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Munafo' C, Loperfido A, Mammarella F, Crosti A, Iannilli F, Millarelli FR, Bellocchi G, Tritapepe L. Safety and efficacy of remifentanil target-controlled infusion for conscious sedation in a pregnant woman: a case report. J Med Case Rep 2024; 18:143. [PMID: 38454441 PMCID: PMC10921671 DOI: 10.1186/s13256-023-04303-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/05/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Every year 2% of pregnant women undergo nonobstetric surgical interventions worldwide. According to the American College of Obstetricians and Gynecologists Committee on Obstetric Practice, pregnant women should never be denied the most appropriate surgical treatment, regardless of the trimester of pregnancy. However, additional attention should be paid during the first trimester since it has the highest risk of inducing teratogenic mutations; additionally, during the third trimester, due to the possibility of preterm birth and low birth weight of the newborn, great care should be paid. CASE PRESENTATION We present the case of a Caucasian 36-year-old woman during her 21st week of pregnancy, with a normal-sized fetus, according to the gestational age on ultrasound exam, and with no additional risk factors. The patient referred to an increasing nasal obstruction associated with rhinorrhea of the left nasal cavity. She also reported episodes of sleep apnea and hyposmia. The patient received a detailed otolaryngological examination, which allowed for identification of a mass within the left nasal cavity. The subsequent nasal endoscopy confirmed a grayish polypoid mass lesion with a multinodular surface occupying the entire left nasal fossa. The lesion totally obliterated the left maxillary sinus, resulting in obstruction of the anterior osteomeatal unit and ethmoidal sinusitis. She was referred for a functional endoscopic sinus surgery using analgosedation with remifentanil target-controlled infusion. DISCUSSION AND CONCLUSION To the very best of our knowledge, this is the first case described in English literature about the use of analgosedation with remifentanil target-controlled infusion for otolaryngology surgery, specifically in functional endoscopic sinus surgery. It could be an interesting option to avoid the use of inhaled anesthetics that could induce fetal damage, especially during the first months of pregnancy. Furthermore, patient intubation is not necessary, which avoids cases of difficult intubation or any trauma to the airways. An adequate informed consent and appropriate compliance are elements of paramount importance in tailoring the anesthetic strategy for pregnant women who need nonobstetric surgical management.
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Affiliation(s)
- Camilla Munafo'
- Anaesthesia and Intensive Care Division, San Camillo-Forlanini Hospital Rome, Rome, Italy
| | | | | | - Arianna Crosti
- Anaesthesia and Intensive Care Division, University of Rome "La Sapienza", Rome, Italy.
| | - Federico Iannilli
- Anaesthesia and Intensive Care Division, University of Rome "La Sapienza", Rome, Italy
| | | | | | - Luigi Tritapepe
- Anaesthesia and Intensive Care Division, San Camillo-Forlanini Hospital Rome, Rome, Italy
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Traweek R, Phan V, Griesbach C, Hall C. General Surgery During Pregnancy and Gynecologic Emergencies. Surg Clin North Am 2023; 103:1217-1229. [PMID: 37838464 DOI: 10.1016/j.suc.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Nonobstetrical surgical emergencies can occur throughout pregnancy but are often difficult to diagnose due to the physiologic and anatomical changes that occur during pregnancy. Medical providers should have insight into these changes and be familiar with options for the diagnosis and management of common nonobstetrical surgical emergencies, such as appendicitis, cholecystitis, and small bowel obstruction. Surgeons should also be aware of obstetrical emergencies, such as ectopic pregnancy and severe vaginal bleeding, which may be life threatening to mother and the fetus. Intraoperatively, surgeons should be familiar with minimally invasive approaches for surgical diseases and special anesthetic considerations for pregnant patients.
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Affiliation(s)
- Raymond Traweek
- Baylor Scott & White Medical Center, 2401 South 31st Street, Temple, TX 76508, USA
| | - Vivy Phan
- Baylor Scott & White Medical Center, 2401 South 31st Street, Temple, TX 76508, USA
| | - Chad Griesbach
- Baylor Scott & White Medical Center, 2401 South 31st Street, Temple, TX 76508, USA
| | - Chad Hall
- Baylor Scott & White Medical Center, 2401 South 31st Street, Temple, TX 76508, USA.
