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Association of Pain, Analgesic, Psychological, and Socioeconomic Factors With Subacute Pain After Childbirth: A Prospective Cohort Study 疼痛、镇痛剂、心理和社会经济因素与产后亚急性疼痛的关系:前瞻性队列研究
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001015992.38242.30
C. Tan, H. Tan, R. Sultana, M. Meaney, M. Ling Kee, B. Sng
(J Clin Anesth. 2022;83:110978 | https://doi.org/10.1016/j.jclinane.2022.110978|) Persistent postpartum pain poses significant societal and health care challenges. It is defined by the International Association for the Study of Pain as pain lasting beyond 3 months after tissue injury, affecting up to 30% of postpartum women. Research primarily focuses on risk factors for persistent pain, including severe acute postpartum pain, psychological factors, and social deprivation. However, there is a lack of investigation into subacute pain after childbirth (lasting 4 wk to 3 mo). A previous study identified some risk factors for subacute pain, but the relationship between acute postpartum pain and subacute pain remains unexplored. This study aims to investigate these associations and explore potential interventions by anesthesiologists.
(J Clin Anesth. 2022;83:110978 | https://doi.org/10.1016/j.jclinane.2022.110978|)产后持续疼痛给社会和医疗保健带来了巨大挑战。国际疼痛研究协会将其定义为组织损伤后持续 3 个月以上的疼痛,影响高达 30% 的产后妇女。研究主要集中于持续性疼痛的风险因素,包括严重的急性产后疼痛、心理因素和社会剥夺。然而,目前还缺乏对产后亚急性疼痛(持续 4 周至 3 个月)的研究。之前的一项研究发现了亚急性疼痛的一些风险因素,但急性产后疼痛与亚急性疼痛之间的关系仍未得到探讨。本研究旨在调查这些关联,并探讨麻醉医师可能采取的干预措施。
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引用次数: 0
Incorporating a Postpartum Hemorrhage Bundle on the Labor and Delivery Unit: A State-Wide Survey of Anesthesiologists in Massachusetts 在产科纳入产后出血捆绑包:马萨诸塞州麻醉医师全州调查
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001015956.32254.7b
D. Villela-Franyutti, K. Hackett, M. Lumbreras-Marquez
(Int J Obstet Anesth. 2023;55:103893/https://doi.org/10.1016/j.ijoa.2023.103893/) Postpartum hemorrhage (PPH) is a significant contributor to preventable maternal morbidity and mortality, necessitating a comprehensive, interdisciplinary approach. Recognizing the urgency, the American College of Obstetricians and Gynecologists advocates adopting PPH bundles to ensure prompt identification and intervention. Obstetric anesthesiologists, possessing expertise in critical care and transfusion, are integral to the resuscitation efforts in PPH. Nevertheless, their involvement in implementing PPH bundles is inconsistent, prompting the need for a more dedicated focus on predelivery risk assessment, early recognition, and institutional protocol development.
(Int J Obstet Anesth. 2023;55:103893/https://doi.org/10.1016/j.ijoa.2023.103893/)产后出血(PPH)是导致可预防的孕产妇发病率和死亡率的重要因素,因此有必要采取跨学科的综合方法。认识到这一紧迫性,美国妇产科医师学会提倡采用 PPH 捆绑程序,以确保及时发现和干预。产科麻醉医师拥有重症监护和输血方面的专业知识,是 PPH 抢救工作中不可或缺的一部分。然而,他们参与实施 PPH 套件的情况并不一致,因此需要更加专注于分娩前风险评估、早期识别和机构协议的制定。
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引用次数: 0
Ethnic Disparities in Obstetric Anesthesia Care in England: Parallels and Paradoxes With Care in the United States 英国产科麻醉护理中的种族差异:英国产科麻醉护理中的种族差异:与美国护理的相似之处和矛盾之处
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001016100.13340.f5
A.J. Lee, A. Palanisamy
(Anaesthesia. 2023;78:799–802) The majority of studies on ethnic disparities in health care environments originate in the United States, where access to care and other factors make the health care experience different for every individual. It has been unclear whether these disparities exist in countries with a more consistently available health care system, such as the United Kingdom. This article comments on a recent study about ethnic disparities in the obstetric anesthesia population in the United Kingdom.
