1
|
Meng ML, Fuller M, Federspiel JJ, Engelhard M, McNeil A, Ernst L, Habib AS, Shah SH, Quist-Nelson J, Raghunathan K, Ohnuma T, Krishnamoorthy V. Maternal Morbidity According to Mode of Delivery Among Pregnant Patients With Pulmonary Hypertension. Anesth Analg 2024; 138:1011-1019. [PMID: 37192132 PMCID: PMC10651791 DOI: 10.1213/ane.0000000000006523] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Patients with pulmonary hypertension have a high risk of maternal morbidity and mortality. It is unknown if a trial of labor carries a lower risk of morbidity in these patients compared to a planned cesarean delivery. The objective of this study was to examine the association of delivery mode with severe maternal morbidity events during delivery hospitalization among patients with pulmonary hypertension. METHODS This retrospective cohort study used the Premier inpatient administrative database. Patients delivering ≥25 weeks gestation from January 1, 2016, to September 30, 2020, and with pulmonary hypertension were included. The primary analysis compared intended vaginal delivery (ie, trial of labor) to intended cesarean delivery (intention to treat analysis). A sensitivity analysis was conducted comparing vaginal delivery to cesarean delivery (as treated analysis). The primary outcome was nontransfusion severe maternal morbidity during the delivery hospitalization. Secondary outcomes included blood transfusion (4 or more units) and readmission to the delivery hospital within 90 days from discharge from delivery hospitalization. RESULTS The cohort consisted of 727 deliveries. In the primary analysis, there was no difference in nontransfusion morbidity between intended vaginal delivery and intended cesarean delivery groups (adjusted odds ratio [aOR], 0.75; 95% confidence interval [CI], 0.49-1.15). In secondary analyses, intended cesarean delivery was not associated with blood transfusion (aOR, 0.71; 95% CI, 0.34-1.50) or readmission within 90 days (aOR, 0.60; 95% CI, 0.32-1.14). In the sensitivity analysis, cesarean delivery was associated with a 3-fold higher risk of nontransfusion morbidity compared to vaginal delivery (aOR, 2.64; 95% CI, 1.54-3.93), a 3-fold higher risk of blood transfusion (aOR, 3.06; 95% CI, 1.17-7.99), and a 2-fold higher risk of readmission within 90 days (aOR, 2.20; 95% CI, 1.09-4.46) compared to vaginal delivery. CONCLUSIONS Among pregnant patients with pulmonary hypertension, a trial of labor was not associated with a higher risk of morbidity compared to an intended cesarean delivery. One-third of patients who required an intrapartum cesarean delivery had a morbidity event, demonstrating the increased risk of adverse events in this group.
Collapse
Affiliation(s)
- Marie-Louise Meng
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Matthew Fuller
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
- Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University School of Medicine, Durham, NC
| | - Jerome J. Federspiel
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina
| | - Matthew Engelhard
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Ashley McNeil
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Liliane Ernst
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Ashraf S Habib
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Svati H. Shah
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Johanna Quist-Nelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Durham, North Carolina
| | - Karthik Raghunathan
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
- Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University School of Medicine, Durham, NC
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Tetsu Ohnuma
- Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University School of Medicine, Durham, NC
| | - Vijay Krishnamoorthy
- Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University School of Medicine, Durham, NC
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| |
Collapse
|
2
|
Meng ML. Reply: Trial of Labor in Cardiomyopathies: Decoding the Fine Print. JACC Heart Fail 2024; 12:793. [PMID: 38569829 DOI: 10.1016/j.jchf.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 04/05/2024]
|
3
|
Quist-Nelson J, Meng ML, Mallampati D, Federspiel JJ, Kucirka LM, Fuller M, Menard MK. Hospital Discharge Codes and Overestimating Severe Maternal Morbidity During Delivery Hospitalization. Obstet Gynecol 2024; 143:582-584. [PMID: 38387035 DOI: 10.1097/aog.0000000000005537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/18/2024] [Indexed: 02/24/2024]
Abstract
Our objective was to identify birth hospitalization severe maternal morbidity (SMM) diagnoses that were also coded during prior encounters and, thus, potentially falsely carried forward as de novo SMM events. This retrospective cohort study included pregnant patients with births between 2016 and 2020. We applied the SMM algorithm to the birth hospitalization and encounters occurring prepregnancy, antepartum, and postpartum. The primary outcome was the rate of SMM diagnoses recorded during the birth hospitalization that were also coded on previous encounters. There were 1,380 (1.8%) birthing patients with SMM. Of patients with SMM codes at the birth hospitalization, 19.0% had the same SMM code during a prior encounter. Certain SMM events may be prone to carry-forward errors and may not signify a de novo birth hospitalization event.
