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Bapodra A, Moy K, Nekola D, Schwartz GS. Neuraxial analgesia, nerve blocks, and special considerations for the parturient. Int Anesthesiol Clin 2024; 62:62-68. [PMID: 38063038 DOI: 10.1097/aia.0000000000000428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Anuj Bapodra
- Department of Anesthesiology, Maimonides Medical Center, Brooklyn, New York
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2
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Alshabibi M, Madkhali AM, Alkinani AA, Alyami AA, Alatassi A. The trends of obstetric anesthesia practice: In a tertiary care center in the Kingdom of Saudi Arabia. Saudi J Anaesth 2021; 15:383-386. [PMID: 34658723 PMCID: PMC8477770 DOI: 10.4103/sja.sja_83_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: Obstetric anesthesia provides several methods for the analgesia of labor pain. The neuraxial technique is considered the standard of care for parturient women. The epidural block is widely used in vaginal delivery while the spinal block is the preferred method for cesarean section (C-section). We aim to know the practice of obstetric anesthesia in our center. Methods: A retrospective cross-sectional study was conducted at a tertiary center in Riyadh, Saudi Arabia. The data of all delivery cases from 1/7/2019 to 30/9/2019 were reviewed. Results: We identified a total of 2,140 cases during the 3 months, vaginal delivery was the most common with 72.4% (1550) while the C-section cases were 27.6% (590). Regarding the type of analgesia/anesthesia for vaginal deliveries, intramuscular analgesia was the commonest group with 34.8% (540), followed by the group of ladies who did not receive any analgesia/anesthesia with 31.9% (495), thirdly was epidural cases with 31.8% (493), and the fourth type was spinal 0.6% (10). Regarding C-section, the emergency cases were 65.4% (386). The types of anesthesia for all C-sections were as follows spinal 63.5% (375), GA 23.8% (141), and epidural 12% (74). Regarding anesthesia for elective cases, spinal was 85% (174), GA 14% (28), and epidural 1% (2). Regarding anesthesia for emergency cases, spinal was 52% (201), GA 29% (113), and epidural 19% (72). Conclusions: The use of epidural was low, and the spinal use was relatively on par if we compare with leading western countries. More focused studies and multicenter studies are needed in the country.
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Affiliation(s)
- Mohammed Alshabibi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Azza M Madkhali
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Amer A Alkinani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Anesthesia, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ali A Alyami
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdulaleem Alatassi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Pediatric Anesthesia, King Abdullah Specialized Children Hospital, Riyadh, Saudi Arabia
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3
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Fan D, Rao J, Lin D, Zhang H, Zhou Z, Chen G, Li P, Wang W, Chen T, Chen F, Ye Y, Guo X, Liu Z. Anesthetic management in cesarean delivery of women with placenta previa: a retrospective cohort study. BMC Anesthesiol 2021; 21:247. [PMID: 34666687 PMCID: PMC8524954 DOI: 10.1186/s12871-021-01472-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background The incidence of placenta preiva is rising. Cesarean delivery is identified as the only safe and appropriate mode of delivery for pregnancies with placenta previa. Anesthesia is important during the cesarean delivery. The aim of this study is to assess maternal and neonatal outcomes of patients with placenta previa managed with neuraxial anesthesia as compared to those who underwent general anesthesia during cesarean delivery. Methods A retrospective cohort study was performed of all patients with placenta preiva at our large academic institution from January 1, 2014 to June 30, 2019. Patients were managed neuraxial anesthesia and general anesthesia during cesarean delivery. Results We identified 1234 patients with placenta previa who underwent cesarean delivery at our institution. Neuraxial anesthesia was performed in 737 (59.7%), and general anesthesia was completed in 497 (40.3%) patients. The mean estimated blood loss at neuraxial anesthesia of 558.96 ± 42.77 ml were significantly lower than the estimated blood loss at general anesthesia of 1952.51 ± 180 ml (p < 0.001). One hundred and forty-six of 737 (19.8%) patients required blood transfusion at neuraxial anesthesia, whereas 381 out of 497 (76.7%) patients required blood transfusion at general anesthesia. The rate neonatal asphyxia and admission to NICU at neuraxial anesthesia was significantly lower than general anesthesia (2.7% vs. 19.5 and 18.2% vs. 44.1%, respectively). After adjusting confounding factors, blood loss was less, Apgar score at 1- and 5-min were higher, and the rate of blood transfusion, neonatal asphyxia, and admission to NICU were lower in the neuraxial group. Conclusions Our data demonstrated that neuraxial anesthesia is associated with better maternal and neonatal outcomes during cesarean delivery in women with placenta previa. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01472-w.
