1
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Galvan J, Van de Velde M. Obstetric emergencies: umbilical cord prolapse. BJA Educ 2024; 24:227-230. [PMID: 38899316 PMCID: PMC11184473 DOI: 10.1016/j.bjae.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 06/21/2024] Open
Affiliation(s)
- J.M. Galvan
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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2
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Tuohey BH, Shelton CL, Dieleman S, McGain F. Time to re-evaluate the routine use of sterile gowns in neuraxial anaesthesia. Anaesth Intensive Care 2024; 52:197-199. [PMID: 38006607 DOI: 10.1177/0310057x231210314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Affiliation(s)
| | - Cliff L Shelton
- Department of Anaesthesia, Wythenshawe Hospital, Manchester, UK
- Lancaster University, Lancaster, UK
| | - Stefan Dieleman
- Department of Anaesthesia, Westmead Hospital, Westmead, Australia
- Western Sydney University, Sydney, Australia
| | - Forbes McGain
- Department of Anaesthesia and Intensive care, Western Health, Footscray, Australia
- Department of Critical Care Medicine, University of Melbourne, Melbourne, Australia
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3
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Nichols W, Nicholls J, Bill V, Shelton C. Temperature changes of CoolSticks during simulated use. Int J Obstet Anesth 2023; 55:103890. [PMID: 37169662 DOI: 10.1016/j.ijoa.2023.103890] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/13/2023] [Accepted: 04/12/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Cold sensation is often used to check neuraxial anaesthesia and analgesia. One opportunity to reduce the carbon footprint of anaesthesia is to replace vapo-coolant sprays such as ethyl chloride with a reusable device called the CoolStick, which is cooled in a refrigerator between uses. We designed a study to investigate how long the CoolStick remains at its working temperature, which we defined as <15 °C. METHOD Experiments were undertaken using a thermocouple and digital temperature sensor attached to the CoolStick. We conducted two experiments to assess temperature changes following removal from the refrigerator for 10 min; the first investigated passive re-warming in the ambient theatre environment and the second investigated re-warming in simulated use. In our third experiment, we investigated the time taken to cool the device in the refrigerator, following use. Each experiment was repeated three times. RESULTS In the passive re-warming experiment, the mean CoolStick temperature was 7.3 °C at the start, and 14.3 °C after 10 min. In the simulated use experiment, the mean CoolStick temperature was 7.3 °C at the start, and 18.9 °C at 10 min. In the cooling experiment, the mean CoolStick temperature was 15 °C at the start and 7.6 °C at 40 min. CONCLUSION Our study indicates that it is feasible to use the CoolStick for providing cold sensation in clinical practice. Further study would be required to directly compare the effectiveness of the device to existing methods such as coolant sprays or ice in the clinical setting.
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Affiliation(s)
- W Nichols
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - J Nicholls
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - V Bill
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - C Shelton
- Department of Anaesthesia, Wythenshawe Hospital, Manchester, UK; Lancaster Medical School, Lancaster University, Lancaster, UK.
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4
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Kumar V. Current indications for spinal anesthesia-a narrative review. Best Pract Res Clin Anaesthesiol 2023; 37:89-99. [PMID: 37321771 DOI: 10.1016/j.bpa.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 03/14/2023] [Accepted: 04/05/2023] [Indexed: 06/17/2023]
Abstract
Spinal anesthesia is a commonly performed regional anesthesia technique by most anesthesiologists worldwide. This technique is learned early during training and is relatively easy to master. Despite being an old technique, spinal anesthesia has evolved and developed in various aspects. This review attempts to highlight the current indications of this technique. Understanding the finer aspects and knowledge gaps will help postgraduates and practicing anesthesiologists in designing patient-specific techniques and interventions.
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Affiliation(s)
- Vinoth Kumar
- Department of Anaesthesiology, Ganga Medical Centre and Hospitals Pvt Ltd, 313, Mettupalayam Road, Coimbatore, 641043, India.
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5
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Lucas DN, Wong R, Kearsley R. 'Cracking' the environmental problem of nitrous oxide in obstetrics. Anaesthesia 2023; 78:288-293. [PMID: 36351439 DOI: 10.1111/anae.15907] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
Affiliation(s)
- D N Lucas
- Department of Anaesthesia, London North West University Healthcare NHS Trust, London, UK
| | - R Wong
- Department of Anaesthesia, The Royal London Hospital, London, UK
| | - R Kearsley
- Department of Anaesthesia, The Rotunda Hospital, Dublin, Ireland
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6
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McCombe K, Bogod DG. Learning from the law: a review of 21 years of litigation for anaesthetic negligence resulting in peripartum hypoxic ischaemic encephalopathy. Anaesthesia 2022; 77:919-928. [PMID: 35489716 DOI: 10.1111/anae.15741] [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: 03/31/2022] [Indexed: 11/29/2022]
Abstract
One of the most devastating complications that can result from medical mismanagement during labour and delivery is hypoxic ischaemic encephalopathy. Hypoxic ischaemic encephalopathy has profound implications for the newborn and its family, as well as for the healthcare team involved. Hypoxic ischaemic encephalopathy can take only minutes to develop, but the repercussions of this complication can last a lifetime. A proportion of these injuries arise from failure to deliver the baby within a sufficiently short time frame once fetal compromise has been recognised. Obstetric anaesthetists are often involved in such claims, usually in relation to a perception that provision of anaesthesia for caesarean section was unduly delayed. In the following article, using a database of over 360 cases spanning 21 years, we break down and examine the recurrent components of medicolegal claims concerning the anaesthetic involvement in hypoxic ischaemic encephalopathy, and consider how increased awareness of the anaesthetic contribution to this complication might reduce future harm, improve clinical standards and consequently decrease the need for litigation.
