher Zaki Zaher

Background

Pruritus is a common adverse effect of neuraxial morphine after cesarean delivery. We tested whether intravenous lidocaine infusion reduces the incidence and severity of neuraxial morphine–induced pruritus.

Methods

In this double-blind randomized trial at a single center, 160 women undergoing elective cesarean delivery under spinal anesthesia with intrathecal morphine 150

μ

g and were randomized to either intravenous lidocaine (bolus 1.5 mg/kg followed by infusion 1.5 mg/kg/h for 6 h) or saline placebo. The primary outcome was the incidence of pruritus within 24 h. Secondary outcomes included pruritus severity over time, rescue nalbuphine use, and adverse events. Analyses used modified intention-to-treat.

Results

Data on 136 patients were analyzed (n = 69 lidocaine vs. n = 67 controls). Pruritus occurred in 36.2% receiving lidocaine vs 73.1% in the control group (absolute risk reduction 36.9%, 95% CI 21.4, 52.4), resulting in a number needed to treat of 3 (95% CI 2, 5). Rescue nalbuphine was given in 23.2% of patients in the lidocaine group vs. 56.7% in the control group (absolute risk reduction 33.5%, 95% CI 18.0, 49.0), with a number needed to treat of 3 (95% CI 2, 6). Pruritus severity was lower in the lidocaine group during the first 12 h postoperatively; differences were not significant at 16 and 24 h. No symptoms of lidocaine toxicity or increased adverse events were observed.

Conclusions

Intravenous lidocaine infusion reduced the incidence and early severity of neuraxial morphine–induced pruritus after cesarean delivery without increased adverse events. Further work should define lower effective doses and shorter infusion durations compatible with enhanced recovery pathways.

背景：瘙痒是剖宫产后常见的神经轴吗啡不良反应。我们测试了静脉输注利多卡因是否能降低吗啡引起的神经轴性瘙痒的发生率和严重程度。方法：在单中心双盲随机试验中，160名在鞘内吗啡150 μg脊髓麻醉下择期剖宫产的妇女，随机分为静脉注射利多卡因组（静脉注射1.5 mg/kg，随后再输注1.5 mg/kg/h，持续6 h）和生理盐水安慰剂组。主要结局是24小时内瘙痒的发生率。次要结局包括随时间推移的瘙痒严重程度、抢救使用纳布啡和不良事件。分析使用改良的意向治疗。结果：136例患者的数据被分析（n = 69利多卡因vs n = 67对照组）。利多卡因组出现瘙痒的比例为36.2%，对照组为73.1%（绝对风险降低36.9%,95% CI 21.4, 52.4），导致需要治疗的人数为3人（95% CI 2,5）。利多卡因组23.2%的患者给予纳布啡抢救，对照组56.7%（绝对风险降低33.5%,95% CI 18.0, 49.0），需要治疗的人数为3人（95% CI 2,6）。利多卡因组术后12 h瘙痒严重程度较低；16和24小时时差异不显著。未观察到利多卡因毒性症状或不良事件增加。结论：静脉输注利多卡因可降低剖宫产后神经轴性吗啡性瘙痒的发生率和早期严重程度，且未增加不良事件。进一步的工作应该确定更低的有效剂量和更短的输注时间，以增强恢复途径。

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引用次数: 0

Curvilinear versus phased array transducer: using the obstetric ultrasound for focused cardiac ultrasound in laboring patients - a randomized controlled assessment 曲线与相控阵换能器：在分娩患者中使用产科超声聚焦心脏超声-随机对照评估

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-12-02 DOI: 10.1016/j.ijoa.2025.104827

L.B. Squires, D.J. Conti, E.E. Martinez, N. Guo, B. Carvalho, C.M. Ortner

Background

Focused cardiac ultrasound is an effective tool for assessing obstetric patients, but access to phased array transducers is limited in many low-resource settings. This study aimed to determine if curvilinear transducers could produce clinically useful ultrasound images non-inferior to phased array transducers.

Methods

Laboring patients were recruited for focused cardiac ultrasound performed by six anesthesiologists with limited echocardiography experience. Curvilinear and phased array transducers were used to obtain standard views. The first transducer used was randomly assigned. Blinded experts graded the images on a scale of 1 to 5, with grades ≥ 3 sufficient for clinical decisions. The primary outcome was the percentage of patients with sufficient images (grade ≥ 3) in at least two views using curvilinear versus phased array transducers. Secondary outcomes included the clinical utility of individual views and a non-inferiority comparison of transducers.

