International journal of obstetric anesthesia最新文献_第7页

The obstetric anesthetic management of fibrosing mediastinitis: a case series and review of the literature (1990–2025) 纤维化性纵隔炎的产科麻醉管理：病例系列和文献回顾（1990-2025）。

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-10-29 DOI: 10.1016/j.ijoa.2025.104810

B.M. Bak , M.A. Wyatt , T. Peikert , C.H. Rose , M.L. Kauss , K.W. Arendt , M.T. Teixeira

Background

Fibrosing mediastinitis is a rare and potentially deadly disease characterized by immune mediated fibrosis. In the United States, it most commonly arises as a post-infectious sequela of Histoplasma capsulatum infection, leading to progressive mediastinal compression that can complicate pregnancy. This case series seeks to provide guidance on the anesthetic considerations and management of patients with fibrosing mediastinitis in the peripartum period.

Methods

We conducted a retrospective review to identify patients with fibrosing mediastinitis who received pregnancy care at Mayo Clinic Rochester since January 1, 1990.

Results

Seven pregnancies were recorded in five patients with fibrosing mediastinitis. Three patients had pulmonary hypertension, three had superior vena cava syndrome, and three had pulmonary vein stenosis. All patients received neuraxial anesthesia or analgesia; three delivered at term; two cases delivered vaginally, three cases by cesarean delivery, one case delivered by cesarean followed by a hysterectomy, and one underwent surgical termination. Two patients with severe PH underwent surgical intervention in the cardiac surgery operating room, with one patient having femoral sheaths placed for extracorporeal membrane oxygenator support on standby. In six of the seven cases, we observed no major maternal morbidity, mortality, or anesthetic complications. One patient with severe pulmonary hypertension experienced postpartum hypoxia resulting in a prolonged hospital stay.

Conclusions

Our findings highlight that fibrosing mediastinitis severity is variable and depends on the presence of long-term sequelae of mediastinal obstruction, specifically the development of pulmonary hypertension. This single center’s experience suggests that pregnant patients with fibrosing mediastinitis can have favorable outcomes with coordinated multidisciplinary care.

背景：纤维化性纵隔炎是一种罕见且具有潜在致命性的疾病，其特征为免疫介导的纤维化。在美国，它最常作为荚膜组织原体感染后的后遗症出现，导致进行性纵隔压迫，使妊娠复杂化。本病例系列旨在为围生期纤维化性纵隔炎患者的麻醉考虑和管理提供指导。方法：我们对1990年1月1日以来在罗切斯特梅奥诊所接受妊娠护理的纤维化性纵隔炎患者进行回顾性分析。结果：5例纤维化性纵隔炎7次妊娠。肺动脉高压3例，上腔静脉综合征3例，肺静脉狭窄3例。所有患者均行轴突麻醉或镇痛；三个足月分娩；2例阴道分娩，3例剖宫产，1例剖宫产后子宫切除术，1例手术终止。2例重度PH患者在心脏外科手术室接受手术干预，1例患者放置股鞘备用体外膜氧合器支持。在7例中的6例中，我们没有观察到主要的产妇发病率、死亡率或麻醉并发症。1例重度肺动脉高压患者产后缺氧导致住院时间延长。结论：我们的研究结果强调，纤维化性纵隔炎的严重程度是可变的，取决于是否存在纵隔梗阻的长期后遗症，特别是肺动脉高压的发展。这个单一中心的经验表明，通过协调的多学科护理，妊娠纤维化纵隔炎患者可以获得良好的结果。

{"title":"The obstetric anesthetic management of fibrosing mediastinitis: a case series and review of the literature (1990–2025)","authors":"B.M. Bak , M.A. Wyatt , T. Peikert , C.H. Rose , M.L. Kauss , K.W. Arendt , M.T. Teixeira","doi":"10.1016/j.ijoa.2025.104810","DOIUrl":"10.1016/j.ijoa.2025.104810","url":null,"abstract":"<div><h3>Background</h3><div>Fibrosing mediastinitis is a rare and potentially deadly disease characterized by immune mediated fibrosis. In the United States, it most commonly arises as a post-infectious sequela of Histoplasma capsulatum infection, leading to progressive mediastinal compression that can complicate pregnancy. This case series seeks to provide guidance on the anesthetic considerations and management of patients with fibrosing mediastinitis in the peripartum period.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review to identify patients with fibrosing mediastinitis who received pregnancy care at Mayo Clinic Rochester since January 1, 1990.</div></div><div><h3>Results</h3><div>Seven pregnancies were recorded in five patients with fibrosing mediastinitis. Three patients had pulmonary hypertension, three had superior vena cava syndrome, and three had pulmonary vein stenosis. All patients received neuraxial anesthesia or analgesia; three delivered at term; two cases delivered vaginally, three cases by cesarean delivery, one case delivered by cesarean followed by a hysterectomy, and one underwent surgical termination. Two patients with severe PH underwent surgical intervention in the cardiac surgery operating room, with one patient having femoral sheaths placed for extracorporeal membrane oxygenator support on standby. In six of the seven cases, we observed no major maternal morbidity, mortality, or anesthetic complications. One patient with severe pulmonary hypertension experienced postpartum hypoxia resulting in a prolonged hospital stay.</div></div><div><h3>Conclusions</h3><div>Our findings highlight that fibrosing mediastinitis severity is variable and depends on the presence of long-term sequelae of mediastinal obstruction, specifically the development of pulmonary hypertension. This single center’s experience suggests that pregnant patients with fibrosing mediastinitis can have favorable outcomes with coordinated multidisciplinary care.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104810"},"PeriodicalIF":2.3,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145458669","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

