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Accidental Awareness Under General Anesthesia During Cesarean Section: An Observational Study. Cureus 2023; 15:e37118. [PMID: 37034140 PMCID: PMC10075182 DOI: 10.7759/cureus.37118] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 04/07/2023] Open
Abstract
Background A Caesarean section (CS) if performed under general anesthesia (GA) is a procedure with an increased risk of accidental awareness. This study aimed to examine the incidence of accidental awareness under GA in hospitals in the Republic of Srpska (Bosnia and Herzegovina) where GA for CS is performed in a significantly higher percentage compared to spinal anesthesia. Methodology In the period from 2016 to 2018, a multicenter, prospective, observational study was conducted in five medical centers in the Republic of Srpska (Bosnia and Herzegovina). The study included 1,161 patients who underwent CS. A total of 427 (36.7%) patients had elective and 734 (63.3%) had emergency CSs. The patients were surveyed postoperatively using the modified Brice questionnaire. Results Of the 1,161 patients included in the study, 12 (1.03%) reported memory in the period between induction and emergence of anesthesia. Five (0.43%) of them reported definite and seven (0.6%) possible and unlikely awareness. Significant psychological trauma due to pain was reported by two patients. Dreams during anesthesia were reported by 42 patients (3.61%) and five of them stated that the dreams were unpleasant. Conclusions Accidental awareness under GA during CS has a significant incidence in medical centers in the Republic of Srpska (Bosnia and Herzegovina). According to our findings, creating new protocols for GA when performing CS is necessary.
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Snavely C, Chan C. Resuscitation of the Obstetric Patient. Emerg Med Clin North Am 2023; 41:323-335. [PMID: 37024167 DOI: 10.1016/j.emc.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Pregnancy is a time of tremendous physiologic change and vulnerability. At any point, symptoms and complications can prompt the need for emergency care, and these can range from minor to life-threatening. Emergency physicians must be prepared to treat any of these complications, in addition to rescucitating the critically ill and injured pregnant patient. To optimally care for these patients, it is paramount to be aware of the unique physiologic changes that occur during pregnancy. The focus of this review is to discuss illnesses unique to pregnancy and additional aspects of resuscitation that must be considered when caring for a critically ill pregnant patient.
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Affiliation(s)
- Cheyenne Snavely
- Department of Medicine, University of Maryland Medical Center, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
| | - Caleb Chan
- Department of Medicine, University of Maryland Medical Center, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA
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3
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Caissie N, Héroux J, Lefebvre M, Lamarche D, Dubois MC, Rivard G, D’Aragon F. Opioids for Cesarean delivery under general anesthesia and neonatal outcome: a historical cohort study. Can J Anaesth 2022; 69:1017-1024. [DOI: 10.1007/s12630-022-02222-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 10/18/2022] Open
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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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5
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Sabetian G, Zand F, Mirhadi F, Hadavi MR, Asadpour E, Dehghanpisheh L, Fattahi Saravi Z, Razavi SM. Adequacy of maternal anesthesia depth with two sodium thiopental doses in elective caesarean section: a randomized clinical trial. BMC Anesthesiol 2021; 21:201. [PMID: 34376153 PMCID: PMC8353765 DOI: 10.1186/s12871-021-01421-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background Administration of an optimal dose of anesthetic agent to ensure adequate depth of hypnosis with the lowest risk of adverse effects to the fetus is highly important in cesarean section. Sodium thiopental (STP) is still the first choice for induction of anesthesia in some countries for this obstetric surgery. We aimed to compare two doses of STP with regarding the depth of anesthesia and the condition of newborn infants. Methods In this clinical trial, parturient undergoing elective Caesarian section were randomized into two groups receiving either low-dose (5 mg/kg) or high-dose (7 mg/kg) STP. Muscle relaxation was provided with succinylcholine 2 mg/kg and anesthesia was maintained with O2/N2O and sevoflurane. The depth of anesthesia was evaluated using isolated forearm technique (IFT) and bispectral index (BIS) in various phases. Additionally, infants were assessed using Apgar score and neurobehavioral test. Results Forty parturient were evaluated in each group. BIS was significantly lower in high-dose group at skin incision to delivery and subcutaneous and skin closure. Also, significant differences were noticed in IFT over induction to incision and incision to delivery. Apgar score was significantly lower in high-dose group at 1 min after delivery. Newborn infants in low-dose group had significantly better outcomes in all three domains of the neurobehavioral test. Conclusion 7 mg/kg STP is superior to 5 mg/kg in creating deeper hypnosis for mothers. However, it negatively impacts Apgar score and neurobehavioral test of neonates. STP seems to has dropped behind as an acceptable anesthetic in Cesarean section. Trial registration IRCT No: 2016082819470 N45, 13/03/2019.