Collapse
Affiliation(s)
- Johanna Quist-Nelson
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, and the Department of Anesthesiology, the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, the Department of Population Health Sciences, and the Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina; and the Department of Obstetrics and Gynecology, University of California, San Francisco, San Francisco, California
| | | | | | | | | | | | | |
Collapse
|
4
|
Craig AM, Campbell A, Snow SC, Spates TN, Goldstein SA, Denoble AE, Meng ML, Schroder JN, Flores KP, Agarwal R, Ward CC, Federspiel JJ. Maternal and Pregnancy Outcomes Following Heart Transplantation in the United States. JACC Heart Fail 2023; 11:1666-1674. [PMID: 37804312 PMCID: PMC10841668 DOI: 10.1016/j.jchf.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/25/2023] [Accepted: 08/03/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Improved survival following heart transplantation (HT) has led to more recipients contemplating pregnancy, but data on outcomes are limited. OBJECTIVES The authors used a national data set to investigate and describe outcomes of pregnancies and deliveries in the United States in HT recipients. METHODS Diagnosis and procedure codes from the 2010-2020 Nationwide Readmissions Database identified delivery hospitalizations, history of HT, comorbid conditions, and outcomes. The authors compared rates of severe maternal morbidity (SMM), nontransfusion SMM, cardiovascular SMM (cSMM), and preterm birth from delivery hospitalization between HT recipients and no-HT recipients. The authors evaluated readmission to 330 days postpartum. Logistic and proportional hazard regressions were performed, adjusting for age, socioeconomic and facility characteristics, and clinical comorbidities. RESULTS Among 19,399,521 deliveries, 105 were HT recipients. Compared with no-HT, HT recipients were at higher risk for all SMM (24.8% vs 1.7%), nontransfusion SMM (20.8% vs 0.7%), cSMM (7.3% vs 0.12%), and preterm birth (43.3% vs 8.2%), all P < 0.001. In adjusted analyses, HT recipients had 16-fold greater odds of SMM, 28-fold greater odds of nontransfusion SMM, 38-fold greater odds of cSMM, and 7-fold greater odds of preterm birth. HT recipients had higher morbidity rates during delivery hospitalization and higher readmission rates within 1 year following delivery (26.9% vs 3.8%; adjusted HR: 6.03 [95% CI: 3.73-9.75]). CONCLUSIONS Delivery with history of HT is associated with significantly increased rates of SMM, preterm birth, and hospital readmission. These results provide data regarding pregnancy outcomes for use when counseling patients with HT history who are considering pregnancy or who are pregnant.
Collapse
Affiliation(s)
- Amanda M Craig
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina.
| | - Alexa Campbell
- Duke University School of Medicine, Durham, North Carolina
| | - Sarah C Snow
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Toi N Spates
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Sarah A Goldstein
- Division of Cardiology, Department of Medicine, Yale University, New Haven, Connecticut
| | - Anna E Denoble
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Yale University, New Haven, Connecticut
| | - Marie-Louise Meng
- Division of Women's Anesthesia, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Jacob N Schroder
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Karen P Flores
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Richa Agarwal
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Cary C Ward
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jerome J Federspiel
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
5
|
Meng ML, Federspiel JJ, Fuller M, McNeil A, Habib AS, Quist-Nelson J, Engelhard M, Shah SH, Krishnamoorthy V. Severe Maternal Morbidity According to Mode of Delivery Among Pregnant Patients With Cardiomyopathies. JACC Heart Fail 2023; 11:1678-1689. [PMID: 37943228 PMCID: PMC10904174 DOI: 10.1016/j.jchf.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/31/2023] [Accepted: 09/19/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Women with cardiomyopathies are at risk for pregnancy complications. The optimal mode of delivery in these patients is guided by expert opinion and limited small studies. OBJECTIVES The objective of this study is to examine the association of delivery mode with severe maternal morbidity events during delivery hospitalization and readmissions among patients with cardiomyopathies. METHODS The Premier inpatient administrative database was used to conduct a retrospective cohort study of pregnant patients with a diagnosis of a cardiomyopathy. Utilizing a target trial emulation strategy, the primary analysis compared outcomes among patients exposed to intended vaginal delivery vs intended cesarean delivery (intention to treat). A secondary analysis compared outcomes among patients who delivered vaginally vs by cesarean (as-treated). Outcomes examined were nontransfusion severe maternal morbidity during the delivery hospitalization, blood transfusion, and readmission. RESULTS The cohort consisted of 2,921 deliveries. In the primary analysis (intention to treat), there was no difference in nontransfusion morbidity (adjusted OR [aOR]: 1.17; 95% CI: 0.91-1.51), blood transfusion (aOR: 1.27; 95% CI: 0.81-1.98), or readmission (aOR: 1.03; 95% CI: 0.73-1.44) between intended vaginal delivery and intended cesarean delivery. In the as-treated analysis, cesarean delivery was associated with a 2-fold higher risk of nontransfusion morbidity (aOR: 2.44; 95% CI: 1.85-3.22) and blood transfusion (aOR: 2.26; 95% CI: 1.34-3.81) when compared with vaginal delivery. CONCLUSIONS In patients with cardiomyopathies, a trial of labor does not confer a higher risk of maternal morbidity, blood transfusion, or readmission compared with planned cesarean delivery.