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3
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Brennan KA, Angelidis IK. Resuscitation in obstetric care. Int Anesthesiol Clin 2023; 61:55-61. [PMID: 37622314 DOI: 10.1097/aia.0000000000000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Affiliation(s)
- Kaitlyn A Brennan
- Department of Anesthesiology & Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennesse
| | - Ioannis K Angelidis
- New York University, Grossman School of Medicine, New York, New York
- Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Langone Health, New York, New York
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4
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Sjöblom A, Hedberg M, Johansson S, Henningsson R, Soumpasis I, Lafrenz H, Törnberg D, Lodenius Å, Fagerlund MJ. Pre-oxygenation using high-flow nasal oxygen in parturients undergoing caesarean section in general anaesthesia: A prospective, multi-centre, pilot study. Acta Anaesthesiol Scand 2023; 67:1028-1036. [PMID: 37164448 DOI: 10.1111/aas.14264] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Parturients undergoing caesarean section in general anaesthesia have an increased risk of desaturating during anaesthesia induction. Pre- and peri-oxygenation with high-flow nasal oxygen prolong the safe apnoea time but data on parturients undergoing caesarean section under general anaesthesia are limited. This pilot study aimed to investigate the clinical effects and frequency of desaturation in parturients undergoing caesarean section in general anaesthesia pre- and peri-oxygenated with high-flow nasal oxygen and compare this to traditional pre-oxygenation using a facemask. METHODS In this prospective, non-randomised, multi-centre study we included pregnant women with a gestational age ≥30 weeks undergoing caesarean section under general anaesthesia. All parturients were asked to participate in the intervention group consisting of pre-oxygenation using high-flow nasal oxygen. Parturients declining participation were pre-oxygenated with a traditional facemask. Primary outcome was the proportion of parturients desaturating below 93% from start of pre-oxygenation until 1 min after tracheal intubation. Secondary outcomes investigated end-tidal oxygen concentrations after tracheal intubation and the proportion of parturients with signs of regurgitation. RESULTS A total of 34 parturients were included, 25 pre- and peri-oxygenated with high-flow nasal oxygen and 9 pre-oxygenated with facemask. No difference in patient or airway characteristics could be seen except for a higher BMI in the high-flow nasal oxygen group (31.4 kg m-2 [4.7] vs. 27.7 kg m-2 [3.1]; p = .034). No woman in any of the two groups desaturated below 93%. The lowest peripheral oxygen saturation observed, in any parturient, was 97%. There was no difference detected in end-tidal oxygen concentration after tracheal intubation, 87% (6) in the high-flow nasal oxygen group vs 80% (15) in the facemask group (p = .308). No signs of regurgitation, in any parturient, were seen. CONCLUSION Pre- and peri-oxygenation with high-flow nasal oxygen maintain adequate oxygen saturation levels during induction of anaesthesia also in parturients. Regurgitation of gastric content did not occur in any parturient and no other safety concerns were observed in this pilot study.
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Affiliation(s)
- Albin Sjöblom
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Hedberg
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sofia Johansson
- Department of Anaesthesia and Intensive Care, Central Hospital of Karlstad, Karlstad, Sweden
| | - Ragnar Henningsson
- Department of Anaesthesia and Intensive Care, Central Hospital of Karlstad, Karlstad, Sweden
| | - Ioannis Soumpasis
- Department of Anaesthesia and Intensive Care, South General Hospital, Stockholm, Sweden
| | - Hannah Lafrenz
- Department of Anaesthesia, Surgery and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniel Törnberg
- Department of Anaesthesia and Intensive Care, Danderyd University Hospital, Stockholm, Sweden
| | - Åse Lodenius
- Department of Anaesthesia and Intensive Care, Danderyd University Hospital, Stockholm, Sweden
| | - Malin Jonsson Fagerlund
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
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5
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Downing J, Sjeklocha L. Trauma in Pregnancy. Emerg Med Clin North Am 2023; 41:223-245. [PMID: 37024160 DOI: 10.1016/j.emc.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Trauma is the leading cause of nonobstetric maternal death. Pregnant patients have a similar spectrum of traumatic injuries with a noted increase in interpersonal violence. A structured approach to trauma evaluation and management is recommended with several guidelines expanding on ATLS principles; however, evidence is limited. Optimal management requires understanding of physiologic changes in pregnancy, a team-based approach, and preparation for interventions that may including neonatal resuscitation. The principles of trauma management are the same in pregnancy with a systematic approach and initial maternal focused resuscitation..