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Affiliation(s)
- Golnar Sabetian
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farid Zand
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Fatemeh Mirhadi
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Hadavi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elham Asadpour
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Laleh Dehghanpisheh
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Kearns RJ, Shaw M, Gromski PS, Iliodromiti S, Pell JP, Lawlor DA, Nelson SM. Neonatal and early childhood outcomes following maternal anesthesia for cesarean section: a population-based cohort study. Reg Anesth Pain Med 2021; 46:482-489. [PMID: 33832987 DOI: 10.1136/rapm-2020-102441] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The fetus is vulnerable to maternal drug exposure. We determined associations of exposure to spinal, epidural, or general anesthesia on neonatal and childhood development outcomes during the first 1000 days of life. METHODS Population-based study of all singleton, cesarean livebirths of 24+0 to 43+6 weeks gestation between January 2007 and December 2016 in Scotland, stratified by urgency with follow-up to age 2 years. Models were adjusted for: maternal age, weight, ethnicity, socioeconomic status, smoking, drug-use, induction, parity, previous cesarean or abortion, pre-eclampsia, gestation, birth weight, and sex. RESULTS 140 866 mothers underwent cesarean section (41.2% (57,971/140,866) elective, 58.8% (82,895/140,866) emergency) with general anesthesia used in 3.2% (1877/57,971) elective and 9.8% (8158/82,895) of emergency cases. In elective cases, general anesthesia versus spinal was associated with: neonatal resuscitation (crude event rate 16.2% vs 1.9% (adjusted RR 8.20, 95% CI 7.20 to 9.33), Apgar <7 at 5 min (4.6% vs 0.4% (adjRR 11.44, 95% CI 8.88 to 14.75)), and neonatal admission (8.6% vs 4.9% (adjRR 1.65, 95% CI 1.40 to 1.94)). Associations were similar in emergencies; resuscitation (32.2% vs 12.3% (adjRR 2.40, 95% CI 2.30 to 2.50)), Apgar <7 (12.6% vs 2.8% (adjRR 3.87, 95% CI 3.56 to 4.20), and admission (31.6% vs 19.9% (adjRR 1.20, 95% CI 1.15 to 1.25). There was a weak association between general anesthesia in emergency cases and having ≥1 concern noted in developmental assessment at 2 years (21.0% vs 16.5% (adjRR 1.08, 95% CI 1.01 to 1.16)). CONCLUSIONS General anesthesia for cesarean section, irrespective of urgency, is associated with neonatal resuscitation, low Apgar, and neonatal unit admission. Associations were strongest in non-urgent cases and at term. Further evaluation of long-term outcomes is warranted.
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Affiliation(s)
| | - Martin Shaw
- Department of medical physics, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - Stamatina Iliodromiti
- Centre for Women's Health, Institute of Population Health Sciences, Queen Mary University, London, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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Zhao T, Chen Y, Sun Z, Shi Z, Qin J, Lu J, Li C, Ma D, Zhou L, Song X. Prenatal sevoflurane exposure causes neuronal excitatory/inhibitory imbalance in the prefrontal cortex and neurofunctional abnormality in rats. Neurobiol Dis 2020; 146:105121. [PMID: 33007389 DOI: 10.1016/j.nbd.2020.105121] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/22/2020] [Accepted: 09/24/2020] [Indexed: 02/02/2023] Open
Abstract
The balance of excitatory and inhibitory neurons in the central nervous system is critical for maintaining brain function and sevoflurane, a general anesthetic and an GABA receptor modulator, may change the balance of excitatory and inhibitory neurons in the cortex during early brain development. Herein, we investigated whether prenatal sevoflurane exposure (PSE) disturbs cortical neuronal development and brain function. Pregnant rats at the gestational day 14.5 were subjected to sevoflurane exposure at 3.0% for 3 h and their offspring were studied thereafter. We found a significant increase of parvalbumin-positive neurons, vesicular GABA transporter (VGAT) and GAD67 expression, and GABA neurotransmitter, and a significant decrease of vesicular glutamate transporter 1 (VGLUT1) expression and glutamate in the medial prefrontal cortex (mPFC) of offspring. Pyramidal neurons showed atrophy with shorter dendrites, less branches and lower spine density visualized by Golgi stain and a decrease of excitability with the increased miniature inhibitory postsynaptic current (mIPSC) frequency and amplitude, the decreased miniature excitatory postsynaptic current (mEPSC) frequency and excitation/inhibition (E/I) ratio using whole-cell recording in offspring. There was a significant increase of inhibitory synapse in the mPFC detected by electron microscopy. Furthermore, PSE animals showed hypo-excitatory phenotype including depression-like behaviors and learning deficits. Thus, our studies provide novel evidence that PSE causes the persisted imbalance of excitatory and inhibitory neurons in the mPFC, and this is very likely the mechanisms of the sevoflurane-induced brain functional abnormalities.
