What’s new and novel in obstetric anesthesia? Contributions from the 2003 scientific literature

Correlation between gestational age and level of sensory block in spinal anesthesia

BACKGROUND AND OBJECTIVES

To identify a specific correlation between progression of gestational age and level of sensory block in spinal anesthesia in patients undergoing cervical cerclage.

METHODS

The medical records of patients who underwent cervical cerclage under spinal anesthesia using hyperbaric bupivacaine between March 2016 and May 2018 were retrospectively reviewed. The primary outcome measure was the correlation between gestational age and sensory block level of spinal anesthesia. Secondary outcomes included the correlations between gestational age and reduction in blood pressure and length of the postanesthesia care unit (PACU) stay. The Pearson correlation test, partial correlation test, and linear regression were used to identify relationships and to adjust for confounding variables.

RESULTS

Of the 261 cases reviewed, there was a linear and significant correlation between gestational age and sensory block level, reduction in systolic blood pressure during surgery, reduction in systolic blood pressure during PACU, and length of PACU stay, after adjusting for confounding factors (partial correlation coefficient=0.71, p<0.001; 0.27, p<0.001; 0.25, p<0.001; 0.21, p=0.001, respectively). A 1-day increase in gestational age corresponded to an increase of 0.04 dermatomes in sensory block level (95% CI 0.035 to 0.045, p<0.001).

CONCLUSION

Results demonstrated that as the gestational age progressed, sensory block level increased, blood pressure was decreased, and length of PACU stay increased after spinal anesthesia. Sensory block increased by 0.28 dermatomes when the pregnancy progressed 1 week. Further controlled prospective studies are needed to support this relationship.

TRIAL REGISTRATION NUMBER

KCT0000538.

Obstetric anaesthesia outcome in obese and non-obese parturients undergoing caesarean delivery: an observational study

BACKGROUND

Maternal obesity is increasing in prevalence and is associated with an increased risk of perioperative complications. This study evaluates the impact of obesity on perioperative outcomes in parturients undergoing caesarean delivery.

METHODS

In this prospective observational study of 1477 consecutive caesarean deliveries, data collected included body mass index, co-morbidities, anaesthetic technique, perioperative complications and patient satisfaction. Outcome measures included obesity prevalence, association of obesity with caesarean delivery, co-morbidities, perioperative complications and patient satisfaction and were compared between the obese and non-obese groups.

RESULTS

The prevalence of obesity was 54.3%, including 7.2% morbidly obese. About 61% of parturients who underwent caesarean delivery because of failure to progress in labour or previous caesarean were obese. The overall prevalence of co-morbidity was 10.2% of whom 57.3% were obese. Neuraxial anaesthesia was used in 73.4% and general anaesthesia in 26.6%, similar in obese and non-obese. The epidural failure rate was 4.3% and the spinal failure rate 2.9%. Difficulty in performing neuraxial anaesthesia was greater in obese patients (P=0.004). There was no association between obesity and laryngoscopy grades. Patient satisfaction was similar in the obese and non-obese groups. Postoperative complications were minimal and similar.

CONCLUSIONS

Neuraxial anaesthesia was effective for caesarean deliveries in obese and non-obese, in elective and emergency cases. Maternal obesity is associated with increased difficulty in performing neuraxial anaesthesia, but not with increased failure rate. Our study found no differences between obese and non-obese parturients in rate of caesarean deliveries, co-morbidities, indications for delivery or anaesthesia complications.

Application of quality improvement strategies in 389 European hospitals: results of the MARQuIS project

CONTEXT

This study was part of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) research project investigating the impact of quality improvement strategies on hospital care in various countries of the European Union (EU), in relation to specific needs of cross-border patients.

AIM

This paper describes how EU hospitals have applied seven quality improvement strategies previously defined by the MARQuIS study: organisational quality management programmes; systems for obtaining patients' views; patient safety systems; audit and internal assessment of clinical standards; clinical and practice guidelines; performance indicators; and external assessment.

METHODS

A web-based questionnaire was used to survey acute care hospitals in eight EU countries. The reported findings were later validated via on-site survey and site visits in a sample of the participating hospitals. Data collection took place from April to August 2006.

RESULTS

389 hospitals participated in the survey; response rates varied per country. All seven quality improvement strategies were widely used in European countries. Activities related to external assessment were the most broadly applied across Europe, and activities related to patient involvement were the least widely implemented. No one country implemented all quality strategies at all hospitals. There were no differences between participating hospitals in western and eastern European countries regarding the application of quality improvement strategies.

CONCLUSIONS

Implementation varied per country and per quality improvement strategy, leaving considerable scope for progress in quality improvements. The results may contribute to benchmarking activities in European countries, and point to further areas of research to explore the relationship between the application of quality improvement strategies and actual hospital performance.

Breastfeeding problems following anesthetic administration

Research literature supports the notion that maternal comfort should be considered a priority and that mothers should receive adequate information regarding any drug prior to receiving that drug. Some studies indicate that difficulties with breastfeeding may be related to the amount of the anesthetic or analgesic that is administered to the mother. Thus, it seems wise to administer the lowest possible dose to the mother in order to minimize the amount of drug (or metabolite) exposure to the nursing infant. Infant exposure can be further reduced if breastfeeding is avoided during the times when the mother receives high doses of anesthetics and analgesics. However, because relatively small amounts of the drug are excreted into the breast milk, some mothers may opt to continue nursing after weighing the benefits of breastfeeding against the potential risk to the infant. Others may choose to "pump and dump" breast milk while they receive anesthetic or analgesic agents. Any concerns in this regard should be discussed with the anesthesia provider, preferably prior to labor or to any surgeries while breastfeeding.