In response to Ogawa et al on editorial “Obstetric anesthesia in Japan: An existential crisis in need of an intervention” 回应Ogawa等人的社论“日本的产科麻醉：需要干预的生存危机”。

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-10-27 DOI: 10.1016/j.ijoa.2025.104812

A. Maeda , Y. Mazda , R. Ohara , S. Tanabe , M. Tokiwa , W. Camann

引用次数: 0

Impact of midwife clinical experience and survey-based attitudes towards labor epidural analgesia on utilization rates in pregnant patients: a survey-based cohort study 助产士临床经验和基于调查的分娩硬膜外镇痛态度对妊娠患者使用率的影响：一项基于调查的队列研究。

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-10-25 DOI: 10.1016/j.ijoa.2025.104809

R. Abu Shqara , L. Rozenkrantz , S. Nahir Biderman , Y. Perez , T. Domfrocht , A. Aiob , N. Ganem , L. Lowenstein , M. Frank Wolf

Background

Labor epidural analgesia (LEA) is widely used for pain relief, but the impact of midwives’ attitudes and experience on its administration is underexplored. We examined whether midwives’ attitudes and experience influence LEA use among their patients.

Methods

This survey-based cohort study included 10,080 term singleton vaginal deliveries (2020–2025) at a tertiary center. Each case was linked to the midwife who attended the patient at the time of admission to the delivery room and provided the initial care. Thirty-five midwives completed a 10-item attitude questionnaire toward LEA, analyzed by principal component analysis to derive the LEA-related concern (PC1) and perceived external influence (PC2) scores. Multivariable regression, stratified by parity, examined associations between midwife characteristics and LEA use, adjusting for maternal and clinical covariates.

Results

The LEA rate was 63.5%, and was more common among primiparas, with admission with lower cervical dilation, and with oxytocin induction (P < 0.001). LEA use decreased with midwife experience, from 70.0% when midwifes’ experience was < 5 years to 55.5% when midwifes’ experience was > 20 years (P < 0.001). In multivariable models, each additional year of experience was independently associated with reduced odds of LEA (primiparas: OR 0.83, 95% CI: 0.76–0.92; multiparas: OR 0.84, 95% CI: 0.79–0.89). Higher LEA-related concern scores (PC1) were associated with lower odds of LEA among primiparas (OR 0.94, 95%CI: 0.89–0.99) but not multiparas.

Conclusions

Midwives’ clinical experience and attitudes toward LEA influence its use in the deliveries they attend, particularly among primiparous patients. These findings underscore the importance of evidence-based counseling to promote informed intrapartum pain management.

背景：分娩硬膜外镇痛（LEA）被广泛用于缓解疼痛，但助产士的态度和经验对其使用的影响尚不清楚。我们调查了助产士的态度和经验是否会影响患者对LEA的使用。方法：这项基于调查的队列研究包括在三级中心（2020-2025）分娩的10080例单胎阴道分娩。每个病例都与在病人进入产房时为其服务并提供初步护理的助产士有关。35名助产士完成了一份包含10个项目的LEA态度问卷，通过主成分分析得出了LEA相关关注（PC1）和感知外部影响（PC2）得分。多变量回归，按胎次分层，检查了助产士特征和LEA使用之间的关系，调整了产妇和临床协变量。结果：LEA率为63.5%，在初产妇中更常见，入院时宫颈扩张度较低，催产素诱导（P 20年）。结论：助产士的临床经验和对LEA的态度影响其在接生中的使用，特别是在初产妇中。这些发现强调了以证据为基础的咨询对促进产中疼痛管理的重要性。