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Affiliation(s)
- Dazhi Fan
- Foshan Fetal Medicine Research Institute, Affiliated Foshan Women and Children Hospital, Southern Medical University, Foshan, 528000, Guangdong, China. .,Department of Obstetrics, Affiliated Foshan Women and Children Hospital, Southern Medical University, Foshan, 528000, Guangdong, China.
| | - Jiaming Rao
- Foshan Fetal Medicine Research Institute, Affiliated Foshan Women and Children Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Dongxin Lin
- Foshan Fetal Medicine Research Institute, Affiliated Foshan Women and Children Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Huishan Zhang
- Foshan Fetal Medicine Research Institute, Affiliated Foshan Women and Children Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Zixing Zhou
- Foshan Fetal Medicine Research Institute, Affiliated Foshan Women and Children Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Gengdong Chen
- Foshan Fetal Medicine Research Institute, Affiliated Foshan Women and Children Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Pengsheng Li
- Foshan Fetal Medicine Research Institute, Affiliated Foshan Women and Children Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Wen Wang
- Department of Obstetrics, Affiliated Foshan Women and Children Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Ting Chen
- Department of Foetal Ultrasonic, Affiliated Foshan Women and Children Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Fengying Chen
- Department of Radiology, Affiliated Foshan Women and Children Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Yuping Ye
- Department of Anesthesiology, Affiliated Foshan Women and Children Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Xiaoling Guo
- Foshan Fetal Medicine Research Institute, Affiliated Foshan Women and Children Hospital, Southern Medical University, Foshan, 528000, Guangdong, China. .,Department of Obstetrics, Affiliated Foshan Women and Children Hospital, Southern Medical University, Foshan, 528000, Guangdong, China.
| | - Zhengping Liu
- Foshan Fetal Medicine Research Institute, Affiliated Foshan Women and Children Hospital, Southern Medical University, Foshan, 528000, Guangdong, China. .,Department of Obstetrics, Affiliated Foshan Women and Children Hospital, Southern Medical University, Foshan, 528000, Guangdong, China.
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4
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Lang Ben Nun E, Sela HY, Ioscovich A, Rotem R, Grisaru-Granovsky S, Rottenstreich M. Epidural analgesia and vacuum-assisted delivery in primiparous women: maternal and neonatal outcomes. J Matern Fetal Neonatal Med 2021; 35:6906-6913. [PMID: 34039246 DOI: 10.1080/14767058.2021.1929161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We aimed to evaluate the effect of epidural analgesia (EA) on maternal and neonatal outcomes. METHODS We conducted a retrospective cohort database study on primiparous women who underwent a vacuum-assisted delivery (VAD) trial between 2005 and 2019 at a university-affiliated tertiary medical center. We compared women with and without the standard "one protocol" patient-controlled EA. The primary outcome was VAD failure. Secondary outcomes were maternal and neonatal morbidities. We performed univariate analysis, followed by multivariable logistic regression analysis to control for potential confounders. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. RESULTS Overall, 7042 primiparous women attempted VAD during the study period; 6238 (88.3%) and 804 (11.7%) women used and did not use EA, respectively. The VAD failure rate was significantly lower among women with than without EA use (2.5% vs. 4.2%, respectively, p < .01). On multivariable analysis, EA use was found to reduce the VAD failure rate (aOR, 0.05; 95% CI [0.01-0.49], p = .01). Notably, EA use was not associated with an increased rate of any maternal or neonatal adverse outcome (aOR, 1.01; 95% CI [0.8-1.27], p = .95 or aOR, 1.14 95% CI [0.89-1.45], p = .3, respectively). CONCLUSIONS EA use in primiparous women is associated with lower rates of VAD failure without an increase in adverse maternal or neonatal outcomes.