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Affiliation(s)
- Tianyun Zhao
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yanxin Chen
- Department of Anesthesiology, Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Zhixiang Sun
- Department of Anesthesiology, Shanghai Fengxian District Central Hospital, Southern Medical University, Shanghai, China
| | - Ziwen Shi
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jingwen Qin
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Junming Lu
- Department of Anesthesiology, Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Chuanxiang Li
- Department of Anesthesiology, Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Daqing Ma
- Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Libing Zhou
- Guangdong-Hongkong-Macau Institute of CNS Regeneration, Ministry of Education CNS Regeneration Collaborative Joint Laboratory, Jinan University, Guangzhou, China.
| | - Xingrong Song
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
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Odor PM, Bampoe S, Moonesinghe SR, Andrade J, Pandit JJ, Lucas DN. General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multicentre observational study. Anaesthesia 2020; 76:460-471. [PMID: 32959372 DOI: 10.1111/anae.15250] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2020] [Indexed: 02/06/2023]
Abstract
There are no current descriptions of general anaesthesia characteristics for obstetric surgery, despite recent changes to patient baseline characteristics and airway management guidelines. This analysis of data from the direct reporting of awareness in maternity patients' (DREAMY) study of accidental awareness during obstetric anaesthesia aimed to describe practice for obstetric general anaesthesia in England and compare with earlier surveys and best-practice recommendations. Consenting patients who received general anaesthesia for obstetric surgery in 72 hospitals from May 2017 to August 2018 were included. Baseline characteristics, airway management, anaesthetic techniques and major complications were collected. Descriptive analysis, binary logistic regression modelling and comparisons with earlier data were conducted. Data were collected from 3117 procedures, including 2554 (81.9%) caesarean deliveries. Thiopental was the induction drug in 1649 (52.9%) patients, compared with propofol in 1419 (45.5%). Suxamethonium was the neuromuscular blocking drug for tracheal intubation in 2631 (86.1%), compared with rocuronium in 367 (11.8%). Difficult tracheal intubation was reported in 1 in 19 (95%CI 1 in 16-22) and failed intubation in 1 in 312 (95%CI 1 in 169-667). Obese patients were over-represented compared with national baselines and associated with difficult, but not failed intubation. There was more evidence of change in practice for induction drugs (increased use of propofol) than neuromuscular blocking drugs (suxamethonium remains the most popular). There was evidence of improvement in practice, with increased monitoring and reversal of neuromuscular blockade (although this remains suboptimal). Despite a high risk of difficult intubation in this population, videolaryngoscopy was rarely used (1.9%).
