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Shippam W, Massey S, Clark K, Saulnier L, Chau A. Time to motor block regression after neuraxial anaesthesia for caesarean delivery: a retrospective, cohort study. Anaesthesia 2024. [PMID: 39073352 DOI: 10.1111/anae.16400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 07/30/2024]
Affiliation(s)
| | - Simon Massey
- British Columbia Women's Hospital, Vancouver, Canada
| | - Kathyrn Clark
- British Columbia Women's Hospital, Vancouver, Canada
| | - Luc Saulnier
- British Columbia Women's Hospital, Vancouver, Canada
| | - Anthony Chau
- British Columbia Women's Hospital, Vancouver, Canada
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2
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Kearns RJ, Broom MA, Lucas DN. Long-term effects of neuraxial analgesia. Curr Opin Anaesthesiol 2024; 37:227-233. [PMID: 38390906 DOI: 10.1097/aco.0000000000001365] [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: 02/24/2024]
Abstract
PURPOSE OF REVIEW This review article explores the potential longer-term implications of neuraxial analgesia in labour for both the mother and her child. RECENT FINDINGS Neuraxial techniques for labour analgesia are well tolerated and effective, and long-term adverse sequelae are rare. Labour epidural analgesia is not independently associated with long-term headache, backache, postnatal depression or anal sphincter injury, and evidence supports that epidurals may offer protection against severe maternal morbidity, particularly in women at a higher risk of complications. However, there is an increasing awareness that postdural puncture headache may be associated with chronic headache, back pain and postnatal depression, emphasizing the need for adequate follow-up until symptoms resolve.For the neonate, a growing body of evidence refutes any association between epidural analgesia in labour and the later development of autism spectrum disorder. The clinical significance of epidural related maternal fever remains uncertain and is a research priority. SUMMARY Women should continue to access the significant benefits of neuraxial analgesia in labour without undue concern about adverse sequelae for themselves or their offspring. Measures to prevent, appropriately manage and adequately follow-up women who have suffered complications of neuraxial analgesia, such as postdural puncture headache, are good practice and can mitigate the development of long-term sequelae.
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Affiliation(s)
- Rachel J Kearns
- Princess Royal Maternity Unit
- School of Medicine, University of Glasgow, Glasgow
| | - Malcolm A Broom
- Princess Royal Maternity Unit
- School of Medicine, University of Glasgow, Glasgow
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3
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Vallejo MC, Kumaraswami S, Zakowski MI. American Society of Anesthesiologists 2023 Guidance on Neurologic Complications of Neuraxial Analgesia/Anesthesia in Obstetrics. Anesthesiology 2024; 140:1235-1236. [PMID: 38578973 DOI: 10.1097/aln.0000000000004967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Affiliation(s)
| | | | - Mark I Zakowski
- Cedars-Sinai Medical Center, Los Angeles, California (M.I.Z.).
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4
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Navti OB, Pavord S. Venous thromboembolism in pregnant obese Individuals. Best Pract Res Clin Obstet Gynaecol 2024; 94:102471. [PMID: 38452607 DOI: 10.1016/j.bpobgyn.2024.102471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/14/2023] [Accepted: 02/05/2024] [Indexed: 03/09/2024]
Abstract
Venous thrombosis and thromboembolism (VTE) remain the leading cause of direct maternal deaths, occurring within 42 days of the end of pregnancy in the UK. Pregnancy is associated with an overall 10-fold higher incidence of VTE than in the non-pregnant state and has been reported to reach up to 30-fold higher in the puerperium. This increased risk is further exacerbated by maternal obesity in a relationship that appears to be proportional with increasing Body Mass Index (BMI). Maternal obesity is the most common health problem in women of reproductive age with clinically significant health risks to women during pregnancy and after delivery. It is associated with poor perinatal and maternal outcomes, The incidence of maternal obesity has increased significantly worldwide over the last few decades and increasingly, pregnancy is being complicated by extreme or morbid obesity. In this review we discuss the challenges associated with the diagnosis and management of VTE in obese pregnant women and provide a review of the available current evidence.
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Affiliation(s)
- Osric B Navti
- Maternal & Fetal Medicine, Al Wakra Hospital, Hamad Medical Corporation, Qatar; Clinical Obstetrics & Gynaecology, Weill Cornell Medicine, Qatar.
| | - Sue Pavord
- Oxford University Hospitals NHS Foundation Trust, UK; Medicine, St Edmund Hall, University of Oxford, UK.
