Pub Date : 2024-10-24DOI: 10.1016/j.ijoa.2024.104288
A.Y.H. Kong , N. Liu , H.S. Tan , A.T.H. Sia , B.L. Sng
The use of artificial intelligence (AI) in obstetric anaesthesiology shows great potential in enhancing our practice and delivery of care. In this narrative review, we summarise the current applications of AI in four key areas of obstetric anaesthesiology (perioperative care, neuraxial procedures, labour analgesia and obstetric critical care), where AI has been employed to varying degrees for decision support, event prediction, risk stratification and procedural assistance. We also identify gaps in current practice and propose areas for further research. While promising, AI cannot replace the expertise and clinical judgement of a trained obstetric anaesthesiologist. It should, instead, be viewed as a valuable tool to facilitate and support our practice.
{"title":"Artificial intelligence in obstetric anaesthesiology – the future of patient care?","authors":"A.Y.H. Kong , N. Liu , H.S. Tan , A.T.H. Sia , B.L. Sng","doi":"10.1016/j.ijoa.2024.104288","DOIUrl":"10.1016/j.ijoa.2024.104288","url":null,"abstract":"<div><div>The use of artificial intelligence (AI) in obstetric anaesthesiology shows great potential in enhancing our practice and delivery of care. In this narrative review, we summarise the current applications of AI in four key areas of obstetric anaesthesiology (perioperative care, neuraxial procedures, labour analgesia and obstetric critical care), where AI has been employed to varying degrees for decision support, event prediction, risk stratification and procedural assistance. We also identify gaps in current practice and propose areas for further research. While promising, AI cannot replace the expertise and clinical judgement of a trained obstetric anaesthesiologist. It should, instead, be viewed as a valuable tool to facilitate and support our practice.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104288"},"PeriodicalIF":2.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692927","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}
Pub Date : 2024-10-19DOI: 10.1016/j.ijoa.2024.104287
A. Brenders , T. Bleeser , J. Deprest , S. Rex , S. Devroe
{"title":"Effect of vasoactive drugs used for management of hypotension during pregnancy on uterine hemodynamic parameters: a systematic review and meta-analysis of preclinical and clinical studies","authors":"A. Brenders , T. Bleeser , J. Deprest , S. Rex , S. Devroe","doi":"10.1016/j.ijoa.2024.104287","DOIUrl":"10.1016/j.ijoa.2024.104287","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104287"},"PeriodicalIF":2.6,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698119","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}
Pub Date : 2024-10-09DOI: 10.1016/j.ijoa.2024.104282
Sharon C. Reale, Michaela K. Farber
{"title":"High flow nasal cannula: A new tool for obstetric pre-oxygenation","authors":"Sharon C. Reale, Michaela K. Farber","doi":"10.1016/j.ijoa.2024.104282","DOIUrl":"10.1016/j.ijoa.2024.104282","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104282"},"PeriodicalIF":2.6,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686782","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}
Pub Date : 2024-10-09DOI: 10.1016/j.ijoa.2024.104284
A. Faruja , A. Idelson , K. Azem , L. Yosef , K. Tenenbaum-Gavish , N.R. Duvdevani , S. Fein , S. Orbach-Zinger , Y. Gielchinsky
Fetal surgery presents distinctive anesthetic challenges due to the need to balance maternal and fetal safety. This retrospective study evaluates the anesthetic management strategies used at a single center for various fetal interventions, including fetoscopic laser photocoagulation, fetal endoluminal tracheal occlusion, bipolar cord coagulation, and fetoscopic spina bifida repair.
We reviewed 195 fetal procedures performed between 2019 and 2023 at Rabin Medical Center. Data collected included maternal and fetal characteristics, anesthetic techniques (spinal, combined spinal-epidural, general), intraoperative hypotension, and perioperative complications. We examined the evolution of anesthetic practice, particularly focusing on hemodynamic management and postoperative pain control.