Collapse
Affiliation(s)
- Marie-Louise Meng
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA.
| | - Jerome J Federspiel
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Matthew Fuller
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA; Critical Care and Perioperative Population Health Research (CAPER) Program, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ashley McNeil
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ashraf S Habib
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Johanna Quist-Nelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Matthew Engelhard
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Svati H Shah
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Vijay Krishnamoorthy
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA; Critical Care and Perioperative Population Health Research (CAPER) Program, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
6
|
Makkad B, Heinke TL, Sheriffdeen R, Khatib D, Brodt JL, Meng ML, Grant MC, Kachulis B, Popescu WM, Wu CL, Bollen BA. In Response. Anesth Analg 2023; 137:e52-e53. [PMID: 37973139 DOI: 10.1213/ane.0000000000006708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- Benu Makkad
- Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, Ohio,
| | - Timothy Lee Heinke
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Raiyah Sheriffdeen
- Department of Anesthesiology, Medstar Washington Hospital Center, Washington, DC
| | - Diana Khatib
- Department of Anesthesiology, Weil Cornell Medical College, New York, New York
| | - Jessica Louise Brodt
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Marie-Louise Meng
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Michael Conrad Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bessie Kachulis
- Department of Anesthesiology, Columbia University, New York, New York
| | - Wanda Maria Popescu
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, VA Connecticut Health Care System, West Haven, Connecticut
| | - Christopher L Wu
- Department of Anesthesiology, Hospital of Special Surgery, Weill Cornell Medical College, New York, New York
| | - Bruce Allen Bollen
- Department of Anesthesiology, Missoula Anesthesiology and The International Heart Institute of Montana, Missoula, Montana
| |
Collapse
|
7
|
Fu L, Shen L, Bian JJ, Li L, Su YX, Zuo JM, Meng ML, Lu Y, Ge SY, Wang DC. [Optic neuritis induced by Dasatinib in patients with Ph(+) acute lymphoblastic leukemia: a case report]. Zhonghua Xue Ye Xue Za Zhi 2023; 44:608. [PMID: 37749048 PMCID: PMC10509613 DOI: 10.3760/cma.j.issn.0253-2727.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Indexed: 09/27/2023]
Affiliation(s)
- L Fu
- Department of Hematology, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233020, China
| | - L Shen
- Department of Hematology, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233020, China
| | - J J Bian
- Department of Hematology, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233020, China
| | - L Li
- Department of Hematology, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233020, China
| | - Y X Su
- Department of Hematology, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233020, China
| | - J M Zuo
- Department of Hematology, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233020, China
| | - M L Meng
- Department of Hematology, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233020, China
| | - Y Lu
- Department of Hematology, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233020, China
| | - S Y Ge
- Department of Hematology, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233020, China
| | - D C Wang
- Department of Hematology, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233020, China
| |
Collapse
|
8
|
Makkad B, Heinke TL, Sheriffdeen R, Khatib D, Brodt JL, Meng ML, Grant MC, Kachulis B, Popescu WM, Wu CL, Bollen BA. Practice Advisory for Preoperative and Intraoperative Pain Management of Cardiac Surgical Patients: Part 2. Anesth Analg 2023; 137:26-47. [PMID: 37326862 DOI: 10.1213/ane.0000000000006506] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Pain after cardiac surgery is of moderate to severe intensity, which increases postoperative distress and health care costs, and affects functional recovery. Opioids have been central agents in treating pain after cardiac surgery for decades. The use of multimodal analgesic strategies can promote effective postoperative pain control and help mitigate opioid exposure. This Practice Advisory is part of a series developed by the Society of Cardiovascular Anesthesiologists (SCA) Quality, Safety, and Leadership (QSL) Committee's Opioid Working Group. It is a systematic review of existing literature for various interventions related to the preoperative and intraoperative pain management of cardiac surgical patients. This Practice Advisory provides recommendations for providers caring for patients undergoing cardiac surgery. This entails developing customized pain management strategies for patients, including preoperative patient evaluation, pain management, and opioid use-focused education as well as perioperative use of multimodal analgesics and regional techniques for various cardiac surgical procedures. The literature related to this field is emerging, and future studies will provide additional guidance on ways to improve clinically meaningful patient outcomes.
Collapse
Affiliation(s)
- Benu Makkad
- From the Department of Anesthesiology, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Timothy Lee Heinke
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Raiyah Sheriffdeen
- Department of Anesthesiology, Medstar Washington Hospital Center, Washington, DC
| | - Diana Khatib
- Department of Anesthesiology, Weil Cornell Medical College, New York, New York
| | - Jessica Louise Brodt
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Marie-Louise Meng
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Michael Conrad Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bessie Kachulis
- Department of Anesthesiology, Columbia University, New York, New York
| | - Wanda Maria Popescu
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Christopher L Wu
- Department of Anesthesiology, Hospital of Special Surgery, Weill Cornell Medical College, New York, New York
| | - Bruce Allen Bollen
- Missoula Anesthesiology, Missoula, Montana
- The International Heart Institute of Montana, Missoula, Montana
| |
Collapse
|
9
|
Makkad B, Heinke TL, Sheriffdeen R, Khatib D, Brodt JL, Meng ML, Grant MC, Kachulis B, Popescu WM, Wu CL, Bollen BA. Practice Advisory for Preoperative and Intraoperative Pain Management of Thoracic Surgical Patients: Part 1. Anesth Analg 2023; 137:2-25. [PMID: 37079466 DOI: 10.1213/ane.0000000000006441] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Pain after thoracic surgery is of moderate-to-severe intensity and can cause increased postoperative distress and affect functional recovery. Opioids have been central agents in treating pain after thoracic surgery for decades. The use of multimodal analgesic strategies can promote effective postoperative pain control and help mitigate opioid exposure, thus preventing the risk of developing persistent postoperative pain. This practice advisory is part of a series developed by the Society of Cardiovascular Anesthesiologists (SCA) Quality, Safety, and Leadership (QSL) Committee's Opioid Working Group. It is a systematic review of existing literature for various interventions related to the preoperative and intraoperative pain management of thoracic surgical patients and provides recommendations for providers caring for patients undergoing thoracic surgery. This entails developing customized pain management strategies for patients, which include preoperative patient evaluation, pain management, and opioid use-focused education as well as perioperative use of multimodal analgesics and regional techniques for various thoracic surgical procedures. The literature related to this field is emerging and will hopefully provide more information on ways to improve clinically relevant patient outcomes and promote recovery in the future.