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Affiliation(s)
- Eyal Lang Ben Nun
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Hen Y Sela
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Alexander Ioscovich
- Department of Anesthesiology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel.,Department of Anesthesiology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel.,Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
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5
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Schtrechman-Levi G, Ioscovich A, Hart J, Bar J, Calderon-Margalit R, Nir EA, Ginosar Y. Obstetric anesthesia services in Israel snapshot (OASIS) study: a 72 hour cross-sectional observational study of workforce supply and demand. Isr J Health Policy Res 2021; 10:24. [PMID: 33722282 PMCID: PMC7958695 DOI: 10.1186/s13584-021-00460-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 03/05/2021] [Indexed: 01/22/2023] Open
Abstract
Background We planned an observational study to assess obstetric anesthesia services nationwide. We aimed to assess the effect of the anesthesia workload/workforce ratio on quality and safety outcomes of obstetric anesthesia care. Methods Observers prospectively collected data from labor units over 72 h (Wednesday, Thursday and Friday). Independent variables were workload (WL) and workforce (WF). WL was assessed by the Obstetric Anesthesia Activity Index (OAAI), which is the estimated time in a 24-h period spent on epidurals and all cesarean deliveries. Workforce (WF) was assessed by the number of anesthesiologists dedicated to the labor ward per week. Dependent variables were the time until anesthesiologist arrival for epidural (quality measure) and the occurrence of general anesthesia for urgent Cesarean section, CS, (safety measure). This census included vaginal deliveries and unscheduled (but not elective) CS. Results Data on 575 deliveries are from 12 maternity units only, primarily because a major hospital chain chose not to participate; eight other hospitals lacked institutional review board approval. The epidural response rate was 94.4%; 321 of 340 parturients who requested epidural analgesia (EA) received it. Of the 19 women who requested EA but gave birth without it, 14 (77%) were due to late arrival of the anesthesiologist. Median waiting times for anesthesiologist arrival ranged from 5 to 28 min. The OAAI varied from 4.6 to 25.1 and WF ranged from 0 to 2 per shift. Request rates for EA in hospitals serving predominantly orthodox Jewish communities and in peripheral hospitals were similar to those of the entire sample. More than a fifth (13/62; 21%) of the unscheduled CS received general anesthesia, and of these almost a quarter (3/13; 23%) were attributed to delayed anesthesiologist arrival. Conclusions Inadequate WF allocations may impair quality and safety outcomes in obstetric anesthesia services. OAAI is a better predictor of WL than delivery numbers alone, especially concerning WF shortage. To assess the quality and safety of anesthetic services to labor units nationally, observational data on workforce, workload, and clinical outcomes should be collected prospectively in all labor units in Israel. Supplementary Information The online version contains supplementary material available at 10.1186/s13584-021-00460-2.
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Affiliation(s)
- Gal Schtrechman-Levi
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.,Department of General and Oncological Surgery - Surgery C, The Haim Sheba Medical Center, Ramat Gan, Israel
| | - Alexander Ioscovich
- Department of Anesthesiology, Perioperative Medicine, and Pain Treatment, Shaare Zedek Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jacob Hart
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.,Health Services Management School, Netanya Academic College, Netanya, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | | | - Eshel A Nir
- Department of Anesthesia and Operating Rooms, Kaplan Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Rehovot, Israel.
| | - Yehuda Ginosar
- Department of Anesthesiology and Critical Care Medicine, and Wohl Institute of Translational Medicine, Hadassah-Hebrew University Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA
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6
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Shatalin D, Weiniger C, Buchman I, Ginosar Y, Orbach-Zinger S, Ioscovich A. A 10-year update: national survey questionnaire of obstetric anesthesia units in Israel. Int J Obstet Anesth 2019; 38:83-92. [DOI: 10.1016/j.ijoa.2018.10.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/07/2018] [Accepted: 10/26/2018] [Indexed: 02/07/2023]
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7
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Srebnik N, Barkan O, Rottenstreich M, Ioscovich A, Farkash R, Rotshenker-Olshinka K, Samueloff A, Grisaru-Granovsky S. The impact of epidural analgesia on the mode of delivery in nulliparous women that attain the second stage of labor. J Matern Fetal Neonatal Med 2019; 33:2451-2458. [PMID: 30608007 DOI: 10.1080/14767058.2018.1554045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: We aimed to evaluate the impact of epidural analgesia on the mode of delivery of nulliparous women with a term single fetus in vertex presentation (NTSV) that attained the second stage of labor.Study design: A single-center retrospective study provided a strict and constant department protocol for epidural analgesia practice and obstetric interventions, between 2005 and 2014. Epidural users were compared to nonusers. The primary outcome was the mode of delivery. Secondary outcomes were diagnosis of prolonged second stage of labor and maternal and neonatal morbidities. The outcomes were evaluated by adjusted multivariate analyses (Adjusted Odds Ratios (aOR), 95% CI).Results: During the study period, 25,643 NTSV attained the second stage of labor; 18 676 (73%) epidural users and 6967 (27%) nonusers. Epidural users had an increased risk of instrumental delivery 2.48, [2.22-2.76], along with a lower risk of cesarean delivery 0.38, [0.29-0.50]. Notably, the diagnosis of prolonged second stage of labor was comparable among the study groups 0.99, [0.89-1.12]. The epidural users had a significantly higher risk of early postpartum hemorrhage 1.15, [1.04-1.27]. The risk for neonatal morbidity was comparable among the study groups 1.21 [0.90-1.63].Conclusion: Epidural analgesia in a population of NTSV that attains the second stage of labor is associated with a higher risk of instrumental delivery, nonetheless with a reduced risk of cesarean delivery; independent of the length of the second stage of labor is and safe for the neonate.
