International journal of obstetric anesthesia最新文献

英文中文

Felicity Reynolds (1935 – 2024) 费利西蒂-雷诺兹

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2024-07-26 DOI: 10.1016/j.ijoa.2024.104240

Robin Russell

引用次数: 0

AI-augmented vs. conventional cardiac POCUS training: a pilot study among obstetric anesthesiologists 人工智能增强与传统心脏 POCUS 培训的对比：产科麻醉医师试点研究

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2024-07-23 DOI: 10.1016/j.ijoa.2024.104238

S. Johnson , S. Feldman , R. Gessouroun , M. Fuller , M. Stafford-Smith , Y.S. Bronshteyn , M.L. Meng

引用次数: 0

Do essential oil diffusers during labor pose a contamination risk to sterile neuraxial procedures? 分娩时使用精油喷雾器会对无菌神经麻醉手术造成污染风险吗？

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2024-07-23 DOI: 10.1016/j.ijoa.2024.104237

N. Lemoine, B. Wakefield, W. Agee, J. Bauchat, H. Ende, B. Raymond

引用次数: 0

Pre-oxygenation using high flow humidified nasal oxygen or face mask oxygen in pregnant people – a prospective randomised controlled crossover non-inferiority study (The HINOP2 study) 孕妇使用高流量鼻氧或面罩氧进行预吸氧--前瞻性随机对照交叉非劣效研究（HINOP2 研究）

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2024-07-23 DOI: 10.1016/j.ijoa.2024.104236

P.C.F. Tan , P.J. Peyton , A. Deane , J. Unterscheider , A.T. Dennis

Background

Airway guidelines recommend pre-oxygenation of obstetric patients to an end tidal oxygen concentration (etO₂) ≥90%. High flow nasal oxygen (HFNO) achieves this in 60% of pregnant people. However face mask (FM) pre-oxygenation also may not achieve this target in all patients. In this study we determined whether HFNO pre-oxygenation is non-inferior to FM pre-oxygenation.

Methods

This randomised controlled crossover non-inferiority trial was conducted on healthy participants of gestational age ≥37 weeks in a simulated environment. Participants underwent pre-oxygenation for three minutes with HFNO and FM oxygen in randomised order. HFNO was delivered at a maximal flow of 70 l.min^-1 and FM oxygen at 10 l.min^-1. The primary outcome was etO₂ on first expired breath after pre-oxygenation. Non-inferiority was defined as a mean difference in first etO₂ between groups of ≤5%.

Results

Seventy participants were randomised with 62 analysed. Age (mean (SD)), gestation (median (IQR)), and body mass index (median (IQR)), were 34.7 (4.6) years, 39 (38.4, 39.4) weeks, 29 (26.6, 32.4) kg.m^-2 respectively. First etO₂ after HFNO pre-oxygenation was greater than after FM pre-oxygenation (HFNO pre-oxygenation mean (SD) 90.2 (3.9)% versus FM pre-oxygenation 88.7 (3.0)%; mean difference = 1.45%, 95% CI 0.19 to 2.72%; p = 0.025. Forty-four (71%) participants achieved ≥90% first etO₂ concentration after HFNO pre-oxygenation versus 27 (44%) after FM pre-oxygenation (p = 0.002).

Conclusions

In this cohort of pregnant people at term in a simulated environment, pre-oxygenation with HFNO was not inferior to FM pre-oxygenation. FM pre-oxygenation did not achieve pre-oxygenation targets in over 50% of participants.

背景气道指南建议对产科病人进行预吸氧，使潮气末氧浓度（etO2）≥90%。高流量鼻氧 (HFNO) 可使 60% 的孕妇达到这一目标。然而，面罩（FM）预吸氧也不一定能使所有患者达到这一目标。在这项研究中，我们确定了高流量鼻氧预吸氧是否不劣于调频预吸氧。方法这项随机对照交叉非劣效性试验是在模拟环境中对孕龄≥37 周的健康参与者进行的。参与者按随机顺序接受高频硝化氧和调频氧预吸氧三分钟。高频硝化氧的最大流量为 70 升/分钟，调频氧的最大流量为 10 升/分钟。主要结果是预吸氧后第一次呼气时的 etO2。非劣效性的定义是组间首次等氧饱和度的平均差异≤5%。年龄（平均值（标清））、孕期（中位数（IQR））和体重指数（中位数（IQR））分别为 34.7 (4.6) 岁、39 (38.4, 39.4) 周和 29 (26.6, 32.4) kg.m-2。HFNO 预吸氧后的首次等氧饱和度高于 FM 预吸氧后（HFNO 预吸氧平均值（标清）90.2 (3.9)% 对 FM 预吸氧 88.7 (3.0)%；平均差异 = 1.45%，95% CI 0.19 至 2.72%；P = 0.025）。结论在模拟环境中对这组临产孕妇进行高频硝化氧预吸氧并不比调频预吸氧差。调频预吸氧在 50% 以上的参与者中无法达到预吸氧目标。

