Pub Date : 2021-07-01DOI: 10.4103/joacc.joacc_40_20
N. D’souza, Tasnim Karachiwala, Pratiksha Kulkarni
Lipomas are benign tumours which are frequently seen, however there is no specific mention regarding the incidence of lumbar lipomas. Literature does not describe challenges of anaesthesia technique in patients with lumbar lipomas without neuro deficit. An ultrasound examination of the spine using a low frequency probe contributes to screening for the path for passage of the needle.
{"title":"Ultrasonography in aid of spinal anaesthesia in lumbar lipomas not infallible","authors":"N. D’souza, Tasnim Karachiwala, Pratiksha Kulkarni","doi":"10.4103/joacc.joacc_40_20","DOIUrl":"https://doi.org/10.4103/joacc.joacc_40_20","url":null,"abstract":"Lipomas are benign tumours which are frequently seen, however there is no specific mention regarding the incidence of lumbar lipomas. Literature does not describe challenges of anaesthesia technique in patients with lumbar lipomas without neuro deficit. An ultrasound examination of the spine using a low frequency probe contributes to screening for the path for passage of the needle.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43229887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.4103/joacc.joacc_27_21
A. Bandyopadhyay, N. Sahni, G. Kanth
{"title":"Pseudodextrocardia delaying the diagnosis of peripartum cardiomyopathy","authors":"A. Bandyopadhyay, N. Sahni, G. Kanth","doi":"10.4103/joacc.joacc_27_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_27_21","url":null,"abstract":"","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49329450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.4103/joacc.joacc_77_21
Abhishek Singh, Karuna Sharma, V. Venkateswaran, A. Trikha
Advancement in the treatment of thalassemia has increased the life span of female patients, with the result that they are reaching the reproductive age group and expecting childbirth. Anesthesia is challenging in such patients due to ineffective erythropoiesis and multiple system involvement as a result of iron overload and chelation therapy. Careful management of the preconception phase, various conception strategies, and multidisciplinary management of pregnancy and childbirth can lead to a healthy and successful outcome of pregnancy. This review provides an overview of the pathophysiology and clinical manifestation of alpha and beta-thalassemia in pregnancy and its successful management. All available literature related to thalassemia was searched in major databases like PubMed, Embase, Scopus, and Google Scholar. Original articles, review articles, book chapters, guidelines, case reports, and correspondence were reviewed for pathophysiology, clinical manifestations, and anesthetic management of thalassemia during pregnancy with keywords like thalassemia, Cooley's anemia, thalassemia and pregnancy, anesthetic management of thalassemia, labor analgesia in thalassemia, and transfusion in thalassemia.
{"title":"Pregnancy in thalassemia, anesthetic implication and perioperative management- A narrative review","authors":"Abhishek Singh, Karuna Sharma, V. Venkateswaran, A. Trikha","doi":"10.4103/joacc.joacc_77_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_77_21","url":null,"abstract":"Advancement in the treatment of thalassemia has increased the life span of female patients, with the result that they are reaching the reproductive age group and expecting childbirth. Anesthesia is challenging in such patients due to ineffective erythropoiesis and multiple system involvement as a result of iron overload and chelation therapy. Careful management of the preconception phase, various conception strategies, and multidisciplinary management of pregnancy and childbirth can lead to a healthy and successful outcome of pregnancy. This review provides an overview of the pathophysiology and clinical manifestation of alpha and beta-thalassemia in pregnancy and its successful management. All available literature related to thalassemia was searched in major databases like PubMed, Embase, Scopus, and Google Scholar. Original articles, review articles, book chapters, guidelines, case reports, and correspondence were reviewed for pathophysiology, clinical manifestations, and anesthetic management of thalassemia during pregnancy with keywords like thalassemia, Cooley's anemia, thalassemia and pregnancy, anesthetic management of thalassemia, labor analgesia in thalassemia, and transfusion in thalassemia.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41660033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.4103/joacc.joacc_89_20
A. Das, N. Sabharwal, M. Kumar
Background: Changes in modified mallampati grade occur with the progress of pregnancy, labor, and delivery due to various reasons. This could lead to unanticipated difficulties in airway management, especially if the parturient were to undergo a surgical procedure in the postpartum period. Our study aimed to evaluate the change in airway parameters after delivery in parturient undergoing lower segment cesarean section (LSCS) under spinal anesthesia. Materials and Methods: This study was conducted at Vardhaman Mahavir (VMMC) and Safdarjung Hospital over a period of 18 months. A total of 160 patients posted for either elective or emergency cesarean section under spinal anesthesia were enrolled in the study (80 in each group). Airway parameters including modified mallampati grade (MMPG) were measured at various time intervals – before cesarean section (T1) and 2 h (T2), 6 h (T3), 24 h (T4), 48 h (T5), and 72 h (T6) after delivery and analyzed statistically. Results: Changes in MMPG occurred in 71.25% of cases in the emergency group as compared with 40% of cases in the elective group (P = 0.0001). The mean MMPG was significantly higher from 2 h up to 72 h after LSCS in the emergency group (having more patients in active labor). (P = 0.0001). Maximum changes in MMPG occurred 6 h after delivery in both groups. Normalization of MMPG to its precesarean value occurred earlier in elective patients (P = 0.0005). An association was found between the duration of labor and normalization of changes in MMPG to its preoperative value (P = 0.023). Conclusion: Airway changes in pregnant women are seen to worsen after emergency LSCS under spinal anesthesia and are affected by prolonged labor. Therefore, the maternal airway should be reassessed after the delivery of the baby, for any surgical procedure thereafter.