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Affiliation(s)
- Naama Srebnik
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Omri Barkan
- Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Alexander Ioscovich
- Department of Anesthesiology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Rivka Farkash
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Keren Rotshenker-Olshinka
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Arnon Samueloff
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
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8
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Ioscovich A, Giladi Y, Fuica RL, Weiniger CF, Orbach‐Zinger S, Gozal Y, Shatalin D. Anesthetic approach to postdural puncture headache in the peripartum period: An Israeli national survey. Acta Anaesthesiol Scand 2018; 62:1460-1465. [PMID: 29971770 DOI: 10.1111/aas.13208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/15/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Accidental dural puncture frequency among pregnant women is about 1.5%, while approximately 60% of these women will suffer from post-dural puncture headache (PDPH) that may be debilitating. METHODS Following IRB approval, we conducted a national survey of the lead anesthesiologist in 23 labor and delivery rooms in Israel. Each survey inquired about medical center annual delivery volume, training program for residents, accidental dural puncture management, processing of information, and PDPH management strategies. RESULTS Data were collected from all 23 surveyed hospitals. As for methods for PDPH prevention, in most hospitals (87%) a prophylactic epidural blood patch (EBP) is not considered. Injection of epidural normal saline after delivery as a preventive measure is never considered in most (78.3%) hospitals, while four (17.4%) hospitals reported of constitutive use of this technique and one hospital only occasionally. Duration of conservative treatment was 24-48 hours in 95.7% of PDPH cases. CONCLUSION In this survey, different aspects of treatment and PDPH management were examined. EBP is considered the gold standard in treating PDPH, although prophylactic blood patch is ineffective. We observed a tendency of very low performance of both prophylactic EBP and epidural normal saline administration after delivery in most centers. Most hospitals perform EBP after 24-48 hours of conservative treatment, along with published recommendations that show increased EBP efficiency with this timeframe. In light of the survey information, we aim to reach a uniform literature-based management strategy across Israeli hospitals.
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Affiliation(s)
- Alexander Ioscovich
- Department of Anesthesiology Perioperative Medicine & Pain Treatment Shaare Zedek Medical Center affiliated with the Hadassah‐Hebrew University Medical School Ein‐Kerem Jerusalem Israel
| | - Yaara Giladi
- Department of Anesthesiology Perioperative Medicine & Pain Treatment Shaare Zedek Medical Center affiliated with the Hadassah‐Hebrew University Medical School Ein‐Kerem Jerusalem Israel
| | - Rivka Leah Fuica
- Department of Anesthesiology Perioperative Medicine & Pain Treatment Shaare Zedek Medical Center affiliated with the Hadassah‐Hebrew University Medical School Ein‐Kerem Jerusalem Israel
| | - Carolyn F. Weiniger
- Department of Anesthesiology and Critical Care Medicine Hadassah‐Hebrew University Medical Center Ein Kerem, Jerusalem, Israel and Division of Anesthesia, Critical Care and Pain Tel Aviv Sourasky Medical Center Tel Aviv Israel
| | - Sharon Orbach‐Zinger
- Department of Anesthesia Rabin Medical Center (Beilinson Campus) Petah Tikvah, Tel Aviv University Tel Aviv Israel
| | - Yaacov Gozal
- Department of Anesthesiology Perioperative Medicine & Pain Treatment Shaare Zedek Medical Center affiliated with the Hadassah‐Hebrew University Medical School Ein‐Kerem Jerusalem Israel
| | - Daniel Shatalin
- Department of Anesthesiology Perioperative Medicine & Pain Treatment Shaare Zedek Medical Center affiliated with the Hadassah‐Hebrew University Medical School Ein‐Kerem Jerusalem Israel
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Abstract
Enhanced recovery after surgery is a concept initially developed for patients undergoing colorectal surgery but has been adopted by other surgical specialties with similar positive outcomes. The adoption of enhanced recovery after surgery in the obstetric patient population is rapidly gaining popularity. This review highlights perioperative interventions that should be considered in an enhanced recovery after surgery protocol for women undergoing cesarean delivery.
