Pub Date : 2024-09-01DOI: 10.1016/j.bpa.2024.04.007
Ning Lynn Chen , Hannah Smyth , Ban Leong Sng , Damien Hughes
Epidural analgesia is considered the gold standard for labour pain but may not be an option for all parturients due to patient choice or medical contraindication. Non-neuraxial alternatives for labour analgesia have been extensively studied and include both pharmacological and non-pharmacological options. Pharmacological options include the use of opioids and inhalational agents while non-pharmacological options range from non-invasive methods such as continuous labour support to techniques such as sterile water injection. Apart from effective analgesia, such techniques may improve maternal satisfaction. This review summarizes the evidence for available non-neuraxial labour analgesia modalities.
{"title":"Non-neuraxial labour analgesia","authors":"Ning Lynn Chen , Hannah Smyth , Ban Leong Sng , Damien Hughes","doi":"10.1016/j.bpa.2024.04.007","DOIUrl":"10.1016/j.bpa.2024.04.007","url":null,"abstract":"<div><div><span>Epidural analgesia is considered the gold standard for labour pain but may not be an option for all parturients due to patient choice or medical contraindication. Non-neuraxial alternatives for </span>labour analgesia have been extensively studied and include both pharmacological and non-pharmacological options. Pharmacological options include the use of opioids and inhalational agents while non-pharmacological options range from non-invasive methods such as continuous labour support to techniques such as sterile water injection. Apart from effective analgesia, such techniques may improve maternal satisfaction. This review summarizes the evidence for available non-neuraxial labour analgesia modalities.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"38 3","pages":"Pages 176-186"},"PeriodicalIF":4.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140787937","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 : 2024-09-01DOI: 10.1016/j.bpa.2024.11.006
Michaela K. Farber , Marc Van de Velde
{"title":"New frontiers in obstetric anesthesiology: Advocacy through innovation","authors":"Michaela K. Farber , Marc Van de Velde","doi":"10.1016/j.bpa.2024.11.006","DOIUrl":"10.1016/j.bpa.2024.11.006","url":null,"abstract":"","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"38 3","pages":"Pages 155-156"},"PeriodicalIF":4.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094089","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 : 2024-09-01DOI: 10.1016/j.bpa.2024.10.003
Sarah Ciechanowicz , Evy De Greef , Marc Van de Velde , Pervez Sultan
Caesarean delivery is the most performed inpatient surgery worldwide, with rates expected to rise. Optimising maternal recovery benefits not only the mother, but also the newborn and society. Enhanced Recovery After Caesarean delivery (ERAC) protocols standardize the approach to perioperative management of patients in order to accelerate early postoperative maternal rehabilitation. Implementation of ERAC protocols has been associated with improved maternal and neonatal outcomes including shorter hospital stay, lower pain scores and opioid consumption, fewer complications, higher maternal satisfaction, and greater breastfeeding success. Higher-quality evidence is needed to support and evaluate ERAC protocols as they continue to be refined with the application of regional analgesia and an individualized approach to pain management. Recent work has described the postpartum period as a complex multidimensional process. A holistic approach to measuring postpartum recovery could provide valuable insights for tailoring interventions and supporting services to promote maternal recovery after caesarean delivery.