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5
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Huang L, Hu N, Jiang L, Xiong X, Shi J, Chen D. Appraisal of clinical practice guidelines and consensus statements on obstetric anaesthesia: a systematic review using the AGREE II instrument. BMJ Open 2024; 14:e084759. [PMID: 38806417 PMCID: PMC11138284 DOI: 10.1136/bmjopen-2024-084759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/10/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVES Despite the publication of hundreds of trials on obstetric anaesthesia, the management of these conditions remains suboptimal. We aimed to assess the quality and consistency of guidance documents for obstetric anaesthesia. DESIGN This is a systematic review and quality assessment using the Appraisal of Guidelines for Research and Evaluation (AGREE) II methodology. DATA SOURCES Data sources include PubMed and Embase (8 June 2023), three Chinese academic databases, six guideline databases (7 June 2023) and Google and Google scholar (1 August 2023). ELIGIBILITY CRITERIA We included the latest version of international and national/regional clinical practice guidelines and consensus statements for the anaesthetic management of pregnant patients during labour, non-operative delivery, operative delivery and selected aspects of perioperative monitoring, postpartum care and analgesia, published in English or Chinese. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened the searched items and extracted data. Four reviewers independently scored documents using AGREE II. Recommendations from all documents were tabulated and visualised in a coloured grid. RESULTS Twenty-two guidance documents (14 clinical practice guidelines and 8 consensus statements) were included. Included documents performed well in the domains of scope and purpose (median 76.4%, IQR 69.4%-79.2%) and clarity of presentation (median 72.2%, IQR 61.1%-80.6%), but were unsatisfactory in applicability (median 21.9%, IQR 13.5%-27.1%) and editorial independence (median 47.9%, IQR 6.3%-73.2%). The majority of obstetric anaesthesia guidelines or consensus centred on different topics. Less than 30% of them specifically addressed the management of obstetric anaesthesia perioperatively. Recommendations were concordant on the perioperative preparation, and on some indications for the choice of anaesthesia method. Substantially different recommendations were provided for some items, especially for preoperative blood type and screen, and for the types and doses of neuraxial administration. CONCLUSIONS The methodological quality in guidance documents for obstetric anaesthesia necessitates enhancement. Despite numerous trials in this area, evidence gaps persist for specific clinical queries in this field. One potential approach to mitigate these challenges involves the endorsement of standardised guidance development methods and the synthesis of robust clinical evidence, aimed at diminishing difference in recommendations.
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Affiliation(s)
- Lu Huang
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Na Hu
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Ling Jiang
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xinglong Xiong
- Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Jing Shi
- Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Dongxu Chen
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
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6
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Beenakkers ICM, Schaap TP, van den Bosch OFC. High Neuraxial Block in Obstetrics: A 2.5-Year Nationwide Surveillance Approach in the Netherlands. Anesth Analg 2024:00000539-990000000-00723. [PMID: 38294948 DOI: 10.1213/ane.0000000000006866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
BACKGROUND High neuraxial block is a rare but serious adverse event in obstetric anesthesia that can ultimately lead to respiratory insufficiency and cardiac arrest. Previous reports on its incidence are limited to populations in the United Kingdom and the United States. Little is known about the incidence and clinical features of high neuraxial block in the Netherlands, where the presence of anesthesiologists in the labor and delivery unit is comparatively lower. We aimed to assess the incidence and clinical features of high neuraxial block in obstetrics and to formulate ways to improve obstetric anesthesia on a national level. METHODS This nationwide, prospective, population-based cohort study was designed to identify cases of high neuraxial block requiring ventilatory support (with supraglottic airway device or tracheal intubation) or cardiopulmonary resuscitation between November 2019 and May 2022. Cases were prospectively collected using the Netherlands Obstetric Surveillance System (NethOSS) in all hospitals with a maternity unit. Complete case file copies were obtained to determine risk factors and clinical course. RESULTS During the study period, 5 cases of high neuraxial block requiring tracheal intubation were identified. The estimated incidence of high neuraxial block requiring tracheal intubation was 1 in 29,770 neuraxial procedures in labor (95% confidence interval, 1:12,758-1:91,659). Three of 5 identified cases occurred in the operating room after single-shot spinal anesthesia for Cesarean delivery after epidural analgesia in labor. One case developed in the labor ward due to an inadvertent intrathecal or subdural catheter placed for labor analgesia. The fifth case followed single-shot spinal anesthesia for elective Cesarean delivery. All 5 patients were successfully extubated in the operating room after Cesarean delivery, without the need for intensive care admission. There were no cardiac arrests and no neonatal deaths. CONCLUSIONS High neuraxial block requiring tracheal intubation is a rare but impactful complication in obstetric anesthesia, potentially affecting both mother and fetus. Spinal anesthesia after epidural analgesia in labor is a common cause of high neuraxial block. Meticulous follow-up of epidurals in labor facilitates conversion to surgical anesthesia and may therefore reduce the need for spinal anesthesia after epidural analgesia. Large-scale surveillance systems in obstetric anesthesia are needed to identify those at risk, as well as to formulate further strategies to mitigate this burden.
