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Orbach-Zinger S, Azem K, Heesen P, Frenkel A, Binyamin Y. Cosyntropin prophylaxis with intrathecal saline: impact on post-dural puncture headache and epidural blood patch. Anaesthesia 2024; 79:91-92. [PMID: 37816309 DOI: 10.1111/anae.16139] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/12/2023]
Affiliation(s)
- S Orbach-Zinger
- Beilinson Hospital, Rabin Medical Center Associated with Sackler Faculty of Medicine, Petach Tikvah, Israel
| | - K Azem
- Beilinson Hospital, Rabin Medical Center Associated with Sackler Faculty of Medicine, Petach Tikvah, Israel
| | - P Heesen
- University of Zurich, Zurich, Switzerland
| | - A Frenkel
- Soroka University Medical Center Associated with Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Y Binyamin
- Soroka University Medical Center Associated with Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Binyamin Y, Azem K, Heesen M, Gruzman I, Frenkel A, Fein S, Eidelman LA, Garren A, Frank D, Orbach-Zinger S. The effect of placement and management of intrathecal catheters following accidental dural puncture on the incidence of postdural puncture headache and severity: a retrospective real-world study. Anaesthesia 2023; 78:1256-1261. [PMID: 37439056 DOI: 10.1111/anae.16088] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/14/2023]
Abstract
Accidental dural puncture during an attempt to establish labour epidural analgesia can result in postdural puncture headache and long-term debilitating conditions. Epidural blood patch, the gold standard treatment for this headache, is invasive and not always successful. Inserting an intrathecal catheter after accidental dural puncture may prevent postdural puncture headache. We evaluated the effect of intrathecal catheter insertion on the incidence of postdural puncture headache and the need for epidural blood patch and whether duration of intrathecal catheterisation or injection of intrathecal saline affected outcome. Our retrospective study was conducted at two tertiary, university-affiliated medical centres between 2017 and 2022 and included 92,651 epidurals and 550 cases of accidental dural puncture (0.59%); 219 parturients (39.8%) received an intrathecal catheter and 331 (60.2%) a resited epidural. Use of an intrathecal catheter versus resiting the epidural did not decrease the odds of postdural puncture headache, adjusted odds ratio (aOR) (95%CI) 0.91 (0.81-1.01), but was associated with a lower need for epidural blood patch (aOR (95%CI) 0.82 (0.73-0.91), p < 0.001). We found no benefit in leaving in the intrathecal catheter for 24 h postpartum (postdural puncture headache, aOR (95%CI) 1.01 (1.00-1.02), p = 0.015; epidural blood patch, aOR (95%CI) 1.00 (0.99-1.01), p = 0.40). We found an added benefit of injecting intrathecal saline as it decreased the incidence of postdural puncture headache (aOR (95%CI) 0.85 (0.73-0.99), p = 0.04) and the need for epidural blood patch (aOR (95%CI) 0.75 (0.64-0.87), p < 0.001). Our study confirms the benefits of intrathecal catheterisation and provides guidance on how to best manage an intrathecal catheter.