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Affiliation(s)
- Unyime Ituk
- Department of Anesthesia, University of Iowa, Iowa City, USA
| | - Ashraf S Habib
- Department of Anesthesiology, Duke University Medical Center, Durham, USA
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10
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Orbach-Zinger S, Einav S, Yona? A, Eidelman LA, Fein S, Davis A, Ioscovich A. A survey of physicians’ attitudes toward uterotonic administration in parturients undergoing cesarean section. J Matern Fetal Neonatal Med 2017; 31:3183-3190. [DOI: 10.1080/14767058.2017.1366981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sharon Orbach-Zinger
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Einav
- Department of Anesthesia, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Assaf Yona?
- Department of Pediatrics, Soroka Medical Center, Ben-Gurion University, Be’er Sheva, Israel
| | - Leonid A. Eidelman
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shia Fein
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Atara Davis
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Ioscovich
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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Ioscovich A, Shatalin D, Butwick AJ, Ginosar Y, Orbach-Zinger S, Weiniger CF. Israeli survey of anesthesia practice related to placenta previa and accreta. Acta Anaesthesiol Scand 2016; 60:457-64. [PMID: 26597396 DOI: 10.1111/aas.12656] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 07/12/2015] [Accepted: 09/24/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anesthesia practices for placenta previa (PP) and accreta (PA) impact hemorrhage management and other supportive strategies. We conducted a survey to assess reported management of PP and PA in all Israeli labor and delivery units. METHODS After Institutional Review Board waiver, we surveyed all 26 Israeli hospitals with a labor and delivery unit by directly contacting the representatives of obstetric anesthesiology services in every department (unit director or department chair). Each director surveyed provided information about the anesthetic and transfusion management in their labor and delivery units for three types of abnormal placentation based on antenatal placental imaging: PP, low suspicion for PA, and high suspicion for PA. The primary outcome was use of neuraxial or general anesthesia for PP and PA Cesarean delivery. Univariate statistics were used for survey responses using counts and percentages. RESULTS The response rate was 100%. Spinal anesthesia is the preferred anesthetic mode for PP cases, used in 17/26 (65.4%) of labor and delivery units. By comparison, most representatives reported that they perform general anesthesia for patients with PA: 18/26 (69.2%) for all low suspicion cases of PA and 25/26 (96.2%) for all high suspicion cases of PA. Although a massive transfusion protocol was available in the majority of hospitals (84.6%), the availability of thromboelastography and cell salvage was much lower (53.8% and 19.2% hospitals respectively). CONCLUSIONS In our survey, representatives of anesthesia labor and delivery services in Israel are almost exclusively using general anesthesia for women with high suspicion for PA; however, almost two-thirds use spinal anesthesia for PP without suspicion of PA. Among representatives, we found wide variations in anesthesia practice patterns with regard to anesthesia mode, multidisciplinary management, and hemorrhage anticipation strategies.
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Affiliation(s)
- A. Ioscovich
- Department of Anesthesiology; Perioperative Medicine and Pain Treatment; Shaare Zedek Medical Center; Hebrew University; Jerusalem Israel
| | - D. Shatalin
- Department of Anesthesiology; Perioperative Medicine and Pain Treatment; Shaare Zedek Medical Center; Hebrew University; Jerusalem Israel
| | - A. J. Butwick
- Department of Anesthesia; Stanford University School of Medicine; Stanford California USA
| | - Y. Ginosar
- Department of Anesthesiology and Critical Care Medicine; Hadassah-Hebrew University Medical Center; Ein Kerem Jerusalem Israel
| | - S. Orbach-Zinger
- Department of Anesthesia; Rabin Medical Center (Beilinson Campus); Petah Tikvah; Tel Aviv University; Tel Aviv Israel
| | - C. F. Weiniger
- Department of Anesthesiology and Critical Care Medicine; Hadassah-Hebrew University Medical Center; Ein Kerem Jerusalem Israel
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12
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Aaron EM, Andrews CS. Integration of advanced practice providers into the Israeli healthcare system. Isr J Health Policy Res 2016; 5:7. [PMID: 26909141 PMCID: PMC4763450 DOI: 10.1186/s13584-016-0065-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 02/10/2016] [Indexed: 11/10/2022] Open
Abstract