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Affiliation(s)
- Ingrid C M Beenakkers
- From the Department of Anesthesiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Timme P Schaap
- Department of Obstetrics, Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Oscar F C van den Bosch
- From the Department of Anesthesiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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7
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Štourač P, Bláha J, Kosinová M, Mannová J, Nosková P, Harazim H, Pešková K, Seidlová D. Year 2022 in review - Anesthesiology in obstetrics. ANESTEZIOLOGIE A INTENZIVNÍ MEDICÍNA 2022. [DOI: 10.36290/aim.2022.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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8
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Prior CH, Burlinson CEG, Chau A. Emergencies in obstetric anaesthesia: a narrative review. Anaesthesia 2022; 77:1416-1429. [PMID: 36089883 DOI: 10.1111/anae.15839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/28/2022]
Abstract
We conducted a narrative review in six areas of obstetric emergencies: category-1 caesarean section; difficult and failed airway; massive obstetric haemorrhage; hypertensive crisis; emergencies related to neuraxial anaesthesia; and maternal cardiac arrest. These areas represent significant research published within the last five years, with emphasis on large multicentre randomised trials, national or international practice guidelines and recommendations from major professional societies. Key topics discussed: prevention and management of failed neuraxial technique; role of high-flow nasal oxygenation and choice of neuromuscular drug in obstetric patients; prevention of accidental awareness during general anaesthesia; management of the difficult and failed obstetric airway; current perspectives on the use of tranexamic acid, fibrinogen concentrate and cell salvage; guidance on neuraxial placement in a thrombocytopenic obstetric patient; management of neuraxial drug errors, local anaesthetic systemic toxicity and unusually prolonged neuraxial block regression; and extracorporeal membrane oxygenation use in maternal cardiac arrest.
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Affiliation(s)
- C H Prior
- Department of Anaesthesia, West Middlesex University Hospital, London, UK
| | - C E G Burlinson
- Department of Anesthesia, BC Women's Hospital, Vancouver, BC, Canada.,Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - A Chau
- Department of Anesthesia, BC Women's Hospital, Vancouver, BC, Canada.,Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.,Department of Anesthesia, St. Paul's Hospital, Vancouver, BC, Canada
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9
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Bishop DG, Lucas DN. If it isn’t written down, then it didn’t happen: documentation in obstetric anaesthesia. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2022. [DOI: 10.36303/sajaa.2022.28.4.2845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- DG Bishop
- Perioperative Research Group, Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal,
South Africa
| | - DN Lucas
- Department of Anaesthesia, London North West University Healthcare NHS Trust,
United Kingdom
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10
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Khan‐Perez J, MacCarrick T, Martin F. The use of nitrous oxide 'cracking' technology in the labour ward: a case report and patient account. Anaesth Rep 2022; 10:e12182. [PMID: 36185641 PMCID: PMC9477560 DOI: 10.1002/anr3.12182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 09/17/2023] Open
Abstract
Nitrous oxide is a common choice of labour analgesia in many countries. However, its use is associated with significant cost to the environment as well as potential risks of long-term occupational exposure. Our hospital is one of a small number of healthcare providers in the United Kingdom trialling technology which catalytically destroys ('cracks') nitrous oxide to reduce greenhouse gas emissions and occupational exposure. When used in the setting of inhaled analgesia, cracking technology relies on capturing the patient's exhaled breath via a facemask or mouthpiece, a technique which requires some user skill and may be challenging for patients. In this report, we present the case of a primiparous 35-year-old consultant anaesthetist, who used nitrous oxide cracking technology with inhaled nitrous oxide analgesia (via a facemask) during labour. We present the patient's experiences and discuss the implications of using such technology on ambient nitrous oxide levels in the delivery room. Notably, despite this patient's professional expertise and familiarity with facemask use, nitrous oxide remained detectable throughout her labour, although generally at low levels. This illustrates that whilst this technology has the potential to reduce ambient nitrous oxide levels, its efficacy may vary depending on how it is used, with implications for patient education and support.