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Affiliation(s)
- P M Odor
- Centre for Peri-operative Medicine, Research Department for Targeted Intervention, University College London Hospital, London, UK
| | - S Bampoe
- Centre for Peri-operative Medicine, Research Department for Targeted Intervention, University College London Hospital, London, UK
| | - S R Moonesinghe
- Centre for Peri-operative Medicine, Research Department for Targeted Intervention, University College London Hospital, London, UK
| | - J Andrade
- School of Psychology, University of Plymouth, Plymouth, UK
| | - J J Pandit
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Trust, Oxford, UK
| | - D N Lucas
- Department of Anaesthesia, Northwick Park Hospital, London, UK
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Park HS, Kim YS, Kim SH, Jeon AR, Kim SE, Choi WJ. Comparison of electroencephalogram between propofol- and thiopental-induced anesthesia for awareness risk in pregnant women. Sci Rep 2020; 10:6192. [PMID: 32277117 PMCID: PMC7148347 DOI: 10.1038/s41598-020-62999-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/21/2020] [Indexed: 12/27/2022] Open
Abstract
There have been few comparative studies using electroencephalogram (EEG) spectral characteristics during the induction of general anesthesia for cesarean section. This retrospective study investigated the differences in the depth of anesthesia through EEG analysis between propofol- and thiopental-induced anesthesia. We reviewed data of 42 patients undergoing cesarean section who received either thiopental (5 mg/kg) or propofol (2 mg/kg). EEG data were extracted from the bispectral index (BIS) monitor, and 10-second segments were selected from the following sections: 1) Stage I, BIS below 60 after induction; 2) Stage II, after intubation completion; 3) Stage III, end-tidal sevoflurane above 0 vol%. The risk of awareness was represented by the BIS and entropy measures. In Stage III, the thiopental group (n = 20) showed significantly higher BIS value than the propofol group (n = 22) (67.9 [18.66] vs 44.5 [20.63], respectively, p = 0.002). The thiopental group had decreased slow-delta oscillations and increased beta-oscillations as compared to the propofol group in Stages II and III (p < 0.05). BIS, spectral entropy, and Renyi permutation entropy were also higher in the thiopental group at Stages II and III (p < 0.05). In conclusion, frontal spectral EEG analysis demonstrated that propofol induction maintained a deeper anesthesia than thiopental in pregnant women.
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Affiliation(s)
- Hee-Sun Park
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yeon-Su Kim
- Department of Electronics and Control Engineering, Hanbat National University, Daejeon, Korea
| | - Sung-Hoon Kim
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - A-Rom Jeon
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seong-Eun Kim
- Department of Electronics and Control Engineering, Hanbat National University, Daejeon, Korea.
| | - Woo-Jong Choi
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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McGuire B, Lucas DN. Planning the obstetric airway. Anaesthesia 2020; 75:852-855. [DOI: 10.1111/anae.14987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2019] [Indexed: 12/16/2022]
Affiliation(s)
- B. McGuire
- Department of Anaesthesia Ninewells Hospital Dundee UK
| | - D. N. Lucas
- Department of Anaesthesia Northwick Park Hospital Middlesex UK
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Montandrau O, Espitalier F, Bouyou J, Laffon M, Remérand F. Thiopental versus propofol on the outcome of the newborn after caesarean section: An impact study. Anaesth Crit Care Pain Med 2019; 38:631-635. [PMID: 30978402 DOI: 10.1016/j.accpm.2019.04.002] [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] [Received: 02/07/2018] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND In 2011, the company that produced thiopental in France and in the United States stopped its marketing. Because of limited evidences, the choice of the best induction agent for caesarean section remains controversial, especially in emergency. The objective of this study was to compare the effects of propofol versus thiopental on the Apgar score of the newborn. METHODS Newborns delivered by elective or emergency caesarean section under general anaesthesia in a university hospital were included from January 2009 to December 2013. Two periods, according to the hypnotic drug used, were compared in this before-and-after comparative study: thiopental before May 2011 and propofol after. The primary outcome was to compare the proportion of newborns with a 5-minute Apgar Score < 7 between both groups. RESULTS 367 newborns were enrolled, 178 in thiopental group and 189 in propofol group. Demographic and clinical characteristics were similar in both groups. The occurrence of a 5-minute Apgar Score less than 7 was not influenced by the use of propofol (OR 1.40 [CI 95% 0.90-2.20] P = 0.135). Blood gas analyses and admission's rate in neonatal intensive care unit were similar in both groups. CONCLUSIONS Thiopental and propofol do not appear to present significant difference in term of outcome of the newborn after caesarean section. In this situation, propofol may probably be a reliable alternative to the supply reduction of thiopental imposed by forces. Prospective studies are required to confirm the safety of propofol, particularly in the long term.