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Affiliation(s)
- K McCombe
- Department of Anaesthesia, Mediclinic City Hospital, Dubai Healthcare City, Dubai, UAE.,Mohammed Bin Rashid University, Dubai, UAE
| | - D G Bogod
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK
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7
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Mehmood R, McGuire AJ, Mansoor Z, Fink AB, Atanasov G. Regional Anaesthetic Techniques and Their Implications During the COVID Pandemic. SN COMPREHENSIVE CLINICAL MEDICINE 2021; 3:2222-2228. [PMID: 34568762 PMCID: PMC8453463 DOI: 10.1007/s42399-021-01035-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 01/08/2023]
Abstract
The current pandemic has highlighted the need to protect both patients and medical staff. The increased use of regional anaesthesia as a primary anaesthetic modality for operations and other invasive procedures has limited the number of aerosol-generating procedures performed during general anaesthesia. Its use is further characterized by decreases in postoperative pain and length of hospitalization. This article provides an overview of regional anaesthetic techniques (peripheral nerve locks, epidural and spinal anaesthesia) and their uses during the COVID pandemic.
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Affiliation(s)
- Raafay Mehmood
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ainsley John McGuire
- Faculty of Health Sciences, University of Northern British Columbia, Prince George, Canada
| | - Zainab Mansoor
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Gabriel Atanasov
- First Faculty of Medicine, Charles University, Prague, Czech Republic
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8
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Seneviratna D, Campbell JP, Plaat F. A 20-minute decision-delivery interval at caesarean section using general anaesthesia. Anaesthesia 2021; 77:112-113. [PMID: 34555185 DOI: 10.1111/anae.15589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 11/30/2022]
Affiliation(s)
- D Seneviratna
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - J P Campbell
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - F Plaat
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
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9
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Ituk U, Wong CA. Anesthetic Choices for Intrapartum Cesarean Delivery in Patients with Epidural Labor Analgesia. Adv Anesth 2021; 38:23-40. [PMID: 34106837 DOI: 10.1016/j.aan.2020.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Unyime Ituk
- Department of Anesthesia, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 6JCP, Iowa City, IA 52242, USA
| | - Cynthia A Wong
- Department of Anesthesia, University of Iowa Carver College of Medicine, 200 Hawkins Drive, JCP6618, Iowa City, IA 52242, USA.
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10
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P.109 Rapid sequence spinal - Encouraging open minded obstetric anaesthesia in the era of COVID-19. Int J Obstet Anesth 2021. [PMCID: PMC8186965 DOI: 10.1016/j.ijoa.2021.103107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Ring L, Landau R, Delgado C. The Current Role of General Anesthesia for Cesarean Delivery. CURRENT ANESTHESIOLOGY REPORTS 2021; 11:18-27. [PMID: 33642943 PMCID: PMC7902754 DOI: 10.1007/s40140-021-00437-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 12/20/2022]
Abstract
Purpose of the Review The use of general anesthesia for cesarean delivery has declined in the last decades due to the widespread utilization of neuraxial techniques and the understanding that neuraxial anesthesia can be provided even in urgent circumstances. In fact, the role of general anesthesia for cesarean delivery has been revisited, because despite recent devices facilitating endotracheal intubation and clinical algorithms, guiding anesthesiologists facing challenging scenarios, risks, and complications of general anesthesia at the time of delivery for both mother and neonate(s) remain significant. In this review, we will discuss clinical scenarios and risk factors associated with general anesthesia for cesarean delivery and address reasons why anesthesiologists should apply strategies to minimize its use. Recent Findings Unnecessary general anesthesia for cesarean delivery is associated with maternal complications, including serious anesthesia-related complications, surgical site infection, and venous thromboembolic events. Racial and socioeconomic disparities and low-resource settings are major contributing factors in the use of general anesthesia for cesarean delivery, with both maternal and perinatal mortality increasing when general anesthesia is provided. In addition, more significant maternal pain and higher rates of postpartum depression requiring hospitalization are associated with general anesthesia for cesarean delivery. Summary Rates of general anesthesia for cesarean delivery have overall decreased, and while general anesthesia no longer is a contributing factor to anesthesia-related maternal deaths, further opportunities to reduce its use should be emphasized. Raising awareness in identifying situations and patients at risk to help avoid unnecessary general anesthesia remains crucial.