Many countries around the world have integrated various types of Advanced Practice Providers (APPs) into their healthcare systems. The main motivating factors for recognizing and developing APPs worldwide include physician shortages and the need for improved access or delivery (US, France, Belgium, Scotland, Switzerland), reduced residency hours (US, UK), shortages in underserved regions (US, Canada, Finland, Australia), and cost containment (Germany, Netherlands, UK, US). Israel is experiencing a shortage of physicians in peripheral geographic regions and in critical medical specialties. Recent by-laws approved by the Knesset (Parliament), combined with Israel Ministry of Health (MOH) policies, have thus far been unable to fully address the shortages. To understand the potential contribution of APPs in Israel, we evaluated the international historical foundations and development of APP roles. We assessed how APPs have impacted healthcare in other countries by analyzing public data and published international research about APP education, safety, quality of care, motivators, barriers, and impact. We found that APPs are recognized in dozens of countries, and have similar scopes of practice, graduate level education requirements (in developed countries), and clinical training. At the same time, there is wide variability among countries in the actual function and independence of the advanced practice nurse (APN), particularly the nurse practitioner (NP). APPs have been established as cost effective, safe healthcare providers who improve healthcare access. Israel has begun to introduce APPs, specifically NPs, in a variety of fields, including geriatrics, palliative care and diabetic care. We recommend a rapid expansion of existing and new APP roles into the Israeli healthcare system based on evidence and the recommendations of international evaluations by non-government organizations. By shifting the education to a university setting, mirroring successful, evidence-based, and established APP models found internationally, Israel could lessen the projected Israeli physician shortage, improve healthcare access in specific areas, and bolster existing resources towards a larger and richer pool of healthcare providers in Israel.
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Affiliation(s)
| | - Caryn Scheinberg Andrews
- />Henrietta Szold School of Nursing, Hadassah Medical Organization, Hebrew University, POB 12000, Ein Kerem, Jerusalem Israel
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Michaan N, Lotan M, Galiner M, Amzalag S, Many A. Risk factors for accidental dural puncture during epidural anesthesia for laboring women. J Matern Fetal Neonatal Med 2015; 29:2845-7. [PMID: 26593850 DOI: 10.3109/14767058.2015.1107040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Accidental dural puncture (ADP) during epidural analgesia is a debilitating complication. Symptoms of ADP post-dural puncture headache (PDPH) are headache while rising from supine to upright position, nausea, and neck stiffness. While age, gender and needle characteristics are established risk factors for ADP, little is known about risk factors in laboring women. METHODS All cases of ADP during epidural analgesia treated with blood-patching during a 3-years period were retrospectively reviewed. Each case was matched to two controls according to delivery period. RESULTS Forty-nine cases of blood patches after ADP out 17 977 epidural anesthesia procedures were identified (0.27%). No differences were found between cases and controls with regards to body mass index, labor stage at time of epidural, length of second stage, location of epidural along the lumbar vertebrae, anesthesiologist's experience or time when epidural was done. In cases of ADP, significantly lower doses of local anesthetics were injected (10.9 versus 13.5 cc, p < 0.001); anesthesiologists reported significantly more trials of epidurals (70 versus 2.8% more than one trial, p < 0.001), more patient movement during the procedure (13 versus 0%, p < 0.001), more intra-procedure suspicion of ADP (69 versus 0%, p < 0.001) and more cases where CSF/blood was drawn with the syringe (57 versus 2.4%, p < 0.001). CONCLUSION ADP during labor is a rare but debilitating complication. Risk factors for this iatrogenic complication include patient movement and repeated epidural trials. Intra-procedure identification of ADP is common, allowing early intervention with blood patching where indicated.
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Affiliation(s)
| | - Michael Lotan
- a Department of Anesthesia , Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University , Israel
| | | | | | - Ariel Many
- b Department of Obstetrics and Gynecology and
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Reuveni A, Orbach-Zinger S, Eidelman LA, Ginosar Y, Ioscovich A. Peripartum anesthetic management of patients with Factor XI deficiency. J Perinat Med 2014; 42:295-300. [PMID: 24096436 DOI: 10.1515/jpm-2013-0144] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 09/08/2013] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Factor XI deficiency is predominantly found in the Ashkenazi Jewish population with a prevalence of 9%, but also seen in other ethnicities. Little information is available on obstetric anesthesia management in women with Factor XI deficiency. Therefore, we undertook a study to evaluate obstetric, anesthetic and perinatal outcomes in parturients with Factor XI deficiency. METHODS A retrospective study was conducted with chart reviews from 1996 to 2011 resulted in 74 women with Factor XI level deficiency. We compared anesthetic and obstetric management in parturients with low (≤30%) level of Factor XI to those with higher levels. RESULTS Ninety-one pregnancy outcomes were reviewed in these 74 women with Factor XI deficiency. Forty-three women had levels ≤30% in 46 labors while 31 women had levels >30% in 45 labors. Women with low levels of Factor XI were significantly more likely to receive FFP and less likely to receive neuroaxial anesthesia. There were no anesthetic complications and no difference in mode of delivery or neonatal outcomes. DISCUSSION This study is the first step in building a national database for anesthetic cases and outcomes of parturients with Factor XI deficiency. Further efforts must be made to provide safe analgesia for these women.