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Affiliation(s)
| | | | - F. Martin
- Department of Anaesthesia, Salford Royal HospitalSalfordUK
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11
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McGlennan CM, Christmas TR. "You test because you cannot afford to make assumptions". Anaesthesia 2022; 77:861-864. [PMID: 35587999 DOI: 10.1111/anae.15759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/30/2022]
Affiliation(s)
- C M McGlennan
- Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - T R Christmas
- Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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12
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Neuraxial and general anaesthesia for caesarean section. Best Pract Res Clin Anaesthesiol 2022; 36:53-68. [PMID: 35659960 DOI: 10.1016/j.bpa.2022.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/16/2022] [Accepted: 04/25/2022] [Indexed: 11/20/2022]
Abstract
Caesarean section (CS) is one of the most performed operations worldwide. In many parts of the world, there has been a reduction in anaesthetic associated obstetric mortality, and this has been attributed to the increased use of neuraxial anaesthesia and improved safety of general anaesthesia, alongside improved training and organisational changes. In resource-limited countries, anaesthesia contributes disproportionately to maternal mortality, with one in seven deaths being due to anaesthesia. A major contributory factor to this is the severe shortage of trained anaesthetic providers. Goals for anaesthesia for CS include the woman's comfort and foetal well-being, focusing on strategies to minimise morbidity and mortality for both. Anaesthetic options for CS include neuraxial techniques (spinal or combined-spinal epidural or epidural extension of labour analgesia) and general anaesthesia. There is increasing evidence of the benefit of neuraxial techniques over general anaesthesia in terms of maternal and foetal outcomes. For elective CS, spinal and combined-spinal anaesthesia predominate. General anaesthesia is mainly reserved for Category 1 CS where there is an immediate threat to the life of the mother or the baby. This review discusses the practical aspects of neuraxial and general anaesthesia for CS.
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Plaat F, Stanford SER, Lucas DN, Andrade J, Careless J, Russell R, Bishop D, Lo Q, Bogod D. Prevention and management of intra-operative pain during caesarean section under neuraxial anaesthesia: a technical and interpersonal approach. Anaesthesia 2022; 77:588-597. [PMID: 35325933 PMCID: PMC9311138 DOI: 10.1111/anae.15717] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/27/2022]
Abstract
A woman who experiences pain during caesarean section under neuraxial anaesthesia is at risk of adverse psychological sequelae. Litigation arising from pain during caesarean section under neuraxial anaesthesia has replaced accidental awareness under general anaesthesia as the most common successful medicolegal claim against obstetric anaesthetists. Generic guidelines on caesarean section exist, but they do not provide specific recommendations for this area of anaesthetic practice. This guidance aims to offer pragmatic advice to support anaesthetists in caring for women during caesarean section. It emphasises the importance of non-technical skills, offers advice on best practice and aims to encourage standardisation. The guidance results from a collaborative effort by anaesthetists, psychologists and patients and has been developed to support clinicians and promote standardisation of practice in this area.