(Anaesthesia. 2023; 78:799-802)关于医疗环境中种族差异的研究大多源于美国,在美国,获得医疗服务的途径和其他因素使得每个人的医疗体验都不尽相同。目前还不清楚在英国等医疗保健系统较为稳定的国家是否也存在这些差异。本文对最近一项关于英国产科麻醉人群种族差异的研究进行了评论。
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引用次数: 0
Topical Negative Pressure Wound Therapy to Prevent Wound Complications Following Cesarean Delivery in High-Risk Obstetric Patients: A Randomized Controlled Trial 预防高危产科病人剖宫产术后伤口并发症的局部负压伤口疗法:随机对照试验
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001016060.91416.b8
M.G. Gonzalez, M. Barske, K.B. Kjellsson, K. Saboda, H. Reed, M.G. Hill
(Aust N Z J Obstet Gynaecol. 2023;63:516–520) The prevalence of cesarean deliveries (CD) has surged in recent decades, paralleling an uptick in medical complications during pregnancy linked to delayed childbearing and rising obesity rates. Consequently, post-CD wound complications have become a significant health concern. Mitigating these complications is a priority, with various wound vacuum systems available. While concerns persist about their effectiveness compared to standard treatments, some evidence suggests modest benefits, particularly in nonobstetric settings. The PICO wound vacuum system has shown promise for clean, noninfected surgical wounds, including cesarean incisions, though data is mainly from small trials or retrospective cohorts. Our study explores the use of PICO in preventing wound infections and breakdown in women with risk factors for complications postcesarean delivery.
(Aust N Z J Obstet Gynaecol. 2023; 63:516-520)近几十年来,剖宫产(CD)的发病率激增,与此同时,与生育延迟和肥胖率上升有关的孕期医疗并发症也在增加。因此,剖腹产后伤口并发症已成为一个重要的健康问题。缓解这些并发症是当务之急,目前有多种伤口真空系统可供选择。虽然与标准治疗方法相比,这些系统的效果仍令人担忧,但一些证据表明,它们的效果并不明显,尤其是在非产科环境中。PICO 伤口真空系统在清洁、未感染的手术伤口(包括剖宫产切口)方面显示出了良好的前景,但数据主要来自小型试验或回顾性队列。我们的研究探讨了 PICO 在预防具有剖宫产后并发症风险因素的产妇伤口感染和破裂方面的应用。
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引用次数: 0
High-Volume Patient-Controlled Epidural Versus Programmed Intermittent Epidural Bolus for Labor Analgesia: A Randomized Controlled Study 大容量患者控制硬膜外注射与程序化间歇性硬膜外注射分娩镇痛:随机对照研究
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001016108.83972.5a
E. Roofthooft, N. Filetici, M. Van Houwe, P. Van Houwe, A. Barbe, S. Fieuws, S. Rex, C.A. Wong, M. Van de Velde
(Anaesthesia. 2023;78(9):1129–1138) Neuraxial labor analgesia is a well-established and effective method for managing pain during labor. The initiation of analgesia through epidural or combined spinal-epidural methods can be followed by various maintenance techniques, including continuous epidural infusion, manual intermittent boluses, patient-controlled epidural analgesia (PCEA), programmed intermittent epidural bolus (PIEB), or a combination of these approaches. Adding PCEA to a continuous infusion was long-favored, demonstrating benefits such as reduced breakthrough pain incidents, lower local anesthetic consumption without compromising efficacy, and heightened patient satisfaction compared with continuous epidural infusion.