Collapse
Affiliation(s)
- Benu Makkad
- From the Department of Anesthesiology, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Timothy Lee Heinke
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Raiyah Sheriffdeen
- Department of Anesthesiology, Medstar Washington Hospital Center, Washington, DC
| | - Diana Khatib
- Department of Anesthesiology, Weil Cornell Medical College, New York, New York
| | - Jessica Louise Brodt
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Marie-Louise Meng
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Michael Conrad Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bessie Kachulis
- Department of Anesthesiology, Columbia University, New York, New York
| | - Wanda Maria Popescu
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | - Christopher L Wu
- Department of Anesthesiology, Hospital of Special Surgery, Weill Cornell Medical College, New York, New York
| | - Bruce Allen Bollen
- Missoula Anesthesiology and The International Heart Institute of Montana, Missoula, Montana
| |
Collapse
|
10
|
Fu L, Li L, Shen L, Bian JJ, Su YX, Zuo JM, Meng ML, Lu Y, Ge SY. [Multiple primary myeloid sarcoma in a child with t(16;21)(p11;q22)-TLS-ERG fusion gene]. Zhonghua Er Ke Za Zhi 2023; 61:467-469. [PMID: 37096269 DOI: 10.3760/cma.j.cn112140-20220922-00830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Affiliation(s)
- L Fu
- Department of Hematology, the Second Affiliated Hospital of Bengbu Medical College,Bengbu 233020,China
| | - L Li
- Department of Hematology, the Second Affiliated Hospital of Bengbu Medical College,Bengbu 233020,China
| | - L Shen
- Department of Hematology, the Second Affiliated Hospital of Bengbu Medical College,Bengbu 233020,China
| | - J J Bian
- Department of Hematology, the Second Affiliated Hospital of Bengbu Medical College,Bengbu 233020,China
| | - Y X Su
- Department of Hematology, the Second Affiliated Hospital of Bengbu Medical College,Bengbu 233020,China
| | - J M Zuo
- Department of Hematology, the Second Affiliated Hospital of Bengbu Medical College,Bengbu 233020,China
| | - M L Meng
- Department of Hematology, the Second Affiliated Hospital of Bengbu Medical College,Bengbu 233020,China
| | - Y Lu
- Department of Hematology, the Second Affiliated Hospital of Bengbu Medical College,Bengbu 233020,China
| | - S Y Ge
- Department of Hematology, the Second Affiliated Hospital of Bengbu Medical College,Bengbu 233020,China
| |
Collapse
|
11
|
Meng ML, Frere Z, Fuller M, Li YJ, Habib AS, Federspiel JJ, Wheeler SM, Gilner JB, Shah SH, Ohnuma T, Raghunathan K, Krishnamoorthy V. Maternal Cardiovascular Morbidity Events Following Preeclampsia: A Retrospective Cohort Study. Anesth Analg 2023; 136:728-737. [PMID: 36729641 PMCID: PMC10023286 DOI: 10.1213/ane.0000000000006310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients with preeclampsia are at high risk for long-term cardiovascular events, yet the short-term, acute cardiovascular complications that follow preeclampsia are understudied. The objective of this study was to compare the short-term, acute maternal cardiovascular morbidity events after delivery among patients with a diagnosis of preeclampsia versus those without this diagnosis. METHODS In this retrospective cohort study, the Premier inpatient database was used to examine a cohort of obstetric patients older than 18 years, who delivered from January 1, 2016, to September 30, 2020. A diagnosis of preeclampsia and preeclampsia with severe features during delivery hospitalization were the exposures of interest. The primary outcome was a composite of maternal cardiovascular morbidity events during delivery hospital admission. The secondary outcome was the occurrence of maternal cardiovascular morbidity events during a readmission within 90 days of delivery hospitalization. RESULTS In total, 4,488,759 patients met inclusion criteria, of which 158,114 (3.5%) were diagnosed with preeclampsia without severe features, and 117,940 (2.6%) with preeclampsia with severe features. Adjusted odds of maternal cardiovascular morbidity events were higher in patients with preeclampsia and in those with preeclampsia with severe features compared with those without preeclampsia during delivery hospitalization (adjusted odds ratio [OR] [95% confidence interval {CI}] 1.87 [1.78-1.97] and 4.74 [4.44-5.05], respectively) and within 90 days (adjusted OR [95% CI] 2.01 [1.83-2.21] and 2.32 [2.10-2.57], respectively). CONCLUSIONS Patients with both preeclampsia and preeclampsia with severe features have higher rates of maternal cardiovascular morbidity events than those without preeclampsia. Future studies are necessary to examine which patients with preeclampsia are at highest risk for cardiovascular complications.
