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Zewdu D, Tantu T. Incidence and predictors of severe postpartum hemorrhage after cesarean delivery in South Central Ethiopia: a retrospective cohort study. Sci Rep 2023; 13:3635. [PMID: 36869166 PMCID: PMC9984450 DOI: 10.1038/s41598-023-30839-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/02/2023] [Indexed: 03/05/2023] Open
Abstract
Severe postpartum hemorrhage is an obstetric emergency that needs immediate intervention and is a leading cause of maternal death. Despite its significant health burden, little is known, about its magnitude and risk factors, especially after cesarean delivery in Ethiopia. This study aimed to evaluate the incidence and predictors of severe postpartum hemorrhage following cesarean section. This study was conducted on 728 women who underwent cesarean section. We retrospectively collected data from the medical records, including baseline characteristics, obstetrics, and perioperative data. Potential predictors were investigated using multivariate logistic regression analyses, adjusted odd ratios, and a 95% confidence interval to see associations. A p-value < 0.05 is considered statistically significant. The incidence of severe postpartum hemorrhage was 26 (3.6%). The independently associated factors were previous CS scar ≥ 2 (AOR 4.08: 95% CI 1.20-13.86), antepartum hemorrhage (AOR 2.89: 95% CI 1.01-8.16), severe preeclampsia (AOR 4.52: 95% CI 1.24-16.46), maternal age ≥ 35 years (AOR 2.77: 95% CI 1.02-7.52), general anesthesia (AOR 4.05: 95% CI 1.37-11.95) and classic incision (AOR 6.01: 95% CI 1.51-23.98). One in 25 women who gave birth during cesarean section experienced severe postpartum hemorrhage. Considering appropriate uterotonic agents and less invasive hemostatic interventions for high-risk mothers would help to decrease its overall rate and related morbidity.
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Affiliation(s)
- Dereje Zewdu
- Department of Anesthesia, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia.
| | - Temesgen Tantu
- Department of Obstetrics and Gynecology, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
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2
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Cesarean delivery using an ERAS-CD process for nonopioid anesthesia and analgesia drug/medication management. Best Pract Res Clin Obstet Gynaecol 2022; 85:35-52. [PMID: 35995654 DOI: 10.1016/j.bpobgyn.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/13/2022] [Indexed: 12/14/2022]
Abstract
Cesarean delivery (CD) is a surgical delivery of a neonate with surgical access through the maternal abdominal and uterine structures. The Enhanced Recovery After Surgery (ERAS) protocol is a standardized perioperative care program and surgery quality improvement process that has had global spread across numerous surgical disciplines. The medical and surgical use of opioids for pain management and the nonmedical opioid use, over the last three decades, have significantly increased the prevalence of abuse and addiction to opioids. This review summarizes pain, pregnancy substance use, and ERAS-directed analgesia and anesthesia for opioid use reduction or elimination in the operative and postoperative periods. Enhanced recovery (quality and safety) in the surgical CD context requires collaboration, consensus, and appropriate clinical prioritization to allow for the identification of 'the right patient, in the right clinical situation, with the right informed consent, and the right clinical care team and health system'.
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3
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Liu X. Effect of patient-controlled epidural analgesia with remifentanil combined with propofol on analgesia and pain mediators after cesarean section. Minerva Surg 2022; 77:604-606. [PMID: 34693676 DOI: 10.23736/s2724-5691.21.09093-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Xinwei Liu
- Department of Surgical Anesthesiology, Taiyuan Central Hospital, Fendong Hospital, Taiyuan, China -
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4
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Swanson K, Liang L, Grobman WA, Higgins N, Roy A, Son M. Duration of Exposure to General Endotracheal Anesthesia during Cesarean Deliveries at Term and Perinatal Complications. Am J Perinatol 2022; 39:232-237. [PMID: 34844279 DOI: 10.1055/s-0041-1739355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine whether the duration of time from initiation of general endotracheal anesthesia (GETA) to delivery for cesarean deliveries (CDs) performed is related to perinatal outcomes. STUDY DESIGN This is a retrospective study of patients with singleton nonanomalous gestations undergoing CD ≥37 weeks of gestation under GETA with reassuring fetal status at a single tertiary care center from 2000 to 2016. Duration from GETA initiation until delivery was calculated as the time interval from GETA induction to delivery (I-D), categorized into tertiles. Outcomes for those in the tertile with the shortest I-D were compared with those in the other two tertiles. The primary perinatal outcome was a composite of complications (continuous positive airway pressure or high-flow nasal cannula for ≥2 consecutive hours, inspired oxygen ≥30% for ≥4 consecutive hours, mechanical ventilation, stillbirth, or neonatal death ≤72 hours after birth). Secondary outcomes were 5-minute Apgar score <7 and a composite of maternal morbidity (bladder injury, bowel injury, and extension of hysterotomy). Bivariable and multivariable analyses were used to compare outcomes. RESULTS Two hundred eighteen