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Affiliation(s)
- Laurence Ring
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY USA
| | - Ruth Landau
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY USA
| | - Carlos Delgado
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA USA
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12
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Ismail S, Hameed M. Evaluating anesthesia practice for caesarean section: A prospective cross-sectional study from a tertiary care institution of low- and middle-income country. JOURNAL OF OBSTETRIC ANAESTHESIA AND CRITICAL CARE 2021. [DOI: 10.4103/joacc.joacc_103_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Abstract
This chapter describes the management of pregnant women infected with COVID-19. Management includes measures taken for prevention of infection and the currently available vaccines and possibility of their use during pregnancy. Special care of women during delivery including monitoring and treatment place and plan of treatment is discussed in details. Vaginal delivery measures were discussed including the proper analgesia. Special precautions during cesarean delivery including the anesthetic considerations were discussed. The management of the parturient in her postpartum period and care of the newborn were explained. Current evidences regarding breastfeeding and mother neonatal contact were discussed in detail. All the current available guidelines for management of COVID-19 pregnant patients with different disease severity starting from asymptomatic and passing through those with mild, moderate, and severe disease and reaching the management of critically ill patients were explained.
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14
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Ring LE, Martinez R, Bernstein K, Landau R. What obstetricians should know about obstetric anesthesia during the COVID-19 pandemic. Semin Perinatol 2020; 44:151277. [PMID: 33127095 PMCID: PMC7449136 DOI: 10.1016/j.semperi.2020.151277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The COVID-19 pandemic has prompted obstetric anesthesiologists to reconsider the ways in which basic anesthesia care is provided on the Labor and Delivery Unit. Suggested modifications include an added emphasis on avoiding general anesthesia, a strong encouragement to infected individuals to opt for early neuraxial analgesia, and the prevention of emergent cesarean delivery, whenever possible. Through team efforts, adopting these measures can have real effects on reducing the transmission of the viral illness and maintaining patient and caregiver safety in the labor room.
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Affiliation(s)
| | | | - Kyra Bernstein
- Department of Anesthesiology, Division of Obstetric Anesthesia, Columbia University College of Physicians and Surgeons, New York, NY, United States.
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15
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Ashokka B, Loh MH, Tan CH, Su LL, Young BE, Lye DC, Biswas A, Illanes SE, Choolani M. Care of the pregnant woman with coronavirus disease 2019 in labor and delivery: anesthesia, emergency cesarean delivery, differential diagnosis in the acutely ill parturient, care of the newborn, and protection of the healthcare personnel. Am J Obstet Gynecol 2020; 223:66-74.e3. [PMID: 32283073 PMCID: PMC7151436 DOI: 10.1016/j.ajog.2020.04.005] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019, caused by the severe acute respiratory syndrome coronavirus 2, has been declared a pandemic by the World Health Organization. As the pandemic evolves rapidly, there are data emerging to suggest that pregnant women diagnosed as having coronavirus disease 2019 can have severe morbidities (up to 9%). This is in contrast to earlier data that showed good maternal and neonatal outcomes. Clinical manifestations of coronavirus disease 2019 include features of acute respiratory illnesses. Typical radiologic findings consists of patchy infiltrates on chest radiograph and ground glass opacities on computed tomography scan of the chest. Patients who are pregnant may present with atypical features such as the absence of fever as well as leukocytosis. Confirmation of coronavirus disease 2019 is by reverse transcriptase-polymerized chain reaction from upper airway swabs. When the reverse transcriptase-polymerized chain reaction test result is negative in suspect cases, chest imaging should be considered. A pregnant woman with coronavirus disease 2019 is at the greatest risk when she is in labor, especially if she is acutely ill. We present an algorithm of care for the acutely ill parturient and guidelines for the protection of the healthcare team who is caring for the patient. Key decisions are made based on the presence of maternal and/or fetal compromise, adequacy of maternal oxygenation (SpO2 >93%) and stability of maternal blood pressure. Although vertical transmission is unlikely, there must be measures in place to prevent neonatal infections. Routine birth processes such as delayed cord clamping and skin-to-skin bonding between mother and newborn need to be revised. Considerations can be made to allow the use of screened donated breast milk from mothers who are free of coronavirus disease 2019. We present management strategies derived from best available evidence to provide guidance in caring for the high-risk and acutely ill parturient. These include protection of the healthcare workers caring for the coronavirus disease 2019 gravida, establishing a diagnosis in symptomatic cases, deciding between reverse transcriptase-polymerized chain reaction and chest imaging, and management of the unwell parturient.