{"title":"Optimising recovery after caesarean delivery","authors":"Sarah Ciechanowicz , Evy De Greef , Marc Van de Velde , Pervez Sultan","doi":"10.1016/j.bpa.2024.10.003","DOIUrl":"10.1016/j.bpa.2024.10.003","url":null,"abstract":"<div><div>Caesarean delivery is the most performed inpatient surgery worldwide, with rates expected to rise. Optimising maternal recovery benefits not only the mother, but also the newborn and society. Enhanced Recovery After Caesarean delivery (ERAC) protocols standardize the approach to perioperative management of patients in order to accelerate early postoperative maternal rehabilitation. Implementation of ERAC protocols has been associated with improved maternal and neonatal outcomes including shorter hospital stay, lower pain scores and opioid consumption, fewer complications, higher maternal satisfaction, and greater breastfeeding success. Higher-quality evidence is needed to support and evaluate ERAC protocols as they continue to be refined with the application of regional analgesia and an individualized approach to pain management. Recent work has described the postpartum period as a complex multidimensional process. A holistic approach to measuring postpartum recovery could provide valuable insights for tailoring interventions and supporting services to promote maternal recovery after caesarean delivery.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"38 3","pages":"Pages 199-208"},"PeriodicalIF":4.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094098","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 : 2024-09-01DOI: 10.1016/j.bpa.2024.11.005
Jimin J. Kim, Michaela K. Farber, Bushra W. Taha
Since 2015, reductions in maternal mortality have stalled globally. In some parts of the world, severe maternal morbidity and mortality have increased, and most cases are thought to be from preventable causes. This is further exacerbated by significant racial, ethnic, and geographic disparities in maternal health outcomes, particularly among countries with diverse populations. Etiologies and presentations of maternal death and disease are broad and diverse, often requiring a multidisciplinary approach to address risk and manage medical complexity. Strategies that may reduce morbidity and mortality include the application of risk stratification models and systems for prompt recognition of clinical deterioration, implementation of maternal safety bundles, and point-of care tools such as coagulation testing and ultrasound. This review aims to provide a comprehensive overview of the epidemiology, etiology, and disparities in maternal morbidity and mortality outcomes, and provide a framework for anesthesiologists in helping mitigate risk and improve maternal health outcomes.
{"title":"Epidemiology, trends, and disparities in maternal mortality: A framework for obstetric anesthesiologists","authors":"Jimin J. Kim, Michaela K. Farber, Bushra W. Taha","doi":"10.1016/j.bpa.2024.11.005","DOIUrl":"10.1016/j.bpa.2024.11.005","url":null,"abstract":"<div><div>Since 2015, reductions in maternal mortality have stalled globally. In some parts of the world, severe maternal morbidity and mortality have increased, and most cases are thought to be from preventable causes. This is further exacerbated by significant racial, ethnic, and geographic disparities in maternal health outcomes, particularly among countries with diverse populations. Etiologies and presentations of maternal death and disease are broad and diverse, often requiring a multidisciplinary approach to address risk and manage medical complexity. Strategies that may reduce morbidity and mortality include the application of risk stratification models and systems for prompt recognition of clinical deterioration, implementation of maternal safety bundles, and point-of care tools such as coagulation testing and ultrasound. This review aims to provide a comprehensive overview of the epidemiology, etiology, and disparities in maternal morbidity and mortality outcomes, and provide a framework for anesthesiologists in helping mitigate risk and improve maternal health outcomes.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"38 3","pages":"Pages 157-167"},"PeriodicalIF":4.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094087","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 : 2024-09-01DOI: 10.1016/j.bpa.2024.11.002
Jennifer E. Dominguez , Cameron R. Taylor , Thierry Girard
The issue of obesity continues to reach new levels globally, affecting individuals across the age continuum. Obesity in pregnancy is associated with myriad comorbidities which may negatively impact the fetus, particularly dysfunctional labor and failure to progress ending in unplanned cesarean delivery. Neuraxial anesthesia represents the gold standard for cesarean delivery anesthesia and is increasingly beneficial for obese patients due to the risk of difficult airway. Obese parturients demonstrate higher rates of venous thromboembolism and wound infections and appropriate prophylaxis strategies to prevent these complications is imperative. While neuraxial anesthesia is the preferred technique for peripartum analgesia and cesarean delivery anesthesia, procedures can be technically challenging in patients with obesity, and may require more time, longer needles, increased experience, or ultrasound guidance. There is some concern for respiratory depression with the administration of neuraxial opioids in patients with obesity which has culminated in the development of post-operative monitoring guidelines.