Spinal anesthesia was increasingly preferred for shorter procedures such as fetoscopic laser photocoagulation and bipolar cord coagulation, while general anesthesia was used exclusively for spina bifida repair. Intraoperative hypotension was a significant issue, leading to the implementation of prophylactic phenylephrine infusions, which improved blood pressure control. A shift from volatile anesthesia to total intravenous anesthesia in spina bifida repair resulted in fewer complications, including reduced bleeding. Postoperative pain management was optimized with a multimodal approach, improving pain scores.
This study underscores the importance of tailoring anesthetic techniques to the specific fetal surgery. Key improvements in hypotension management, adopting total intravenous anesthesia for complex surgeries, and optimized postoperative pain control have contributed to better maternal and fetal outcomes. Ongoing reassessment and adaptation of anesthetic protocols remain critical as fetal surgery evolves.
{"title":"Anesthetic management for fetal surgery: Lessons from a single-center experience (2019–2023)","authors":"A. Faruja , A. Idelson , K. Azem , L. Yosef , K. Tenenbaum-Gavish , N.R. Duvdevani , S. Fein , S. Orbach-Zinger , Y. Gielchinsky","doi":"10.1016/j.ijoa.2024.104284","DOIUrl":"10.1016/j.ijoa.2024.104284","url":null,"abstract":"<div><div>Fetal surgery presents distinctive anesthetic challenges due to the need to balance maternal and fetal safety. This retrospective study evaluates the anesthetic management strategies used at a single center for various fetal interventions, including fetoscopic laser photocoagulation, fetal endoluminal tracheal occlusion, bipolar cord coagulation, and fetoscopic spina bifida repair.</div><div>We reviewed 195 fetal procedures performed between 2019 and 2023 at Rabin Medical Center. Data collected included maternal and fetal characteristics, anesthetic techniques (spinal, combined spinal-epidural, general), intraoperative hypotension, and perioperative complications. We examined the evolution of anesthetic practice, particularly focusing on hemodynamic management and postoperative pain control.</div><div>Spinal anesthesia was increasingly preferred for shorter procedures such as fetoscopic laser photocoagulation and bipolar cord coagulation, while general anesthesia was used exclusively for spina bifida repair. Intraoperative hypotension was a significant issue, leading to the implementation of prophylactic phenylephrine infusions, which improved blood pressure control. A shift from volatile anesthesia to total intravenous anesthesia in spina bifida repair resulted in fewer complications, including reduced bleeding. Postoperative pain management was optimized with a multimodal approach, improving pain scores.</div><div>This study underscores the importance of tailoring anesthetic techniques to the specific fetal surgery. Key improvements in hypotension management, adopting total intravenous anesthesia for complex surgeries, and optimized postoperative pain control have contributed to better maternal and fetal outcomes. Ongoing reassessment and adaptation of anesthetic protocols remain critical as fetal surgery evolves.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104284"},"PeriodicalIF":2.6,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500480","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}
Pub Date : 2024-09-24DOI: 10.1016/j.ijoa.2024.104277
Anthony Chau , Ilana Sebbag , Eduardo Sutherland , Giselle Villar
The clinical guidelines on postpartum hemorrhage from the Society of Obstetricians and Gynaecologists of Canada (SOGC) provide evidence-based recommendations structured around the 6Rs framework: Risk Assessment, Risk Reduction, Recognition and Evaluation, Reaction, Resuscitation, and Review. Since its publication, our institution has begun implementing all the guideline recommendations. One key recommendation is to calculate the Maximum Allowable Blood Loss (MABL) to reach a hemoglobin level of 70 g/L for every obstetric patient. This practice was introduced to promote an individualized approach to hemorrhage risk assessment, accounting for variations in patients’ anthropometric characteristics. However, there is currently a lack of evidence supporting the use of MABL calculation in the obstetric population. In this commentary, we highlight the limitations of the MABL calculation through specific examples and propose areas for further research.