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Affiliation(s)
- Jessica Downing
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Lucas Sjeklocha
- Department of Emergency Medicine, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
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Singha D, Kattimani MM, Kanwar M, Bhandari S, Singh J. Evaluation of changes in Mallampati class in patients undergoing lumbar spine surgeries in the prone position: A prospective observational study. Saudi J Anaesth 2023; 17:163-167. [PMID: 37260643 PMCID: PMC10228842 DOI: 10.4103/sja.sja_438_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/28/2022] [Indexed: 03/11/2023] Open
Abstract
Background Positioning of patients during surgery, whether prone or head down, can lead to airway edema which, in turn, may lead to a difficult airway, and enhanced chances for reintubation. We aimed to assess and evaluate modified Mallampati class (MMC) change in patients scheduled for lumbar spine surgery in the prone position. Materials and Methods This prospective observational study included 80 patients scheduled for lumbar spine surgery. The MMC was assessed up to 48 h postoperatively. The time taken by the patients in the postoperative period for MMC class to revert to preoperative value and airway complications, if any, was noted. Other parameters observed were surgical duration, intraoperative fluids used, and blood loss to look for any significant correlation with changes in MMC. Results MMC increase by one grade was observed in 73 patients (91%). MMC in 54 patients (74%) returned to baseline within 18 h, in 12 patients (16%) it took 24 h, and in the remaining 7 patients (10%) the time taken was 36 h. Conclusion It was concluded and established by this study that the MMC declined by one grade and reverted to baseline value within 36 h. This change in MMC necessitates extra caution to be adopted during the postoperative period as surgery in a prone position may predispose to an increased risk of encountering difficult reintubation. The change in MMC was not significantly correlated to intraoperative variables like duration of surgery, amount of intraoperative fluid given, and blood loss.
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Affiliation(s)
- Dheeraj Singha
- Department of Anaesthesia, Dr. RPGMC Tanda, Kangra, Himachal Pradesh, India
| | | | - Manjeet Kanwar
- Department of Anaesthesia, Dr. RKGMC, Hamirpur, Himachal Pradesh, India
| | - Shyam Bhandari
- Department of Anaesthesia, Dr. RPGMC Tanda, Kangra, Himachal Pradesh, India
| | - Jai Singh
- Department of Anaesthesia, Dr. RPGMC Tanda, Kangra, Himachal Pradesh, India
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7
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Achu RA, Reale SC. Airway Management in Pregnancy. CURRENT ANESTHESIOLOGY REPORTS 2023. [DOI: 10.1007/s40140-023-00556-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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Zaleski KL, Blazey MH, Carabuena JM, Economy KE, Valente AM, Nasr VG. Perioperative Anesthetic Management of the Pregnant Patient With Congenital Heart Disease Undergoing Cardiac Intervention: A Systematic Review. J Cardiothorac Vasc Anesth 2022; 36:4483-4495. [PMID: 36195521 DOI: 10.1053/j.jvca.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 11/11/2022]
Abstract
Maternal congenital heart disease is increasingly prevalent, and has been associated with a significantly increased risk of maternal, obstetric, and neonatal complications. For patients with CHD who require cardiac interventions during pregnancy, there is little evidence-based guidance with regard to optimal perioperative management. The periprocedural management of pregnant patients with congenital heart disease requires extensive planning and a multidisciplinary teams-based approach. Anesthesia providers must not only be facile in the management of adult congenital heart disease, but cognizant of the normal, but significant, physiologic changes of pregnancy.