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Affiliation(s)
- Balakrishnan Ashokka
- Department of Anaesthesia, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - May-Han Loh
- Department of Anaesthesia, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Lin Lin Su
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Obstetrics & Gynaecology, National University Hospital, Singapore
| | - Barnaby Edward Young
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; National Centre for Infectious Diseases, Singapore
| | - David Chien Lye
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; National Centre for Infectious Diseases, Singapore
| | - Arijit Biswas
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Obstetrics & Gynaecology, National University Hospital, Singapore
| | - Sebastian E Illanes
- Department Obstetrics & Gynecology, Faculty of Medicine, Universidad de los Andes, Santiago, Chile
| | - Mahesh Choolani
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Obstetrics & Gynaecology, National University Hospital, Singapore
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16
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Ashokka B, Chakraborty A, Subramanian BJ, Karmakar MK, Chan V. Reconfiguring the scope and practice of regional anesthesia in a pandemic: the COVID-19 perspective. Reg Anesth Pain Med 2020; 45:536-543. [PMID: 32471930 PMCID: PMC7362872 DOI: 10.1136/rapm-2020-101541] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023]
Abstract
The COVID-19 outbreak is on the world. While many countries have imposed general lockdown, emergency services are continuing. Healthcare professionals have been infected with the virulent severe acute respiratory syndrome coronavirus-2 (SARS), which spreads by close contact and aerosols. The anesthesiologist is particularly vulnerable to aerosols while performing intubation and other airway related procedures. Regional anesthesia (RA) minimizes the need for airway manipulation and the risks of cross infection to other patients, and the healthcare personnel. In this context, for prioritizing RA over general anesthesia, wherever possible, a structured algorithmic approach is outlined. The role of percentage saturation of hemoglobin with oxygen (oxygen saturation), blood pressure and early use of point-of-care ultrasound in differential diagnosis and specific management is detailed. The perioperative anesthetic implications of multisystem manifestations of COVID-19, anesthetic management options, the scope of RA and considerations for its safe conduct in operating rooms is described. An outline for safe and rapid training of healthcare personnel, with an Entrustable Professional Activity framework for ascertaining the practice readiness among trained residents for RA in COVID-19, is suggested. These are the authors' experiences gained from the current pandemic and similar SARS, Middle East Respiratory Syndrome and influenza outbreaks in recent past faced by our authors in Singapore, India, Hong Kong and Canada.
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Affiliation(s)
- Balakrishnan Ashokka
- Anaesthesia, National University Health System, Singapore
- Centre for Medical Education, National University Singapore Yong Loo Lin School of Medicine, Singapore
| | | | | | - Manoj Kumar Karmakar
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vincent Chan
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, Ontario, Canada
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17
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Wagh HD. Rapid sequence spinal must be the new norm for an emergency LSCS in this Covid pandemic. Reg Anesth Pain Med 2020; 46:191-192. [PMID: 32487702 DOI: 10.1136/rapm-2020-101725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Harshal D Wagh
- Anaesthesia, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
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18
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Guasch E, Brogly N, Gilsanz F. Combined spinal epidural for labour analgesia and caesarean section: indications and recommendations. Curr Opin Anaesthesiol 2020; 33:284-290. [DOI: 10.1097/aco.0000000000000866] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Varandas JS, Dias R, Mendes AB, Lages N, Machado H. New indication for an old anesthetic technique: could we consider now rapid sequence spinal anesthesia in a COVID-19 time? Reg Anesth Pain Med 2020; 46:191. [PMID: 32381730 PMCID: PMC7239652 DOI: 10.1136/rapm-2020-101572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Joana Santos Varandas
- Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Raquel Dias
- Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Angela Barbosa Mendes
- Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Neusa Lages
- Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Humberto Machado
- Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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20
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Ryalino C, Agung Senapathi T, Raju A, Sastra Winata IG, Budi Hartawan IN, Agung Utara Hartawan IG. Perioperative management for cesarean section in COVID-19 patients. BALI JOURNAL OF ANESTHESIOLOGY 2020. [DOI: 10.4103/bjoa.bjoa_101_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Agegnehu AF, Gebregzi AH, Endalew NS. Review of evidences for management of rapid sequence spinal anesthesia for category one cesarean section, in resource limiting setting. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020; 26:101-105. [PMID: 34568612 PMCID: PMC7470710 DOI: 10.1016/j.ijso.2020.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Globally obstetric anesthesia is being done under spinal and epidural than general anesthesia (GA) for most caesarean sections (CSs). This is because GA is associated with failed endotracheal intubation and aspiration of gastric contents. Eventhough general anesthesia is the fastest method for anesthetizing a category 1 cesarean section, it is associated with increased maternal mortality and morbidity. Spinal anesthesia is the preferred regional technique for cesarean section but failure sometimes occurs. To minimize the time factor of spinal anesthesia as well as to avoid the side effects of general anesthesia 'rapid sequence spinal '(RSS) has developed as a novel approach in cases of category one cesarean sections. METHODS The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Search engines like PubMed through HINARI, Cochrane database and Google Scholars were used to find high-level evidences that help to draw appropriate conclusions. DISCUSSION Neuraxial anesthetic techniques have several advantages which include low risk of aspiration and failed intubation, avoidance of central nervous system (CNS) and respiratory depressant drugs, the ability to maintain a wakeful state of mother enjoying the experience of delivery of baby and also lower incidence of blood loss. 'Rapid sequence spinal' described to minimize anesthetic time. This consists of a no-touch spinal technique, consideration of omission of the spinal opioid, limiting spinal attempts, allowing the start of surgery before full establishment of the spinal block, and being prepared for conversion to general anesthesia if there are delays or problems. To do rapid sequence spinal anesthesia safely and timely, cooperative work is mandatory with good team relation for those simultaneous and necessary tasks. CONCLUSION The choice of anesthetic in Cesarean section has long been recognized as one of prime importance, because there are two lives to safeguard instead of one. A balance must be struck between the anesthetic dictated by the general condition of the mother and that suited to the needs of the fetal respiratory system.
