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Duarte SS, Nguyen TAT, Koch C, Williams K, Murphy JD. Remote Obstetric Anesthesia: Leveraging Telemedicine to Improve Fetal and Maternal Outcomes. Telemed J E Health 2019; 26:967-972. [PMID: 31710285 DOI: 10.1089/tmj.2019.0174] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In the United States, the prevalence of pregnancy-related deaths has risen significantly over the past 20 years. Pregnant women at high risk for peripartum complications should undergo anesthesia consultation before delivery so that a management plan can be created between the obstetrician, anesthesiologist, and patient to ensure optimal outcomes for both the mother and newborn. However, few hospitals outside of major, urban, academic medical centers have dedicated anesthesiologists specially trained in obstetric anesthesia and the resources available to expedite optimization of high-risk parturient comorbidities. Telemedicine is a valuable tool by which evaluation, triaging, and multidisciplinary coordination can be provided for high-risk obstetric patients living in remote or rural communities without access to specialized, maternal care medical facilities. This review examines the existing literature regarding telemedicine use in preoperative anesthesia and antenatal obstetrics and identifies areas for future research. Furthermore, the benefits and potential barriers of implementing a telemedicine program specifically dedicated to obstetric anesthesia are discussed.
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Affiliation(s)
- Shirley S Duarte
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Truc-Anh T Nguyen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Colleen Koch
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Kayode Williams
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Jamie D Murphy
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
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Roe M, Nabeih W. Antenatal anaesthetic assessment clinics: a survey of United Kingdom practice. Int J Obstet Anesth 2019; 37:139-141. [DOI: 10.1016/j.ijoa.2018.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/08/2018] [Accepted: 11/13/2018] [Indexed: 11/28/2022]
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Antenatal anaesthesia clinics - the way forward? Isr J Health Policy Res 2018; 7:53. [PMID: 30126465 PMCID: PMC6102930 DOI: 10.1186/s13584-018-0244-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 07/29/2018] [Indexed: 11/10/2022] Open
Abstract
Specialist antenatal clinics are increasingly being used to enable anaesthetists to evaluate pregnant women with co-morbidities and those at high risk of obstetric complications. In this journal a team from Israel describe the process of setting up and running such a clinic over a 14 year period. One of the challenges they identify was the limited referral of high risk women. Based on UK and US literature, the use of structured referral tools, clear criteria for referral and regular antenatal multidisciplinary meetings may help to address this.
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Shatalin D, Gozal Y, Grisaru-Granovsky S, Ioscovich A. Five years' experience in an anesthesiology antenatal clinic for high-risk patients. J Perinat Med 2018; 46:287-291. [PMID: 28599396 DOI: 10.1515/jpm-2017-0016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 04/19/2017] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The aim, of this study is to describe our approach and outcomes in an outpatient anesthesia/analgesia antepartum clinic among ambulatory high-risk obstetric patients. METHODS This was a retrospective evaluation of the activity of the anesthesiology antenatal clinic from its inception in 2010 until 2016 (a 5-year period). The clinic works in collaboration with the Department of Obstetrics and Gynecology. The catchment area of the study University Affiliated Hospital attends a multiethnic population characterized by high parity. RESULTS There were 241 referrals over the 5 years, each of whom was discharged with a consult and a delivery management plan and 228 (95%) of which were performed as planned. Mean gestational age at consultation was 34.4 weeks (range: 20-37). There were no preconceptional consultation. No limitations regarding mode of anesthesia/analgesia was considered for 47% of the referrals. Nulliparous women accounted for 50% of the referrals and 17% were in their second pregnancy. The greatest number of referrals (30%) was for musculoskeletal conditions. No maternal death encountered. The mode of delivery was vaginal in 139 (65%) women; elective cesarean section in 44 (21%) women; and emergent cesarean section in 30 (14%) women. The neonatal outcomes were unremarkable; 210 (87%) in hospital births, 97.1% had an a 5' Apgar score of 9. CONCLUSION Our findings reveal the need for high-risk obstetric patients consult with a dedicated obstetric anesthesiologist to devise a management plan for labor and delivery that is tailored to their comorbidity and obstetric status, to ensure an optimum outcome for mother and child.
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Affiliation(s)
- Daniel Shatalin
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Hadassah-Hebrew University Medical School Ein-Karem, Jerusalem, Israel
| | - Yaacov Gozal
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Hadassah-Hebrew University Medical School Ein-Karem, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hadassah-Hebrew University Medical School Ein-Karem, Jerusalem, Israel
| | - Alexander Ioscovich
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Hadassah-Hebrew University Medical School Ein-Karem, Jerusalem, Israel
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Weiniger CF, Einav S, Elchalal U, Ozerski V, Shatalin D, Ioscovich A, Ginosar Y. Concurrent medical conditions among pregnant women - ignore at their peril: report from an antenatal anesthesia clinic. Isr J Health Policy Res 2018; 7:16. [PMID: 29551095 PMCID: PMC5858140 DOI: 10.1186/s13584-018-0210-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/07/2018] [Indexed: 01/14/2023] Open
Abstract
Background Care of pregnant women with concurrent medical conditions can be optimized by multidisciplinary antenatal management. In the current study we describe women with concurrent medical conditions who attended our antenatal anesthesia clinic over a 14-year period, 2002–2015 and, based on the findings, we suggest new policies, strategies and practices to improve antenatal care. Methods In 2002, an antenatal anesthesia clinic was established in Hadassah Medical Center. Each consultation focused on the concurrent medical condition. A written anesthesia strategy according to the medical condition and its anesthesia considerations was discussed and given to the patient. Data regarding clinic visits were recorded. Results A total of 451 clinic women attended the antenatal anesthesia clinic. Maternal age was 31.7 ± 6.0 years (mean ± SD), with gestational age of pregnancy 33.0 ± 5.4 weeks at the clinic visit. Musculoskeletal conditions (23% of all the women seen) were the most frequent concurrent conditions, followed by anesthesia related concerns 20%, neurologic conditions 19%, and cardiac conditions 15%. Women were provided plans that were deliberated carefully rather than being concocted during labor. Conclusions A wide range of concurrent medical conditions was seen in the antenatal anesthesia clinic, however fewer women attended the clinic than expected according to known population frequencies of concurrent medical conditions. Women with concurrent medical conditions should have labor and anesthesia plans considered during the nine months of pregnancy, prior to delivery, and hospitals should have a means of obtaining this information in a timely manner. Finally, there is a need to develop additional antenatal anesthesia clinics.