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Affiliation(s)
- Katherine L Zaleski
- Department of Anesthesiology, Critical Care, and Pain Medicine-Boston Children's Hospital, Harvard Medical School, Boston, MA
| | | | - Jean M Carabuena
- Department of Anesthesiology, Perioperative and Pain Medicine-Brigham and Women's Hospital, Harvard Medical School, Boston MA
| | - Katherine E Economy
- Division of Maternal-Fetal Medicine, Brigham, and Women's Hospital, Harvard Medical School, Boston, MA
| | - Anne M Valente
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Viviane G Nasr
- Department of Anesthesiology, Critical Care, and Pain Medicine-Boston Children's Hospital, Harvard Medical School, Boston, MA.
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Obstructive sleep apnoea and sleep disorders in pregnancy. Best Pract Res Clin Obstet Gynaecol 2022; 85:107-113. [PMID: 36443159 DOI: 10.1016/j.bpobgyn.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
This review provides a summary for obstetricians, midwives, other health professionals and women contemplating pregnancy about the interactions between pregnancy and breathing during sleep. This review will first examine the normal physiological changes of pregnancy and their relationship to sleep-disordered breathing (SDB), and it will then summarise the current knowledge of SDB in pregnancy. Many changes in the respiratory system during pregnancy, particularly during the third trimester, can alter respiratory function during sleep, increasing the incidence and severity of SDB. These changes include increased ventilatory drive and metabolic rate, reduced functional residual capacity and residual volume, increased alveolar-arterial oxygen gradients and changes in the upper airway. The clinical importance of these changes during pregnancy is demonstrated by the increased incidence of snoring and obstructive sleep apnoea hypopnoea syndrome. As SDB is associated with obesity, the increasing incidence of obesity pre-pregnancy will likely increase SDB during pregnancy over the next decade. If a physician is asked to review a pregnant patient, they should always consider the possibility of SDB.
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10
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Burger A, Smit MI, van Dyk D, Reed AR, Dyer RA, Hofmeyr R. Predictors of difficult tracheal intubation during general anaesthesia: an analysis of an obstetric airway management registry. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2022. [DOI: 10.36303/sajaa.2022.28.5.2829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- A Burger
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital,
South Africa
| | - MI Smit
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital,
South Africa
| | - D van Dyk
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital,
South Africa
| | - AR Reed
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital,
South Africa
| | - RA Dyer
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital,
South Africa
| | - R Hofmeyr
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital,
South Africa
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Li Y, Li Y, Chen Q, Hua H, Jiao J, Zhang L, Chen L, Huang S. The effect of first trimester body mass index on the changes in the upper lip bite test classification before and after delivery: A prospective observational study. Front Med (Lausanne) 2022; 9:969862. [PMID: 36186764 PMCID: PMC9515353 DOI: 10.3389/fmed.2022.969862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe difficult airway (DA) assessment and management of pregnant woman has always brought specific challenges. The aim of this study was to investigate the effect of labor on the airway by assessing changes in the upper lip bite test (ULBT) classes and to explore its correlation with the first trimester's body mass index (BMI).MethodsAccording to the BMI of the first trimester, 354 full-term women were divided into low BMI group, normal BMI group and high BMI group. The ULBT class and pregnancy outcome were recorded and compared at early labor, after delivery, and 48 h after delivery.ResultsThe ULBT class was increased in 75(21.1%) patients after delivery. Compared to the normal BMI group, the high BMI group had a higher probability of increasing (34.8 vs. 17.5%; P = 0.002). The number of women with ULBT class 2–3 increased to 157, which was 1.48 times that of early labor. The number of women with ULBT class 3 increased from 4 to 16, of which 7 (53.8%) were from the high BMI group. Binary logistic regression analysis showed that first trimester's BMI was associated with a significant increase in ULBT class after delivery (adjusted odds ratio [aOR] = 2.13 [0.91–4.98], P = 0.02). The ULBT classes of the three groups tended to return to their initial level 48 h after delivery (P > 0.05).ConclusionLabor results in an approximately one-fifth increase in ULBT class. Being overweight or obese in the first trimester is associated with an increased risk of DA during labor.Trial registrationThis study was registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn) on September 26, 2020. Registration number ChiCTR2000038643.