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引用次数: 0

Postpartum neurological deficits following neuraxial intervention: a retrospective analysis in a tertiary obstetric centre (2021-2023) 神经轴介入术后产后神经功能缺损：一家三级产科中心的回顾性分析

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2024-07-18 DOI: 10.1016/j.ijoa.2024.104234

A.M. Brumby, M. Bright, S. Maffey, E. Schulz

引用次数: 0

Pain during caesarean delivery in a tertiary maternity hospital: a retrospective cohort study (2022–2023) 一家三级妇产医院剖腹产术中疼痛分析

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2024-07-18 DOI: 10.1016/j.ijoa.2024.104235

Ciara Luke, Lorcan O’ Carroll, Roger McMorrow

Background

Intra-operative pain during Caesarean delivery (PDCD) is the leading cause of successful litigation against obstetric anaesthesiologists. PDCD may require conversion to general anaesthesia (GA). The aim of this analysis is to assess our incidence of PDCD and associated GA conversion.

Methods

Data were collected from electronic patient records. Data included baseline demographics, incidence of PDCD and rates of GA conversion, proportion of PDCD cases attributable to failed epidural (EA) or spinal anaesthesia (SA), and level of sensory and motor blockade in cases of PDCD. Results were audited against current standards set by the Royal College of Anaesthetists ‘rates of PDCD should be <5% for category 4, <15% for categories 2-3, and <20 % for category 1 CD ’ and that ‘rates of conversion to GA due to neuraxial complications should be <1% for category 4, <5% for categories 2-3 and <15% for category 1 patients’.

Results

During the 12-month study period, 2,429 patients underwent CD, of whom 52 (2.1%) experienced PDCD. The incidence of PDCD was 3.1% (41/1,309) for category 1-3 patients, while 1% (11/1,120) of category 4 patients experienced PDS. Of the 52 patients with PDCD, 17 patients required GA (33%). SA was used in 24/52 (47%) cases and EA in 28/52 (53%) cases. The median level of sensory block in patients with PDCD was located at the T4 dermatome, the median level of motor block was Bromage level 2.

Conclusions

PDCD occurred in 2.1% of CD, one-third required conversion to GA. Most patients experiencing PDCD met current motor and sensory blockade criteria.

背景剖腹产术中疼痛（PDCD）是导致产科麻醉医师胜诉的主要原因。PDCD可能需要转为全身麻醉（GA）。本分析旨在评估我们的 PDCD 发生率和相关的 GA 转换情况。数据包括基线人口统计学、PDCD 发生率和全身麻醉转换率、硬膜外麻醉（EA）或脊髓麻醉（SA）失败导致的 PDCD 病例比例，以及 PDCD 病例中的感觉和运动阻滞水平。根据英国皇家麻醉师学院制定的现行标准对结果进行了审核，该标准规定："第 4 类患者的 PDCD 发生率应为 5%，第 2-3 类患者的 PDCD 发生率应为 15%，第 1 类患者的 PDCD 发生率应为 20%"，"因神经轴并发症而转为 GA 的发生率应为：第 4 类患者 1%，第 2-3 类患者 5%，第 1 类患者 15%"。1-3 类患者的 PDCD 发生率为 3.1%（41/1,309），而 1%（11/1,120）的 4 类患者经历了 PDS。在 52 名 PDCD 患者中，17 名患者需要进行 GA（33%）。24/52（47%）例患者使用了 SA，28/52（53%）例患者使用了 EA。PDCD 患者感觉阻滞的中位水平位于 T4 皮节，运动阻滞的中位水平为 Bromage 2 水平。大多数 PDCD 患者符合当前的运动和感觉阻滞标准。

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引用次数: 0

Anaesthetic management of obstetric patients with Chiari type I malformation: a retrospective case series and literature review Chiari I 型畸形产妇的麻醉管理：回顾性病例系列和文献综述

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2024-07-17 DOI: 10.1016/j.ijoa.2024.104232

A. Simpson , C. Ferguson

The peripartum management of obstetric patients with Chiari type I malformation remains a challenge due to the degree of cerebellar tonsillar herniation and a paucity of published evidence. There is concern about neuraxial anaesthetic blocks and uncertainty regarding the optimum mode of delivery.

We systematically searched the literature for the obstetric management of patients with Chiari type I malformation, independent of publication date and language. We also searched our local hospital database from December 2009 to December 2022 for all deliveries to patients with this condition. We identified 137 cases comprising 103 deliveries described in 40 publications that met our inclusion criteria; 34 deliveries were identified in our local database. There were 84 spontaneous vaginal deliveries, 52 caesarean deliveries, and one delivery by unknown modality. Sixty neuraxial blocks were performed; approximately half of these were epidural procedures for labour analgesia. Six patients had new or worsened symptoms following delivery, but it is unclear whether these were related to their Chiari malformation. We identified no cases with brainstem herniation or severe symptoms.