maternal-perinatal dyads were analyzed. They were dichotomized based on I-D ≤4 minutes (those in the tertile with the shortest duration) or >4 minutes. Women with I-D >4 minutes were more likely to have prior abdominal surgery and less likely to have labored prior to CD. I-D >4 minutes was associated with significantly increased frequency of the primary perinatal outcome. This persisted after multivariable adjustment. In bivariable analysis, 5-minute Apgar <7 was more common in the group with I-D >4 minutes, but this did not persist in multivariable analysis. Frequency of maternal morbidity did not differ. CONCLUSION When CD is performed at term using GETA without evidence of nonreassuring fetal status prior to delivery, I-D interval >4 minutes is associated with increased frequency of perinatal complications. KEY POINTS · Cesarean delivery under general anesthesia is associated with increased perinatal complications.. · Perinatal complications are increased with increasing duration of exposure to general anesthetics.. · Maternal complications were not increased with shorter duration of exposure to general anesthesia..
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Affiliation(s)
- Kate Swanson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, San Francisco, San Francisco, California.,Division of Medical Genetics, Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Luzhou Liang
- Section of Obstetric Anesthesiology, Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nicole Higgins
- Section of Obstetric Anesthesiology, Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Archana Roy
- Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Moeun Son
- Section of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, New Haven, Connecticut
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5
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Yu PX, Bo LJ. Evaluation of efficacy and safety of propofol in the treatment of procedural sedation/anesthesia in neonates: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27147. [PMID: 34664839 PMCID: PMC8448078 DOI: 10.1097/md.0000000000027147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In newborns, propofol anesthesia is commonly utilized. Propofol is increasingly being shown to be effective and safe in treating procedural sedation and anesthesia in neonates. This research aims to evaluate the efficacy and safety of propofol in neonates using systematic review and meta-analysis methodologies. METHODS A thorough review and meta-analysis of studies on propofol anesthesia in neonates will be conducted. Conduct comprehensive searches in Web of Science, PubMed, Cochrane Library, EMBASE database, WanFang database, and Chinese biomedical literature database before May 25, 2021, to obtain published and qualified research. Two reviewers will assess the quality of the included papers and extract the data independently. Then, for meta-analysis, we will utilize RevMan 5.3 software. RESULTS This study will pool the data of separate trials to analyze the efficacy and safety of propofol in the treatment of procedural sedation/anesthesia in neonates. CONCLUSION Our findings will give strong data for determining whether propofol is an effective treatment for procedural anesthesia in neonates.
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Affiliation(s)
- Pei-Xia Yu
- Department of Anesthesiology, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Li-Jun Bo
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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6
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Nair A, Louis A, Tiwary M, Sharma P. Comparison of postoperative pulmonary outcomes in patients undergoing cesarean section under general and spinal anesthesia: A single-center audit. Anesth Essays Res 2021; 15:439-442. [PMID: 35422556 PMCID: PMC9004269 DOI: 10.4103/aer.aer_6_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction: Regional anesthesia (RA), i.e., spinal or epidural anesthesia when performed for lower segment cesarean section (LSCS) provides excellent surgical conditions, avoiding manipulation of the maternal airway, maternal satisfaction, and good postoperative analgesia. However, in situations like fetal distress (fetal heart rate abnormalities), obstetric indications (abruption of placenta, antenatal placental bleeding, cord prolapse), maternal refusal for RA, contraindications to neuraxial anesthesia (anticoagulation, coagulopathy), and at times failed RA general anesthesia (GA) is administered. Several studies have demonstrated greater mortality and morbidity when LSCS is done under GA when compared to neuraxial block. Methods: After necessary approval, we retrospectively reviewed data over a period of 1 year (January 1, 2020–December 31, 2020) of LSCS under GA versus RA. The aim was to compare immediate postoperative complications, postoperative pulmonary complications up to 4 weeks from the time of elective and emergency LSCS under either RA or GA. Results: Of the 753 patients who underwent LSCS in one calendar year, there were 272 (36.12%) elective and 481 (63.87%) emergency LSCS. The number of elective LSCS under neuraxial block was 219 (29.09%) and under GA were 53 (7.03%). Emergency LSCS done under neuraxial block were 268 (35.59%) and under GA were 213 (28.28%). There were no adverse pulmonary complications at the end of 4 weeks in either group. Conclusion: RA provides maternal satisfaction and excellent perioperative analgesia in LSCS. Safe GA can be achieved with proper airway planning, if case is attended by at least two anesthesiologist with adequate preoperative fasting, and postoperative monitoring.
