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Wuthe S, Veraar C, Jantsch-Watzinger U, Skhirtladze-Dworschak K, Schweiger T, Hoetzenecker K, Tschernko E, Dworschak M. Use of Laryngeal Mask Airway With Continuous Transcutaneous PCO 2 monitoring for Crico-tracheal Resection Requiring Intermittent Prolonged Apnea in a Pregnant Woman. J Cardiothorac Vasc Anesth 2024; 38:1738-1741. [PMID: 38876814 DOI: 10.1053/j.jvca.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 06/16/2024]
Affiliation(s)
- Sophie Wuthe
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine; Division of Cardiac-, Thoracic-, and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Cecilia Veraar
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine; Division of Cardiac-, Thoracic-, and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Ursula Jantsch-Watzinger
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine; Division of Cardiac-, Thoracic-, and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Keso Skhirtladze-Dworschak
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine; Division of Cardiac-, Thoracic-, and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Thomas Schweiger
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Edda Tschernko
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine; Division of Cardiac-, Thoracic-, and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Martin Dworschak
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine; Division of Cardiac-, Thoracic-, and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Austria.
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Crane AA, Russo CM, Wands K, Gafner JL, Burch RH. Challenges of Providing Optimal and Safe Intrapartum Analgesia in Patients With HELLP Syndrome: A Case Report and Literature Review. Mil Med 2024:usae296. [PMID: 38850222 DOI: 10.1093/milmed/usae296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/22/2024] [Accepted: 05/22/2024] [Indexed: 06/10/2024] Open
Abstract
HELLP (Hemolysis, Elevated Liver enzymes, Low Platelets) Syndrome is a rare but serious complication of pregnancy that can lead to disseminated intravascular coagulation, pulmonary edema, respiratory failure, hepatic and renal injury, and death if not recognized and treated promptly. A 36-year-old nulligravid (G0) active duty Marine at 36 weeks and 1 day gestation with dichorionic diamniotic twins presented to triage for routine cervical examination found to have elevated blood pressures and symptomatic thrombocytopenia, with a suspected diagnosis of HELLP. A multidisciplinary decision was made by anesthesiology, obstetrics and gynecology, and pediatrics to deliver the twins to avoid any further complications. The twins were in cephalic presentation and the patient desired to attempt a vaginal delivery. Due to the patient's thrombocytopenia, neuraxial anesthesia (spinal and/or epidural) left the patient at a high risk of developing catastrophic complications such as an epidural hematoma, and the subsequent motor block/weakness would likely lessen the patient's ability to participate in active labor for a vaginal delivery. A Cesarean section under general anesthesia was also to be avoided as the patient's elevated risk of catastrophic hemorrhage would be worsened by volatile anesthetic agents which cause significant uterine vascular relaxation and reduced uterine muscular tone. Ultimately, the decision was made to provide analgesia through a remifentanil PCA (patient-controlled analgesia) for labor and a ketamine bolus for delivery. The mother delivered both twins vaginally in the operating room without perioperative complication. This case demonstrates the safety of alternate forms of anesthesia for delivery when neuraxial anesthesia is contraindicated.
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Affiliation(s)
- Anise A Crane
- Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Christopher M Russo
- Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Kayla Wands
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA
| | - Jeffrey L Gafner
- Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Robert H Burch
- Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
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Obiyo LT, Tobes D, Cole NM. Anesthetic recommendations for maternal and fetal safety in nonobstetric surgery: a balancing act. Curr Opin Anaesthesiol 2024; 37:285-291. [PMID: 38390901 DOI: 10.1097/aco.0000000000001363] [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 Nonobstetric surgery during pregnancy is associated with maternal and fetal risks. Several physiologic changes create unique challenges for anesthesiologists. This review highlights physiologic changes of pregnancy and presents clinical recommendations based on recent literature to guide anesthetic management for the pregnant patient undergoing nonobstetric surgery. RECENT FINDINGS Nearly every anesthetic technique has been safely used in pregnant patients. Although it is difficult to eliminate confounding factors, exposure to anesthetics could endanger fetal brain development. Perioperative fetal monitoring decisions require an obstetric consult based on anticipated maternal and fetal concerns. Given the limitations of fasting guidelines, bedside gastric ultrasound is useful in assessing aspiration risk in pregnant patients. Although there is concern about appropriateness of sugammadex for neuromuscular blockade reversal due its binding to progesterone, preliminary literature supports its safety. SUMMARY These recommendations will equip anesthesiologists to provide safe care for the pregnant patient and fetus undergoing nonobstetric surgery.