{"title":"Impact of midwife clinical experience and survey-based attitudes towards labor epidural analgesia on utilization rates in pregnant patients: a survey-based cohort study","authors":"R. Abu Shqara , L. Rozenkrantz , S. Nahir Biderman , Y. Perez , T. Domfrocht , A. Aiob , N. Ganem , L. Lowenstein , M. Frank Wolf","doi":"10.1016/j.ijoa.2025.104809","DOIUrl":"10.1016/j.ijoa.2025.104809","url":null,"abstract":"<div><h3>Background</h3><div>Labor epidural analgesia (LEA) is widely used for pain relief, but the impact of midwives’ attitudes and experience on its administration is underexplored. We examined whether midwives’ attitudes and experience influence LEA use among their patients.</div></div><div><h3>Methods</h3><div>This survey-based cohort study included 10,080 term singleton vaginal deliveries (2020–2025) at a tertiary center. Each case was linked to the midwife who attended the patient at the time of admission to the delivery room and provided the initial care. Thirty-five midwives completed a 10-item attitude questionnaire toward LEA, analyzed by principal component analysis to derive the LEA-related concern (PC1) and perceived external influence (PC2) scores. Multivariable regression, stratified by parity, examined associations between midwife characteristics and LEA use, adjusting for maternal and clinical covariates.</div></div><div><h3>Results</h3><div>The LEA rate was 63.5%, and was more common among primiparas, with admission with lower cervical dilation, and with oxytocin induction (<em>P</em> < 0.001). LEA use decreased with midwife experience, from 70.0% when midwifes’ experience was < 5 years to 55.5% when midwifes’ experience was > 20 years (<em>P</em> < 0.001). In multivariable models, each additional year of experience was independently associated with reduced odds of LEA (primiparas: OR 0.83, 95% CI: 0.76–0.92; multiparas: OR 0.84, 95% CI: 0.79–0.89). Higher LEA-related concern scores (PC1) were associated with lower odds of LEA among primiparas (OR 0.94, 95%CI: 0.89–0.99) but not multiparas.</div></div><div><h3>Conclusions</h3><div>Midwives’ clinical experience and attitudes toward LEA influence its use in the deliveries they attend, particularly among primiparous patients. These findings underscore the importance of evidence-based counseling to promote informed intrapartum pain management.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104809"},"PeriodicalIF":2.3,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145409054","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

General anaesthesia for caesarean delivery in women with class 3 obesity: case series from nine hospitals across the north-west of England (2022–2023) 3级肥胖妇女剖宫产的全身麻醉：来自英格兰西北部9家医院的病例系列（2022-2023）

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-10-23 DOI: 10.1016/j.ijoa.2025.104806

A Ashour , B. Roberts , K. Turner , K Bhatia , M. Columb , on behalf of Group of Obstetric Anaesthetist’s of Lancashire, Greater Manchester, and Mersey (GOAL-GM) Study Collaborators

Introduction

The literature is scarce on how to perform general anaesthesia for caesarean delivery in women with class 3 obesity.

Methods

In this retrospective study, we evaluated characteristics related to the conduct of general anaesthesia for elective and non-elective caesarean delivery in 56 pregnant women with class 3 obesity in nine maternity units across the north-west of England, between 2022–2023. We analysed the pre-oxygenation technique, anaesthetic agents utilised, documented hypoxia (SpO₂ ≤ 94%) occurrence, and the frequency of difficult intubation.

Results

A de novo facemask technique was used for preoxygenation in 82% of cases, whilst high-flow nasal oxygen was utilised in 13.2%. Propofol was utilised in 78% whilst an opioid predelivery was administered to 55% of women. Rocuronium was the preferred neuromuscular blocking agent to facilitate endotracheal intubation in 68% of cases. Video laryngoscopy was employed in 68% whilst hypoxia was documented in 25% of women. Difficult intubation occurred in one woman (1.8%, 95% CI 0.0–9.6), and no failed intubations were recorded.

Conclusion

Our study highlights variability in the administration of general anaesthesia for caesarean delivery in women with class 3 obesity, and frequent occurrence of hypoxia. Further research is needed to determine optimal preoxygenation strategy and general anaesthesia technique to minimise hypoxia and difficult intubation risk in this cohort.

关于3级肥胖妇女剖宫产时如何实施全身麻醉的文献很少。方法在这项回顾性研究中，我们评估了2022-2023年间英格兰西北部9个产科单位56名3级肥胖孕妇择期和非择期剖宫产全麻的相关特征。我们分析了预充氧技术、麻醉药物的使用、记录的缺氧（SpO2≤94%）的发生以及插管困难的频率。结果82%的病例采用从头面罩技术进行预充氧，13.2%的病例采用高流量鼻氧。78%的妇女使用异丙酚，55%的妇女在分娩前使用阿片类药物。在68%的病例中，罗库溴铵是促进气管插管的首选神经肌肉阻断剂。68%的女性采用视频喉镜检查，25%的女性有缺氧记录。1名女性出现插管困难（1.8%,95% CI 0.0-9.6），无插管失败记录。结论：我们的研究强调了3级肥胖和经常发生缺氧的妇女剖宫产全麻给药的可变性。需要进一步的研究来确定最佳的预充氧策略和全身麻醉技术，以尽量减少缺氧和插管困难的风险。