Collapse
Affiliation(s)
- Marie-Louise Meng
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
- Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University School of Medicine, Durham, NC
| | - Zachary Frere
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
- Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University School of Medicine, Durham, NC
| | - Matthew Fuller
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
- Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University School of Medicine, Durham, NC
| | - Yi-Ju Li
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
- Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University School of Medicine, Durham, NC
| | - Ashraf S. Habib
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
- Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University School of Medicine, Durham, NC
| | - Jerome J. Federspiel
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina
- Department of Gynecology and Obstetrics, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Sarahn M. Wheeler
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina
| | - Jennifer B. Gilner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina
| | - Svati H. Shah
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Tetsu Ohnuma
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
- Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University School of Medicine, Durham, NC
| | - Karthik Raghunathan
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
- Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University School of Medicine, Durham, NC
| | - Vijay Krishnamoorthy
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
- Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University School of Medicine, Durham, NC
| |
Collapse
|
12
|
Meng ML, Arendt KW, Banayan JM, Bradley EA, Vaught AJ, Hameed AB, Harris J, Bryner B, Mehta LS. Anesthetic Care of the Pregnant Patient With Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2023; 147:e657-e673. [PMID: 36780370 DOI: 10.1161/cir.0000000000001121] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The pregnancy-related mortality rate in the United States is excessively high. The American Heart Association is dedicated to fighting heart disease and recognizes that cardiovascular disease, preexisting or acquired during pregnancy, is the leading cause of maternal mortality in the United States. Comprehensive scientific statements from cardiology and obstetrics experts guide the treatment of cardio-obstetric patients before, during, and after pregnancy. This scientific statement aims to highlight the role of specialized cardio-obstetric anesthesiology care, presenting a systematic approach to the care of these patients from the anesthesiology perspective. The anesthesiologist is a critical part of the pregnancy heart team as the perioperative physician who is trained to prevent or promptly recognize and treat patients with peripartum cardiovascular decompensation. Maternal morbidity is attenuated with expert anesthesiology peripartum care, which includes the management of neuraxial anesthesia, inotrope and vasopressor support, transthoracic echocardiography, optimization of delivery location, and consideration of advanced critical care and mechanical support when needed. Standardizing the anesthesiology approach to patients with high peripartum cardiovascular risk and ensuring that cardio-obstetrics patients have access to the appropriate care team, facilities, and advanced cardiovascular therapies will contribute to improving peripartum morbidity and mortality.
Collapse
|
13
|
Varvoutis MS, Wein LE, Sugrue R, Darwin KC, Vaught AJ, Meng ML, Hughes BL, Grotegut CA, Federspiel JJ. Pregnancy-Associated Extracorporeal Membrane Oxygenation in the United States. Am J Perinatol 2023:10.1055/a-2008-8462. [PMID: 36608702 PMCID: PMC10425568 DOI: 10.1055/a-2008-8462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The use of extracorporeal membrane oxygenation (ECMO) therapy has increased in the adult population. Studies from the H1N1 influenza pandemic suggest that ECMO deployment in pregnancy is associated with favorable outcomes. With increasing numbers of pregnant women affected by COVID-19 (coronavirus disease 2019) and potentially requiring this life-saving therapy, we sought to compare comorbidities, costs, and outcomes between pregnancy- and nonpregnancy-associated ECMO therapy among reproductive-aged female patients. STUDY DESIGN We used the 2013 to 2019 National Readmissions Database. Diagnosis and procedural coding were used to identify ECMO deployment, potential indications, comorbid conditions, and pregnancy outcomes. The primary outcome was in-hospital mortality during the patient's initial ECMO stay. Secondary outcomes included length of stay and hospital charges/costs, occurrence of thromboembolic or bleeding complications during ECMO hospitalization, and mortality and readmissions up to 330 days following ECMO stay. Univariate and multivariate regression models were used to model the associations between pregnancy status and outcomes. RESULTS The sample included 324 pregnancy-associated hospitalizations and 3,805 nonpregnancy-associated hospitalizations, corresponding to national estimates of 665 and 7,653 over the study period, respectively. Pregnancy-associated ECMO had lower incidence of in-hospital death (adjusted odds ratio [aOR]: 0.56, 95% confidence interval [CI]: 0.41-0.75) and bleeding complications (aOR: 0.67, 95% CI: 0.49-0.93). Length of stay was significantly shorter (adjusted rate ratio (aRR): 0.86, 95% CI: 0.77-0.96) and total hospital costs were less (aRR: 0.83, 95% CI: 0.75-0.93). Differences in the incidence of thromboembolic events (aOR: 1.04, 95% CI: 0.78-1.38) were not statistically significant. CONCLUSION Pregnancy-associated ECMO therapy had lower incidence of in-hospital death, bleeding complications, total inpatient cost, and length of stay when compared with nonpregnancy-associated ECMO therapy without increased thromboembolic complications. Pregnancy-associated ECMO therapy should be offered to eligible patients. KEY POINTS · Pregnancy-related ECMO use was compared with nonpregnant use.. · Outcomes were equal or favored pregnancy-related deployment.. · These data may be useful when considering ECMO use in pregnancy..