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Ikeda T, Kato A, Bougaki M, Araki Y, Ohata T, Kawashima S, Imai Y, Ninagawa J, Oba K, Chang K, Uchida K, Yamada Y. A retrospective review of 10-year trends in general anesthesia for cesarean delivery at a university hospital: the impact of a newly launched team on obstetric anesthesia practice. BMC Health Serv Res 2020; 20:421. [PMID: 32404093 PMCID: PMC7371464 DOI: 10.1186/s12913-020-05314-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/08/2020] [Indexed: 01/09/2023] Open
Abstract
Background The indications for general anesthesia (GA) in obstetric settings, which are determined in consideration of maternal and fetal outcome, could be affected by local patterns of clinical practice grounded in unique situations and circumstances that vary among medical institutions. Although the use of GA for cesarean delivery has become less common with more frequent adoption of neuraxial anesthesia, GA was previously chosen for pregnancy with placenta previa at our institution in case of unexpected massive hemorrhage. However, the situation has been gradually changing since formation of a team dedicated to obstetric anesthesia practice. Here, we report the results of a review of all cesarean deliveries performed under GA, and assess the impact of our newly launched team on trends in clinical obstetric anesthesia practice at our institution. Methods Our original database for obstetric GA during the period of 2010 to 2019 was analyzed. The medical records of all parturients who received GA for cesarean delivery were reviewed to collect detailed information. Interrupted time series analysis was used to evaluate the impact of the launch of our obstetric anesthesia team. Results As recently as 2014, more than 10% of cesarean deliveries were performed under GA, with placenta previa accounting for the main indication in elective and emergent cases. Our obstetric anesthesia team was formed in 2015 to serve as a communication bridge between the department of anesthesiology and the department of obstetrics. Since then, there has been a steady decline in the percentage of cesarean deliveries performed under GA, decreasing to a low of less than 5% in the latest 2 years. Interrupted time series analysis revealed a significant reduction in obstetric GA after 2015 (P = 0.04), which was associated with decreased use of GA for pregnancy with placenta previa. On the other hand, every year has seen a number of urgent cesarean deliveries requiring GA. Conclusions There has been a trend towards fewer obstetric GA since 2015. The optimized use of GA for cesarean delivery was made possible mainly through strengthened partnerships between anesthesiologists and obstetricians with the support of our obstetric anesthesia team.
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Affiliation(s)
- Takamitsu Ikeda
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan.
| | - Atsuko Kato
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiko Bougaki
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuko Araki
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Takuya Ohata
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Seiichiro Kawashima
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Yousuke Imai
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan.,Department of Anesthesiology, Sanraku Hospital, Tokyo, Japan
| | - Jun Ninagawa
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan.,Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan
| | - Koji Oba
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kyungho Chang
- Department of Anesthesiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kanji Uchida
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoshitsugu Yamada
- Department of Anesthesiology, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
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8
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Dexmedetomidine as a part of general anaesthesia for caesarean delivery in patients with pre-eclampsia. Eur J Anaesthesiol 2018; 35:372-378. [DOI: 10.1097/eja.0000000000000776] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Orbach-Zinger S, Weiniger CF, Aviram A, Balla A, Fein S, Eidelman LA, Ioscovich A. Anesthesia management of complete versus incomplete placenta previa: a retrospective cohort study. J Matern Fetal Neonatal Med 2017; 31:1171-1176. [PMID: 28335653 DOI: 10.1080/14767058.2017.1311315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Placenta previa (PP) is a major cause of obstetric hemorrhage. Clinical diagnosis of complete versus incomplete PP has a significant impact on the peripartum outcome. Our study objective is to examine whether distinction between PP classifications effect anesthetic management. METHODS AND MATERIALS This multi-center, retrospective, cohort study was performed in two tertiary university-affiliated medical centers between the years 2005 and 2013. Electronic delivery databases were reviewed for demographic, anesthetic, obstetric hemorrhage, and postoperative outcomes for all cases. RESULTS Throughout the study period 452 cases of PP were documented. We found 134 women (29.6%) had a complete PP and 318 (70.4%) had incomplete PP. Our main findings were that women with complete PP intraoperatively had higher incidence of general anesthesia (p = .017), higher mean estimated blood loss (p < .001), increased blood components transfusions (p < .001), and significant increase in cesarean hysterectomy rate (p < .001) than women with incomplete PP. Additionally, complete PP was associated with more postoperative complications: higher incidence of admission to the intensive care unit (ICU) (p < .001), more mechanical ventilation (p = .02), a longer median postoperative care unit (PACU) (p = .02), ICU (p = .002), and overall length of stay in the hospital (p < .001). CONCLUSIONS Complete PP is associated with increased risk of hemorrhage compared with incomplete PP. Therefore distinction between classifications should be factored into anesthetic management protocols.