{"title":"General anaesthesia for caesarean delivery in women with class 3 obesity: case series from nine hospitals across the north-west of England (2022–2023)","authors":"A Ashour , B. Roberts , K. Turner , K Bhatia , M. Columb , on behalf of Group of Obstetric Anaesthetist’s of Lancashire, Greater Manchester, and Mersey (GOAL-GM) Study Collaborators","doi":"10.1016/j.ijoa.2025.104806","DOIUrl":"10.1016/j.ijoa.2025.104806","url":null,"abstract":"<div><h3>Introduction</h3><div>The literature is scarce on how to perform general anaesthesia for caesarean delivery in women with class 3 obesity.</div></div><div><h3>Methods</h3><div>In this retrospective study, we evaluated characteristics related to the conduct of general anaesthesia for elective and non-elective caesarean delivery in 56 pregnant women with class 3 obesity in nine maternity units across the north-west of England, between 2022–2023. We analysed the pre-oxygenation technique, anaesthetic agents utilised, documented hypoxia (SpO<sub>2</sub> ≤ 94%) occurrence, and the frequency of difficult intubation.</div></div><div><h3>Results</h3><div>A de novo facemask technique was used for preoxygenation in 82% of cases, whilst high-flow nasal oxygen was utilised in 13.2%. Propofol was utilised in 78% whilst an opioid predelivery was administered to 55% of women. Rocuronium was the preferred neuromuscular blocking agent to facilitate endotracheal intubation in 68% of cases. Video laryngoscopy was employed in 68% whilst hypoxia was documented in 25% of women. Difficult intubation occurred in one woman (1.8%, 95% CI 0.0–9.6), and no failed intubations were recorded.</div></div><div><h3>Conclusion</h3><div>Our study highlights variability in the administration of general anaesthesia for caesarean delivery in women with class 3 obesity, and frequent occurrence of hypoxia. Further research is needed to determine optimal preoxygenation strategy and general anaesthesia technique to minimise hypoxia and difficult intubation risk in this cohort.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104806"},"PeriodicalIF":2.3,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462778","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

“This is how we do it” Anaesthesia for uterine transplant and associated surgeries: the Australian-Swedish collaborative protocol 子宫移植及相关手术的麻醉：澳大利亚-瑞典合作协议

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-10-23 DOI: 10.1016/j.ijoa.2025.104800

G. Caponas , R. Deans , S. Letafat , I. Stewart , M. Brännström , J. Abbott , C. Downs

Uterine transplantation represents a groundbreaking fertility treatment for individuals with uterine factor infertility. Since the first successful live birth from uterine transplantation in 2014, surgical technique and outcomes have been widely reported yet published anaesthetic guidance remains limited. Australia’s first uterine transplantation was performed in early 2023 at the Royal Hospital for Women, Sydney, Australia.

Anaesthesia for uterine transplantation is complex, requiring multidisciplinary planning. Donor hysterectomy is an extended procedure (8 to 12 h) involving radical dissection, anticoagulation, thromboembolic prophylaxis, and postoperative pain control, with epidural analgesia. Recipient surgery, while shorter (4 to 7 h), demands coordination between surgical teams to minimise graft ischaemia time and optimise immunosuppressant administration. Aseptic technique and haemodynamic monitoring are critical components of perioperative care.

Following uterine transplantation, recipients may require anaesthesia for cervical biopsies for rejection surveillance or for embryo transfer. These procedures may be prior to, or during pregnancy. Obstetric anaesthetic considerations include the impact of immunosuppression, heightened risks of preeclampsia and acute kidney injury and preterm delivery, and requirements for perioperative planning of caesarean section. Elective and emergency caesarean deliveries can be successfully managed with combined spinal-epidural anaesthesia, with special attention to haemorrhage risk and postoperative analgesia. The final stage of the uterine transplantation pathway is graft hysterectomy, performed electively following completed fertility treatment or for medical indications.

This review outlines the anaesthetic considerations for uterine transplantation and all related surgeries, providing insights into perioperative planning, multidisciplinary collaboration, and evolving protocols drawing on the experience at the Royal Hospital for Women.

The uterine transplants referred to in this paper were part of a clinical trial, registration number ACTRN12622000917730, Ethics approval 2019/ETH13038.

子宫移植是一种开创性的生育治疗与子宫因素不孕的个体。自2014年首例成功的子宫移植活产以来，手术技术和结果被广泛报道，但发表的麻醉指导仍然有限。澳大利亚首例子宫移植手术于2023年初在澳大利亚悉尼皇家妇女医院进行。子宫移植的麻醉是复杂的，需要多学科的规划。供体子宫切除术是一个延长的过程（8至12小时），涉及根治性清扫、抗凝、血栓栓塞预防和术后疼痛控制，并伴有硬膜外镇痛。受体手术虽然较短（4至7小时），但需要手术团队之间的协调，以最大限度地减少移植物缺血时间并优化免疫抑制剂的施用。无菌技术和血流动力学监测是围手术期护理的重要组成部分。子宫移植后，受者可能需要麻醉进行宫颈活检以监测排斥反应或胚胎移植。这些程序可以在怀孕前或怀孕期间进行。产科麻醉的考虑因素包括免疫抑制的影响、子痫前期、急性肾损伤和早产的风险增加以及剖宫产围手术期计划的要求。选择性和紧急剖宫产可通过脊髓-硬膜外联合麻醉成功管理，特别注意出血风险和术后镇痛。子宫移植途径的最后阶段是移植物子宫切除术，在完成生育治疗或医学指征后选择性地进行。这篇综述概述了子宫移植和所有相关手术的麻醉注意事项，为围手术期计划、多学科合作和借鉴皇家妇女医院经验的发展方案提供了见解。本文中提到的子宫移植是临床试验的一部分，注册号为ACTRN12622000917730，伦理批准2019/ETH13038。