{"title":"Airway changes before & after delivery-does labour has any effect on the modified mallampati score?","authors":"A. Das, N. Sabharwal, M. Kumar","doi":"10.4103/joacc.joacc_89_20","DOIUrl":"https://doi.org/10.4103/joacc.joacc_89_20","url":null,"abstract":"Background: Changes in modified mallampati grade occur with the progress of pregnancy, labor, and delivery due to various reasons. This could lead to unanticipated difficulties in airway management, especially if the parturient were to undergo a surgical procedure in the postpartum period. Our study aimed to evaluate the change in airway parameters after delivery in parturient undergoing lower segment cesarean section (LSCS) under spinal anesthesia. Materials and Methods: This study was conducted at Vardhaman Mahavir (VMMC) and Safdarjung Hospital over a period of 18 months. A total of 160 patients posted for either elective or emergency cesarean section under spinal anesthesia were enrolled in the study (80 in each group). Airway parameters including modified mallampati grade (MMPG) were measured at various time intervals – before cesarean section (T1) and 2 h (T2), 6 h (T3), 24 h (T4), 48 h (T5), and 72 h (T6) after delivery and analyzed statistically. Results: Changes in MMPG occurred in 71.25% of cases in the emergency group as compared with 40% of cases in the elective group (P = 0.0001). The mean MMPG was significantly higher from 2 h up to 72 h after LSCS in the emergency group (having more patients in active labor). (P = 0.0001). Maximum changes in MMPG occurred 6 h after delivery in both groups. Normalization of MMPG to its precesarean value occurred earlier in elective patients (P = 0.0005). An association was found between the duration of labor and normalization of changes in MMPG to its preoperative value (P = 0.023). Conclusion: Airway changes in pregnant women are seen to worsen after emergency LSCS under spinal anesthesia and are affected by prolonged labor. Therefore, the maternal airway should be reassessed after the delivery of the baby, for any surgical procedure thereafter.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46414512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.4103/joacc.joacc_42_21
Ketan Parikh, S. Pandya
{"title":"“Too powerful to push”: A rise in “on demand” caesarean section","authors":"Ketan Parikh, S. Pandya","doi":"10.4103/joacc.joacc_42_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_42_21","url":null,"abstract":"","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41512065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.4103/joacc.joacc_10_21
P. Bhatia, D. Dwivedi, A. Gautam, Shalendra Singh
{"title":"Implications of active infective endocarditis with pregnancy and its management","authors":"P. Bhatia, D. Dwivedi, A. Gautam, Shalendra Singh","doi":"10.4103/joacc.joacc_10_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_10_21","url":null,"abstract":"","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44604703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.4103/joacc.joacc_86_21
A. Trikha
{"title":"A ten-year-old obstetric anaesthesia journal: Musings of an editor","authors":"A. Trikha","doi":"10.4103/joacc.joacc_86_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_86_21","url":null,"abstract":"","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46079997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.4103/joacc.joacc_16_21
Patriot Yang, R. Sikachi, M. Gerasimov, J. Aronsohn, G. Palleschi
Acute fatty liver of pregnancy (AFLP) is a potentially fatal metabolic disorder in pregnant patients that requires urgent delivery and aggressive medical and aesthetic management of maternal complications associated with acute liver failure. A 41-year-old female (79 kg) G1P0 at 31 weeks gestation presented with nausea, vomiting, pruritus, and jaundice. A diagnosis of severe liver dysfunction secondary to AFLP was made. We proceeded with urgent delivery under general anaesthesia. The patient had an uncomplicated caesarean section and gave birth to female infant with Apgar scores of 7 and 8. The patient remained stable for the following 2 weeks, however, given the lack of further recovery of hepatic function, a transjugular liver biopsy was performed, revealing persistent AFLP. She received N-acetylcysteine infusion and 4 cycles of plasma exchange with no improvement. Over the next few days her mental status worsened and her liver functions further deteriorated. She was listed for a deceased liver donor transplant and underwent successful orthotopic liver transplantation. She was discharged on post-operative day (POD) 14 of liver transplant.