{"title":"Morbid obesity: Optimizing neuraxial analgesia and cesarean delivery outcomes","authors":"Jennifer E. Dominguez , Cameron R. Taylor , Thierry Girard","doi":"10.1016/j.bpa.2024.11.002","DOIUrl":"10.1016/j.bpa.2024.11.002","url":null,"abstract":"<div><div>The issue of obesity continues to reach new levels globally, affecting individuals across the age continuum. Obesity in pregnancy is associated with myriad comorbidities which may negatively impact the fetus, particularly dysfunctional labor and failure to progress ending in unplanned cesarean delivery. Neuraxial anesthesia represents the gold standard for cesarean delivery anesthesia and is increasingly beneficial for obese patients due to the risk of difficult airway. Obese parturients demonstrate higher rates of venous thromboembolism and wound infections and appropriate prophylaxis strategies to prevent these complications is imperative. While neuraxial anesthesia is the preferred technique for peripartum analgesia and cesarean delivery anesthesia, procedures can be technically challenging in patients with obesity, and may require more time, longer needles, increased experience, or ultrasound guidance. There is some concern for respiratory depression with the administration of neuraxial opioids in patients with obesity which has culminated in the development of post-operative monitoring guidelines.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"38 3","pages":"Pages 257-266"},"PeriodicalIF":4.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094105","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}
Preeclampsia is a life-threatening complication that develops in 2–8% of pregnancies. It is characterized by elevated blood pressure after 20 weeks of gestation and may progress to multiorgan dysfunction, leading to severe maternal and fetal morbidity and mortality. The only definitive treatment is delivery, and efforts are focused on early risk prediction, surveillance, and severity mitigation. Anesthesiologists, as part of the interdisciplinary team, should evaluate patients early in labor in order to optimize cardiovascular, pulmonary, and coagulation status. Neuraxial techniques are safe in the absence of coagulopathy and aid avoidance of general anesthesia, which is associated with high risk in these patients. This review aims to provide anaesthesiologists with a comprehensive update on the latest strategies and evidence-based practices for managing preeclampsia, with an emphasis on perioperative care.
{"title":"Preeclampsia and eclampsia: Enhanced detection and treatment for morbidity reduction","authors":"Vesela P. Kovacheva , Shakthi Venkatachalam , Claire Pfister , Tooba Anwer","doi":"10.1016/j.bpa.2024.11.001","DOIUrl":"10.1016/j.bpa.2024.11.001","url":null,"abstract":"<div><div>Preeclampsia is a life-threatening complication that develops in 2–8% of pregnancies. It is characterized by elevated blood pressure after 20 weeks of gestation and may progress to multiorgan dysfunction, leading to severe maternal and fetal morbidity and mortality. The only definitive treatment is delivery, and efforts are focused on early risk prediction, surveillance, and severity mitigation. Anesthesiologists, as part of the interdisciplinary team, should evaluate patients early in labor in order to optimize cardiovascular, pulmonary, and coagulation status. Neuraxial techniques are safe in the absence of coagulopathy and aid avoidance of general anesthesia, which is associated with high risk in these patients. This review aims to provide anaesthesiologists with a comprehensive update on the latest strategies and evidence-based practices for managing preeclampsia, with an emphasis on perioperative care.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"38 3","pages":"Pages 246-256"},"PeriodicalIF":4.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956746","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 : 2024-09-01DOI: 10.1016/j.bpa.2024.10.006
M.J. Wong , B.S. Kodali , S. Rex
Critical illness during pregnancy poses significant challenges driven by complex interactions between physiological changes, pre-existing conditions, and healthcare disparities. In high-income countries, increasing maternal age and comorbidities complicate obstetric care by triggering an unprecedented rise in cardiac disease during pregnancy, while infections like influenza and COVID-19 are important causes of maternal adult respiratory distress syndrome. Extracorporeal membrane oxygenation (ECMO) gained prominence as a vital intervention, providing respiratory and/or cardiac support, for varying indications between antenatal and postpartum periods. The physiological changes of pregnancy demand close attention and adjustment of ECMO parameters, along with multidisciplinary collaboration. While potential complications such as bleeding and thromboembolism require vigilant management and optimal management of ECMO support in pregnancy still needs to be elucidated, ECMO nevertheless yields favorable maternal and fetal outcomes.