Collapse
Affiliation(s)
- Megan S. Varvoutis
- Department of Obstetrics and Gynecology, West Virginia University, Morgantown, WV, USA
| | - Lauren E. Wein
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA
| | - Ronan Sugrue
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA
| | - Kristin C. Darwin
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Arthur J. Vaught
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marie-Louise Meng
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Brenna L. Hughes
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA
| | - Chad A. Grotegut
- Department of Obstetrics and Gynecology, Wake Forest University, Winston-Salem, NC, USA
| | - Jerome J. Federspiel
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
14
|
Hoffman M, Convissar DL, Meng ML, Montgomery S, Bronshteyn YS. Image Acquisition Method for the Sonographic Assessment of the Inferior Vena Cava. J Vis Exp 2023. [PMID: 36715419 DOI: 10.3791/64790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Over the past several decades, clinicians have incorporated several applications of diagnostic point-of-care ultrasound (POCUS) into medical decision-making. Among the applications of POCUS, imaging the inferior vena cava (IVC) is practiced by a wide variety of specialties, such as nephrology, emergency medicine, internal medicine, critical care, anesthesiology, pulmonology, and cardiology. Although each specialty uses IVC data in slightly different ways, most medical specialties, at minimum, attempt to use IVC data to make predictions about intravascular volume status. While the relationship between IVC sonographic data and intravascular volume status is complex and highly context-dependent, all clinicians should collect the sonographic data in standardized ways to ensure repeatability. This paper describes standardized IVC image acquisition including patient positioning, transducer selection, probe placement, image optimization, and the pitfalls and limitations of IVC sonographic imaging. This paper also describes the commonly performed anterior IVC long-axis view and three other views of the IVC that can each provide helpful diagnostic information when the anterior long-axis view is difficult to obtain or interpret.
Collapse
Affiliation(s)
| | | | | | | | - Yuriy S Bronshteyn
- Department of Anesthesiology, Duke University School of Medicine; Department of Anesthesiology, Durham VA
| |
Collapse
|
15
|
Federspiel JJ, Kucirka LM, Mallampati DP, Wheeler SM, Menard MK, Hughes BL, Quist-Nelson J, Meng ML. For better care we need better data: towards a national obstetrics registry. Am J Obstet Gynecol MFM 2023; 5:100787. [PMID: 36404523 PMCID: PMC10065844 DOI: 10.1016/j.ajogmf.2022.100787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/29/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022]
Abstract
Unacceptably high rates of severe maternal morbidity and mortality in the United States and stark racial disparities in outcomes are generating efforts to improve both research capacity and quality improvement in obstetrical care. Comprehensive, high-quality datasets on which to build these efforts are crucial to the success of obstetrical quality improvement efforts. However, existing data sources in obstetrics have notable limitations. Other medical and surgical specialties have addressed similar challenges through the creation of national registries, and we argue that obstetrics must take the same approach to improve outcomes. In this article, we summarized the current availability and limitations of large-scale data in obstetrics research and compared the data with registries developed in other specialties. Moreover, we have outlined the guiding principles for the development of a national obstetrics registry and have proposed future directions.
Collapse
Affiliation(s)
- Jerome J Federspiel
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC (Drs Federspiel, Wheeler, and Hughes).
| | - Lauren M Kucirka
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Durham, NC (Drs Kucirka, Mallampati, Menard, and Quist-Nelson)
| | - Divya P Mallampati
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Durham, NC (Drs Kucirka, Mallampati, Menard, and Quist-Nelson)
| | - Sarahn M Wheeler
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC (Drs Federspiel, Wheeler, and Hughes)
| | - M Kathyrn Menard
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Durham, NC (Drs Kucirka, Mallampati, Menard, and Quist-Nelson)
| | - Brenna L Hughes
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC (Drs Federspiel, Wheeler, and Hughes)
| | - Johanna Quist-Nelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Durham, NC (Drs Kucirka, Mallampati, Menard, and Quist-Nelson)
| | - Marie-Louise Meng
- Division of Women's Anesthesiology, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA (Dr Meng)
| |
Collapse
|
16
|
Affiliation(s)
- Andrea Girnius
- Department of Anesthesiology, University of Cincinnati, Cincinnati, OH
| | | |
Collapse
|
17
|
Meng ML, Smiley R. The Cardio-Obstetrics Patient and the Cardiothoracic Anesthesiologist. J Cardiothorac Vasc Anesth 2021; 36:546-548. [PMID: 34903461 DOI: 10.1053/j.jvca.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Marie-Louise Meng
- Department of Anesthesiology, Duke University Medical Center, Durham, NC.
| | - Richard Smiley
- Division of Obstetrical Anesthesia, Columbia University Irving Medical Center, New York, NY
| |
Collapse
|
18
|
Zheng X, Siddiqui Z, Anderson N, Chen CM, Chatterji M, Smiley R, Landau R, Meng ML. Check the Blood Pressure!: An Educational Tool for Anesthesiology Trainees Converting Epidural Labor Analgesia to Cesarean Delivery Anesthesia. A A Pract 2021; 14:e01174. [PMID: 32132359 DOI: 10.1213/xaa.0000000000001174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Recognition and treatment of maternal hypotension during epidural anesthesia administration for intrapartum cesarean delivery preserves maternal-fetal perfusion. A case that required quality assurance review uncovered lapses in maternal hemodynamic monitoring during the transition to intrapartum cesarean delivery anesthesia. To address this, a practice outline was designed for trainee's education describing intrapartum epidural dosing for cesarean delivery and adequate blood pressure monitoring. The time-lapse between epidural dosing and subsequent blood pressure was evaluated before and after the introduction of our educational tool. The time-lapse between blood pressure measures decreased to <10 minutes (10.78-13.92 vs 8.8-9.76 minutes).