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Affiliation(s)
- Olivier Montandrau
- Department of anaesthesia and intensive care, Hôpital Trousseau, CHRU de Tours, 37044 cedex 9 Tours, France.
| | - Fabien Espitalier
- Department of anaesthesia and intensive care, Hôpital Trousseau, CHRU de Tours, 37044 cedex 9 Tours, France.
| | - Joseph Bouyou
- Department of obstetrics and gynaecology, Hôpital Lariboisière AP-HP, 2, rue Ambroise Paré, 75010 Paris, France.
| | - Marc Laffon
- Department of anaesthesia and intensive care, Hôpital Trousseau, CHRU de Tours, 37044 cedex 9 Tours, France.
| | - Francis Remérand
- Department of anaesthesia and intensive care, Hôpital Trousseau, CHRU de Tours, 37044 cedex 9 Tours, France.
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Houthoff Khemlani K, Weibel S, Kranke P, Schreiber JU. Hypnotic agents for induction of general anesthesia in cesarean section patients: A systematic review and meta-analysis of randomized controlled trials. J Clin Anesth 2018; 48:73-80. [DOI: 10.1016/j.jclinane.2018.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/29/2018] [Accepted: 04/26/2018] [Indexed: 11/29/2022]
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„Rapid sequence induction and intubation“ beim aspirationsgefährdeten Patienten. Anaesthesist 2018; 67:568-583. [DOI: 10.1007/s00101-018-0460-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 04/23/2018] [Accepted: 05/03/2018] [Indexed: 12/19/2022]
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14
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Staikou C, Μakris A, Theodoraki K, Τsaroucha A, Douma A, Μoka E, Αrnaoutoglou E, Paraskevopoulos T, Siafaka I, Stavropoulou E, Αrgyra E. Current Practice in Obstetric Anesthesia and Analgesia in Public Hospitals of Greece: A 2016 National Survey. Balkan Med J 2018; 35:394-397. [PMID: 29914232 PMCID: PMC6158474 DOI: 10.4274/balkanmedj.2018.0083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aims: This descriptive survey was to evaluate the use of regional anesthesia in obstetrics in Greek public hospitals. Methods: The survey was conducted between March and August 2016. A structured questionnaire was sent to 50 anesthesia departments in Greek public hospitals with obstetric units. Results: The response rate was 94%. Data corresponding to 9475 cesarean and 8155 vaginal deliveries were collected. Regional anesthesia was used in 69.2% of all cesareans, with single shot spinal being the most popular (44.3% of all cesareans). Combined spinal-epidural anesthesia was used in 18.1% of all cesareans (35.1% in hospitals of Athens versus 7.9% outside Athens, p<0.001). Post-cesarean analgesia was applied with simple analgesics and systematic opioids (78.6%). Long-acting spinal opioids were rarely used (4.4% of spinal and spinal/epidurals). Labor epidural analgesia was applied in 19.1% of all vaginal deliveries (30.3% in Athens versus 13.1% outside Athens, p<0.001). Paracetamol and pethidine represented the standard labor analgesics in 48.9% and 55.3% of all hospitals. Intravenous remifentanil was used in 10.6% of hospitals (50% in Athens versus 2.5% outside Athens, p=0.002). In 48.9% of hospitals, mainly outside Athens, the anesthesiologists did not get involved in labor analgesia. Conclusion: Regional anesthesia is the most common practice for cesareans in Greek public hospitals; however, the percentage of general anesthesia remains high. In addition, the use of labor epidural analgesia is limited in hospitals outside Athens.