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Affiliation(s)
- Y Binyamin
- Department of Anaesthesia, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Karam Azem
- Department of Anaesthesia, Beilinson Hospital, Rabin Medical Center Associated with Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - M Heesen
- Department of Anaesthesia, Kantonsspital Baden, Baden, Switzerland
| | - I Gruzman
- Department of Anaesthesia, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - A Frenkel
- Department of Anaesthesia, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - S Fein
- Department of Anaesthesia, Beilinson Hospital, Rabin Medical Center Associated with Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - L A Eidelman
- Department of Anaesthesia, Assuta Medical Center, Ashdod, Israel
| | - A Garren
- Columbia University, New York, NY, USA
| | - D Frank
- Department of Anaesthesia, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - S Orbach-Zinger
- Department of Anaesthesia, Beilinson Hospital, Rabin Medical Center Associated with Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
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Guasch E, Ioscovich A, Brogly N, Orbach-Zinger S, Kranke P, Morau E, Gilsanz F. Obstetric anaesthesia manpower and service provision issues (introduction and European perspective). Int J Obstet Anesth 2023; 55:103647. [PMID: 37085390 DOI: 10.1016/j.ijoa.2023.103647] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/03/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023]
Abstract
Global health is an important and far-reaching concept in which health and access to surgical and anaesthetic care is crucial. Universal access to anaesthesia is a challenge in many countries. Manpower shortages are an important cause of difficulties and each European country has found different ways of facing a lack of healthcare professionals. In obstetric anaesthesia, the availability of competent anaesthesiologists has been related to the morbidity and mortality outcomes of patients. In this narrative review, authors from different European countries explain how manpower is managed in obstetric anaesthesia in delivery suites and obstetric operating rooms in different settings. To address manpower difficulties and issues, the goals are to achieve a minimum standard of care and at the same time, to promote clinical excellence through training, delegation to younger or less experienced colleagues, direct or at-a-distance supervision, or other means. The experience of sharing knowledge about the way in which manpower and service provision are organised in other healthcare settings is a significant opportunity to develop strategies for advancing tomorrow's obstetric anaesthesia in the world. While taking into account the level of socio-economic development in different countries, the aim is to standardise practice and workload organisation. Co-operative international projects in training and education in obstetric anaesthesia are ways in which better obstetric patient care can be achieved in the future.
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Affiliation(s)
- E Guasch
- Department of Anaesthesiology and Critical Care, Hospital Universitario La Paz, Madrid, Spain.
| | - A Ioscovich
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Affiliated with The Hebrew University, Israel
| | - N Brogly
- Department of Anaesthesiology and Critical Care, Hospital Universitario La Paz, Madrid, Spain; Department of Anaesthesiology, Hospital Universitario La Zarzuela, Madrid, Spain
| | - S Orbach-Zinger
- Department of Anaesthesiology, Beilinson Hospital, Petah Tikvah, Affiliated with Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - P Kranke
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - E Morau
- Department of Anaesthesia Intensive Care and Perioperative Medicine, CHU Nîmes, Nîmes, France
| | - F Gilsanz
- Anaesthesiology and Intensive Care Medicine, Department of Surgery, Universidad Autónoma de Madrid, Spain
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Orbach-Zinger S, Grant T, Zahalka M, Ioscovich A, Fein S, Ginosar Y, Matkovski O, Weiniger C, Binyamin Y. A national Israeli survey of neuraxial anesthesia for cesarean delivery: pre-operative block assessment and intra-operative pain management. Int J Obstet Anesth 2022; 50:103255. [DOI: 10.1016/j.ijoa.2022.103255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/29/2021] [Accepted: 01/07/2022] [Indexed: 12/25/2022]
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Giladi Y, Shatalin D, Weiniger C, Ifraimov R, Orbach-Zinger S, Heesen P, Ioscovich A. Epidural augmentation for urgent Cesarean Section : a nationwide Israeli survey. Acta Anaest Belg 2021. [DOI: 10.56126/72.1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background : Epidural augmentation to convert analgesia to emergency cesarean delivery anesthesia is a common practice. In this survey we examined the common augmentation practices in different hospitals in Israel. We investigated whether practices vary by hospital size and if written protocols for conversion correlate with intra-hospital homogeneity.
Methods : A questionnaire containing 39 questions was sent to obstetric anesthesia unit heads and to four additional anesthesiologists (attending and residents) in 24 obstetric anesthesia units nationwide. Answers were received online anonymously using web-based survey site.
Results : 99/120 participants responded to the survey. 80% of large hospitals have a detailed epidural augmentation protocol. The existence of a written protocol does not affect intrahospital management variability. Overall, 18 different drug mixtures for epidural augmentation were reported, and the most used drug combination is lidocaine, fentanyl and bicarbonate. In large hospitals, 72% add epinephrine and 96% initiate augmentation before operating room arrival. Most respondents reported a final administered total volume of 15-20 ml. In most hospitals there is no maternal or fetal monitoring during patient transfer from delivery room to the operating room, lasting 3.68 minutes on average, with a relative low risk of significant complication as a result of augmentation.