(麻醉。神经轴性分娩镇痛是一种行之有效的分娩镇痛方法。通过硬膜外或脊髓-硬膜外联合方法启动镇痛后,可采用各种维持技术,包括硬膜外连续输注、人工间歇栓注、患者控制硬膜外镇痛(PCEA)、程序化硬膜外间歇栓注(PIEB)或这些方法的组合。与连续硬膜外输注相比,在连续输注中加入 PCEA 长期以来一直备受青睐,其优点包括减少了突破性疼痛的发生、在不影响疗效的情况下降低了局麻药消耗量,以及提高了患者满意度。
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引用次数: 0
Automated Identification of Landmarks During Preprocedure Lumbar Ultrasound for Spinal Anesthesia in Obese Parturients: A Prospective Cohort Study 肥胖产妇脊柱麻醉术前腰椎超声的地标自动识别:前瞻性队列研究
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001016116.81658.39
H.S. Tan, J.J.I. Chan, T.T. Oh, M.J. Lim, C.W. Tan, R. Sultana, B. Sng
(Eur J Anaesthesiol. 2023;40(9):710–714) Traditional neuraxial procedures, relying on palpation, face a notable 27% failure rate. The integration of preprocedure ultrasonography offers a potential solution, although challenges arise in obese parturients, resulting in a 76% procedural success rate compared to over 90% in nonobese counterparts.
(Eur J Anaesthesiol. 2023;40(9):710-714) 传统的神经麻醉手术依赖触诊,失败率高达 27%。虽然肥胖产妇的手术成功率只有 76%,而非肥胖产妇的手术成功率超过 90%,但术前超声波检查的整合提供了一种潜在的解决方案。
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引用次数: 0
Automated Insulin Delivery in Women With Pregnancy Complicated by Type 1 Diabetes 1 型糖尿病并发妊娠妇女的胰岛素自动输送系统
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001016092.68961.48
T.T.M. Lee, C. Collett, S. Bergford, S. Hartnell, H. R. Murphy, E. Scott, R. S. Lindsay, K. F. Hunt, D. R. McCance, K. Barnard-Kelly, D. Rankin, J. Lawton, R. Reynolds, E. Flanagan, M. Hammond, L. Shepstone, M. Wilinska, J. Sibayan, C. Kollman, R. Beck, R. Hovorka
(N Engl J Med. 2023;389:1566–1578) Type 1 diabetes often causes significant complications both during pregnancy and immediately after delivery for both mother and infant. This makes glycemic control during pregnancy for these women of utmost importance for their health and that of their baby. Several therapies have been introduced for pregnancies complicated by type 1 diabetes, and one that is relatively new is hybrid closed loop therapy; because of its recent development, the efficacy of this treatment is still unclear. This study was designed to test if the initiation of hybrid closed loop therapy before 16 weeks of gestation would improve glucose levels during pregnancy. The primary outcome for this study was the percentage of time that glucose levels were within the pregnancy-specific target range of 63 to 140 mg per deciliter.
(N Engl J Med. 2023;389:1566-1578) 1 型糖尿病通常会在孕期和产后立即对母婴造成严重的并发症。因此,在怀孕期间控制血糖对这些妇女及其婴儿的健康至关重要。针对 1 型糖尿病并发症的妊娠,已经推出了几种疗法,其中一种相对较新的疗法是混合闭环疗法;由于该疗法刚刚推出不久,其疗效尚不明确。本研究旨在测试在妊娠 16 周前开始混合闭环疗法是否能改善孕期血糖水平。本研究的主要结果是血糖水平在妊娠特定目标范围(每分升 63 至 140 毫克)内的时间百分比。
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引用次数: 0
Maternal and Neonatal Outcomes With the Addition of Intrathecal Midazolam as an Adjuvant to Spinal Anesthesia in Cesarean Delivery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials 在剖宫产脊髓麻醉中添加鞘内咪达唑仑作为辅助药物的产妇和新生儿结局:随机对照试验的系统回顾和元分析
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001016120.15111.ba
T. Hung, Y. Huang, Y. Lin
(J Clin Anesth. 2022;80:110786 | https://doi.org/10.1016/j.jclinane.2022.110786.) In 2015, global cesarean deliveries (CD) reached 29.7 million. While evidence indicates comparable outcomes between general and regional anesthesia, the latter is preferred for elective CD due to benefits like reduced fetal exposure to anesthetics. Intrathecal bupivacaine is effective but can cause adverse effects like hypotension. Low-dose bupivacaine minimizes risks but may require additional analgesics, potentially leading to general anesthesia. Various adjuvants, such as opioids and alpha-2-agonists, enhance spinal anesthesia quality, each with unique effects. Intrathecal midazolam, studied since the 1980s, has shown promise in reducing nausea and vomiting. However, its safety for neonates and effectiveness in cesarean delivery remained uncertain. This systematic review and meta-analysis aimed to fill this gap by comprehensively assessing the efficacy and safety of adding intrathecal midazolam to spinal anesthesia for CD in healthy pregnant patients, considering maternal and neonatal outcomes.