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Affiliation(s)
- Chryssoula Staikou
- Clinic of Anesthesia, Aretaieio Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Alexandros Μakris
- Clinic of Anesthesia, Asklipieio Voulas General Hospital, Athens, Greece
| | - Kassiani Theodoraki
- Clinic of Anesthesia, Aretaieio Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Athanasia Τsaroucha
- Clinic of Anesthesia, Aretaieio Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Amalia Douma
- Clinic of Anesthesia, Georgios Gennimatas General Hospital, Athens, Greece
| | - Eleni Μoka
- Clinic of Anesthesia, Creta Interclinic Hospital, Heraklion, Crete, Greece
| | - Eleni Αrnaoutoglou
- Clinic of Anesthesia, General University Hospital of Larissa, Larissa, Greece
| | | | - Ioanna Siafaka
- Clinic of Anesthesia, Aretaieio Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Efi Stavropoulou
- Clinic of Anesthesia, General Hospital of Attica KAT, Athens, Greece
| | - Eriphili Αrgyra
- Clinic of Anesthesia, Aretaieio Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
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A survey of practice of rapid sequence induction for caesarean section in England. Int J Obstet Anesth 2018; 36:3-10. [PMID: 30392651 DOI: 10.1016/j.ijoa.2018.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/03/2018] [Accepted: 05/27/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND In view of newer techniques of preoxygenation and laryngoscopy and recent obstetric guidelines concerning the management of difficult intubation, we aimed to evaluate the current practice of rapid sequence induction for caesarean section in England. METHODS In 2017, 316 questionnaire surveys were posted to all 158 hospitals with caesarean section capabilities in England. At each hospital, one questionnaire was to be completed by the obstetric anaesthetic consultant lead and one by an anaesthetic trainee. Differences in responses between consultants and trainees, regardless of their place of work, were compared for all data using the chi-square and the Fisher's exact tests. RESULTS One-hundred-and-eighty complete questionnaires were returned, with an overall response rate of 57%, 98 (54%) from obstetric anaesthetic consultant leads and 82 (45.6%) from trainees). Both head up (57%) and ramped (56%) were the preferred positions for preoxygenation. Less than half of respondents (43%) preoxygenated until the surgeon was scrubbed. Cricoid pressure was used by almost all respondents (98%). Thiopentone (67%) was the most commonly chosen anaesthetic induction agent and most respondents (82%) supported a change to the use of propofol. Suxamethonium (92%) was the neuromuscular blocker of choice but more than half the respondents (52%) supported a change to rocuronium. In the event of a failed intubation, the rescue supraglottic airway device of choice was the i-gel® (65%). CONCLUSIONS Our survey demonstrated the significant variation in the practice of rapid sequence induction for caesarean section in obstetrics in the United Kingdom.
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Dumps C, Halbeck E, Bolkenius D. Medikamente zur intravenösen Narkoseinduktion: Barbiturate. Anaesthesist 2018; 67:535-552. [DOI: 10.1007/s00101-018-0440-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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王 志, 马 珏, 王 晟, 郁 丽, 韦 锦, 徐 金. [Application of sevoflurane and laryngeal mask in cesarean section in women with heart disease]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:229-233. [PMID: 29502065 PMCID: PMC6743878 DOI: 10.3969/j.issn.1673-4254.2018.02.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To compare the safety of sevoflurane anesthesia with laryngeal mask and tracheal intubation in cesarean section in women with heart disease. METHODS Fifty-two pregnant women with heart diseases undergoing cesarean section were randomized into laryngeal mask (LAM) group and tracheal intubation group. In LAM group, 6% sevoflurane was given at the rate of 6 L/min for induction with a maintenance sevoflurane concentration of 3%. In the intubation group, 1.5 mg/kg propofol and 1 µg/kg remifentanil were injected intravenously, and after achieving D0 with Narcotrend monitoring, 0.9 mg/kg rocuronium was injected and intubation was performed 1 min later. The systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded in the two groups before anesthesia induction (T0), at intubation or laryngeal mask placement (T1), skin incision (T2), and extubation or laryngeal mask removal (T3). The surgery to fetal birth time, uterine incision to fetal childbirth time, drug discontinuation to awake time, and newborn Apgar scores were also recorded. Sevoflurane consumption and maternal comfort during hospitalization were compared between the two groups. RESULTS In LAM group, HR and MBP at T1 and T3 were significantly lower than those in the intubation group (P<0.05). The drug discontinuation to extubation time and to awaken time were significantly shorter in LAM group than in the intubation group (P<0.05), but the operation time and fetal child birth time were comparable between the two groups (P>0.05). The women in LAM group reported better physical and psychological comforts than those in the intubation group (P<0.05). The neonatal Apgar scores and the scores of health education, satisfaction with hospital environment and service were all similar between the two groups (P>0.05). CONCLUSION Sevoflurane anesthesia with laryngeal mask can achieve satisfactory anesthetic effects in cesarean section in women with heart disease.