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Affiliation(s)
- F Plaat
- Department of Anaesthesia, Queen Charlottes and Chelsea Hospital, London, UK
| | | | - D N Lucas
- Department of Anaesthesia, London North West University Healthcare NHS Trust, London, UK
| | - J Andrade
- School of Psychology, University of Plymouth, Plymouth, UK
| | - J Careless
- Associate Specialist, Department of Anaesthesia, Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK
| | - R Russell
- Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - D Bishop
- Metropolitan Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Q Lo
- Department of Anaesthesia, The Royal Marsden NHS Foundation Trust, London, UK
| | - D Bogod
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK
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14
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Gaines M, Pinder A, MacCarrick T, Khan-Perez J, Fang L, Shelton C. Bench experiments to investigate the effect of nitrous oxide cracking technology in ideal circumstances. Anaesthesia 2021; 77:225-226. [PMID: 34875718 DOI: 10.1111/anae.15632] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 12/15/2022]
Affiliation(s)
- M Gaines
- North West School of Anaesthesia, Manchester, UK
| | - A Pinder
- North West School of Anaesthesia, Manchester, UK
| | - T MacCarrick
- North West School of Anaesthesia, Manchester, UK
| | - J Khan-Perez
- North West School of Anaesthesia, Manchester, UK
| | - L Fang
- North West School of Anaesthesia, Manchester, UK
| | - C Shelton
- Wythenshawe Hospital, Manchester, UK
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15
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P.152 The anaesthetic management of a patient with bilateral foot drop for caesarean section. Int J Obstet Anesth 2021. [DOI: 10.1016/j.ijoa.2021.103150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Berry S, McPherson J, Pearson F, Quinn A. P.15 Neuraxial block monitoring after epidural analgesia for labour. Int J Obstet Anesth 2021. [DOI: 10.1016/j.ijoa.2021.103013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Chen X, Cai M, Lei X, Yu J. Obesity decreases the EC50 of epidural ropivacaine when combined with dexmedetomidine for labor analgesia. Expert Rev Clin Pharmacol 2021; 14:1051-1056. [PMID: 33980116 DOI: 10.1080/17512433.2021.1929924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES This study aims to estimate the EC50 of ropivacaine when co-administered with dexmedetomidine for epidural labor analgesia in antepartum obese and non-obese parturients. METHODS Sixty parturients scheduled for epidural labor analgesia were enrolled and divided into antepartum obesity (AO) and control (CON) groups, according to their body mass index at labor. Both groups received 0.5 µg/mL dexmedetomidine with ropivacaine as anesthetics. The concentration of ropivacaine was initially set at 0.125% and varied by 0.01% according to the up-and-down rule for sequential allocation. Hemodynamic parameters were monitored and pain intensity was assessed using a visual analog scale. RESULTS When co-administered with dexmedetomidine, the EC50 of ropivacaine was 0.095% (95% confidence interval [CI]: 0.090-0.100%) and 0.070% (95% CI: 0.062-0.076%) in CON and AO groups, respectively. There was a significant difference between the two groups (P < 0.001). EC95 values of ropivacaine were 0.084% (95% CI: 0.077-0.122%) and 0.106% (95% CI: 0.101-0.128%) in AO and CON groups, respectively. CONCLUSION Patients with antepartum obese may require decreased ropivacaine concentration for epidural labor analgesia when co-administered with 0.5 µg/mL dexmedetomidine.
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Affiliation(s)
- Xiaojun Chen
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Yubei District. Chongqing, China
| | - Meng Cai
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Yubei District. Chongqing, China
| | - Xiaofeng Lei
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Yubei District. Chongqing, China
| | - Jin Yu
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Yubei District. Chongqing, China
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Xiang B, Yang J, Lei X, Yu J. Adjuvant Sufentanil Decreased the EC50 of Epidural Ropivacaine for Labor Analgesia in Healthy Term Pregnancy. DRUG DESIGN DEVELOPMENT AND THERAPY 2021; 15:2143-2149. [PMID: 34040352 PMCID: PMC8140882 DOI: 10.2147/dddt.s307478] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/05/2021] [Indexed: 12/14/2022]
Abstract
Objective The optimal concentration of ropivacaine as epidural labor analgesia combined with sufentanil has not been established. This study aimed to determine the median effective concentration (EC50) of epidural ropivacaine for labor analgesia in healthy term pregnancy when co-administered with sufentanil as an adjuvant or alone. Patients and Methods Sixty healthy parturients scheduled for epidural labor analgesia were enrolled in the study. They were divided into a saline group (Group C) and an epidural sufentanil (0.5 µg/mL) group (Group S). The initial concentration of ropivacaine was set at 0.125%, which was then varied by 0.01% using the up-and-down sequential allocation method. The hemodynamics were continuously monitored during delivery. A visual analog scale was used to evaluate the degree of pain. The Ramsay sedation score, duration of the labor stages, the onset of epidural analgesia, and adverse effects were recorded. Neonatal outcomes were evaluated using the Apgar scores and umbilical artery blood gas analysis. Results The EC50 of ropivacaine was 0.085% (95% CI, 0.079–0.090%) in Group S and 0.109% (95% CI, 0.105–0.112%) in Group C. The EC95 of ropivacaine was 0.096% (95% CI, 0.090–0.118%) in Group S, and 0.116% (95% CI, 0.113–0.127%) in Group C. The difference between the groups was statistically significant (p < 0.001). The stable hemodynamics, satisfactory analgesia, and good neonatal outcomes were comparable in both groups (P > 0.05). Conclusion The EC50 of ropivacaine was reduced by 22% when co-administered with sufentanil for epidural labor analgesia in primipara. (www.chictr.org.cn; registration number: ChiCTR2000039547).