(J Clin Anesth. 2022;80:110786 | https://doi.org/10.1016/j.jclinane.2022.110786.)2015年,全球剖宫产(CD)达到2970万例。虽然有证据表明全身麻醉和区域麻醉的效果相当,但由于可减少胎儿对麻醉药的暴露等优点,选择性剖宫产首选后者。鞘内注射布比卡因效果显著,但可能导致低血压等不良反应。低剂量布比卡因可将风险降至最低,但可能需要额外的镇痛剂,从而可能导致全身麻醉。阿片类药物和α-2-激动剂等各种辅助药物可提高脊髓麻醉的质量,但每种药物都有其独特的效果。自 20 世纪 80 年代开始研究的鞘内咪达唑仑有望减少恶心和呕吐。然而,它对新生儿的安全性和剖宫产的有效性仍不确定。本系统综述和荟萃分析旨在填补这一空白,全面评估在健康孕妇的脊髓麻醉中加入鞘内咪达唑仑进行剖宫产的有效性和安全性,同时考虑到孕产妇和新生儿的预后。
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引用次数: 0
Why Anesthetists Should Care About Postnatal Care 麻醉师为何应关注产后护理
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001016132.17694.bd
J. Bamber
(Anaesthesia. 2023;78(9):1058–1061) The National Institute for Health and Care Excellence (NICE) characterizes current UK postnatal care as a “Cinderella service,” marked by insufficient provisions and only 8.5% of the maternity care budget. Despite 97% of births occurring in hospitals, the average postnatal stay of 1.5 days is the shortest among high-income countries. While most women find their stay appropriate, empowering them to choose its duration enhances satisfaction without adverse effects.
(麻醉。英国国家健康与护理卓越研究所(NICE)将英国目前的产后护理描述为 "灰姑娘服务",其特点是提供的服务不足,仅占产妇护理预算的 8.5%。尽管 97% 的分娩是在医院进行的,但平均 1.5 天的产后住院时间却是高收入国家中最短的。虽然大多数妇女认为她们的住院时间是合适的,但赋予她们选择住院时间的权利会提高她们的满意度,而不会产生不利影响。
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引用次数: 0
Early Delivery for Pre-eclampsia Might Save Lives in Low-Income and Middle-Income Settings 在低收入和中等收入地区,子痫前期早产可挽救生命
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001016048.40147.f4
C.A. Cluver, S.P. Walker
(Lancet. 2023;402(10399):350–352) It is well known in the field that pre-eclampsia is a large contributor to maternal and perinatal morbidity and mortality, with the burden disproportionately falling on lower income countries; much of the research surrounding pre-eclampsia and its management has been done in high-income countries, even though the disease burden in these countries is felt less severely. This article is a commentary arguing for more research in this area particularly for the settings in which people are most affected.
(柳叶刀。2023;402(10399):350-352) 众所周知,子痫前期是造成孕产妇和围产期发病率和死亡率的一个重要因素,而这一负担不成比例地落在了低收入国家;围绕子痫前期及其管理的大部分研究都是在高收入国家进行的,尽管这些国家对疾病负担的感受并不那么严重。本文是一篇评论文章,主张在这一领域开展更多的研究,特别是针对受影响最严重的人群。
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引用次数: 0
期刊
Obstetric Anesthesia Digest
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