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Affiliation(s)
- Carolyn F Weiniger
- Hadassah Hebrew University Medical Center, Jerusalem, Israel. .,Division of Anesthesia, Pain and Critical Care, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
| | - Sharon Einav
- Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Uriel Elchalal
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Daniel Shatalin
- Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Alexander Ioscovich
- Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Yehuda Ginosar
- Hadassah Hebrew University Medical Center, Jerusalem, Israel.,Washington University Medical Center, St Louis, MO, USA
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Lie SA, Mok MUS. Peri-operative management of caesarean section for the occasional obstetric anaesthetist – an aide memoire. PROCEEDINGS OF SINGAPORE HEALTHCARE 2017. [DOI: 10.1177/2010105817698160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Anaesthesia practice for caesarean section (CS) has evolved in the past 20 years. This article aims to update occasional obstetric anaesthesiologists, obstetricians and clinicians involved in the management of pregnant women on the latest guidelines and recommendations for anaesthesia management, including pre-operative evaluation, informed consent, intra-operative and postoperative management for CS. In addition, this article will also summarise the management of CS associated emergencies such as difficult intubation, obstetric major postpartum haemorrhage, local anaesthetic toxicity and (pre-) eclampsia. At the end of the article, a charted summary will be provided as an aide memoire.
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Affiliation(s)
- Sui An Lie
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - May Un Sam Mok
- Department of Anaesthesiology, Singapore General Hospital, Singapore
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Eley VA, van Zundert AAJ, Lipman J, Callaway LK. Anaesthetic Management of Obese Parturients: What is the Evidence Supporting Practice Guidelines? Anaesth Intensive Care 2016; 44:552-9. [DOI: 10.1177/0310057x1604400517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Increasing rates of obesity in western populations present management difficulties for clinicians caring for obese pregnant women. Various governing bodies have published clinical guidelines for the care of obese parturients. These guidelines refer to two components of anaesthetic care: anaesthetic consultation in the antenatal period for women with a body mass index (BMI) > 40 kg/m2 and the provision of early epidural analgesia in labour. These recommendations are based on the increased incidence of obstetric complications and the predicted risks and difficulties in providing anaesthetic care. The concept behind early epidural analgesia is logical—site the epidural early, use it for surgical anaesthesia and avoid general anaesthesia if surgery is required. Experts support this recommendation, but there is weak supporting evidence. It is known that the management of labour epidurals in obese women is complicated and that women with extreme obesity require higher rates of general anaesthesia. Anecdotally, anaesthetists view and apply the early epidural recommendation inconsistently and the acceptability of early epidural analgesia to pregnant women is variable. In this topic review, we critically appraise these two practice recommendations. The elements required for effective implementation in multidisciplinary maternity care are considered. We identify gaps in the current literature and suggest areas for future research. While prospective cohort studies addressing epidural extension (‘top-up’) in obese parturients would help inform practice, audit of local practice may better answer the question “is early epidural analgesia beneficial to obese women in my practice?”.
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Affiliation(s)
- V. A. Eley
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, School of Medicine, The University of Queensland, Brisbane, Queensland
| | - A. A. J. van Zundert
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, School of Medicine, Professor and Chairman, Discipline of Anaesthesiology, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Queensland
| | - J. Lipman
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, School of Medicine, The University of Queensland, Faculty of Health, Queensland University of Technology, Brisbane, Queensland
| | - L. K. Callaway
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, School of Medicine, The University of Queensland, Brisbane, Queensland
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Butwick AJ, Tiouririne M. Evaluation of high-risk obstetric patients: a survey of US academic centers. J Clin Anesth 2016; 33:460-8. [DOI: 10.1016/j.jclinane.2016.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 04/01/2016] [Accepted: 04/07/2016] [Indexed: 11/30/2022]
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Tsen LC, Kodali BS. Can general anesthesia for cesarean delivery be completely avoided? An anesthetic perspective. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.10.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Review of a high-risk obstetric anesthesia antepartum consult clinic. Can J Anaesth 2013; 61:282-3. [DOI: 10.1007/s12630-013-0094-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 12/09/2013] [Indexed: 11/26/2022] Open
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A national survey of obstetric anaesthesia guidelines in the UK. Int J Obstet Anesth 2008; 17:322-8. [DOI: 10.1016/j.ijoa.2008.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2007] [Accepted: 04/01/2008] [Indexed: 11/19/2022]
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Butwick AJ, Carvalho B. Can we improve maternal outcome for high-risk obstetric patients? Int J Obstet Anesth 2007; 16:311-3. [PMID: 17698338 DOI: 10.1016/j.ijoa.2007.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2007] [Indexed: 11/20/2022]
Affiliation(s)
- A J Butwick
- Department of Anesthesia, Stanford University School of Medicine, Stanford, California 94305, USA
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