International journal of obstetric anesthesia最新文献

{"title":"Patient-reported postoperative pain and stigmatizing language in anesthesia notes: a cross-sectional study (2017–2019)","authors":"S.E. Harkins ,&nbsp;C.D. Thomas II ,&nbsp;I.I. Hulchafo ,&nbsp;M Topaz ,&nbsp;R Landau ,&nbsp;V Barcelona","doi":"10.1016/j.ijoa.2025.104824","DOIUrl":"10.1016/j.ijoa.2025.104824","url":null,"abstract":"<div><h3>Background</h3><div>Stigmatizing language reflects provider bias. Researchers found that documentation of stigmatizing language in obstetric clinical notes differed by patient race and ethnicity. The purpose of this study was to examine associations between postoperative pain and stigmatizing language documented by anesthesiologists.</div></div><div><h3>Methods</h3><div>We studied the electronic health records of obstetric patients at two hospitals between 2017 and 2019 (n = 4383). Pain was defined as a verbal numerical pain score (VNPS) <span><math><mo>≥</mo></math></span> 1 following cesarean delivery or other operative procedure during the delivery hospitalization. Stigmatizing language was identified in the free-text narratives of postoperative anesthesia notes using a well-performing natural language processing algorithm. Multivariable logistic regression was employed to examine associations between pain and stigmatizing language.</div></div><div><h3>Results</h3><div>Stigmatizing language was found in 9.9% of postoperative notes. Patients with documented pain were significantly more likely to have any stigmatizing language documented by anesthesiologists compared with patients with no pain (adjusted odds ratio [aOR], 1.64; 95% confidence interval [CI], 1.26–2.13). Patients with pain were also significantly more likely to have language labeling them as ‘difficult’ (aOR, 1.81; 95% CI, 1.34–2.45). There were no significant differences between patients with and without postoperative pain in language related to marginalized language/identities, unilateral/authoritarian decisions, or questioning patient credibility categories.</div></div><div><h3>Conclusions</h3><div>In this cross-sectional study, postpartum patients with pain had increased odds of stigmatizing language. Findings suggest anesthesiologists may perceive patients who report pain as being ‘difficult.’ Quality improvement studies should track inequities in pain management as patient-centered, bias-free care is crucial for improving perinatal equity.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104824"},"PeriodicalIF":2.3,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614200","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}

{"title":"Adverse childhood experiences and post-cesarean pain and in-hospital opioid use: a prospective cohort study","authors":"Noor Joudi ,&nbsp;Nidhee S. Reddy ,&nbsp;Elizabeth B. Sherwin ,&nbsp;Metabel Markwei ,&nbsp;Janet Hurtado ,&nbsp;Samantha L. Simpson ,&nbsp;Jordan J. Burgess ,&nbsp;Stephanie A. Leonard ,&nbsp;Miriam Schultz ,&nbsp;Brendan Carvalho ,&nbsp;Pervez Sultan ,&nbsp;Katherine Bianco ,&nbsp;Danielle M. Panelli","doi":"10.1016/j.ijoa.2025.104822","DOIUrl":"10.1016/j.ijoa.2025.104822","url":null,"abstract":"<div><h3>Background</h3><div>Adverse childhood experiences (ACEs) are linked to higher opioid use and pain in non-pregnant populations, yet their effect after cesarean delivery is unclear. We evaluated whether ACEs influence postpartum opioid use and pain following cesarean.</div></div><div><h3>Methods</h3><div>We prospectively enrolled English or Spanish speaking women undergoing scheduled or intrapartum cesarean delivery under neuraxial anesthesia (2023–2024).The exposure was ≥ 1 ACEs, assessed via a validated questionnaire 24–48 h post-delivery. The primary outcome was opioid use (0–48 h) post-delivery in milligram morphine equivalents (MME). Pain was measured using the Short-Form Brief Pain Inventory (SF-BPI) 24–48 h postpartum and average numerical rating scale pain scores (recorded every 4 h). We used multivariable modified Poisson regression models to evaluate the association between ACEs and any opioid use, and multinomial regression to examine opioid dose quartiles.</div></div><div><h3>Results</h3><div>Among 129 participants, 53 (41%) reported ≥ 1 ACEs. Women with ACEs were more likely to use opioids in the first 48 h postpartum than those without ACEs (89% vs. 59%, adjusted risk ratio [aRR] 1.52; CI 1.20, 1.91). ACEs were also associated with higher opioid dosage across quartiles: 2^nd [adjusted odds ratio (aOR) 8.60; CI 2.47, 29.9], 3^rd (aOR 5.74; CI 1.54–21.4), and 4^th (highest) [aOR 4.54; CI 1.30, 15.9] vs. the lowest quartile. Numerical rating scale pain scores were higher among women with ACEs (3/10 vs. 2/10, <em>P</em> = 0.037), as were SF-BPI worst pain scores (7/10 vs. 6/10, <em>P</em> = 0.029).</div></div><div><h3>Conclusions</h3><div>Adverse childoohd experiences were common and associated with higher opioid consumption and greater pain after cesarean delivery, supporting trauma-informed approaches to postpartum analgesia.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104822"},"PeriodicalIF":2.3,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145723353","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}