Conclusion : We report variations in common practices, depending on hospital size. We recognized low rate of intra-hospital concordance between centers with or without a written protocol of augmentation. Regarding points for improvement, we would recommend adhering to the accepted institutional protocol.
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Orbach-Zinger S, Jadon A, Lucas DN, Sia AT, Tsen LC, Van de Velde M, Heesen M. Intrathecal catheter use after accidental dural puncture in obstetric patients: literature review and clinical management recommendations. Anaesthesia 2021; 76:1111-1121. [PMID: 33476424 DOI: 10.1111/anae.15390] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 01/20/2023]
Abstract
If an accidental dural puncture occurs, one option is to insert a catheter and use it as an intrathecal catheter. This avoids the need for a further injection and can rapidly provide labour analgesia and anaesthesia for caesarean section. However, there are no recommendations for managing intrathecal catheters and, therefore, significant variation in clinical practice exists. Mismanagement of the intrathecal catheter can lead to increased motor block, high spinal anaesthesia, drug error, hypotension and fetal bradycardia. Care must be taken with an intrathecal catheter to adhere to strict aseptic technique, meticulous labelling, cautious administration of medications and good communication with the patient and other staff. Every institution considering the use of intrathecal catheters should establish a protocol. For labour analgesia, we recommend the use of dilute local anaesthetic agents and opioids. For caesarean section anaesthesia, gradual titration to the level of the fourth thoracic dermatome, with full monitoring, in a facility equipped to manage complications, should be performed using local anaesthetics combined with lipophilic opioids and morphine or diamorphine. Although evidence of the presence and duration of intrathecal catheters on the development of post-dural puncture headache and need for epidural blood patch is limited, we suggest considering leaving the intrathecal catheter in for 24 hours to reduce the chance of developing a post-dural puncture headache while maintaining precautions to avoid drug error and cerebrospinal fluid leakage. Injection of sterile normal saline into the intrathecal catheter may reduce post-dural puncture headache. The level of evidence for these recommendations was low.
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Affiliation(s)
- S Orbach-Zinger
- Department of Anaesthesia, Rabin Medical Centre, Beilinson Hospital, Petach Tikvah, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - A Jadon
- Tata Motors Hospital, Jamshedpur, Jharkhand, India.,Anaesthesia, Pain Relief Service, Department of Anaesthesia and Pain Relief Service, Jata Motors Hospital, Jamshedpur, Jharkhand, India
| | - D N Lucas
- LNWH NHS Trust, Harrow, UK.,Department of Anaesthesia, London North West University Healthcare NHS Trust, London, UK
| | - A T Sia
- Department of Women's Anaesthesia, KK Women and Children Hospital, Singapore, Anaesthesiology Program, Duke-NUS Graduate Medical School, Singapore
| | - L C Tsen
- Harvard Medical School, Department of Anesthesiology, Peri-operative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - M Van de Velde
- Department of Cardiovascular Sciences, KU Leuven, Belgium.,Department of Anesthesiology, UZ Leuven, Leuven, Belgium
| | - M Heesen
- Department of Anaesthesia, Kantonsspital Baden, Baden, Switzerland
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Orbach-Zinger S, Heesen M, Grigoriadis S, Heesen P, Halpern S. A systematic review of the association between postpartum depression and neuraxial labor analgesia. Int J Obstet Anesth 2020; 45:142-149. [PMID: 33221120 DOI: 10.1016/j.ijoa.2020.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/21/2020] [Accepted: 10/10/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Postpartum depression (PPD) is the most common complication after childbirth, affecting 10-15% of women. It is associated with serious long-term consequences for the mother and family. Whether or not neuraxial labor analgesia mitigates the risk is uncertain and controversial. The purpose of this review was to summarize studies investigating the association between neuraxial labor analgesia and the incidence of PPD. METHODS A systematic literature search for randomized controlled trials and cohort studies reporting the incidence of PPD among parturients who received neuraxial analgesia compared with non-neuraxial or no analgesia. The primary outcome was the incidence of PPD between 5 and 12 weeks' postpartum. Depression was diagnosed using a cutoff score of ≥10 on the Edinburgh Postnatal Depression scale, a validated screening tool. The risk of bias of each study was evaluated, and odds ratios and 95% confidence intervals calculated from raw data or reported as adjusted odds ratios. RESULTS Eleven observational studies involving 5717 patients were included. Three studies had a critical risk, three a serious risk, and five a moderate risk of bias. Two studies reported significantly lower odds for PPD associated with neuraxial analgesia compared with non-neuraxial or no analgesia, whereas the odds ratios in the remaining nine studies were not significantly different. CONCLUSIONS Our systematic review did not find compelling evidence for an association between PPD and labor analgesia. Studies were heterogenous in nature and had a high risk of bias. Further research controlling for confounding factors is recommended to determine if a relationship exists.