{"title":"Extracorporeal membrane oxygenation and pregnancy","authors":"M.J. Wong , B.S. Kodali , S. Rex","doi":"10.1016/j.bpa.2024.10.006","DOIUrl":"10.1016/j.bpa.2024.10.006","url":null,"abstract":"<div><div>Critical illness during pregnancy poses significant challenges driven by complex interactions between physiological changes, pre-existing conditions, and healthcare disparities. In high-income countries, increasing maternal age and comorbidities complicate obstetric care by triggering an unprecedented rise in cardiac disease during pregnancy, while infections like influenza and COVID-19 are important causes of maternal adult respiratory distress syndrome. Extracorporeal membrane oxygenation (ECMO) gained prominence as a vital intervention, providing respiratory and/or cardiac support, for varying indications between antenatal and postpartum periods. The physiological changes of pregnancy demand close attention and adjustment of ECMO parameters, along with multidisciplinary collaboration. While potential complications such as bleeding and thromboembolism require vigilant management and optimal management of ECMO support in pregnancy still needs to be elucidated, ECMO nevertheless yields favorable maternal and fetal outcomes.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"38 3","pages":"Pages 293-301"},"PeriodicalIF":4.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094102","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 : 2024-09-01DOI: 10.1016/j.bpa.2024.10.002
Nicholas Gill , Alexander Butwick , Sarah F. Bell
Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality and morbidity worldwide. Recent advances in understanding the hemostatic changes of pregnancy and PPH have led to the development of obstetric-specific approaches to resuscitation. This article aims to examine.
1) changes in the coagulation system during pregnancy.
2) types of coagulopathy associated with PPH, and.
3) the role of point of care tests of coagulation in PPH.
{"title":"Navigating coagulopathy in obstetric hemorrhage: The role of point-of-care testing","authors":"Nicholas Gill , Alexander Butwick , Sarah F. Bell","doi":"10.1016/j.bpa.2024.10.002","DOIUrl":"10.1016/j.bpa.2024.10.002","url":null,"abstract":"<div><div>Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality and morbidity worldwide. Recent advances in understanding the hemostatic changes of pregnancy and PPH have led to the development of obstetric-specific approaches to resuscitation. This article aims to examine.</div><div>1) changes in the coagulation system during pregnancy.</div><div>2) types of coagulopathy associated with PPH, and.</div><div>3) the role of point of care tests of coagulation in PPH.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"38 3","pages":"Pages 233-245"},"PeriodicalIF":4.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094106","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 : 2024-09-01DOI: 10.1016/j.bpa.2024.11.004
A.M.J.V. Schyns-van den Berg , D.N. Lucas , L.R. Leffert
Despite advances in procedural techniques and equipment, postdural puncture headache (PDPH) remains a serious complication of labour epidural analgesia after accidental dural puncture (ADP). Often considered a temporary inconvenience, PDPH can be debilitating in the short term. It can also be associated with chronic manifestations and serious complications.
The precise underlying mechanisms of PDPH are still incompletely understood, and longstanding beliefs of dysregulation of cerebrospinal fluid (CSF) homeostasis due to CSF fluid loss are currently being challenged. The existence of orthostatic headaches unrelated to CSF loss demands consideration of other mechanisms involved, for instance, related to the autonomic nervous system or the release of calcitonin gene-related peptide (CGRP) associated with activation of the meningeal and cerebral arteries.
A multi-society international working group recently provided evidence-based recommendations on the prevention, diagnosis, and management of PDPH resulting from neuraxial procedures. According to the recommendations, there was insufficient evidence to support the routine use of intrathecal catheters or sphenopalatine ganglion blocks to prevent or treat PDPH. Both evidence-based and experimental strategies include stabilizing CSF dynamics through preventing CSF loss, supplementing CSF, or increasing production, and reducing cerebral vasodilation.
Future research in PDPH preventive and therapeutic strategies can be facilitated with standardised definitions, interventions, and outcome measures. Analyses should consider various confounding factors and recognise the complex multifactorial nature of pain experience across diverse populations. Clinical care and research on PDPH will demand a multidisciplinary collaborative effort to elucidate the complexities of its pathophysiology and further improve patient outcome and quality of care.