{"title":"Obstetric hemorrhage risk assessment using the maximum allowable blood loss calculation: are we on the right track?","authors":"Anthony Chau , Ilana Sebbag , Eduardo Sutherland , Giselle Villar","doi":"10.1016/j.ijoa.2024.104277","DOIUrl":"10.1016/j.ijoa.2024.104277","url":null,"abstract":"<div><div>The clinical guidelines on postpartum hemorrhage from the Society of Obstetricians and Gynaecologists of Canada (SOGC) provide evidence-based recommendations structured around the 6Rs framework: Risk Assessment, Risk Reduction, Recognition and Evaluation, Reaction, Resuscitation, and Review. Since its publication, our institution has begun implementing all the guideline recommendations. One key recommendation is to calculate the Maximum Allowable Blood Loss (MABL) to reach a hemoglobin level of 70 g/L for every obstetric patient. This practice was introduced to promote an individualized approach to hemorrhage risk assessment, accounting for variations in patients’ anthropometric characteristics. However, there is currently a lack of evidence supporting the use of MABL calculation in the obstetric population. In this commentary, we highlight the limitations of the MABL calculation through specific examples and propose areas for further research.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104277"},"PeriodicalIF":2.6,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346583","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}
Pub Date : 2024-09-16DOI: 10.1016/j.ijoa.2024.104268
S.C. Ragbourne , E. Charles , M. Herincs , N. Desai
Background
Impacted fetal head occurs when the fetal head is deeply engaged within the maternal pelvis and difficult to deliver during caesarean delivery. In order to deliver the fetal head, additional surgical manoeuvres and/or pharmacological tocolysis are needed. The aim of this focused review is to outline the incidence, risk factors, management and complications of this obstetric emergency from the perspective of the anaesthetist.
Methods
Databases were searched for free text headings and subject headings associated with different permutations of terms related to impacted fetal head and caesarean delivery.
Results
Impacted fetal head has been estimated to occur in 1.5 % of elective caesarean deliveries and 2.9–18.4% of all emergency caesarean deliveries at any cervical dilatation. Risk factors include advanced cervical dilatation, labour augmentation with oxytocin, prolonged second stage of labour, fetal malposition and junior grade of operating obstetrician. If impacted fetal head occurs, the anaesthetist in conjunction with the multidisciplinary team should consider decreasing the height of the operating table, providing a step for the obstetrician to stand on, placing the patient in the head down position, providing pharmacological tocolysis with glyceryl trinitrate (or nitroglycerin), beta-2 adrenoreceptor agonists or volatile anaesthetic agents, and managing complications such as postpartum haemorrhage.
Conclusion
Impacted fetal head is an obstetric emergency that the anaesthetist should be familiar with and has a vital role in managing. We propose an algorithm for management that may serve as a clinical decision aid.
{"title":"Anaesthetic considerations for impacted fetal head at caesarean delivery: a focused review","authors":"S.C. Ragbourne , E. Charles , M. Herincs , N. Desai","doi":"10.1016/j.ijoa.2024.104268","DOIUrl":"10.1016/j.ijoa.2024.104268","url":null,"abstract":"<div><h3>Background</h3><div>Impacted fetal head occurs when the fetal head is deeply engaged within the maternal pelvis and difficult to deliver during caesarean delivery. In order to deliver the fetal head, additional surgical manoeuvres and/or pharmacological tocolysis are needed. The aim of this focused review is to outline the incidence, risk factors, management and complications of this obstetric emergency from the perspective of the anaesthetist.</div></div><div><h3>Methods</h3><div>Databases were searched for free text headings and subject headings associated with different permutations of terms related to impacted fetal head and caesarean delivery.</div></div><div><h3>Results</h3><div>Impacted fetal head has been estimated to occur in 1.5 % of elective caesarean deliveries and 2.9–18.4% of all emergency caesarean deliveries at any cervical dilatation. Risk factors include advanced cervical dilatation, labour augmentation with oxytocin, prolonged second stage of labour, fetal malposition and junior grade of operating obstetrician. If impacted fetal head occurs, the anaesthetist in conjunction with the multidisciplinary team should consider decreasing the height of the operating table, providing a step for the obstetrician to stand on, placing the patient in the head down position, providing pharmacological tocolysis with glyceryl trinitrate (or nitroglycerin), beta-2 adrenoreceptor agonists or volatile anaesthetic agents, and managing complications such as postpartum haemorrhage.</div></div><div><h3>Conclusion</h3><div>Impacted fetal head is an obstetric emergency that the anaesthetist should be familiar with and has a vital role in managing. We propose an algorithm for management that may serve as a clinical decision aid.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104268"},"PeriodicalIF":2.6,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-14DOI: 10.1016/j.ijoa.2024.104267
E. Fiszer , V. Rabkin , B. Aptekman , E. Reider , R. Chavez , A. Lavie , I. Matot , C.F. Weiniger
Background
Neuraxial anesthesia is the preferred anesthesia mode for cesarean delivery (CD). The primary study aim was to study the rate of neuraxial anesthesia for cesarean delivery before and after educational strategies were implemented, focusing on neuraxial anesthesia use for CD.