{"title":"Neuraxial labor analgesia in type 2N von Willebrand disease: a case report","authors":"K. Li,&nbsp;Y. Li,&nbsp;P.E. Hess,&nbsp;A.A. Berger","doi":"10.1016/j.ijoa.2025.104823","DOIUrl":"10.1016/j.ijoa.2025.104823","url":null,"abstract":"<div><div>Von Willebrand disease (VWD) is a family of disorders involving quantitative or qualitative deficiencies of von Willebrand factor. Type 2N von Willebrand disease is a rare variant in which defective von Willebrand factor fails to stabilize factor VIII. Factor VIII deficiency may pose increased risks of postpartum hemorrhage and spinal-epidural hematoma after neuraxial analgesia, yet clinical guidance on its peripartum management remains extremely limited.</div><div>This case reports on the successful administration of neuraxial analgesia in a 23-year-old nulliparous patient with type 2N VWD who presented with active vaginal bleeding and impending preterm delivery. Targeted preprocedural correction of factor VIII and von Willebrand factor levels, with adjunct thromboelastography, enabled uneventful neuraxial analgesia administration and uncomplicated preterm vaginal delivery. No complications from neuraxial were noted. However, despite satisfactory factor VIII and von Willebrand factor levels at discharge, the patient experienced delayed postpartum bleeding requiring readmission.</div><div>This case demonstrates the feasibility of neuraxial labor analgesia in women with type 2N VWD after thorough risk assessment and mitigation, interdisciplinary collaboration, and individualized care. The occurrence of delayed bleeding additionally underscores the importance of postpartum monitoring as factor levels decline. This report contributes to the limited but growing body of evidence on obstetric anesthesia neuraxial procedures in the setting of rare bleeding disorders.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104823"},"PeriodicalIF":2.3,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145661122","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}

{"title":"Corrigendum to \"Effect of prophylactic intravenous calcium gluconate on uterine atony during intrapartum cesarean delivery with spinal anesthesia: a placebo controlled, randomized clinical trial\". [Int. J. Obst. Anesth. 63 (2025) 104704].","authors":"T L Abirami, P Rudingwa, A K Jha, A Kuberan, N S Kubera, S Ramachandran, B Ravichandrane","doi":"10.1016/j.ijoa.2025.104821","DOIUrl":"https://doi.org/10.1016/j.ijoa.2025.104821","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":" ","pages":"104821"},"PeriodicalIF":2.3,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604254","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}

{"title":"Maternal hemodynamic effects associated with intravenous and neuraxial dexmedetomidine during labor and cesarean delivery: a single center retrospective study (2021–2024)","authors":"S.L. Armstrong ,&nbsp;A.A. Berger ,&nbsp;S. Zec,&nbsp;M. Douek,&nbsp;K. Li,&nbsp;M.C. Borrelli,&nbsp;Y. Li,&nbsp;P.E. Hess","doi":"10.1016/j.ijoa.2025.104820","DOIUrl":"10.1016/j.ijoa.2025.104820","url":null,"abstract":"<div><h3>Background</h3><div>Dexmedetomidine is a highly selective alpha₂-adrenoceptor agonist with anxiolytic, sedative, and analgesic properties. The use of this medication in obstetric anesthesia has increased with publications describing intravenous (IV) use for shivering, and epidural and intrathecal use for anesthesia and analgesia. Limited data exists on the frequency of adverse events during clinical use. We reviewed our use of dexmedetomidine in the peripartum period to identify specific indications and maternal adverse events</div></div><div><h3>Methods</h3><div>We performed a retrospective review of dexmedetomidine administration during labor and delivery over three years (2022–2024). The route of administration, indication and doses were collected and all identifiable adverse events related to dexmedetomidine administration were recorded.</div></div><div><h3>Results</h3><div>There were 1,177 records available for review and 1,100 were analyzed. Dexmedetomidine was administered most often for augmentation of cesarean anesthesia, treatment of breakthrough pain during labor, and for shivering. Maternal heart rate abnormalities were noted in 47 cases (6.1%; 95% CI 4.5-8.0), bradycardia in 16 cases (2.1%; 95% CI 1.2-3.4), hypotension in 57 cases (7.2%; 95% CI 5.5-9.3), and sedation in 9 cases (1.2% 95% CI 0.6-2.3). Maternal adverse events were less common after neuraxial administration compared with IV.</div></div><div><h3>Conclusions</h3><div>Our clinical experience demonstrated maternal adverse events that might be traced to the administration of either IV or neuraxial dexmedetomidine, which were more common after IV administration. As adverse events are likely to be dose-related, we would recommend starting with the lowest appropriate dose and titrating to the desired effect.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104820"},"PeriodicalIF":2.3,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604174","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}