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Affiliation(s)
- Abatneh Feleke Agegnehu
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Hailekiros Gebregzi
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nigussie Simeneh Endalew
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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22
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Abstract
Cesarean section (CS) is a common surgical procedure worldwide. The anesthesiologist is responsible, together with obstetrician and neonatologist, for safe perioperative management. A continuum of risk exists for urgent CS. The decision-to-delivery interval is an important audit tool, to ensure international standards are upheld and good outcomes for mother and neonate are achieved. Urgent CS may be performed under either GA or RA, with benefits and risks attributable to each. Specific clinical scenarios require an individualized approach to anesthesia, including hemorrhage, hypertensive disorders, cardiac disease, the difficult airway and fetal compromise. Ongoing training is integral to the provision of safe anesthesia.
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Affiliation(s)
- Nicole L Fernandes
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Groote Schuur Hospital, D23 Groote Schuur Hospital, Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Robert A Dyer
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Groote Schuur Hospital, D23 Groote Schuur Hospital, Anzio Road, Observatory, Cape Town 7925, South Africa.
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Bidon C, Desgranges FP, Riegel AC, Allaouchiche B, Chassard D, Bouvet L. Retrospective cohort study of decision-to-delivery interval and neonatal outcomes according to the type of anaesthesia for code-red emergency caesarean sections in a tertiary care obstetric unit in France. Anaesth Crit Care Pain Med 2019; 38:623-630. [DOI: 10.1016/j.accpm.2019.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/09/2019] [Accepted: 05/11/2019] [Indexed: 10/26/2022]
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Young F. Is rapid sequence spinal anaesthesia a valid alternative for an emergency caesarean? Br J Hosp Med (Lond) 2019; 80:554-555. [PMID: 31498663 DOI: 10.12968/hmed.2019.80.9.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Frances Young
- Specialist Trainee in Anaesthesia, Department of Anaesthesia, Manchester University NHS Foundation Trust - Wythenshawe, Manchester M23 9LT
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Abstract
PURPOSE OF REVIEW Simulation training in obstetric anesthesia has become widespread in recent years. Simulations are used to train staff and trainees, assess and improve team performance, and evaluate the work environment. This review summarizes current research in these categories. RECENT FINDINGS Simulation to improve individual technical skills has focused on induction of general anesthesia for emergent cesarean delivery, an infrequently encountered scenario by anesthesia trainees. Low- and high-fidelity simulation devices for the learning and practicing neuraxial and non-neuraxial procedures have been described, and both are equally effective. The use of checklists in obstetric emergencies has become common as and post-scenario debriefing techniques have improved. Although participant task performance improves, whether participants retain learned skills or whether simulation improves patient outcomes has not yet been established. Tools to assess teamwork during simulation have been developed, but none have been rigorously validated. In-situ vs. offsite simulations do not differ in effectiveness. SUMMARY Simulation allows for practice of tasks and teamwork in a controlled manner. There is little data whether simulation improves patient outcomes and metrics to predict the long-term retention of skills by simulation participants have not been developed.
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Thangaswamy CR, Kundra P, Velayudhan S, Aswini LN, Veena P. Influence of anaesthetic technique on maternal and foetal outcome in category 1 caesarean sections - A prospective single-centre observational study. Indian J Anaesth 2018; 62:844-850. [PMID: 30532319 PMCID: PMC6236792 DOI: 10.4103/ija.ija_406_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background and Aims: In category 1 caesarean section (CS), there is limited evidence regarding superior anaesthetic technique. Hence, this study was designed to study the influence of anaesthetic technique on the maternal and foetal outcome. Methods: Patient characteristics, indication for CS, decision-to-delivery interval (DDI), uterine incision-to-delivery time (UIDT), cord blood pH, Apgar scores and neonatal and maternal outcome were noted. Composite endpoint (Apgar score <7, umbilical cord blood pH <7.2, neonatal intensive care unit admission or death) was created for adverse neonatal outcome. Logistic regression was done to assess the influence of confounding factors on the occurrence of adverse neonatal outcome. Results: Of 123 patients who underwent category 1 cesarean section, 114 patients were included for analysis. The DDI and UIDT were comparable. One and 5-min Apgar scores were significantly lower in the group general anaesthesia (GA) than in the group spinal anaesthesia (SA). The umbilical cord blood pH was comparable (7.21 ± 0.15 vs 7.25 ± 0.11 in groups GA and SA, respectively). Neonatal intensive care admission and maternal outcome were comparable in both the groups. Subgroup analysis of patients with foetal heart rate of less than 100 showed that group GA had significantly lower 1-min Apgar scores and umbilical cord blood pH and significantly more neonatal admission and mortality. Binominal logistic regression showed that group GA (odds ratio 2.9, 95% confidence intervals 1.27-6.41) and gestational age were independently associated with adverse neonatal outcome. Conclusion: GA for category 1 CS was associated with increased incidence of adverse neonatal outcome.