Collapse
Affiliation(s)
- Xiwen Zheng
- From the Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York; and
| | - Zuhair Siddiqui
- From the Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York; and
| | - Nick Anderson
- Teachers College, Columbia University, New York, New York
| | - Chen-Miao Chen
- Teachers College, Columbia University, New York, New York
| | | | - Richard Smiley
- From the Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York; and
| | - Ruth Landau
- From the Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York; and
| | - Marie-Louise Meng
- From the Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York; and
| |
Collapse
|
19
|
Hussey H, Hussey P, Meng ML. Peripartum considerations for women with cardiac disease. Curr Opin Anaesthesiol 2021; 34:218-225. [PMID: 33935168 PMCID: PMC8610034 DOI: 10.1097/aco.0000000000000992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this review of cardiac disease in pregnancy is to delineate current best practices and highlight emerging themes in the literature. RECENT FINDINGS Cardiovascular disease is the leading cause of death among pregnant women in the United States. Many clinicians and institutions have developed care pathways to approach care in these high-risk patients including highly coordinated multidisciplinary teams. The diagnosis of pulmonary hypertension is the greatest risk factor for an adverse event in pregnant women. Vaginal delivery, with good neuraxial anesthesia, is usually the preferred mode of delivery in women with cardiac disease, although the rate of cesarean delivery is higher among women with heart disease. SUMMARY The leading cause of morbidity and mortality in pregnant women is cardiac disease. Preconception counseling is useful for optimizing patients for pregnancy and setting appropriate expectations about care and outcomes. Ensuring that women are cared for in centers with appropriate multidisciplinary resources is key for improving outcomes for cardio-obstetric patients.
Collapse
Affiliation(s)
- Hanna Hussey
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Patrick Hussey
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Marie-Louise Meng
- Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| |
Collapse
|
20
|
Pena JJ, Chen CJ, Clifford H, Xue Z, Wang S, Argenziano M, Landau R, Meng ML. Introduction of an Analgesia Prescription Guideline Can Reduce Unused Opioids After Cardiac Surgery: A Before and After Cohort Study. J Cardiothorac Vasc Anesth 2020; 35:1704-1711. [PMID: 33455887 DOI: 10.1053/j.jvca.2020.12.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE(S) The authors aimed to assess whether the introduction of a tailored Analgesia Prescription Guideline would decrease the amount of unused opioid following discharge from cardiac surgery. DESIGN Prospective, observational, before and after study. SETTING Quaternary care university hospital. PARTICIPANTS A total of 191 participants who underwent cardiac surgery requiring midline sternotomy and cardiopulmonary bypass. There were 99 participants in the before cohort (prior to introduction of the Analgesia Prescription Guideline), and 92 participants in the after cohort (after introduction of the Analgesia Prescription Guideline). INTERVENTIONS Using prospectively collected observational data on participant opioid consumption in the before cohort, a tailored Analgesia Prescription Guideline was developed. This guideline then was introduced to all opioid-prescribing providers in the cardiothoracic surgery department. Prospective data then were collected in the after cohort of participants. Opioid prescription practices and opioid consumption between the two groups then were compared. MEASUREMENTS AND MAIN RESULTS Opioid prescriptions were given to 62/99 participants (63%) in the before cohort, and 48/92 (52%) in the after cohort (rate difference 0.1, CI 95% -0.26, 0.046). In the before cohort, the mean (± standard deviation) number of opioid tablets prescribed, used, and leftover was 26 (±10), 11 (±10), and 15 (±12), respectively. In the after cohort, the mean number of opioid tablets prescribed, used, and leftover was 18 (mean difference -8, CI 95% -12, -5), 10 (mean difference -1, CI 95% -5, 3), and 8 (mean difference -7, CI 95% -11, -3), respectively. There were 110/191 (58%) participants using no opioids following discharge, and 10/191 (5%) still using opioids two weeks after discharge. There were no differences between groups with regard to demographics, opioid-related side effects, pain scores, satisfaction, opioid storage. and disposal practices. CONCLUSIONS The development and implementation of a tailored Analgesia Prescription Guideline decreased the amount of opioids prescribed after cardiac surgery and resulted in lower numbers of unused leftover opioid tablets in the community. Patient comfort and satisfaction scores remained high.
Collapse
Affiliation(s)
- Joseph J Pena
- Columbia University Irving Medical Center, Department of Anesthesiology, New York, NY.