{"title":"Obstetric anesthesia in Latin America: a workforce and clinical practice survey (2025)","authors":"Hector J. Lacassie ,&nbsp;René de la Fuente ,&nbsp;Mauricio Vasco ,&nbsp;Mónica Siaulys","doi":"10.1016/j.ijoa.2025.104818","DOIUrl":"10.1016/j.ijoa.2025.104818","url":null,"abstract":"<div><h3>Background</h3><div>This study offers the first comprehensive assessment of the obstetric anesthesia workforce in Latin America. It aims to describe workforce composition, clinical practices, and safety protocols, and compares findings with United States data.</div></div><div><h3>Methods</h3><div>A web-based, anonymous survey was administered in August 2025 to national leaders in obstetric anesthesia from 24 Latin American countries. The survey tool was adapted from the United States Obstetric Anesthesia Workforce Survey. Responses were descriptively analyzed and averaged after weighting for national birth rates. Comparisons with United States data were descriptive.</div></div><div><h3>Results</h3><div>Of 62 anesthesiologists contacted from 19 countries, 50 responded. Most respondents (90%) worked in high-risk referral hospitals, and 54% in academic centers with residency programs. During daytime, 50% reported non-obstetric concurrent duties, increasing to 60% after hours. Neuraxial labor analgesia was provided in 69% of cases (epidural 37%, combined spinal epidural 23%, dural puncture epidural 3.4%, single spinal 3.8%); 26% of laboring patients received no analgesia. Spinal anesthesia was most common for planned cesarean delivery (86%), with intrathecal morphine used in 83% of centers. Enhanced Recovery protocols were used in 27%. General anesthesia was reported in 18% of urgent cesarean deliveries. Safety measures—massive transfusion protocols, advanced life support training, and ultrasound—were available in 79%, 69%, and 87% of centers.</div></div><div><h3>Conclusions</h3><div>The survey reveals strengths including high rates of neuraxial analgesia and safety protocols, but substantial variation in staffing, analgesia, and techniques. Opportunities exist to expand coverage, standardize practices, and improve maternal safety in Latin America.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"66 ","pages":"Article 104818"},"PeriodicalIF":2.3,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074361","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}

{"title":"Patient experiences of chronic postsurgical pain after caesarean delivery: findings from a prospective qualitative study","authors":"S. Ciechanowicz ,&nbsp;P. Callihan ,&nbsp;G. Michel ,&nbsp;D.M. Panelli ,&nbsp;B. Carvalho ,&nbsp;P. Sultan","doi":"10.1016/j.ijoa.2025.104817","DOIUrl":"10.1016/j.ijoa.2025.104817","url":null,"abstract":"<div><h3>Background</h3><div>Chronic postsurgical pain after caesarean delivery affects 10–20% of women at 3–6 months postpartum, yet its broader impact on recovery is underexplored. This study examined lived experiences of chronic postsurgical pain and identified key domains of impact.</div></div><div><h3>Methods</h3><div>Twenty-four women with self-reported pain at 3–6 months after intrapartum or planned caesarean delivery were recruited from two prospective studies. Semi-structured interviews, conducted in English or Spanish via secure video call, were transcribed and analysed using inductive reflexive thematic analysis.</div></div><div><h3>Results</h3><div>Patients described a multidimensional, interconnected symptom burden. Pain persisted or worsened unpredictably, interfering with mobility, infant care, and daily life. Poor sleep and fatigue compounded distress. Cognitive and affective disruptions, including anxiety and fear, were common. Many patients avoided opioid analgesics due to concerns about alertness or breastfeeding. Patients sometimes reported feeling dismissed or unsupported by healthcare professionals. Ten themes were identified: pain and sensory disruption; functional limitations and fatigue; interference with infant care and identity; psychological distress and cognitive load; sleep disruption; control and coping; intimacy and embodied recovery; healthcare gaps; peer and online normalisation; and reflections on future health.</div></div><div><h3>Conclusions</h3><div>Chronic pain after caesarean rarely occurs in isolation. Interacting symptoms across sleep, pain, emotional wellbeing, cognitive function, and energy domains shape women’s lived experiences. These findings provide qualitative support for a multidomain, possibly syndromic pattern of postpartum pain and recovery.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104817"},"PeriodicalIF":2.3,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145563957","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}