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Affiliation(s)
- Sharon Orbach-Zinger
- a Department of Anesthesia , Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel
| | - Carolyn F Weiniger
- b Department of Anesthesia , Hadassah Hebrew University Medical Center , Jerusalem , Israel
| | - Amir Aviram
- c Lis Maternity and Women's Hospital, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel
| | - Alexander Balla
- a Department of Anesthesia , Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel
| | - Shai Fein
- a Department of Anesthesia , Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel
| | - Leonid A Eidelman
- a Department of Anesthesia , Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel
| | - Alexander Ioscovich
- d Department of Anesthesia , Shaare Zedek Medical Center , Jerusalem , Israel
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10
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Geng ZY, Wang DX. Laryngeal Mask Airway for Cesarean Delivery: A 5-Year Retrospective Cohort Study. Chin Med J (Engl) 2017; 130:404-408. [PMID: 28218212 PMCID: PMC5324375 DOI: 10.4103/0366-6999.199833] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The laryngeal mask airway (LMA) is the most commonly used rescue airway in obstetric anesthesia. The aim of this retrospective cohort study was to evaluate the application of the LMA in parturients undergoing cesarean delivery (CD) for 5 years in our hospital. As a secondary objective, we investigated the incidence of airway-related complication in obstetric general anesthesia (GA). METHODS We collected electronic data for all obstetric patients who received GA for CD between January 2010 and December 2014 in Peking University First Hospital. Based on the different types of airway device, patients were divided into endotracheal intubation (ET) group and LMA group. The incidences of regurgitation and aspiration, as well as maternal and neonatal postoperative outcomes were compared between groups. RESULTS During the 5-year study, GA was performed in 192 cases, which accounted for 2.0% of all CDs. The main indications for GA were contraindication to neuraxial anesthesia or a failed block. Among these, ET tube was used in 124 cases (68.9%) and LMA in 56 cases (31.1%). The percentage of critical patients above the American Society of Anesthesiologists' Grade II was 24/124 in ET group and 4/56 in LMA group (P = 0.036). The emergent delivery rate was 63.7% for ET group and 37.5% for LMA group (P = 0.001). None of the patients had regurgitation or aspiration. There were no significant differences in terms of neonatal Apgar scores, maternal and neonatal postoperative outcomes between the two groups. CONCLUSIONS Our results suggested that GA was mainly used for contraindication to neuraxial anesthesia or a failed block, and emergent CDs accounted for most cases. The second-generation LMA could be used for obstetric anesthesia, but correct position to achieve a good seal is the key to prevent reflux and aspiration. Whether they could replace the tracheal tube in routine practice needs further large prospective studies.