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Affiliation(s)
- 志鹏 王
- />广东省心血管病研究所//广东省人民医院//广东省医学科学院麻醉科,广东 广州 510080Department of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - 珏 马
- />广东省心血管病研究所//广东省人民医院//广东省医学科学院麻醉科,广东 广州 510080Department of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - 晟 王
- />广东省心血管病研究所//广东省人民医院//广东省医学科学院麻醉科,广东 广州 510080Department of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - 丽娜 郁
- />广东省心血管病研究所//广东省人民医院//广东省医学科学院麻醉科,广东 广州 510080Department of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - 锦锋 韦
- />广东省心血管病研究所//广东省人民医院//广东省医学科学院麻醉科,广东 广州 510080Department of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - 金东 徐
- />广东省心血管病研究所//广东省人民医院//广东省医学科学院麻醉科,广东 广州 510080Department of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
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Gandhi KA, Jain K. Management of anaesthesia for elective, low-risk (Category 4) caesarean section. Indian J Anaesth 2018; 62:667-674. [PMID: 30237591 PMCID: PMC6144555 DOI: 10.4103/ija.ija_459_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
An increasing number of caesarean sections are being performed for both elective as well as emergency cases. Category 4 caesarean section refers to a planned elective surgery after 39 weeks of gestation at a time suitable to the mother and the maternity team. For a safe conduct of anaesthesia, the updated obstetric anaesthesia guidelines recommend administration of neuraxial anaesthesia, whenever feasible. The management should include adequate postoperative pain relief, early ambulation, and thromboprophylaxis to ensure early recovery. This review will discuss the anaesthetic management including regional anaesthesia, general anaesthesia, and postoperative analgesia for elective, low-risk (Category 4) caesarean section.
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Affiliation(s)
- Komal Anil Gandhi
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kajal Jain
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Perez-Zoghbi J, Zhu W, Grafe M, Brambrink A. Dexmedetomidine-mediated neuroprotection against sevoflurane-induced neurotoxicity extends to several brain regions in neonatal rats. Br J Anaesth 2017; 119:506-516. [DOI: 10.1093/bja/aex222] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2017] [Indexed: 12/21/2022] Open
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Desai N, Carvalho B. General anaesthesia for caesarean section: is the end in sight for thiopental? Br J Hosp Med (Lond) 2017; 78:358. [DOI: 10.12968/hmed.2017.78.6.358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Neel Desai
- Specialist Registrar in Anaesthetics, Department of Anaesthetics, Royal Free Hospital, London NW3 2QG
| | - Brendan Carvalho
- Professor, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA
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Abstract
Awareness during general anesthesia for cesarean delivery continues to be a major problem. The key to preventing awareness is strict attention to anesthetic technique. The prevalence and implications of aortocaval compression have been firmly established. Compression of the vena cava is a real occurrence when assuming the supine position. Relief of this compression most likely does not occur until the patient is turned 30°, which is not feasible for performing cesarean delivery. Although it is still wise to tilt the patient, the benefit of this tilt may not be as great as once thought.
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Patel S, Fernando R. Opioids should be given before cord clamping for caesarean delivery under general anaesthesia. Int J Obstet Anesth 2016; 28:76-80. [PMID: 27720615 DOI: 10.1016/j.ijoa.2016.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 08/27/2016] [Indexed: 11/26/2022]
Affiliation(s)
- S Patel
- Department of Anaesthetics, University College London Hospitals NHS Foundation Trust, London, UK.
| | - R Fernando
- Department of Anaesthetics, University College London Hospitals NHS Foundation Trust, London, UK
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Stourac P, Adamus M, Seidlova D, Pavlik T, Janku P, Krikava I, Mrozek Z, Prochazka M, Klucka J, Stoudek R, Bartikova I, Kosinova M, Harazim H, Robotkova H, Hejduk K, Hodicka Z, Kirchnerova M, Francakova J, Obare Pyszkova L, Hlozkova J, Sevcik P. Low-Dose or High-Dose Rocuronium Reversed with Neostigmine or Sugammadex for Cesarean Delivery Anesthesia. Anesth Analg 2016; 122:1536-45. [DOI: 10.1213/ane.0000000000001197] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Mushambi MC, Kinsella SM, Popat M, Swales H, Ramaswamy KK, Winton AL, Quinn AC. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia 2016; 70:1286-306. [PMID: 26449292 PMCID: PMC4606761 DOI: 10.1111/anae.13260] [Citation(s) in RCA: 298] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2015] [Indexed: 12/16/2022]
Abstract
The Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably second-generation) supraglottic airway device if appropriate. Algorithm 3 covers the management of the 'can't intubate, can't oxygenate' situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how to awaken or proceed with surgery. The background paper covers recommendations on drugs, new equipment, teaching and training.