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Affiliation(s)
- S Orbach-Zinger
- Department of Anesthesia, Beilinson Hospital, Petach Tikvah, Israel; Affiliated with Saklar Medical School, Tel Aviv University, Tel Aviv, Israel.
| | - M Heesen
- Department of Anesthesia, Kantonsspital Baden, Switzerland
| | - S Grigoriadis
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - P Heesen
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - S Halpern
- Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Shalev S, Orbach-Zinger S, Sultan P, Guo N, Ronel I, Davis A, Weiniger CF. Obstetric quality of recovery scoring tool: assessment of validity, reliability and feasibility in an Israeli cesarean delivery population. Int J Obstet Anesth 2020; 44:51. [PMID: 32799064 DOI: 10.1016/j.ijoa.2020.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 05/21/2020] [Accepted: 07/20/2020] [Indexed: 12/26/2022]
Affiliation(s)
- S Shalev
- Division of Anesthesia, Critical Care and Pain, TelAviv Sourasky Medical Center, Israel
| | - S Orbach-Zinger
- Department of Anesthesia, Rabin Medical Centre and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - P Sultan
- Division of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - N Guo
- Division of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - I Ronel
- Division of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical Center, Israel
| | - A Davis
- Department of Anesthesia, Rabin Medical Centre and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - C F Weiniger
- Division of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical Center, Israel.
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Shatalin D, Weiniger C, Buchman I, Ginosar Y, Orbach-Zinger S, Ioscovich A. A 10-year update: national survey questionnaire of obstetric anesthesia units in Israel. Int J Obstet Anesth 2019; 38:83-92. [DOI: 10.1016/j.ijoa.2018.10.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/07/2018] [Accepted: 10/26/2018] [Indexed: 02/07/2023]
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Kornilov E, Orbach-Zinger S, Hoshen M, Weiniger C, Fein S, Fireman S, Firman S, Aviram A, Eidelman L. A prospective observational study of the change in regional cerebral oxygen saturation during cesarean delivery in women receiving phenylephrine prophylaxis for spinal hypotension. Int J Obstet Anesth 2019; 37:29-35. [DOI: 10.1016/j.ijoa.2018.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/02/2018] [Accepted: 09/12/2018] [Indexed: 11/28/2022]
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Orbach-Zinger S, Razinsky E, Bizman I, Firman S, Gat R, Davis A, Ashwal E, Shmueli A, Vaturi M, Gabbay-Benziv R, Eidelman LA. Perioperative noninvasive cardiac output monitoring in parturients with singleton and twin pregnancies undergoing cesarean section under spinal anesthesia with prophylactic phenylephrine drip: a prospective observational cohort study. J Matern Fetal Neonatal Med 2018; 32:3980-3985. [DOI: 10.1080/14767058.2018.1480604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- S. Orbach-Zinger
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E. Razinsky
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - I. Bizman
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S. Firman
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R. Gat
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Helen Schneider Hospital for Women, Obstetrics and Gynecology, Rabin Medical Center, Petah Tikva, Israel