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Aksoy M, Aksoy AN, Dostbil A, Çelik MG, Ahıskalıoğlu A. Anaesthesia Techniques for Caesarean Operations: Retrospective Analysis of Last Decade. Turk J Anaesthesiol Reanim 2014; 42:128-32. [PMID: 27366406 DOI: 10.5152/tjar.2014.80774] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 07/31/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The technique of anaesthesia in caesarean sections is selected according to the patient's clinical presentation, experience of the anaesthesist and the patient's wishes. The purpose of this study was to evaluate the anaesthesia methods employed in our clinic in the last decade (2003-2012). METHODS Records of caesarean operations performed between 2003-2012 in the Anaesthesia department of Atatürk University Medical Faculty and stored in the hospital computer system were examined. The annual distribution of methods of anaesthesia in operations was analysed. RESULTS During 2003-2012, 9049 caesarean operations were performed in our clinic. General anaesthesia was used in 45% of operations and regional anaesthesia in 54%. Whereas the rate of regional anaesthesia in 2003 was 34%, this increased to 69% in 2012. The most commonly used method of regional anaesthesia was spinal anaesthesia (34%) in 2003, and spinal anaesthesia (41%) and combined spinal-epidural anaesthesia (27%) in 2012. CONCLUSION The most commonly used anaesthesia technique for caesarean operations in our clinic between 2003-2012 was spinal anaesthesia. The most widely used regional anaesthetic method in our clinic was spinal anaesthesia. A significant increase in the use of the combined spinal-epidural anaesthetic technique occurred in the last two years of the study period.
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Affiliation(s)
- Mehmet Aksoy
- Department of Anaesthesiology and Reanimation, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Ayşe Nur Aksoy
- Department of Obstetrics and Gynaecology, Nenehatun Maternity Hospital, Erzurum, Turkey
| | - Ayşenur Dostbil
- Department of Anaesthesiology and Reanimation, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Mine Gürsaç Çelik
- Department of Anaesthesiology and Reanimation, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Ali Ahıskalıoğlu
- Department of Anaesthesiology and Reanimation, Atatürk University Faculty of Medicine, Erzurum, Turkey
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Loewenberg-Weisband Y, Grisaru-Granovsky S, Ioscovich A, Samueloff A, Calderon-Margalit R. Epidural analgesia and severe perineal tears: a literature review and large cohort study. J Matern Fetal Neonatal Med 2014; 27:1864-9. [DOI: 10.3109/14767058.2014.889113] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ioscovich A, Orbach-Zinger S, Zemzov D, Reuveni A, Eidelman LA, Ginosar Y. Peripartum anesthetic management of renal transplant patients--a multicenter cohort study. J Matern Fetal Neonatal Med 2013; 27:484-7. [PMID: 23799895 DOI: 10.3109/14767058.2013.818973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
As the number and success of renal transplantation has grown, there has been an increase in the number of renal transplant patients giving birth. To date, there has been no data on obstetric anesthesia management of these patients. The purpose of this study was to build an Israeli national database on parturients after renal transplant. A sixteen-year (calendar years 1996-2011) retrospective study was conducted at three major tertiary centers with a combined current birth rate of approximately 25,000 deliveries annually. We found 83 labors in 64 women. Forty-two percent of this population suffered from hypertension while 12.5% had diabetes. Forty-seven percent of women had a vaginal delivery while 53% of women had a cesarean section. The rate of epidural analgesia for labor was 59%, and rate of regional anesthesia during cesarean section was 75%. There were no anesthetic complications in any cases. Standard ASA monitoring was used in all cases except for one woman with severe hypertension who required an arterial line during her cesarean section. Forty-seven percent of newborn were under 37 weeks with average gestational week 36 ± 3 days and birth weight 2.5 ± 0.7 kg. Average Apgar was 8.4 ± 1.3 at one minute and 9.3 ± 0.7 at five minutes. There was one neonatal death in the CS group due to placental abruption. Patients after renal transplant can safely undergo birth and obstetric analgesia.