{"title":"“This is how we do it” Anaesthesia for uterine transplant and associated surgeries: the Australian-Swedish collaborative protocol","authors":"G. Caponas , R. Deans , S. Letafat , I. Stewart , M. Brännström , J. Abbott , C. Downs","doi":"10.1016/j.ijoa.2025.104800","DOIUrl":"10.1016/j.ijoa.2025.104800","url":null,"abstract":"<div><div>Uterine transplantation represents a groundbreaking fertility treatment for individuals with uterine factor infertility. Since the first successful live birth from uterine transplantation in 2014, surgical technique and outcomes have been widely reported yet published anaesthetic guidance remains limited. Australia’s first uterine transplantation was performed in early 2023 at the Royal Hospital for Women, Sydney, Australia.</div><div>Anaesthesia for uterine transplantation is complex, requiring multidisciplinary planning. Donor hysterectomy is an extended procedure (8 to 12 h) involving radical dissection, anticoagulation, thromboembolic prophylaxis, and postoperative pain control, with epidural analgesia. Recipient surgery, while shorter (4 to 7 h), demands coordination between surgical teams to minimise graft ischaemia time and optimise immunosuppressant administration. Aseptic technique and haemodynamic monitoring are critical components of perioperative care.</div><div>Following uterine transplantation, recipients may require anaesthesia for cervical biopsies for rejection surveillance or for embryo transfer. These procedures may be prior to, or during pregnancy. Obstetric anaesthetic considerations include the impact of immunosuppression, heightened risks of preeclampsia and acute kidney injury and preterm delivery, and requirements for perioperative planning of caesarean section. Elective and emergency caesarean deliveries can be successfully managed with combined spinal-epidural anaesthesia, with special attention to haemorrhage risk and postoperative analgesia. The final stage of the uterine transplantation pathway is graft hysterectomy, performed electively following completed fertility treatment or for medical indications.</div><div>This review outlines the anaesthetic considerations for uterine transplantation and all related surgeries, providing insights into perioperative planning, multidisciplinary collaboration, and evolving protocols drawing on the experience at the Royal Hospital for Women.</div><div>The uterine transplants referred to in this paper were part of a clinical trial, registration number ACTRN12622000917730, Ethics approval 2019/ETH13038.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104800"},"PeriodicalIF":2.3,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417459","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

Anesthetic management of congenital methemoglobinemia in emergency caesarean delivery: a case report 急诊剖宫产中先天性高铁血红蛋白血症的麻醉处理：1例报告

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-10-22 DOI: 10.1016/j.ijoa.2025.104807

M. Büyükcavlak

引用次数: 0

Outcomes with intrathecal 2-chloroprocaine 3% 60 mg and fentanyl 15 μg for cervical cerclage: a retrospective quality assurance study (2021 – 2023) 鞘内2-氯普鲁卡因3% 60 mg和芬太尼15 μg用于宫颈环扎术的结果：一项回顾性质量保证研究（2021 - 2023）

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-10-22 DOI: 10.1016/j.ijoa.2025.104808

Ebubechukwu Obiora , Richard M. Smiley , Prahlad G. Menon , Allison J. Lee

Background

In a prior study at our institution comparing intrathecal chloroprocaine to bupivacaine for spinal anesthesia for cervical cerclage, the use of intrathecal 2- chloroprocaine 3% 50 mg with fentanyl 15 μg was associated with intraoperative discomfort in 9% of patients, prompting a practice change to increase the dose to 60 mg. We report outcomes from two years of experience with the higher dose.

Methods

We conducted a retrospective chart review of patients who underwent transvaginal cervical cerclage with spinal anesthesia with 2-chloroprocaine 3% 60 mg and fentanyl 15 μg (July 2021 − July 2023). Outcomes included surgery duration, anesthetic supplementation, time from spinal injection to meet discharge criteria, and postoperative concerns documented during postoperative day 1 phone calls (n=122, available from July 2022).

Results

A total of 208 patients were included. The median surgery duration was 17 [11–25] min. A lower supplementation rate was observed with 60 mg (2% vs 9% (2/22)), but the study lacked statistical power to confirm a significant difference (P = 0.104); none required general anesthesia. The median time from spinal injection to discharge was 186 [163–218] min, compared with 158 [137–188] min in the prior 50 mg cohort (median difference −15.0 min (−20.5 to −9.5, P < 0.001). No patients reported transient neurologic symptoms, difficulty ambulating, or voiding. One reported back pain, and three reported abdominal discomfort.