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Affiliation(s)
- Leziga T Obiyo
- Department of Anesthesia & Critical Care, University of Chicago, Chicago, Illinois, USA
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Mangla M. Occupational risks to pregnant obstetrics and gynaecology trainees and physicians: Is it time to think about this? JOURNAL OF MOTHER AND CHILD 2022; 26:111-117. [PMID: 35853832 PMCID: PMC10032316 DOI: 10.34763/jmotherandchild.20222601.d-22-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/15/2022] [Indexed: 02/23/2023]
Abstract
The proportion of women in the workforce has been steadily increasing worldwide. Women now constitute approximately 75% of the global health workforce and almost 90% in nursing and midwifery professions. The present times have witnessed a dramatic gender shift in the speciality of obstetrics and gynaecology. Women now comprise a significant proportion of practicing obstetrics and gynaecology specialists all over the world. In 2018, more than 80% of resident doctors and nearly 60% of physicians in the speciality were female, far exceeding any other surgical speciality. Most resident doctors and a significant proportion of practising physicians in obstetrics and gynaecology are in the reproductive age group. They will become pregnant at some point in their training program or career. The present review focuses on all work-related exposure risks for pregnant obstetrics and gynaecology professionals. It discusses the risks of infectious diseases, radiation, stress, violence against doctors, and even peer support (or lack of it) that can have deleterious effects on the health of pregnant physicians and the health of their unborn foetuses.
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Affiliation(s)
- Mishu Mangla
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
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Borre-Naranjo D, Santacruz J, Gonzalez-Hernandez J, Anichiarico W, Rubio-Romero J. Infección por SARS-CoV-2 en la paciente obstétrica: una perspectiva desde el cuidado crítico. ACTA COLOMBIANA DE CUIDADO INTENSIVO 2020. [PMCID: PMC7158844 DOI: 10.1016/j.acci.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
La nueva infección por coronavirus (COVID-19) se constituye en el principal problema de salud pública en el mundo. Entre el 5 y el 30% de los pacientes afectados por esta enfermedad requieren manejo en una unidad de cuidado intensivo. Se han generado diferentes publicaciones con recomendaciones para la población general. Sin embargo, en la población obstétrica la evidencia científica es reducida, aún más cuando se trata de infección por COVID-19 en escenarios de cuidado intensivo obstétrico. Por esta razón, se realizó una revisión narrativa no sistemática de la literatura utilizando como fuente de información MEDLINE, sociedades científicas y los repositorios de la Organización Mundial de la Salud y el Ministerio de Salud y Protección Social de Colombia, con el objetivo de describir algunas sugerencias para el manejo de una paciente embarazada con COVID-19 en una unidad de cuidado intensivo. Se resalta que la atención debe ser realizada por un equipo interdisciplinario, bajo monitorización materna y fetal cuando corresponda, vigilando los niveles de saturación de oxígeno y la hemodinamia materna para minimizar la hipoxemia fetal. Se describen recomendaciones sobre algunos tópicos relevantes en el escenario crítico, como la intubación oportuna, la utilización adecuada de los equipos de protección personal (EPP), el manejo de la falla circulatoria, las estrategias restrictivas de fluidos y/o vasopresores, entre otros.
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Tawfik MM, Badran BA, Eisa AA, Barakat RI. Simultaneous cesarean delivery and craniotomy in a term pregnant patient with traumatic brain injury. Saudi J Anaesth 2015; 9:207-10. [PMID: 25829914 PMCID: PMC4374231 DOI: 10.4103/1658-354x.152890] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The management of pregnant patients with traumatic brain injury is challenging. A multidisciplinary team approach is mandatory, and management should be individualized according to the type and extent of injury, maternal status, gestational age, and fetal status. We report a 27-year-old term primigravida presenting after head injury with Glasgow coma scale score 11 and anisocoria. Depressed temporal bone fracture and acute epidural hematoma were diagnosed, necessitating an urgent neurosurgery. Her fetus was viable with no signs of distress and no detected placental abnormalities. Cesarean delivery was performed followed by craniotomy in the same setting under general anesthesia with good outcome of the patient and her baby.
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Affiliation(s)
- Mohamed Mohamed Tawfik
- Department of Anesthesia and Surgical Intensive Care, Mansoura University Hospitals, Mansoura, Daqahlia, Egypt
| | - Basma Abed Badran
- Department of Anesthesia and Surgical Intensive Care, Mansoura University Hospitals, Mansoura, Daqahlia, Egypt
| | - Ahmed Amin Eisa
- Department of Anesthesia and Surgical Intensive Care, Mansoura University Hospitals, Mansoura, Daqahlia, Egypt
| | - Rafik Ibrahim Barakat
- Department of Obstetrics and Gynecology, Mansoura University Hospitals, Mansoura, Daqahlia, Egypt
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Daly O, Kelly KP, McCormack JG, Heidemann BH. Remifentanil PCA in labour. Anaesthesia 2013; 68:780-1. [PMID: 24044396 DOI: 10.1111/anae.12339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- O Daly
- Western General Hospital, Edinburgh, UK.
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