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Affiliation(s)
- Bo Xiang
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Chongqing, 401147, People's Republic of China
| | - Jian Yang
- Department of Anesthesiology, Chongqing Dongnan Hospital, Chongqing, 401336, People's Republic of China
| | - Xiaofeng Lei
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Chongqing, 401147, People's Republic of China
| | - Jin Yu
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Chongqing, 401147, People's Republic of China
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19
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Kearsley R, Stocks G. Venous thromboembolism in pregnancy-diagnosis, management, and treatment. BJA Educ 2021; 21:117-123. [PMID: 33664981 DOI: 10.1016/j.bjae.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 10/22/2022] Open
Affiliation(s)
- R Kearsley
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - G Stocks
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
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20
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Charlesworth M, Klein AA. Celebrating 75 years of Anaesthesia: our past, present and future. The science of neuromusclar blockade, 75 years on. Anaesthesia 2021; 76:128-131. [PMID: 33295655 DOI: 10.1111/anae.15287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 11/28/2022]
Affiliation(s)
- M Charlesworth
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Wythenshawe Hospital, Manchester, UK
| | - A A Klein
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
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21
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Carvalho B, Sultan P. Spinal prilocaine for caesarean section: walking a fine line. Anaesthesia 2021; 76:740-742. [PMID: 33428235 DOI: 10.1111/anae.15341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 11/26/2022]
Affiliation(s)
- B Carvalho
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - P Sultan
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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22
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Dooley A, Djabatey E. Incidence of antenatal lower limb/sub-umbilical neurological complications and antenatal backache in a tertiary maternity hospital obstetric anaesthesia clinic. Anaesthesia 2021; 76:426-427. [PMID: 33406292 DOI: 10.1111/anae.15377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/10/2020] [Indexed: 11/26/2022]
Affiliation(s)
- A Dooley
- Liverpool Women's Hospital, Liverpool, UK
| | - E Djabatey
- Liverpool Women's Hospital, Liverpool, UK
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23
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Prior C, Bhiladvala C, Weale J, Taylor J, Massey S. Obstetric neuraxial anaesthesia resolution monitoring: when should we be concerned? Int J Obstet Anesth 2020; 44:58-59. [PMID: 32799068 DOI: 10.1016/j.ijoa.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/20/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Affiliation(s)
- C Prior
- Department of Anesthesia, British Columbia Women's Hospital, Vancouver, BC, Canada.
| | - C Bhiladvala
- Department of Anesthesia, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - J Weale
- Department of Anesthesia, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - J Taylor
- Department of Anesthesia, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - S Massey
- Department of Anesthesia, British Columbia Women's Hospital, Vancouver, BC, Canada
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24
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Charlesworth M, Daly Guris RJ, Dalay S. Novel presentations, rare complications and educational content: cases in clinical practice. Anaesth Rep 2020; 8:73-75. [PMID: 32656534 DOI: 10.1002/anr3.12056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2020] [Indexed: 12/16/2022] Open
Affiliation(s)
- M Charlesworth
- Department of Cardiothoracic Critical Care, Anaesthesia and ECMO Wythenshawe Hospital Manchester UK
| | - R J Daly Guris
- Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia and University of Pennsylvania Philadelphia PA USA
| | - S Dalay
- Department of Anaesthesia Worcestershire Acute Hospitals NHS Trust Worcester UK
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