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Affiliation(s)
- Chitra Rajeswari Thangaswamy
- Departments of Anaesthesiology and Critical Care, Pondicherry Institute of Medical Sciences, Puducherry, Tamil Nadu, India
| | - Pankaj Kundra
- Departments of Anaesthesiology and Critical Care, Pondicherry Institute of Medical Sciences, Puducherry, Tamil Nadu, India
| | - Savitri Velayudhan
- Department of Anaesthesiology and Critical Care, Pondicherry Institute of Medical Sciences, Puducherry, Tamil Nadu, India
| | | | - P Veena
- Department of Obstetrics and Gynaecology Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry Institute of Medical Sciences, Puducherry, Tamil Nadu, India
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Abstract
Labor causes severe pain for many women. There is no other circumstance in which it is considered acceptable for an individual to experience untreated severe pain that is amenable to safe intervention while the individual is under a physician's care. Many women desire pain management during labor and delivery, and there are many medical indications for analgesia and anesthesia during labor and delivery. In the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor. A woman who requests epidural analgesia during labor should not be deprived of this service based on the status of her health insurance. Third-party payers that provide reimbursement for obstetric services should not deny reimbursement for labor analgesia because of an absence of "other medical indications." Anesthesia services should be available to provide labor analgesia and surgical anesthesia in all hospitals that offer maternal care (levels I-IV) (). Although the availability of different methods of labor analgesia will vary from hospital to hospital, the methods available within an institution should not be based on a patient's ability to pay.The American College of Obstetricians and Gynecologists believes that in order to allow the maximum number of patients to benefit from neuraxial analgesia, labor nurses should not be restricted from participating in the management of pain relief during labor. Under appropriate physician supervision, labor and delivery nursing personnel who have been educated properly and have demonstrated current competence should be able to participate in the management of epidural infusions.The purpose of this document is to review medical options for analgesia during labor and anesthesia for surgical procedures that are common at the time of delivery. Nonpharmacologic options such as massage, immersion in water during the first stage of labor, acupuncture, relaxation, and hypnotherapy are not covered in this document, though they may be useful as adjuncts or alternatives in many cases.
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Hori K, Oda Y, Ryokai M, Okutani R. Rapid sequence spinal anesthesia for the most urgent cesarean section: a simulation and clinical application. JA Clin Rep 2016; 2:6. [PMID: 29497661 PMCID: PMC5818730 DOI: 10.1186/s40981-016-0037-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 05/10/2016] [Indexed: 11/10/2022] Open
Abstract
Rapid sequence spinal anesthesia is a recently developed technique for the most urgent, category-1 cesarean section. To successfully perform this technique, it is important to multi-disciplinarily discuss with all staffs related to delivery, make a local protocol in each hospital and simulate the procedure with them. Owing to the above preparation, we were able to perform the technique smoothly also in the real patient. Considering possible benefits of rapid sequence spinal anesthesia, we should prepare enough before we use it in the actual clinical situations.
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Krom AJ, Cohen Y, Miller JP, Ezri T, Halpern SH, Ginosar Y. Choice of anaesthesia for category-1 caesarean section in women with anticipated difficult tracheal intubation: the use of decision analysis. Anaesthesia 2016; 72:156-171. [DOI: 10.1111/anae.13729] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 12/29/2022]
Affiliation(s)
- A. J. Krom
- Department of Anesthesiology; Hadassah Hebrew University Medical Center; Jerusalem Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Y. Cohen
- Post-Anesthesia Care Unit; Department of Anesthesiology; Chaim Sheba Medical Center; Tel-Hashomer Ramat-Gan Israel
| | - J. P. Miller
- Washington University School of Medicine; St Louis MO USA
| | - T. Ezri
- Department of Anesthesia; Wolfson Medical Center; Holon Israel
- Outcomes Research Consortium; Cleveland OH USA
| | - S. H. Halpern
- Department of Anesthesia; Sunnybrook Health Sciences Centre; University of Toronto; Toronto Canada
| | - Y. Ginosar
- Department of Anesthesiology and Director; Mother and Child Anesthesia Unit; Hadassah Hebrew University Hospital; Jerusalem Israel
- Department of Anesthesiology and Director; Division of Obstetric Anesthesiology; Washington University School of Medicine; St Louis MO USA
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Malhotra R, Johnstone C, Halpern S, Hunter J, Banerjee A. Duration of motor block with intrathecal ropivacaine versus bupivacaine for caesarean section: a meta-analysis. Int J Obstet Anesth 2016; 27:9-16. [DOI: 10.1016/j.ijoa.2016.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 02/23/2016] [Accepted: 03/13/2016] [Indexed: 01/08/2023]
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Maes S, Laubach M, Poelaert J. Randomised controlled trial of spinal anaesthesia with bupivacaine or 2-chloroprocaine during caesarean section. Acta Anaesthesiol Scand 2016; 60:642-9. [PMID: 26608876 DOI: 10.1111/aas.12665] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 05/31/2015] [Accepted: 11/03/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neuraxial anaesthesia is the desired method for Caesarean section. Bupivacaine is a well-known local anaesthetic. It has a long duration of action and can cause unpredictable levels of anaesthesia with subsequent prolonged discharge time. 2-Chloroprocaine has a rapid onset of action, producing an excellent sensory and motor block and has a rapid hydrolysis in the bloodstream by pseudocholinesterase. We compared bupivacaine and 2-chloroprocaine for spinal anaesthesia during Caesarean section. The primary endpoint was the earliest reversal sign of the motor block. METHODS Sixty ASAI/II patients, planned for elective singleton Caesarean section, were equally randomised to three groups. All patients received a combined spinal-epidural anaesthesia. The first group received 2-chloroprocaine (40 mg) without sufentanil, the second group received 2-chloroprocaine (40 mg) with sufentanil (1 μg) and the third group received hyperbaric bupivacaine (7.5 mg) with sufentanil (1 μg) as a spinal anaesthetic. Motor and sensory blockade were assessed at specific time points. RESULTS There was no difference between the three groups regarding the time to regression of the motor block. However, at 5 min post spinal injection, the level of sensory block was higher for both groups with 2-chloroprocaine, in comparison with the bupivacaine group. CONCLUSION 2-Chloroprocaine can be used for low risk Caesarean section in healthy parturients. There is no difference in time to motor block resolution compared to bupivacaine. Motor recovery seems more predictable for 2-chloroprocaine and may be beneficial for the breastfeeding initiation.