| | - A. Davis
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E. Ashwal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Helen Schneider Hospital for Women, Obstetrics and Gynecology, Rabin Medical Center, Petah Tikva, Israel
| | - A. Shmueli
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Helen Schneider Hospital for Women, Obstetrics and Gynecology, Rabin Medical Center, Petah Tikva, Israel
| | - M. Vaturi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - R. Gabbay-Benziv
- Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel
| | - L. A. Eidelman
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Orbach-Zinger S, Fireman S, Ben-Haroush A, Karoush T, Klein Z, Mazarib N, Artyukh A, Chen R, Ioscovich A, Eidelman LA, Landau R. Preoperative sleep quality predicts postoperative pain after planned caesarean delivery. Eur J Pain 2016; 21:787-794. [PMID: 27977073 DOI: 10.1002/ejp.980] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Severe post-caesarean pain remains an important issue associated with persistent pain and postpartum depression. Women's sleep quality prior to caesarean delivery and its influence on postoperative pain and analgesic intake have not been evaluated yet. METHODS Women undergoing caesarean delivery with spinal anaesthesia (bupivacaine 12 mg, fentanyl 20 μg, morphine 100 μg) were evaluated preoperatively for sleep quality using the Pittsburgh Sleep Quality Index (PSQI) questionnaire (PSQI 0-5 indicating good sleep quality, PSQI 6-21 poor sleep quality). Peak and average postoperative pain scores at rest, movement and uterine cramping were evaluated during 24 h using a verbal numerical pain score (VNPS; 0 indicating no pain and 100 indicating worst pain imaginable), and analgesic intake was recorded. Primary outcome was peak pain upon movement during the first 24 h. RESULTS Seventy-eight of 245 women reported good sleep quality (31.2%; average PSQI 3.5 ± 1.2) and 167 poor sleep quality (68.2%; average PSQI 16.0 ± 3.4; p < 0.001). Women with poor sleep quality had significantly higher peak pain scores upon movement (46.7 ± 28.8 vs. 36.2 ± 25.6, respectively; p = 0.006). With multivariable logistic regression analysis, poor sleep quality significantly increased the risk for severe peak pain upon movement (VNPS ≥70; OR 2.64; 95% CI 1.2-6.0; p = 0.02). DISCUSSION A significant proportion of women scheduled for caesarean delivery were identified preoperatively as having poor sleep quality, which was associated with more severe pain and increased analgesic intake after delivery. The PSQI score may therefore be a useful tool to predict increased risk for acute post-caesarean pain and higher analgesic requirements, and help tailor anaesthetic management. SIGNIFICANCE Multiple studies have evaluated predictors for severe acute pain after caesarean delivery that may be performed in a clinical setting, however, sleep quality prior to delivery has not been included in predictive models for post-caesarean pain. The PSQI questionnaire, a simple test to administer preoperatively, identified that up to 70% of women report poor sleep quality before delivery, and poor sleep quality was associated with increased post-caesarean pain scores and analgesic intake, indicating that PSQI could help identify preoperatively women at risk for severe pain after caesarean delivery.