We discuss our findings in relation to other published literature and address the concerns described. Our review reveals the use of a variety of modes of delivery and anaesthetic techniques and that most patients suffered no neurological complication. We conclude there is no of evidence to avoid any one approach to labour analgesia, delivery and anaesthesia. We propose a holistic, individualised and patient-centred approach with an appraisal of the risks and benefits to support shared-decision making.

由于小脑扁桃体疝的程度和已发表证据的匮乏，对患有 Chiari I 型畸形的产科患者进行围产期管理仍是一项挑战。我们系统地检索了有关I型脊柱畸形患者产科管理的文献，这些文献不受发表日期和语言的限制。我们还检索了本地医院数据库中 2009 年 12 月至 2022 年 12 月期间所有此类患者的分娩情况。我们发现了 137 例符合纳入标准的病例，其中包括 40 篇出版物中描述的 103 例分娩；本地数据库中还发现了 34 例分娩。其中 84 例为阴道自然分娩，52 例为剖腹产，1 例分娩方式不明。共进行了 60 次神经阻滞，其中约一半是用于分娩镇痛的硬膜外手术。六名患者在分娩后出现了新的症状或症状加重，但尚不清楚这些症状是否与恰里畸形有关。我们没有发现脑干疝或严重症状的病例。我们结合其他已发表的文献讨论了我们的研究结果，并解决了所述的问题。我们的综述显示使用了多种分娩方式和麻醉技术，大多数患者没有出现神经系统并发症。我们的结论是，没有证据表明分娩镇痛、分娩和麻醉应避免使用任何一种方法。我们建议采用整体、个性化和以患者为中心的方法，并对风险和益处进行评估，以支持共同决策。

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引用次数: 0

Obstetric anesthesia considerations in pregnancy-associated myocardial infarction: a focused review "妊娠合并心肌梗死的产科麻醉注意事项：重点回顾"

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2024-07-17 DOI: 10.1016/j.ijoa.2024.104233

E.E. Sharpe , C.H. Rose , M.S. Tweet

Pregnancy-associated myocardial infarction (PAMI) is a rare but serious complication that can occur either during pregnancy or postpartum. The etiologies of PAMI are atherosclerosis, spontaneous coronary artery dissection, coronary thrombosis, coronary embolism, and coronary vasospasm. Therapy of acute PAMI depends largely on the ECG presentation, hemodynamic stability, and suspected etiology of myocardial infarction. Anesthetic management during delivery in patients with PAMI should consist of early and carefully titrated neuraxial analgesia and anesthesia, maintenance of normal sinus rhythm, preservation of afterload, and monitoring for and avoiding myocardial ischemia. To improve the care of women with PAMI, a multidisciplinary team of cardiologists, maternal fetal medicine specialists, obstetric providers, neonatologists, and anesthesiologists must work collectively to manage these complex patients.

妊娠相关性心肌梗死（PAMI）是一种罕见但严重的并发症，可发生在妊娠期或产后。PAMI 的病因包括动脉粥样硬化、自发性冠状动脉夹层、冠状动脉血栓形成、冠状动脉栓塞和冠状动脉血管痉挛。急性 PAMI 的治疗主要取决于心电图表现、血液动力学稳定性和心肌梗死的可疑病因。PAMI 患者分娩时的麻醉管理应包括早期和仔细滴定的神经镇痛和麻醉、维持正常窦性心律、保护后负荷以及监测和避免心肌缺血。为了改善对 PAMI 患者的护理，由心脏病专家、母体胎儿医学专家、产科医生、新生儿专家和麻醉专家组成的多学科团队必须通力合作，共同管理这些复杂的患者。

引用次数: 0

Retrograde intravenous cannulation: an alternative approach for blood draw for epidural blood patch 逆行静脉插管用于硬膜外血液补片

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2024-07-17 DOI: 10.1016/j.ijoa.2024.104231

Lim Rui Chun Sean , Jingzhi An

引用次数: 0

Corrigendum to “Association of free maternal and fetal ropivacaine after epidural analgesia for intrapartum caesarean delivery: a prospective observational trial” [Int J Obstet Anesth. 2024;58:103975] 产后剖宫产硬膜外镇痛后母体和胎儿游离罗哌卡因的关联：一项前瞻性观察试验"[Int J Obstet Anesth.］

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2024-07-16 DOI: 10.1016/j.ijoa.2024.104219

J. Amian , C.F. Weber , M. Sonntagbauer , L. Messroghli , F. Louwen , H. Buxmann , A. Paulke , K. Zacharowski

引用次数: 0

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