{"title":"Acute fatty liver of pregnancy leading to a delayed hepatic failure necessitating liver transplantation: A case report","authors":"Patriot Yang, R. Sikachi, M. Gerasimov, J. Aronsohn, G. Palleschi","doi":"10.4103/joacc.joacc_16_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_16_21","url":null,"abstract":"Acute fatty liver of pregnancy (AFLP) is a potentially fatal metabolic disorder in pregnant patients that requires urgent delivery and aggressive medical and aesthetic management of maternal complications associated with acute liver failure. A 41-year-old female (79 kg) G1P0 at 31 weeks gestation presented with nausea, vomiting, pruritus, and jaundice. A diagnosis of severe liver dysfunction secondary to AFLP was made. We proceeded with urgent delivery under general anaesthesia. The patient had an uncomplicated caesarean section and gave birth to female infant with Apgar scores of 7 and 8. The patient remained stable for the following 2 weeks, however, given the lack of further recovery of hepatic function, a transjugular liver biopsy was performed, revealing persistent AFLP. She received N-acetylcysteine infusion and 4 cycles of plasma exchange with no improvement. Over the next few days her mental status worsened and her liver functions further deteriorated. She was listed for a deceased liver donor transplant and underwent successful orthotopic liver transplantation. She was discharged on post-operative day (POD) 14 of liver transplant.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42367976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.4103/joacc.joacc_30_21
Isha Kunagpa, B. Sharma, P. Verma, S. Siwatch, G. Prasad, Kajal Sharma
{"title":"Failure of resuscitative hysterotomy to rescue peripartum cardiac arrest","authors":"Isha Kunagpa, B. Sharma, P. Verma, S. Siwatch, G. Prasad, Kajal Sharma","doi":"10.4103/joacc.joacc_30_21","DOIUrl":"https://doi.org/10.4103/joacc.joacc_30_21","url":null,"abstract":"","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45529445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.4103/joacc.JOACC_91_20
S. Pandya, Jyotsna Mikkilineni, Manokanth Madapu
Aim: to determine the rates of failed conversion of EA to surgical anaesthesia for patient and clinician information and benchmarking, and to develop an algorithmic approach for safe conversion of EA. Materials and Methods: A retrospective audit of parturients who had labour epidural analgesia (EA) at an advanced tertiary care institute for women and newborn health in south India. Information on EA, caesarean sections, conversion of EA, failure of regional anaesthesia, use of general anaesthesia, alternate techniques and supplemental medications were retrieved from electronic medical records. Results: Emergency cesarean section (CS) was performed for 4,259 (26.93%, 95% CI: 26.25, 27.63) of 15, 812 parturients that had EA at the study institute between Jan 2012 and December 2016. The EA was successful in 4,078 (95.75%, 95% CI: 95.11, 96.32) of these 4,259 women. Seventy three (1.71%, 95% CI: 1.37, 2.15) of the 4,259 women reported mild discomfort on the VAS for pain and required supplemental sedation for the emergency CS and 108 (2.53%, 95% CI: 2.11, 3.05) of the 4,259 women needed alternate techniques. The failure rate of EA was thus 4.25% (95% CI: 3.68, 4.89, n = 181) in this audit. Conclusions: The failure rates of EA at the study institute are well within the recommended standards of the RCA (Royal College of Anaesthesiologists – UK). This audit helped us to develop an algorithmic approach to further improve performance based on problems identified during the audit.
{"title":"Conversion of labour epidural analgesia to anaesthesia for emergency caesarean section: A retrospective audit","authors":"S. Pandya, Jyotsna Mikkilineni, Manokanth Madapu","doi":"10.4103/joacc.JOACC_91_20","DOIUrl":"https://doi.org/10.4103/joacc.JOACC_91_20","url":null,"abstract":"Aim: to determine the rates of failed conversion of EA to surgical anaesthesia for patient and clinician information and benchmarking, and to develop an algorithmic approach for safe conversion of EA. Materials and Methods: A retrospective audit of parturients who had labour epidural analgesia (EA) at an advanced tertiary care institute for women and newborn health in south India. Information on EA, caesarean sections, conversion of EA, failure of regional anaesthesia, use of general anaesthesia, alternate techniques and supplemental medications were retrieved from electronic medical records. Results: Emergency cesarean section (CS) was performed for 4,259 (26.93%, 95% CI: 26.25, 27.63) of 15, 812 parturients that had EA at the study institute between Jan 2012 and December 2016. The EA was successful in 4,078 (95.75%, 95% CI: 95.11, 96.32) of these 4,259 women. Seventy three (1.71%, 95% CI: 1.37, 2.15) of the 4,259 women reported mild discomfort on the VAS for pain and required supplemental sedation for the emergency CS and 108 (2.53%, 95% CI: 2.11, 3.05) of the 4,259 women needed alternate techniques. The failure rate of EA was thus 4.25% (95% CI: 3.68, 4.89, n = 181) in this audit. Conclusions: The failure rates of EA at the study institute are well within the recommended standards of the RCA (Royal College of Anaesthesiologists – UK). This audit helped us to develop an algorithmic approach to further improve performance based on problems identified during the audit.","PeriodicalId":16611,"journal":{"name":"Journal of Obstetric Anaesthesia and Critical Care","volume":"11 1","pages":"5 - 8"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43092307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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