Results

Seventy parturients were scanned. Clinically useful examinations were achieved in 91.4% (95% CI 82.3%, 96.8%) of patients with curvilinear transducers compared to 95.7% (95% CI 88.0%, 99.1%) with phased array transducers. Using a noninferiority margin of 15%, curvilinear transducers were noninferior for clinical decisions (−4.3% 90% CI: −11.9%, −3.3%) largely due to parasternal views. Subcostal and apical views were individually inconclusive and IVC views were inferior. Measures of cardiac dimensions and systolic function were deemed measurable with less frequency on curvilinear images but concordant when measured.

Conclusions

Anesthesiologists can effectively use curvilinear transducers for focused cardiac ultrasound in obstetric patients, although phased array transducers may be superior for measuring cardiac dimensions and function.

聚焦心脏超声是评估产科患者的有效工具，但在许多资源匮乏的环境中，相控阵换能器的使用受到限制。本研究旨在确定曲线换能器是否可以产生临床有用的超声图像，而不逊色于相控阵换能器。方法选取临产患者，由6名超声心动图经验有限的麻醉师进行心脏聚焦超声检查。曲线和相控阵换能器被用来获得标准视图。使用的第一个换能器是随机分配的。盲法专家将图像按1 - 5级进行评分，评分≥3级足以用于临床决策。主要结局是使用曲线与相控阵换能器在至少两个视图中获得足够图像（分级≥3）的患者百分比。次要结果包括个体视图的临床效用和换能器的非劣效性比较。结果共扫描70例产妇。曲线换能器的91.4% （95% CI 82.3%, 96.8%）患者获得了临床有用的检查，而相控阵换能器的95.7% （95% CI 88.0%, 99.1%）患者获得了临床有用的检查。使用15%的非劣效性裕度，曲线传感器在临床决策中是非劣效性的（- 4.3% 90% CI: - 11.9%, - 3.3%），主要是由于胸骨旁视图。肋下和根尖位单独不确定，下颌骨位次之。测量心脏尺寸和收缩功能被认为是可测量的，在曲线图像上频率较低，但测量时一致。结论虽然相控阵换能器在测量心脏尺寸和功能方面更胜一筹，但曲线换能器可以有效地用于产科患者的聚焦心脏超声。

{"title":"Curvilinear versus phased array transducer: using the obstetric ultrasound for focused cardiac ultrasound in laboring patients - a randomized controlled assessment","authors":"L.B. Squires, D.J. Conti, E.E. Martinez, N. Guo, B. Carvalho, C.M. Ortner","doi":"10.1016/j.ijoa.2025.104827","DOIUrl":"10.1016/j.ijoa.2025.104827","url":null,"abstract":"<div><h3>Background</h3><div>Focused cardiac ultrasound is an effective tool for assessing obstetric patients, but access to phased array transducers is limited in many low-resource settings. This study aimed to determine if curvilinear transducers could produce clinically useful ultrasound images non-inferior to phased array transducers.</div></div><div><h3>Methods</h3><div>Laboring patients were recruited for focused cardiac ultrasound performed by six anesthesiologists with limited echocardiography experience. Curvilinear and phased array transducers were used to obtain standard views. The first transducer used was randomly assigned. Blinded experts graded the images on a scale of 1 to 5, with grades ≥ 3 sufficient for clinical decisions. The primary outcome was the percentage of patients with sufficient images (grade ≥ 3) in at least two views using curvilinear versus phased array transducers. Secondary outcomes included the clinical utility of individual views and a non-inferiority comparison of transducers.</div></div><div><h3>Results</h3><div>Seventy parturients were scanned. Clinically useful examinations were achieved in 91.4% (95% CI 82.3%, 96.8%) of patients with curvilinear transducers compared to 95.7% (95% CI 88.0%, 99.1%) with phased array transducers. Using a noninferiority margin of 15%, curvilinear transducers were noninferior for clinical decisions (−4.3% 90% CI: −11.9%, −3.3%) largely due to parasternal views. Subcostal and apical views were individually inconclusive and IVC views were inferior. Measures of cardiac dimensions and systolic function were deemed measurable with less frequency on curvilinear images but concordant when measured.</div></div><div><h3>Conclusions</h3><div>Anesthesiologists can effectively use curvilinear transducers for focused cardiac ultrasound in obstetric patients, although phased array transducers may be superior for measuring cardiac dimensions and function.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104827"},"PeriodicalIF":2.3,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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