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Affiliation(s)
- A Ioscovich
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Hebrew University Jerusalem , Israel
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Ginosar Y, Ioscovich A, Weissman C, Calderon-Margalit R, Weiniger CF. Comparison of the obstetric anesthesia activity index with total delivery numbers as a single denominator of workload demand in Israeli maternity units. Isr J Health Policy Res 2012; 1:48. [PMID: 23241308 PMCID: PMC3541973 DOI: 10.1186/2045-4015-1-48] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 08/23/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED BACKGROUND Obstetric anesthesia workload demand in Israel has increased due to both an increase in the requests for labor analgesia and a marked increase in the cesarean delivery rate. We propose a new workload-driven performance indicator, the Obstetric Anesthesia Activity Index (OAAI), to serve as a single denominator of obstetric anesthesia activity to enable direct comparison of different hospitals despite dissimilar rates of epidural labor analgesia and cesarean delivery. METHODS We performed a secondary analysis of two recent national surveys by the Israel Association of Obstetric Anesthesia. In 2005 and 2007 questionnaires were sent to all Israeli hospitals requesting information on the total numbers of deliveries, epidurals, and cesareans annually, together with the anesthesia workforce allocated for the provision of obstetric anesthesia services. The OAAI was calculated based on the premise that epidurals and cesareans are the predominant determinants of obstetric anesthesia workload and that a typical epidural takes about half the time of a typical cesarean. Accordingly, the OAAI for each hospital was calculated as ((0.75 * number of epidurals per year) + (1.5 * number of cesareans per year))/365. RESULTS This secondary analysis assessed the 25 maternity units in Israel that participated in both the 2005 and 2007 surveys. As expected, there was a wide inter-hospital variability in epidural and cesarean rates. Hospital rankings based on annual delivery numbers were different from those based on the OAAI. The OAAI correlated closely both with the number of epidurals (2005: Pearson 0.97, p < 0.0001; 2007: Pearson 0.97, p < 0.0001) and cesareans (2005: Pearson 0.94, p < 0.0001; 2007: Pearson 0.92, p < 0.0001). These correlations were better for the OAAI than for the annual delivery numbers. CONCLUSIONS As there was such a wide range of demand for different obstetric anesthesia services among different hospitals, the total number of deliveries is a poor summary indicator of obstetric anesthesia workload. The calculated OAAI better reflected the obstetric anesthesia workload as a single denominator of activity.
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Affiliation(s)
- Yehuda Ginosar
- Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Alex Ioscovich
- Department of Anesthesiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Charles Weissman
- Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Carolyn F Weiniger
- Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Ioscovich A, Fadeev A, Rivilis A, Elstein D. Requests and usage of epidural analgesia in grand-grand multiparous and similar-aged women with lesser parity: prospective observational study. J Perinat Med 2011; 39:697-700. [PMID: 21801032 DOI: 10.1515/jpm.2011.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Epidural analgesia in older and multiparous women has been associated with risks. The aim of this study was to compare epidural analgesia use for labor/delivery in grand-grand multiparous women (GGMP; ≥10 births) relative to that in similar-aged women with lesser parity. METHODS This was a prospective observational study of advanced age gravida. All laboring women in a six-month period admitted to a tertiary Israeli center were included if they were advanced age (≥36 years old) with one to two previous births (Low parity; n=128) or four to five previous births (Medium parity; n=181), and all GGMP (any age; n=187). Primary outcome was comparison of requests for and use of epidural analgesia for labor/delivery. RESULTS There were no significant differences across parity groups in percent of gravida requesting or receiving epidural analgesia (46.5-59.4%). Time from admission to epidural administration (range mean times: 168-187 min) and from advent of epidural to delivery (range mean times: 155-160 min) were comparable across parity groups. Use of other analgesia (5.8-8%) was not significantly different. CONCLUSIONS Requests for and use of epidural analgesia was comparable in older gravida and was not correlated with parity. Mean times from presentation to epidural administration, mean cervical dilatation at epidural initiation, and mean time from performing of epidural to delivery were comparable across groups.
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Affiliation(s)
- Alexander Ioscovich
- Department of Anesthesiology, ShaareZedek Medical Center, Jerusalem, Israel.
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Weiniger C, Ivri S, Ioscovich A, Grimberg L, Evron S, Ginosar Y. Obstetric anesthesia units in Israel: a national questionnaire-based survey. Int J Obstet Anesth 2010; 19:410-6. [DOI: 10.1016/j.ijoa.2010.04.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 12/08/2009] [Accepted: 04/16/2010] [Indexed: 10/19/2022]
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