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Affiliation(s)
- S Orbach-Zinger
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
| | - S Fireman
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
| | - A Ben-Haroush
- Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
| | - T Karoush
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
| | - Z Klein
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
| | - N Mazarib
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
| | - A Artyukh
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
| | - R Chen
- Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
| | - A Ioscovich
- Department of Anesthesia, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - L A Eidelman
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
| | - R Landau
- Department of Anesthesia, Columbia University College of Physicians and Surgeons, New York, USA
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Ioscovich A, Shatalin D, Butwick AJ, Ginosar Y, Orbach-Zinger S, Weiniger CF. Israeli survey of anesthesia practice related to placenta previa and accreta. Acta Anaesthesiol Scand 2016; 60:457-64. [PMID: 26597396 DOI: 10.1111/aas.12656] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 07/12/2015] [Accepted: 09/24/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anesthesia practices for placenta previa (PP) and accreta (PA) impact hemorrhage management and other supportive strategies. We conducted a survey to assess reported management of PP and PA in all Israeli labor and delivery units. METHODS After Institutional Review Board waiver, we surveyed all 26 Israeli hospitals with a labor and delivery unit by directly contacting the representatives of obstetric anesthesiology services in every department (unit director or department chair). Each director surveyed provided information about the anesthetic and transfusion management in their labor and delivery units for three types of abnormal placentation based on antenatal placental imaging: PP, low suspicion for PA, and high suspicion for PA. The primary outcome was use of neuraxial or general anesthesia for PP and PA Cesarean delivery. Univariate statistics were used for survey responses using counts and percentages. RESULTS The response rate was 100%. Spinal anesthesia is the preferred anesthetic mode for PP cases, used in 17/26 (65.4%) of labor and delivery units. By comparison, most representatives reported that they perform general anesthesia for patients with PA: 18/26 (69.2%) for all low suspicion cases of PA and 25/26 (96.2%) for all high suspicion cases of PA. Although a massive transfusion protocol was available in the majority of hospitals (84.6%), the availability of thromboelastography and cell salvage was much lower (53.8% and 19.2% hospitals respectively). CONCLUSIONS In our survey, representatives of anesthesia labor and delivery services in Israel are almost exclusively using general anesthesia for women with high suspicion for PA; however, almost two-thirds use spinal anesthesia for PP without suspicion of PA. Among representatives, we found wide variations in anesthesia practice patterns with regard to anesthesia mode, multidisciplinary management, and hemorrhage anticipation strategies.
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Affiliation(s)
- A. Ioscovich
- Department of Anesthesiology; Perioperative Medicine and Pain Treatment; Shaare Zedek Medical Center; Hebrew University; Jerusalem Israel
| | - D. Shatalin
- Department of Anesthesiology; Perioperative Medicine and Pain Treatment; Shaare Zedek Medical Center; Hebrew University; Jerusalem Israel
| | - A. J. Butwick
- Department of Anesthesia; Stanford University School of Medicine; Stanford California USA
| | - Y. Ginosar
- Department of Anesthesiology and Critical Care Medicine; Hadassah-Hebrew University Medical Center; Ein Kerem Jerusalem Israel
| | - S. Orbach-Zinger
- Department of Anesthesia; Rabin Medical Center (Beilinson Campus); Petah Tikvah; Tel Aviv University; Tel Aviv Israel
| | - C. F. Weiniger
- Department of Anesthesiology and Critical Care Medicine; Hadassah-Hebrew University Medical Center; Ein Kerem Jerusalem Israel
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Orbach-Zinger S, Aviram A, Fireman S, Kadechenko T, Klein Z, Mazarib N, Artiuch A, Reuveni A, Ioscovich A, Eidelman L, Landau R. Severe pain during local infiltration for spinal anaesthesia predicts post-caesarean pain. Eur J Pain 2015; 19:1382-8. [DOI: 10.1002/ejp.737] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2015] [Indexed: 11/09/2022]
Affiliation(s)
- S. Orbach-Zinger
- Department of Anaesthesia; Rabin Medical Center; Beilinson Hospital; Petach Tikvah Israel
| | - A. Aviram
- Department of Obstetrics Gynecology; Rabin Medical Center; Beilinson Hospital; Petach Tikvah Israel
| | - S. Fireman
- Department of Anaesthesia; Rabin Medical Center; Beilinson Hospital; Petach Tikvah Israel
| | - T. Kadechenko
- Department of Anaesthesia; Rabin Medical Center; Beilinson Hospital; Petach Tikvah Israel
| | - Z. Klein
- Department of Anaesthesia; Rabin Medical Center; Beilinson Hospital; Petach Tikvah Israel
| | - N. Mazarib
- Department of Anaesthesia; Rabin Medical Center; Beilinson Hospital; Petach Tikvah Israel
| | - A. Artiuch
