Anesthesiology最新文献

Cardiovascular collapse and arrest in the periprocedural setting and intensive care unit differ from arrests in other contexts (such as out-of-hospital or hospital ward) because clinicians almost always witness the event, and the most likely precipitating cause may be known. In comparison to other settings, the response can be timelier and more focused on treating the underlying cause(s). Since many patients deteriorate over minutes to hours, clinicians can evaluate the patient expeditiously, generate a diagnosis, and initiate appropriate treatment more rapidly than in other arrest circumstances. This iteration of Perioperative Resuscitation and Life Support (PeRLS) employs Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology to review the most recent evidence on preventing and managing cardiac arrest during the perioperative period. Furthermore, many of the recommendations and algorithms may also be applicable to areas outside the operating room, such as the intensive care unit and emergency room.

The current practice of delaying tranexamic acid administration until after cord clamping may blunt its therapeutic potential in obstetric hemorrhage. Although this precaution aims to avoid fetal exposure, pharmacokinetic and available safety data suggest that such exposure poses minimal fetal risk. Data from limited cesarean and placenta previa studies indicate that earlier administration-before surgical incision or onset of bleeding-may reduce blood loss without harming neonates. Given that tranexamic acid is most effective when given early or before the onset of fibrinolysis, obstetric clinical trials and future protocols should reconsider the current default to post-cord clamping dosing. Earlier, targeted tranexamic acid administration may improve maternal outcomes without compromising neonatal safety and should be considered part of a rational approach in obstetric hemorrhage clinical trials.

Background: Neuraxial anesthesia techniques are considered the preferred technique for cesarean delivery, however the true incidence of pain during cesarean delivery with neuraxial anesthesia is not currently known. To date studies have been retrospective or conducted in a single center. The primary aim of this international cohort study was to prospectively determine the incidence of patient reported pain during cesarean delivery with neuraxial anesthesia.

Methods: We conducted, over 8 weeks, a multicenter cohort study in 15 centers across the United States of America and Canada; all patients who underwent cesarean delivery with neuraxial anesthesia were surveyed on postpartum day 1 regarding the presence of intraoperative pain, grade their pain using a numeric rating score (0-10) and rate their satisfaction (Yes/No) with their pain management..

Results: A total of 3,693 patients were included in the analysis. An overall incidence of patient reported pain during cesarean delivery was 7.6% (95% CI 6.8%, 8.5%) with 282 of 3,693 patients reporting pain. In patients undergoing elective cesarean delivery, intraoperative pain was reported in 3.7% (95% CI 2.7%, 5.0%) with spinal, 9.2% (95% CI 6.7%, 12.2%) with combined spinal-epidural and 12.2% (95% CI 4.1%, 26.2%) with epidural top-up anesthesia. In the non-elective setting, pain was more commonly reported by patients, 5.7% (95% CI 4.0, 7.8) with spinal, 7.1% (95% CI 4.7%, 10.1%) with combined spinal-epidural, 8.0% (95% CI 2.2%, 19.2%) with dural puncture epidural and 13.2% (CI 95% CI 11.1%, 15.5%) with epidural top-up anesthesia. Patients who had intraoperative pain reported a median (IQR) numeric rating score of 6 (4-8) out of 10. In those who reported pain, dissatisfaction with how the pain was managed by the anesthesia team was reported by 29 (10.3%) patients.

Conclusions: Overall incidence of patient reported pain during cesarean delivery with neuraxial anesthesia in this multicenter cohort was 7.6%. This varied significantly by anesthesia technique, with spinal having the lowest incidence and epidural top-up the highest. Further work is required to characterize the pain experience, understand its impact, and develop techniques to reduce its incidence.