{"title":"Intrathecal dexmedetomidine for cesarean delivery and postoperative outcomes: a single-center retrospective cohort study (2019–2020)","authors":"E. Takalo ,&nbsp;M. Karpala ,&nbsp;X. An ,&nbsp;B. Cobb ,&nbsp;S. Zhao ,&nbsp;R. Bari ,&nbsp;M. Hylton ,&nbsp;S. Grant ,&nbsp;J. Schoenherr","doi":"10.1016/j.ijoa.2025.104819","DOIUrl":"10.1016/j.ijoa.2025.104819","url":null,"abstract":"<div><h3>Background</h3><div>Intrathecal opioids are the standard adjuvant for spinal anesthesia in cesarean delivery, but investigating alternatives is warranted. A community hospital began adding intrathecal dexmedetomidine 10 µg to spinal anesthetics for cesarean deliveries due to a local shortage in opioids. This retrospective study evaluates its impact on postoperative pain, opioid use, and hemodynamic outcomes.</div></div><div><h3>Methods</h3><div>After IRB approval, cesarean delivery cases conducted between 2019 and 2020 were screened. Exclusion criteria included epidural labor analgesia, general anesthesia, intrathecal catheters, or intrathecal dexmedetomidine dose other than 10 µg. Primary outcome was postoperative pain score; secondary outcomes included opioid use (in milligram morphine equivalents), incidence of intraoperative hypotension, vasopressor use, postoperative mean arterial pressure, Apgar scores, and length of stay.</div></div><div><h3>Results</h3><div>Of 572 cesarean deliveries, 414 met inclusion criteria; 163 received 10 µg of intrathecal dexmedetomidine, 251 did not. Demographics were similar. Patients who received intrathecal dexmedetomidine 10 µg had significantly lower postoperative pain scores (effect size −0.41, 95% CI −0.18 to −0.64; <em>P</em> &lt; 0.001). Opioid use was significantly reduced 0–6 h after anesthesia (15.0 mg vs. 22.5 mg; <em>P</em> &lt; 0.001) and 6–24 h after anesthesia end (26.1 mg vs. 29.4 mg; <em>P</em> = 0.0465). However, there was a higher incidence of intraoperative hypotension (44.2% vs. 28.3%; <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Intrathecal dexmedetomidine 10 µg was associated with reduced postoperative pain and opioid use, supporting its role as an intrathecal adjuvant. However, its association with increased hypotension highlights the need for cautious use and further investigation.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104819"},"PeriodicalIF":2.3,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145563937","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}