Conclusion

Intrathecal 2-chloroprocaine 3% 60 mg with fentanyl showed fewer anesthetic failures (but this was not statistically significant) and a modestly longer discharge time than 50 mg.

在我们机构之前的一项研究中，比较了鞘内氯普鲁卡因和布比卡因用于颈椎环扎术的脊髓麻醉，鞘内使用2-氯普鲁卡因3% 50 mg和芬太尼15 μg与9%的患者术中不适相关，促使实践改变剂量增加到60 mg。我们报告两年来高剂量治疗的结果。方法回顾性分析2021年7月~ 2023年7月在2-氯普鲁卡因3% 60 mg和芬太尼15 μg脊髓麻醉下行阴道宫颈环切术的患者。结果包括手术持续时间、麻醉补充、从脊髓注射到满足出院标准的时间，以及术后第1天电话记录的术后问题（n=122，从2022年7月开始）。结果共纳入患者208例。中位手术时间为17[11-25]分钟。60 mg组的补给率较低（2% vs 9%(2/22)），但该研究缺乏统计学能力来证实显著差异（P = 0.104）；没有人需要全身麻醉。从脊髓注射到出院的中位时间为186[163-218]分钟，而先前50 mg队列的中位时间为158[137-188]分钟(中位差异为- 15.0分钟（- 20.5至- 9.5,P < 0.001）。无患者报告短暂性神经症状、行走困难或排尿。1人报告背部疼痛，3人报告腹部不适。结论鞘内2-氯普鲁卡因3% 60 mg联合芬太尼麻醉失败较少（但无统计学意义），出院时间略长于50 mg。

{"title":"Outcomes with intrathecal 2-chloroprocaine 3% 60 mg and fentanyl 15 μg for cervical cerclage: a retrospective quality assurance study (2021 – 2023)","authors":"Ebubechukwu Obiora , Richard M. Smiley , Prahlad G. Menon , Allison J. Lee","doi":"10.1016/j.ijoa.2025.104808","DOIUrl":"10.1016/j.ijoa.2025.104808","url":null,"abstract":"<div><h3>Background</h3><div>In a prior study at our institution comparing intrathecal chloroprocaine to bupivacaine for spinal anesthesia for cervical cerclage, the use of intrathecal 2- chloroprocaine 3% 50 mg with fentanyl 15 μg was associated with intraoperative discomfort in 9% of patients, prompting a practice change to increase the dose to 60 mg. We report outcomes from two years of experience with the higher dose.</div></div><div><h3>Methods</h3><div>We conducted a retrospective chart review of patients who underwent transvaginal cervical cerclage with spinal anesthesia with 2-chloroprocaine 3% 60 mg and fentanyl 15 μg (July 2021 − July 2023). Outcomes included surgery duration, anesthetic supplementation, time from spinal injection to meet discharge criteria, and postoperative concerns documented during postoperative day 1 phone calls (n=122, available from July 2022).</div></div><div><h3>Results</h3><div>A total of 208 patients were included. The median surgery duration was 17 [11–25] min. A lower supplementation rate was observed with 60 mg (2% vs 9% (2/22)), but the study lacked statistical power to confirm a significant difference (<em>P</em> = 0.104); none required general anesthesia. The median time from spinal injection to discharge was 186 [163–218] min, compared with 158 [137–188] min in the prior 50 mg cohort (median difference −15.0 min (−20.5 to −9.5, <em>P</em> < 0.001). No patients reported transient neurologic symptoms, difficulty ambulating, or voiding. One reported back pain, and three reported abdominal discomfort.</div></div><div><h3>Conclusion</h3><div>Intrathecal 2-chloroprocaine 3% 60 mg with fentanyl showed fewer anesthetic failures (but this was not statistically significant) and a modestly longer discharge time than 50 mg.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104808"},"PeriodicalIF":2.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145358974","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

In response to “Obstetric anesthesia in Japan: an existential crisis in need of an intervention” 回应“日本的产科麻醉：需要干预的生存危机”

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-10-21 DOI: 10.1016/j.ijoa.2025.104805

K. Ogawa, H. Azuma, F. Shimizu, K. Yamano, S. Wada

引用次数: 0

Ultrasound assessment of cricothyroid membrane anatomy before and after labor: a prospective observational study 产前和产后环甲膜解剖的超声评估：一项前瞻性观察研究

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-10-19 DOI: 10.1016/j.ijoa.2025.104802

J.F. Casellato , F.B. Zasso , E. Wild , X.Y. Ye , K. Downey , E. You-Ten , N. Siddiqui