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Affiliation(s)
- S. Maes
- Department of Anaesthesiology and Perioperative Medicine; UZ Brussel; Brussels Belgium
| | - M. Laubach
- Department of Gynaecology; UZ Brussel; Brussels Belgium
| | - J. Poelaert
- Department of Anaesthesiology and Perioperative Medicine; UZ Brussel; Brussels Belgium
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Affiliation(s)
- Hiroyuki Sumikura
- Juntendo University, Faculty of Medicine, Department of Anesthesiology and Pain Medicine
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Vaida S, Cattano D, Hurwitz D, Mets B. Algorithm for the anesthetic management of cesarean delivery in patients with unsatisfactory labor epidural analgesia. F1000Res 2015; 4:98. [PMID: 26167271 PMCID: PMC4482209 DOI: 10.12688/f1000research.6381.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2015] [Indexed: 11/20/2022] Open
Abstract
The management of a patient presenting with unsatisfactory labor epidural analgesia poses a severe challenge for the anesthetist wanting to provide safe anesthetic care for a cesarean delivery. Early recognition of unsatisfactory labor analgesia allows for replacement of the epidural catheter. The decision to convert labor epidural analgesia to anesthesia for cesarean delivery is based on the urgency of the cesarean delivery, airway examination, and the existence of a residual sensory and motor block. We suggest an algorithm which is implemented in our department, based on the urgency of the cesarean delivery.
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Affiliation(s)
- Sonia Vaida
- Department of Anesthesiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennysylvania, 17033, USA
| | - Davide Cattano
- Preoperative clinic, Department of Anesthesiology, The University of Texas Medical School at Houston, Houston, Texas, 77030, USA
| | - Debra Hurwitz
- Department of Anesthesiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennysylvania, 17033, USA
| | - Berend Mets
- Department of Anesthesiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennysylvania, 17033, USA
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Jigajinni SV, Rajala B, El Sharawi N. The rapid sequence spinal for category 1 caesarean section: anaesthetic trainee knowledge and practice. J Perioper Pract 2015; 25:24-26. [PMID: 26016261 DOI: 10.1177/1750458915025001-205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Rapid sequence induction of general anaesthesia (GA) is the fastest anaesthetic technique in a category-1 caesarean section (C1CS) for foetal distress. Recently rapid sequence spinal anaesthesia (RSS) has been explored as a technique to avoid the potential risks of GA in such cases. Out of hours, trainee anaesthetists are often required to provide anaesthesia for these emergencies. We surveyed their practices when performing a RSS. The aim of a RSS is to rapidly and safely achieve anaesthesia for C1CS, while optimising foetal oxygenation and preparing for possible GA. It requires anaesthetic skill, team work and communication. Many trainees understood the principles of the RSS, however, a significant number did not. Practice varied widely and no trainee had received any formal RSS training. Training for junior anaesthetists and those working in obstetric theatres, in the conduct of the RSS is crucial, to ensure safe practice, avoid delays in delivery and safely avoid the risks associated with GA in the C1CS.