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Affiliation(s)
- Zhi-Yu Geng
- Department of Anesthesiology, Peking University First Hospital, Beijing 100034, China
| | - Dong-Xin Wang
- Department of Anesthesiology, Peking University First Hospital, Beijing 100034, China
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11
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Haliloglu M, Bilgen S, Menda F, Ozcan P, Ozbay L, Tatar S, Unal DO, Koner O. Analgesic efficacy of wound infiltration with tramadol after cesarean delivery under general anesthesia: Randomized trial. J Obstet Gynaecol Res 2016; 42:816-21. [PMID: 27096471 DOI: 10.1111/jog.12999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/25/2016] [Accepted: 02/18/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Murat Haliloglu
- Department of Anesthesiology, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Sevgi Bilgen
- Department of Anesthesiology, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Ferdi Menda
- Department of Anesthesiology, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Pinar Ozcan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Bezmialem University, Istanbul, Turkey
| | - Latif Ozbay
- Department of Pharmacology, Faculty of Pharmacy, Yeditepe University, Istanbul, Turkey
| | - Sevgi Tatar
- Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
| | | | - Ozge Koner
- Department of Anesthesiology, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
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12
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Maternal and fetal outcomes following unplanned conversion to general anesthetic at elective cesarean section. J Perinatol 2015; 35:695-9. [PMID: 26067473 PMCID: PMC4552585 DOI: 10.1038/jp.2015.62] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/25/2015] [Accepted: 04/28/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate risk factors predicting unplanned conversion to general anesthesia during elective cesarean section, and to examine maternal and fetal outcomes associated with unplanned conversion compared with other modes of anesthesia. STUDY DESIGN A retrospective cohort at a UK center (2008 to 2013). Women (4337) underwent elective cesarean section. Delivery outcomes were compared according to anesthesia type using logistic regression. RESULT Women (1.6%) underwent unplanned conversion to general anesthetic. Unplanned conversion was associated with higher parity (odds ratio (OR) 3.82, confidence interval (CI; (1.58 to 9.62)) and maternal age ⩾40 (OR 4.40, CI (1.08 to 29.88)). Compared with spinal anesthetic, unplanned conversion was associated with increased likelihood of maternal hemorrhage ⩾1.5 l (OR 5.74, CI (1.90 to 14.01)) and delayed neonatal respiration (OR 4.76, CI (1.76 to 11.05)). Adverse outcomes were not significantly more likely compared with planned general anesthetic. CONCLUSION Higher parity and maternal age are risk factors for unplanned conversion to general anesthetic. There is no increase in the likelihood of adverse outcomes with unplanned versus planned general anesthetic.
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13
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Yu M, Han C, Jiang X, Wu X, Yu L, Ding Z. Effect and Placental Transfer of Dexmedetomidine During Caesarean Section Under General Anaesthesia. Basic Clin Pharmacol Toxicol 2015; 117:204-8. [PMID: 25652672 DOI: 10.1111/bcpt.12389] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 01/26/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Min Yu
- Department of Anaesthesiology; The First Affiliated Hospital; Nanjing Medical University; Nanjing China
| | - Chuanbao Han
- Department of Anaesthesiology; The First Affiliated Hospital; Nanjing Medical University; Nanjing China
| | - Xiuhong Jiang
- Department of Anaesthesiology; The First Affiliated Hospital; Nanjing Medical University; Nanjing China
| | - Xia Wu
- Department of Anaesthesiology; The First Affiliated Hospital; Nanjing Medical University; Nanjing China
| | - Li Yu
- Department of Anaesthesiology; The First Affiliated Hospital; Nanjing Medical University; Nanjing China
| | - Zhengnian Ding
- Department of Anaesthesiology; The First Affiliated Hospital; Nanjing Medical University; Nanjing China
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14
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Affiliation(s)
- Yusuke Mazda
- Saitama Medical Center, Saitama Medical University; Division of Obstetric Anesthesia, Department of Anesthesiology; 1981 Kamoda Kawagoe Saitama Japan 350-8550
| | - Erika Ota
- National Center for Child Health and Development; Department of Health Policy; 2-10-1 Okura, Setagaya-ku Tokyo Japan 157-8535
| | - Rintaro Mori
- National Center for Child Health and Development; Department of Health Policy; 2-10-1 Okura, Setagaya-ku Tokyo Japan 157-8535
| | - Katsuo Terui
- Saitama Medical Center, Saitama Medical University; Division of Obstetric Anesthesia, Department of Anesthesiology; 1981 Kamoda Kawagoe Saitama Japan 350-8550
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15
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Abstract
In the first part of this review, the epidemiology of obstetric critical care is discussed. This includes the incidence of severe morbidity in pregnancy, identification of critically ill and potentially critically ill patients, the incidence of obstetric ICU admissions, the type of critical illness by stage of pregnancy, ICU admission diagnoses, the severity of illness in obstetric ICU patients compared to non-obstetric patients, ICU mortality of obstetric patients, the ICU proportion of total maternal mortality, and the causes of death for obstetric patients in ICU. In the second part, the management of obstetric patients who happen to be admitted to a general ICU is discussed. Rather than focusing on the management of particular obstetric conditions, general principles of ICU management will be discussed as applied to obstetric ICU patients. These include drug safety, monitoring the fetus, management of the airway, sedation, muscle relaxation, ventilation, cardiovascular support, thromboprophylaxis, and radiology and ethical issues.
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Affiliation(s)
- Alan Gaffney
- Department of Anesthesiology, Columbia University Medical Center, 622 W 168th St PH5-505, New York, NY 10032.
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