Methods
We performed a retrospective analysis of the mode of anesthesia for CD. Educational strategies to inform about neuraxial anesthesia for CD included interdisciplinary daily handovers and ward rounds, and interdisciplinary academic meetings and simulation sessions. We retrieved data from the hospital electronic record for mode of anesthesia for CD, intravenous supplementation, to assess the impact of our strategies on neuraxial anesthesia use for CD (2014–2023).
Results
The rate of neuraxial anesthesia increased from 89.8% in 2014 to 96.3% in 2023, with corresponding decrease in general anesthesia from 10.2% to 4.5% for all CD. The use of labor epidural augmentation for unplanned CD increased from 31.9% to 55.1%. Intravenous supplementation with spinal anesthesia for unplanned CD increased from 18.1% to 32.1%.
Conclusions
This study demonstrates the utility of educational strategies to increase neuraxial anesthesia use and highlights the importance of proactive interdisciplinary labor management.
背景神经轴麻醉是剖宫产（CD）的首选麻醉方式。研究的主要目的是研究教育策略实施前后剖宫产神经麻醉的使用率，重点关注神经麻醉在 CD 中的使用情况。有关 CD 神经阻滞麻醉的教育策略包括跨学科的每日交接班和查房，以及跨学科的学术会议和模拟课程。我们从医院电子病历中检索了CD的麻醉方式、静脉补充麻醉的数据，以评估我们的策略对CD使用神经轴麻醉的影响（2014-2023年）。结果神经轴麻醉率从2014年的89.8%增至2023年的96.3%，所有CD的全身麻醉率相应地从10.2%降至4.5%。计划外分娩时使用硬膜外麻醉的比例从 31.9% 增加到 55.1%。结论这项研究表明，教育策略有助于提高神经麻醉的使用率，并强调了积极主动的跨学科产程管理的重要性。
{"title":"Impact of an interdisciplinary process to increase utilization of neuraxial anesthesia for cesarean delivery: A retrospective database analysis","authors":"E. Fiszer , V. Rabkin , B. Aptekman , E. Reider , R. Chavez , A. Lavie , I. Matot , C.F. Weiniger","doi":"10.1016/j.ijoa.2024.104267","DOIUrl":"10.1016/j.ijoa.2024.104267","url":null,"abstract":"<div><h3>Background</h3><div>Neuraxial anesthesia is the preferred anesthesia mode for cesarean delivery (CD). The primary study aim was to study the rate of neuraxial anesthesia for cesarean delivery before and after educational strategies were implemented, focusing on neuraxial anesthesia use for CD.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of the mode of anesthesia for CD. Educational strategies to inform about neuraxial anesthesia for CD included interdisciplinary daily handovers and ward rounds, and interdisciplinary academic meetings and simulation sessions. We retrieved data from the hospital electronic record for mode of anesthesia for CD, intravenous supplementation, to assess the impact of our strategies on neuraxial anesthesia use for CD (2014–2023).</div></div><div><h3>Results</h3><div>The rate of neuraxial anesthesia increased from 89.8% in 2014 to 96.3% in 2023, with corresponding decrease in general anesthesia from 10.2% to 4.5% for all CD. The use of labor epidural augmentation for unplanned CD increased from 31.9% to 55.1%. Intravenous supplementation with spinal anesthesia for unplanned CD increased from 18.1% to 32.1%.</div></div><div><h3>Conclusions</h3><div>This study demonstrates the utility of educational strategies to increase neuraxial anesthesia use and highlights the importance of proactive interdisciplinary labor management.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104267"},"PeriodicalIF":2.6,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328170","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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