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Affiliation(s)
- M C Mushambi
- Department of Anaesthesia, Leicester Royal Infirmary, Leicester, UK
| | - S M Kinsella
- Department of Anaesthesia, St Michael's Hospital, Bristol, UK
| | - M Popat
- Nuffield Department of Anaesthesia, Oxford University Hospital NHS Trust, Oxford, UK
| | - H Swales
- Department of Anaesthesia, University Hospitals Southampton Foundation Trust, Southampton, UK
| | - K K Ramaswamy
- Department of Anaesthesia, Northampton General Hospital, Northampton, UK
| | - A L Winton
- Department of Anaesthesia, St Michael's Hospital, Bristol, UK
| | - A C Quinn
- Department of Anaesthesia, James Cook University Hospital, Middlesborough, UK.,Leeds University, Leeds, UK
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Attenuation of cardiovascular stress response to endotracheal intubation by the use of remifentanil in patients undergoing Cesarean delivery. J Anesth 2015; 30:274-83. [DOI: 10.1007/s00540-015-2118-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 12/01/2015] [Indexed: 12/19/2022]
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Sumikura H, Niwa H, Sato M, Nakamoto T, Asai T, Hagihira S. Rethinking general anesthesia for cesarean section. J Anesth 2015; 30:268-73. [DOI: 10.1007/s00540-015-2099-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 10/30/2015] [Indexed: 12/19/2022]
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Podder S, Kumar A, Mahajan S, Saha PK. Initial non-opioid based anesthesia in a parturient having severe aortic stenosis undergoing cesarean section with aortic valve replacement. Ann Card Anaesth 2015; 18:98-100. [PMID: 25566720 PMCID: PMC4900321 DOI: 10.4103/0971-9784.148330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pregnancy in presence of severe aortic stenosis (AS) causes worsening of symptoms needing further intervention. In the advanced stages of pregnancy, some patients may even require aortic valve replacement (AVR) and cesarean delivery in the same sitting. Opioid based general anesthesia for combined lower segment cesarean section (LSCS) with AVR has been described. However, the use of opioid may lead to fetal morbidity and need of respiratory support for the baby. We describe successful anesthetic management for LSCS with AVR in a >33 week gravida with severe AS and congestive heart failure. We avoided opioids till delivery of the baby AVR; the delivered neonate showed a normal APGAR score.
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Affiliation(s)
| | - Ajay Kumar
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Stourac P, Blaha J, Klozova R, Noskova P, Seidlova D, Brozova L, Jarkovsky J. Anesthesia for Cesarean Delivery in the Czech Republic. Anesth Analg 2015; 120:1303-8. [DOI: 10.1213/ane.0000000000000572] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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MBRRACE-UK: Saving Lives, Improving Mothers' Care – implications for anaesthetists. Int J Obstet Anesth 2015; 24:161-73. [DOI: 10.1016/j.ijoa.2015.03.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/08/2015] [Indexed: 11/23/2022]
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Lucas DN, Yentis SM. Unsettled weather and the end for thiopental? Obstetric general anaesthesia after the NAP5 and MBRRACE-UK reports. Anaesthesia 2015; 70:375-9. [DOI: 10.1111/anae.13034] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- D. N. Lucas
- Northwick Park Hospital; Harrow Middlesex UK
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Be wary of awareness – lessons from NAP5 for obstetric anaesthetists. Int J Obstet Anesth 2015; 24:1-4. [DOI: 10.1016/j.ijoa.2014.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 12/12/2014] [Indexed: 11/24/2022]
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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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Sury M, Palmer J, Cook T, Pandit J. The State of UK anaesthesia: a survey of National Health Service activity in 2013 †. Br J Anaesth 2014; 113:575-84. [DOI: 10.1093/bja/aeu292] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Cesarean delivery under general anesthesia: Continuing Professional Development. Can J Anaesth 2014; 61:489-503. [DOI: 10.1007/s12630-014-0125-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 02/13/2014] [Indexed: 12/15/2022] Open
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Rucklidge M. Up-to-date or out-of-date: does thiopental have a future in obstetric general anaesthesia? Int J Obstet Anesth 2013; 22:175-8. [DOI: 10.1016/j.ijoa.2013.03.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 03/23/2013] [Indexed: 11/30/2022]
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Affiliation(s)
- P. J. Stewart
- Altnagelvin Area Hospital Londonderry Northern Ireland
| | - R. Laird
- Altnagelvin Area Hospital Londonderry Northern Ireland
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