Background

Pregnant patients are at increased risk of airway management difficulties. Ultrasound is a valuable tool for predicting difficult intubation and improving cricothyrotomy success in simulation models. We investigated whether labor and delivery alter the anatomy of the cricothyroid membrane. Methods: In this prospective observational study, we enrolled parturients in early active labor. Ultrasound was used to measure cricothyroid membrane depth (primary outcome), and cricothyroid membrane height and neck circumference (secondary outcomes). Measurements at enrollment and post-delivery were compared using the Wilcoxon signed-rank test. Results: Fifty patients were included in the final analysis. At enrollment, the median [interquartile range] cricothyroid membrane depth was 0.80 [0.63–0.96] cm, height 1.03 [0.80–1.16] cm, and neck circumference 37.0 [34.5–38.5] cm. Cricothyroid membrane depth and neck circumference were significantly greater after labor (median difference 0.03 cm, 95% CI 0.004 to 0.09, P = 0.034; and 1.0 cm, 95% CI 0.50 to 1.50, P < 0.001, respectively), while cricothyroid membrane height remained unchanged (median difference 0.01 cm, 95% CI –0.06 to 0.10, P = 0.85). Body mass index ≥35 and total oxytocin dose were associated with increased neck circumference; no other labor-related factors were significantly associated with cricothyroid membrane measurements. Conclusion: cricothyroid membrane depth increased slightly during labor, but the change fell within expected ultrasound variability and is unlikely to be clinically significant. Neck circumference increased and was associated with body mass index ≥35 and oxytocin dose. These findings require validation in larger studies.

背景：孕妇气道管理困难的风险增加。在模拟模型中，超声是预测插管困难和提高环甲环切开术成功率的有价值的工具。我们研究了分娩是否会改变环甲膜的解剖结构。方法：在这项前瞻性观察研究中，我们招募了早期活产的产妇。超声测量环甲膜深度（主要结局）、环甲膜高度和颈围（次要结局）。采用Wilcoxon符号秩检验比较入组时和分娩后的测量值。结果：50例患者纳入最终分析。入组时，环甲膜深度中位数[四分位数间距]为0.80 [0.63-0.96]cm，高度为1.03 [0.80 - 1.16]cm，颈围为37.0 [34.5-38.5]cm，产程后环甲膜深度和颈围明显大于产程后(中位数差异0.03 cm, 95% CI 0.004 ~ 0.09, P = 0.034；和1.0 cm， 95% CI分别为0.50 ~ 1.50,P < 0.001)，而环甲膜高度保持不变（中位数差异为0.01 cm， 95% CI为-0.06 ~ 0.10,P = 0.85）。体重指数≥35和催产素总剂量与颈围增加相关；没有其他与劳动相关的因素与环甲膜测量显著相关。结论：产程中环甲膜深度略有增加，但这种变化在超声变异性范围内，不太可能具有临床意义。颈围增加，并与体重指数≥35和催产素剂量相关。这些发现需要在更大规模的研究中得到验证。

{"title":"Ultrasound assessment of cricothyroid membrane anatomy before and after labor: a prospective observational study","authors":"J.F. Casellato , F.B. Zasso , E. Wild , X.Y. Ye , K. Downey , E. You-Ten , N. Siddiqui","doi":"10.1016/j.ijoa.2025.104802","DOIUrl":"10.1016/j.ijoa.2025.104802","url":null,"abstract":"<div><h3>Background</h3><div>Pregnant patients are at increased risk of airway management difficulties. Ultrasound is a valuable tool for predicting difficult intubation and improving cricothyrotomy success in simulation models. We investigated whether labor and delivery alter the anatomy of the cricothyroid membrane. Methods: In this prospective observational study, we enrolled parturients in early active labor. Ultrasound was used to measure cricothyroid membrane depth (primary outcome), and cricothyroid membrane height and neck circumference (secondary outcomes). Measurements at enrollment and post-delivery were compared using the Wilcoxon signed-rank test. Results: Fifty patients were included in the final analysis. At enrollment, the median [interquartile range] cricothyroid membrane depth was 0.80 [0.63–0.96] cm, height 1.03 [0.80–1.16] cm, and neck circumference 37.0 [34.5–38.5] cm. Cricothyroid membrane depth and neck circumference were significantly greater after labor (median difference 0.03 cm, 95% CI 0.004 to 0.09, <em>P</em> = 0.034; and 1.0 cm, 95% CI 0.50 to 1.50, <em>P</em> < 0.001, respectively), while cricothyroid membrane height remained unchanged (median difference 0.01 cm, 95% CI –0.06 to 0.10, <em>P</em> = 0.85). Body mass index ≥35 and total oxytocin dose were associated with increased neck circumference; no other labor-related factors were significantly associated with cricothyroid membrane measurements. Conclusion: cricothyroid membrane depth increased slightly during labor, but the change fell within expected ultrasound variability and is unlikely to be clinically significant. Neck circumference increased and was associated with body mass index ≥35 and oxytocin dose. These findings require validation in larger studies.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104802"},"PeriodicalIF":2.3,"publicationDate":"2025-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145359047","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

Obstetric critical care admissions to a tertiary referral hospital from a level 1 obstetric unit in Ireland – a single center retrospective observational study (2019–2023) 爱尔兰一级产科住院至三级转诊医院的产科重症住院情况——一项单中心回顾性观察研究（2019-2023年）。

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-10-17 DOI: 10.1016/j.ijoa.2025.104803

Ciara Luke, Amy Walsh, Sabina Czernecka, Erika Shanley, Seosamh O’ Riain, Nicholas Barrett, Catherine M. Nix

Background

Current gaps in the provision of obstetric critical care in Europe, potentially compromising patient safety and the childbirth experience, have been recognised. However, data on indications for critical care admission from stand-alone obstetric units remain scarce. We evaluated the indications for transfer from a community level 1 obstetric unit to the critical care department of a tertiary referral hospital, and describe management of these obstetric admissions.