| | - Chung Jen Chen
- Columbia University Irving Medical Center, Department of Anesthesiology, New York, NY
| | - Hugo Clifford
- Columbia University Irving Medical Center, Department of Anesthesiology, New York, NY
| | - Zenghui Xue
- Mailman School of Public Health, Department of Biostatistics, Columbia University, New York, NY
| | - Shuang Wang
- Mailman School of Public Health, Department of Biostatistics, Columbia University, New York, NY
| | - Michael Argenziano
- Columbia University Irving Medical Center, Department of Cardiothoracic Surgery, New York, NY
| | - Ruth Landau
- Columbia University Irving Medical Center, Department of Anesthesiology, New York, NY
| | - Marie-Louise Meng
- Duke University Medical Center, Department of Anesthesiology, Durham, NC
| |
Collapse
|
21
|
Meng ML, Landau R, Haythe J, Takayama H, Spellman J. Mechanical Aortic Valve Thrombus in Pregnancy: A Case Report. A A Pract 2019; 13:44-47. [PMID: 30807301 DOI: 10.1213/xaa.0000000000000984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cardiac disease is one of the leading causes of maternal mortality in developed countries. The presence of a mechanical valve is a predictor of cardiac complications in obstetric patients, likely due to the challenges associated with pregnancy hypercoagulability and the imperative of meticulous management of anticoagulation throughout pregnancy, delivery, and the postpartum and to prevent the devastating event of a mechanical valve thrombosis. We report on the management of a pregnant woman with a mechanical aortic valve found to have a thrombus at 37 weeks gestation. It was decided to perform cesarean delivery to allow for a reoperative mechanical aortic valve replacement 24 hours thereafter.
Collapse
Affiliation(s)
| | | | | | - Hiroo Takayama
- Surgery, Columbia University Medical Center, New York, New York
| | | |
Collapse
|
22
|
|
23
|
Zhang Y, Liu ZX, Zheng ND, Wang WJ, Wang XJ, Meng ML, Wang Q, Cao Y, Li ZJ. [The long-term effect analysis of the tongue base traction/ hyoid suspension with Repose system in multiplanar surgery]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2018; 32:673-677. [PMID: 29771084 DOI: 10.13201/j.issn.1001-1781.2018.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Indexed: 11/12/2022]
Abstract
Objective:To explore the long-term effect of Repose bone screw system in the treatment of severe obstructive sleep apnea syndrome in patients with severe obstructive sleep apnea. Method:The follow-up group was divided into the short-term (<12 months, control group, 30 cases) and the long-term (more than 12 months, observation, 46 cases). And compared the operation effect of the two groups. Furthermore, the parameters and related factors of surgical efficacy of patients with different follow-up time and different surgical methods were further analyzed.Result:①There was no statistical difference in the preoperative parameters of the two groups, and the overall efficiency of the postoperative long-term observation group was 78.3%, compared with 90.0% in the short-term control group, and the inefficiencies increased from 10.0% to 21.7%. ②In the observation group, the mean of the AHI increased gradually with the follow-up time, and the blood oxygen gradually decreased. The effectiveness of the surgical treatment gradually decreased, the total efficiency of the tongue base traction group decreased from 100% to 60%, and the hyoid suspension group decreased from 94.4% to 77.8%. ③And 15 patients with a second review X-head shadow measurements,we found there are statistically significant (P<0.05) in vallecula epiglottica-lateral pharyngealwall,pharyngeal airway space. Conclusion:Repose screw system of tongue base traction/ hyoid suspension technique is positive in the treatment of severe OSAHS lingual pharyngeal plane obstruction, but short-term surgical results are not stable.
Collapse
Affiliation(s)
- Y Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, 263 Clinical Department, Army General Hospital, Beijing, 101149, China
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Meng ML, Spellman J. Anesthetic management of the patient with a ventricular assist device. Best Pract Res Clin Anaesthesiol 2017; 31:215-226. [PMID: 29110794 DOI: 10.1016/j.bpa.2017.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/12/2017] [Accepted: 06/19/2017] [Indexed: 12/25/2022]
Abstract
The use of long- and short-term mechanical circulatory support in the form of ventricular assist device (VAD) has increased over the last decade. Although cardiothoracic anesthesiologists care for these patients during device placement, increasingly higher numbers of general anesthesiologists are involved in the management of VAD patients during noncardiac surgery and procedures. An understanding of devices, their indications, and complications is essential to the anesthesiologists caring for these patients. We review the anesthetic considerations for the implantation of these devices and concerns when caring for patients with durable and short-term devices already in place.
Collapse
Affiliation(s)
- Marie-Louise Meng
- Columbia University Medical Center, 622 W 168th Street, PH5, New York, NY 10032, USA.
| | - Jessica Spellman
- Columbia University Medical Center, 622 W 168th Street, PH5, New York, NY 10032, USA.
| |
Collapse
|
25
|
Abstract
The availability of safe, effective analgesia during labor has become an expectation for women in most of the developed world over the past two or three decades. More than 60% of women in the United States now receive some kind of neuraxial procedure during labor. This article is a brief review of the advantages and techniques of neuraxial labor analgesia along with the recent advances and controversies in the field of labor analgesia. For the most part, we have aimed the discussion at the non-anesthesiologist to give other practitioners a sense of the state of the art and science of labor analgesia in the second decade of the 21st century.
Collapse
Affiliation(s)
- Marie-Louise Meng
- Department of Anesthesiology, Columbia University Medical Center, New York, NY, USA
| | - Richard Smiley
- Department of Anesthesiology, Columbia University Medical Center, New York, NY, USA
| |
Collapse
|
26
|
Abstract
Primary carcinoma of the fallopian tube is rare, but still occurs frequently enough to warrant consideration when certain specific symptoms are present. It is also possible to diagnose the tumor correctly if, in the presence of certain symptoms, the following diagnostic tools are used in addition to repeated Pap smears and dilatation and curettage: hysteroscopy, cervical biopsy, colposcopy, laparoscopy, laparotomy, and pathological examination of every tubal specimen.
Collapse
|