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Zhang Q, Dunn CN, Sia JT, Sng BL. Category one caesarean section: A team-based approach. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2014. [DOI: 10.1016/j.tacc.2014.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Regional anaesthesia for caesarean section (and what to do when it fails). ANAESTHESIA AND INTENSIVE CARE MEDICINE 2013. [DOI: 10.1016/j.mpaic.2013.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Miskovic AM, Dob DP. Spinal anaesthesia for caesarean section in the presence of respiratory failure and spinal metastases from a soft tissue clear cell sarcoma. Int J Obstet Anesth 2013; 22:247-50. [PMID: 23809016 DOI: 10.1016/j.ijoa.2013.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 02/04/2013] [Accepted: 03/10/2013] [Indexed: 11/15/2022]
Abstract
Spinal metastases occur in up to 70% of all patients with cancer. However, only 10% are symptomatic. Before considering central neuraxial blockade in patients with malignancy, a history of back pain should be excluded. Anaesthetists should be aware that intrathecal and epidural injections could cause paraplegia if metastases are impinging on the spinal cord. Failure to achieve adequate sensory anaesthesia after central neuraxial blockade or presentation with postoperative paraplegia may indicate the presence of asymptomatic vertebral canal metastases. In this report, the anaesthetic management of a patient with respiratory failure and spinal metastases from a soft tissue sarcoma, requiring caesarean section is described. Sensory anaesthesia extending above a level of imminent cord compression was achieved despite loss of cerebrospinal fluid signal on magnetic resonance imaging.
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Affiliation(s)
- A M Miskovic
- Magill Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK.
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Kathirgamanathan A, Douglas MJ, Tyler J, Saran S, Gunka V, Preston R, Kliffer P. Speed of spinal vs general anaesthesia for category-1 caesarean section: a simulation and clinical observation-based study. Anaesthesia 2013; 68:753-9. [DOI: 10.1111/anae.12290] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - M. J. Douglas
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
| | - J. Tyler
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
| | - S. Saran
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
| | - V. Gunka
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
| | - R. Preston
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
| | - P. Kliffer
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
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Hurford DM, De Zoysa N. Rapid sequence spinal anaesthesia - a survey of current use. Anaesthesia 2012; 67:1284-5. [DOI: 10.1111/anae.12013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Checketts MR. Wash & go - but with what? Skin antiseptic solutions for central neuraxial block. Anaesthesia 2012; 67:819-22. [DOI: 10.1111/j.1365-2044.2012.07263.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Beckmann M, Calderbank S. Mode of anaesthetic for category 1 caesarean sections and neonatal outcomes. Aust N Z J Obstet Gynaecol 2012; 52:316-20. [PMID: 22676478 DOI: 10.1111/j.1479-828x.2012.01457.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 05/04/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Birth by emergency caesarean section (CS) is common and often considered urgent (category 1). In the UK, over half of all category 1 CS are performed under general anaesthesia (GA). In this setting, little is known about the effect of the mode of anaesthesia on the neonate. METHODS A retrospective cohort study was performed using routinely collected de-identified data from Mater Health Services, Brisbane, Australia. The data set included 533 term babies born by category 1 CS for presumed fetal compromise between 2008 and 2011. Bivariate and multivariate analyses were undertaken. RESULTS The outcomes of 81 babies born by GA CS were compared with 452 by CS under regional anaesthesia (RA). Compared with a category 1 CS under RA, the decision-to-delivery interval for a GA CS was almost eight minutes faster (24.7 vs 32.6 minutes; P < 0.001). When adjusted for confounders, babies born by category 1 GA CS were significantly more likely to have an Apgar score < 7 at five minutes (aOR 6.89; 95%CI 1.79-26.55; P = 0.005), to require Neopuff or bag/mask ventilation for > 60 seconds (aOR 2.34; 95%CI 1.13-4.84; P = 0.022) and to be admitted to a neonatal intensive care nursery (aOR 2.24; 95%CI 1.16-4.31; P = 0.016). CONCLUSIONS General anaesthesia was associated with short-term neonatal morbidity of term babies born by category 1 CS for presumed fetal compromise, despite enabling a more rapid delivery of the baby. These data should help inform the discussion between anaesthetist and obstetrician, in balancing the risks and benefits of the mode of anaesthesia.
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Affiliation(s)
- Michael Beckmann
- Department of Obstetrics and Gynaecology, Mater Health Services, South Brisbane, Queensland, Australia.
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Sumikura H. Keep our guard up against general anesthesia for cesarean section! J Anesth 2012; 26:324-5. [PMID: 22610378 DOI: 10.1007/s00540-012-1403-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 04/19/2012] [Indexed: 10/28/2022]
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Yeoh SB, Leong SB, Heng AST. Anaesthesia for lower-segment caesarean section: Changing perspectives. Indian J Anaesth 2011; 54:409-14. [PMID: 21189878 PMCID: PMC2991650 DOI: 10.4103/0019-5049.71037] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The number of caesarean sections has increased over the last two decades, especially in the developed countries. Hence, it has increasingly become a greater challenge to provide care for the parturient, but this has given obstetric anaesthetists a greater opportunity to contribute to obstetric services. While caesarean deliveries were historically performed using general anaesthesia, there is a recent significant move towards regional anaesthesia. Unique problems that patients with obesity and pre-eclampsia present will be discussed in the present article. New medications and devices now used in obstetric anaesthesia will change the practice and perspectives of our clinical practice.
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Affiliation(s)
- Sean Brian Yeoh
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
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Dyer RA. Update on general anaesthesia for Caesarean section. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2011. [DOI: 10.1080/22201173.2011.10872748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- RA Dyer
- Department of Anaesthesia, Faculty of Health Sciences, University of Cape Town
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