{"title":"Effect of magnesium sulfate in patients with preeclampsia with severe features on gastric antrum cross-sectional area: a prospective observational study","authors":"M.A. Helmy ,&nbsp;K.A. Helmy ,&nbsp;M.R. Salem ,&nbsp;M.A. El-Monem Morsy ,&nbsp;M. Fikry ,&nbsp;L.M. Milad","doi":"10.1016/j.ijoa.2025.104816","DOIUrl":"10.1016/j.ijoa.2025.104816","url":null,"abstract":"<div><h3>Background</h3><div>While the systemic effects of magnesium sulfate administration are well described, its effects on gastric motility and aspiration risk remain underexplored. We evaluated the effect of magnesium sulfate administration on the gastric antrum cross-sectional area (CSA) in the setting of preeclampsia with severe features.</div></div><div><h3>Methods</h3><div>This prospective observational study included 31 patients with preeclampsia and severe features receiving an intravenous bolus of magnesium sulfate 5 g over 20 min, followed by an infusion (1 g/h). Gastric ultrasound was performed at baseline (pre-bolus) and 10- and 20-min post-bolus. Serum magnesium levels were measured at baseline and 20 min post-bolus. The primary outcome was the change in gastric CSA from baseline to 20 min post-bolus. The secondary outcomes included the proportion of patients with unsafe gastric volume (CSA &gt; 608 mm²) and correlation between the increasing serum magnesium levels and change in CSA.</div></div><div><h3>Results</h3><div>There was an increase in gastric antrum CSA from baseline to 10- and 20-min post-bolus, with median CSA values rising from 403 mm² to 440 mm² and 507 mm², respectively (<em>P</em> &lt; 0.001). Serum magnesium levels increased from 1.96 ± 0.26 mg/dL to 5.24 ± 0.86 mg/dL (mean difference: 3.27 ± 0.80 mg/dL). At baseline and 10- and 20-min post-bolus, 2, 5, and 7 of 31 participants, respectively, met criteria for unsafe gastric volume. A strong positive correlation was observed between change in serum magnesium levels and change in CSA (r = +0.896, <em>P</em> &lt; 0.001)</div></div><div><h3>Conclusions</h3><div>In patients with preeclampsia with severe features, magnesium sulfate 5 g is associated with a significant increase in gastric antrum CSA. The strong positive correlation between serum magnesium levels and CSA supports a potential dose-dependent effect on gastric smooth muscle relaxation. However, further research is warranted to determine whether these sonographic changes correspond to clinically significant increases in gastric volume or translate into a measurable risk of pulmonary aspiration.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104816"},"PeriodicalIF":2.3,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516374","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}

{"title":"Airway events in pregnant patients with morbid obesity undergoing caesarean delivery under general anaesthesia: a retrospective cohort study (2015–2024)","authors":"A. Saracoglu ,&nbsp;S. Padhy ,&nbsp;K.C. Yilmaz ,&nbsp;M. Arif ,&nbsp;S.R. Kapoor ,&nbsp;L. Ramanathan ,&nbsp;A. Kumar ,&nbsp;K.T. Saracoglu","doi":"10.1016/j.ijoa.2025.104815","DOIUrl":"10.1016/j.ijoa.2025.104815","url":null,"abstract":"<div><h3>Background</h3><div>Airway management in morbidly obese obstetric patients is challenging, with increased risk of difficult ventilation, failed intubation, and maternal morbidity. By focusing exclusively on pregnant patients with a BMI 40 kg/m², this study aimed to quantify the frequency and types of airway complications occurring during cesarean section under general anesthesia, stratified by obesity class. The secondary objective was to identify risk factors for difficult mask ventilation, difficult laryngoscopy, and difficult airway.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included all 315 pregnant patients aged ≥ 18 years with a BMI ≥ 40 kg/m² who underwent caesarean delivery under general anaesthesia between January 2015 and December 2024. Data on demographics, comorbidities, airway assessments, intubation metrics, and perioperative complications were extracted from electronic medical records. Statistical analyses included correlation testing, group comparisons, and multivariable logistic regression (adjusted for age, BMI, and comorbidties).</div></div><div><h3>Results</h3><div>A total of 315 patients with morbid obesity were analyzed (Class III: 94.3%; Class IV/V: 5.7%). Overall, the most common airway-related complication was cardiovascular instability (7.9%), followed by laryngospasm (1.6%). When stratified by obesity class, cardiovascular instability was similar in Class III and IV, while other airway complications were generally rare and varied. A positive correlation was observed between BMI and peak airway pressure post-intubation. Thyromental distance inversely correlated with intubation attempts (r = −0.150, <em>P</em> = 0.008) and showed the strongest predictive value (OR 0.22, 95% CI 0.11–0.44; <em>P</em> &lt; 0.001) for difficult mask ventilation. Perioperative complications were infrequent: cardiovascular instability (7.9%) and desaturation &lt; 94% during intubation (1.0%).</div></div><div><h3>Conclusion</h3><div>In conclusion, cardiovascular instability was the most common airway-related complication, difficult airway incidence increased with obesity class, and thyromental distance was the most consistent predictor, highlighting the need for tailored airway management in obstetric patients with morbid obesity.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104815"},"PeriodicalIF":2.3,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516373","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}