{"title":"Postdural puncture headache: Beyond the evidence","authors":"A.M.J.V. Schyns-van den Berg , D.N. Lucas , L.R. Leffert","doi":"10.1016/j.bpa.2024.11.004","DOIUrl":"10.1016/j.bpa.2024.11.004","url":null,"abstract":"<div><div>Despite advances in procedural techniques and equipment, postdural puncture headache (PDPH) remains a serious complication of labour epidural analgesia after accidental dural puncture (ADP). Often considered a temporary inconvenience, PDPH can be debilitating in the short term. It can also be associated with chronic manifestations and serious complications.</div><div>The precise underlying mechanisms of PDPH are still incompletely understood, and longstanding beliefs of dysregulation of cerebrospinal fluid (CSF) homeostasis due to CSF fluid loss are currently being challenged. The existence of orthostatic headaches unrelated to CSF loss demands consideration of other mechanisms involved, for instance, related to the autonomic nervous system or the release of calcitonin gene-related peptide (CGRP) associated with activation of the meningeal and cerebral arteries.</div><div>A multi-society international working group recently provided evidence-based recommendations on the prevention, diagnosis, and management of PDPH resulting from neuraxial procedures. According to the recommendations, there was insufficient evidence to support the routine use of intrathecal catheters or sphenopalatine ganglion blocks to prevent or treat PDPH. Both evidence-based and experimental strategies include stabilizing CSF dynamics through preventing CSF loss, supplementing CSF, or increasing production, and reducing cerebral vasodilation.</div><div>Future research in PDPH preventive and therapeutic strategies can be facilitated with standardised definitions, interventions, and outcome measures. Analyses should consider various confounding factors and recognise the complex multifactorial nature of pain experience across diverse populations. Clinical care and research on PDPH will demand a multidisciplinary collaborative effort to elucidate the complexities of its pathophysiology and further improve patient outcome and quality of care.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"38 3","pages":"Pages 267-277"},"PeriodicalIF":4.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094104","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 : 2024-09-01DOI: 10.1016/j.bpa.2024.10.007
Desire N. Onwochei , Neel Desai , Lawrence C. Tsen
Uterotonics are the mainstay of management for postpartum haemorrhage and an understanding of their use is essential for the obstetric anaesthetist. First-line uterotonics comprise oxytocin and carbetocin, which act on the oxytocin receptor, and recent research has shown that lower doses of first-line uterotonics can be used to adequate effect. The oxytocin receptor is known to undergo desensitisation with exposure to the agonist over time and with increasing concentrations. Therefore, second-line uterotonics, such as ergometrine, carboprost, sulprostone or misoprostol, need to be considered earlier than they have been in past clinical practice. Choice of second-line uterotonic will vary depending on the comorbidities of the patient. This article will outline each of the available first- and second-line uterotonics, their mechanisms of action, pharmacokinetics, side effects and contraindications. Comparisons between them will also be discussed, as well as differences in superiority and guidance on dosing, based on recent evidence.
{"title":"Uterotonics update","authors":"Desire N. Onwochei , Neel Desai , Lawrence C. Tsen","doi":"10.1016/j.bpa.2024.10.007","DOIUrl":"10.1016/j.bpa.2024.10.007","url":null,"abstract":"<div><div>Uterotonics are the mainstay of management for postpartum haemorrhage and an understanding of their use is essential for the obstetric anaesthetist. First-line uterotonics comprise oxytocin and carbetocin, which act on the oxytocin receptor, and recent research has shown that lower doses of first-line uterotonics can be used to adequate effect. The oxytocin receptor is known to undergo desensitisation with exposure to the agonist over time and with increasing concentrations. Therefore, second-line uterotonics, such as ergometrine, carboprost, sulprostone or misoprostol, need to be considered earlier than they have been in past clinical practice. Choice of second-line uterotonic will vary depending on the comorbidities of the patient. This article will outline each of the available first- and second-line uterotonics, their mechanisms of action, pharmacokinetics, side effects and contraindications. Comparisons between them will also be discussed, as well as differences in superiority and guidance on dosing, based on recent evidence.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"38 3","pages":"Pages 209-220"},"PeriodicalIF":4.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094100","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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