- Department of Anaesthesia; Rabin Medical Center; Beilinson Hospital; Petach Tikvah Israel
| | - A. Reuveni
- Department of Anaesthesia; Rabin Medical Center; Beilinson Hospital; Petach Tikvah Israel
| | - A. Ioscovich
- Department of Anaesthesia; Shaare Zedek Medical Center; Hebrew University; Jerusalem Israel
| | - L.A. Eidelman
- Department of Anaesthesia; Rabin Medical Center; Beilinson Hospital; Petach Tikvah Israel
| | - R. Landau
- Department of Anesthesia; Columbia University College of Physicians and Surgeons; New York USA
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Ioscovich A, Orbach-Zinger S, Zemzov D, Reuveni A, Eidelman LA, Ginosar Y. Peripartum anesthetic management of renal transplant patients--a multicenter cohort study. J Matern Fetal Neonatal Med 2013; 27:484-7. [PMID: 23799895 DOI: 10.3109/14767058.2013.818973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
As the number and success of renal transplantation has grown, there has been an increase in the number of renal transplant patients giving birth. To date, there has been no data on obstetric anesthesia management of these patients. The purpose of this study was to build an Israeli national database on parturients after renal transplant. A sixteen-year (calendar years 1996-2011) retrospective study was conducted at three major tertiary centers with a combined current birth rate of approximately 25,000 deliveries annually. We found 83 labors in 64 women. Forty-two percent of this population suffered from hypertension while 12.5% had diabetes. Forty-seven percent of women had a vaginal delivery while 53% of women had a cesarean section. The rate of epidural analgesia for labor was 59%, and rate of regional anesthesia during cesarean section was 75%. There were no anesthetic complications in any cases. Standard ASA monitoring was used in all cases except for one woman with severe hypertension who required an arterial line during her cesarean section. Forty-seven percent of newborn were under 37 weeks with average gestational week 36 ± 3 days and birth weight 2.5 ± 0.7 kg. Average Apgar was 8.4 ± 1.3 at one minute and 9.3 ± 0.7 at five minutes. There was one neonatal death in the CS group due to placental abruption. Patients after renal transplant can safely undergo birth and obstetric analgesia.
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Affiliation(s)
- A Ioscovich
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Hebrew University Jerusalem , Israel
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Ginosar Y, Orbach-Zinger S. Reply from the authors. Br J Anaesth 2013; 110:845-6. [PMID: 23599517 DOI: 10.1093/bja/aet083] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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17
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Ginosar Y, Orbach-Zinger S. Reply from the authors. Br J Anaesth 2013; 110:846-7. [PMID: 23599520 DOI: 10.1093/bja/aet090] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Orbach-Zinger S, Ginosar Y, Elliston J, Fadon C, Abu-Lil M, Raz A, Goshen-Gottstein Y, Eidelman L. Influence of preoperative anxiety on hypotension after spinal anaesthesia in women undergoing Caesarean delivery. Br J Anaesth 2012; 109:943-9. [DOI: 10.1093/bja/aes313] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Orbach-Zinger S, Friedman L, Avramovich A, Ilgiaeva N, Orvieto R, Sulkes J, Eidelman LA. Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for Cesarean section. Acta Anaesthesiol Scand 2006; 50:1014-8. [PMID: 16923099 DOI: 10.1111/j.1399-6576.2006.01095.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [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: 11/30/2022]
Abstract
OBJECTIVE To identify parturients at risk of inability to extend labor epidural analgesia in whom alternative methods of anesthesia should be considered for Cesarean section (CS). METHODS For 6 months, we prospectively studied women undergoing a CS with a functioning epidural catheter in place from the delivery ward. All parturients received the same epidural protocol: bolus of bupivacaine 0.1% and fentanyl, then bupivacaine 0.1% and fentanyl (2 microg/ml) 10-15 ml/h and an additional 5 ml of bupivacaine 0.125% top-ups according to patient request. Sixteen millilitres of lidocaine 2%, 1 ml of bicarbonate, and 100 microg of fentanyl were given for CS. Failed epidural analgesia was defined as the need to convert to general anesthesia. RESULTS Of the 101 parturients studied, 20 (19.8%) required conversion to general anesthesia. In univariate analysis, the likelihood of failed epidural anesthesia was inversely correlated with parturient's age (P = 0.014) and directly correlated with pre-pregnancy weight (P = 0.019), weight at the end of pregnancy (P = 0.003), body mass index (BMI) at the end of pregnancy (P = 0.0004), gestational week (P = 0.008), number of top-ups (P = 0.0004) and visual analog scale (VAS) 2 h before CS (P = 0.03). In multivariate analysis, the number of top-ups in the delivery ward was the best predictor of epidural anesthesia failure (odds ratio 4.39, P = 0.005). CONCLUSION Younger, more obese parturients at a higher gestational week, requiring more top-ups during labor, having a higher VAS in the 2 h before CS are at risk of inability to extend labor epidural analgesia to epidural anesthesia for CS.