Methods

All obstetric admissions to the high dependency/intensive care unit in a tertiary referral hospital providing critical care services to a level 1 obstetric unit in Ireland were evaluated. Data collected included the indication for transfer, obstetric data, type and number of organ support, length of stay, and maternal outcomes.

Results

Between 2019 and 2023, 81 women were admitted to the critical care department of which 24 were still pregnant (29.6%), with haemorrhage as the most common indication. Obstetric admission represented 0.9% of high dependency and 1.9% of all intensive care unit admissions. Mechanical ventilation occurred in 40% of intensive care admissions, and

\geq

2 types of organ support in 36% of patients. There were no maternal deaths.

Conclusion

Less than 0.5% of obstetric patients were transferred from a stand-alone obstetric unit for maternal critical care. Though obstetric patients represented only 1.9% of all intensive care unit admissions in the tertiary referral centre, a significant proportion were admitted before delivery. This emphasizes the importance for critical care staff to be adequately trained and resourced in the management of pregnant and postpartum patients.

背景：目前在欧洲提供产科重症护理的差距，可能危及患者安全和分娩经验，已被承认。然而，关于独立产科病房重症监护入院指征的数据仍然很少。我们评估了从社区一级产科转到三级转诊医院重症监护室的指征，并描述了这些产科入院的管理。方法：对爱尔兰一家三级转诊医院的高依赖性/重症监护病房的所有产科入院情况进行评估，该医院为一级产科病房提供重症监护服务。收集的数据包括转院指征、产科数据、器官支持类型和数量、住院时间和产妇结局。结果：2019年至2023年，81名妇女入住重症监护室，其中24名仍在怀孕（29.6%），出血是最常见的指征。产科住院占高度依赖患者的0.9%，占所有重症监护病房住院患者的1.9%。40%的重症监护住院患者采用机械通气，36%的患者采用≥2种器官支持。没有产妇死亡。结论：不到0.5%的产科患者从独立产科病房转到产妇重症监护。虽然产科病人只占三级转诊中心重症监护病房入院人数的1.9%，但很大一部分是在分娩前入院的。这强调了重症监护人员在管理孕妇和产后患者方面得到充分培训和资源的重要性。

{"title":"Obstetric critical care admissions to a tertiary referral hospital from a level 1 obstetric unit in Ireland – a single center retrospective observational study (2019–2023)","authors":"Ciara Luke, Amy Walsh, Sabina Czernecka, Erika Shanley, Seosamh O’ Riain, Nicholas Barrett, Catherine M. Nix","doi":"10.1016/j.ijoa.2025.104803","DOIUrl":"10.1016/j.ijoa.2025.104803","url":null,"abstract":"<div><h3>Background</h3><div>Current gaps in the provision of obstetric critical care in Europe, potentially compromising patient safety and the childbirth experience, have been recognised. However, data on indications for critical care admission from stand-alone obstetric units remain scarce. We evaluated the indications for transfer from a community level 1 obstetric unit to the critical care department of a tertiary referral hospital, and describe management of these obstetric admissions.</div></div><div><h3>Methods</h3><div>All obstetric admissions to the high dependency/intensive care unit in a tertiary referral hospital providing critical care services to a level 1 obstetric unit in Ireland were evaluated. Data collected included the indication for transfer, obstetric data, type and number of organ support, length of stay, and maternal outcomes.</div></div><div><h3>Results</h3><div>Between 2019 and 2023, 81 women were admitted to the critical care department of which 24 were still pregnant (29.6%), with haemorrhage as the most common indication. Obstetric admission represented 0.9% of high dependency and 1.9% of all intensive care unit admissions. Mechanical ventilation occurred in 40% of intensive care admissions, and <span><math><mo>≥</mo></math></span> 2 types of organ support in 36% of patients. There were no maternal deaths.</div></div><div><h3>Conclusion</h3><div>Less than 0.5% of obstetric patients were transferred from a stand-alone obstetric unit for maternal critical care. Though obstetric patients represented only 1.9% of all intensive care unit admissions in the tertiary referral centre, a significant proportion were admitted before delivery. This emphasizes the importance for critical care staff to be adequately trained and resourced in the management of pregnant and postpartum patients.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104803"},"PeriodicalIF":2.3,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604179","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