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Affiliation(s)
- S Orbach-Zinger
- Department of Anesthesiology, Rabin Medical Center/Beilinson Campus, Sackler School for Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Orbach-Zinger S, Friedman L, Avramovich A, Ilgiaeva N, Orvieto R, Sulkes J, Eidelman LA. Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for Cesarean section. Acta Anaesthesiol Scand 2006; 50:793-7. [PMID: 16879460 DOI: 10.1111/j.1399-6576.2006.01083.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [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: 11/30/2022]
Abstract
AIM To identify parturients at risk of inability to extend labor epidural analgesia in whom alternative methods of anesthesia should be considered for Cesarean section (CS). METHODS For 6 months, we prospectively studied women undergoing CS with a functioning epidural catheter in place from the delivery ward. All parturients received the same epidural protocol: bolus of bupivacaine 0.1% and fentanyl, followed by bupivacaine 0.1% and fentanyl (2 microg/ml) 10-15 ml/h and an additional 5 ml of bupivacaine 0.125% as top-up according to patient request. Sixteen milliliters of lidocaine 2%, 1 ml of bicarbonate and 100 microg of fentanyl were given for CS. Failed epidural analgesia was defined as the need to convert to general anesthesia. RESULTS Of the 101 parturients studied, 20 (19.8%) required conversion to general anesthesia. In univariate analysis, the likelihood of failed epidural anesthesia was inversely correlated with parturient age (P = 0.014) and directly correlated with pre-pregnancy weight (P = 0.019), weight at the end of pregnancy (P = 0.003), body mass index at the end of pregnancy (P = 0.0004), gestational week (P = 0.008), number of top-ups (P = 0.0004) and visual analog scale (VAS) score 2 h before CS (P = 0.03). In multivariate analysis, the number of top-ups in the delivery ward was the best predictor of epidural anesthesia failure (odds ratio, 4.39; P = 0.005). CONCLUSION Younger, more obese parturients at a higher gestational week, requiring more top-ups during labor and having a higher VAS score in the 2 h before CS are at risk for inability to extend labor epidural analgesia to epidural anesthesia for CS.
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Affiliation(s)
- S Orbach-Zinger
- Department of Anesthesiology, Rabin Medical Center/Beilinson Campus, Petach-Tiqva 49100, Israel
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Abstract
Chemotherapy with bleomycin may cause a syndrome of pulmonary sensitivity to supranormal inspired oxygen concentrations that persists for an unknown period of time after exposure. We present a mentally retarded adolescent patient in whom supranormal inspired oxygen was temporarily necessary to manage her difficult airway. Subsequently her pulmonary function deteriorated acutely and, after intermittent stabilization, irreversibly. In this case, bleomycin exposure may have played a pivotal role in modulating minor insults to trigger fatal acute respiratory distress syndrome (ARDS).
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Affiliation(s)
- S Orbach-Zinger
- Department of Anesthesiology, Rabin Medical Center, Beilinson Campus, Petach Tikvah, Israel
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