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12
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Impact of changing head and neck position on cricothyroid membrane localisation and height in third trimester parturients: An observational study. Eur J Anaesthesiol 2022; 39:566-568. [PMID: 35608882 DOI: 10.1097/eja.0000000000001564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Dominguez JE, Habib AS. Obstructive sleep apnea in pregnant women. Int Anesthesiol Clin 2022; 60:59-65. [PMID: 35261345 PMCID: PMC9045012 DOI: 10.1097/aia.0000000000000360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The prevalence of OSA in the low-risk obstetric population is thought to be low; best estimates have been extrapolated from the one available large prospective study and likely range between 3–8%.1 OSA prevalence in high-risk pregnant women such as those with obesity and chronic hypertension is significantly higher as extrapolated from several smaller prospective studies which have reported a prevalence as high as 37% in obese women.2 –6 Despite the high prevalence of OSA in high-risk pregnant women, it remains underdiagnosed due to several factors. An emerging body of literature suggests that OSA may also have serious implications for the health of mothers and fetuses during and beyond pregnancy, but there is still no data to determine if OSA treatment mitigates these adverse outcomes. In this review, we will examine this body of literature from the perspective of the anesthesiologist: the association between pregnancy and the development or worsening of OSA; OSA as it relates to adverse maternal and fetal outcomes; antepartum and screening considerations for OSA in pregnant women; and recommendations regarding the peripartum management of OSA.
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Affiliation(s)
- Jennifer E Dominguez
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
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14
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Obstructive Sleep Apnea: Another Condition to Screen for in Women with Infertility. WOMEN 2022. [DOI: 10.3390/women2010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Women with obstructive sleep apnea (OSA) are at increased risk of poor pregnancy outcomes such as fetal growth restriction, hypertensive disorders of pregnancy, and gestational diabetes mellitus. Given this increased risk, we aimed to study the screening prevalence of OSA in women seeking fertility treatment. We performed a cross sectional study of patients presenting to a university-affiliated fertility clinic between March-April 2021. Patients were asked to complete OSA screening (STOP-BANG), anxiety screening (GAD-7), and depression screening (PHQ-2) questionnaires. 107 women completed the surveys. Mean age was 35.1 years and mean body mass index (BMI) was 25.7 kg/m2. Nine (8.4%) women screened positive for OSA using the STOP-BANG screening tool. Women who screened positive for OSA were more likely to be older (37.8 years vs. 34.7 years, p = 0.02) and have a higher BMI (42.6 kg/m2 vs. 27.4 kg/m2, p < 0.001). Women who screened positive for OSA were also more likely to screen positive for mild-severe depressive symptoms (22.2% vs. 3.1%, p = 0.006) and mild-severe anxiety (66.7% vs. 21.4%, p = 0.003) symptoms. 24.3% of the population had polycystic ovary syndrome (PCOS). Women with PCOS were more likely to screen positive for OSA (19.2% vs. 4.9%; p = 0.04). Despite this being a low-risk population of young women seeking fertility evaluation or treatment, 8% screened positive for OSA. Given the association between OSA and adverse pregnancy outcomes, our results underline the need to screen women seeking fertility treatment.
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Maxwell M, Sanapo L, Monteiro K, Bublitz M, Avalos A, Habr N, Bourjeily G. Impact of nasal dilator strips on measures of sleep-disordered breathing in pregnancy. J Clin Sleep Med 2022; 18:477-483. [PMID: 34432628 PMCID: PMC8804998 DOI: 10.5664/jcsm.9624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES Women with sleep-disordered breathing (SDB) in pregnancy are at a greater risk of developing serious adverse perinatal outcomes. However, the pathogenesis of SDB in pregnancy is poorly understood. As nasal congestion is common in pregnancy, nasal obstruction may contribute to SDB in this population. This study aims to assess the impact of nasal dilator strips (NDS) on measures of SDB and their potential for use as a placebo condition. METHODS Pregnant women ≥ 18 years old, body mass index ≥ 27 kg/m2, and habitual snoring were enrolled. Participants completed 2 consecutive level III home sleep apnea tests and used NDS during the second test. Objective measures including respiratory event index and pulse transit time drop index, a measure of increased arterial stiffness, were compared across tests. Subjective assessments of participants' perceived impact of NDS use was also obtained. RESULTS 54 women, 59% White, 60% in the third trimester were enrolled. Median time between the 2 studies was 1 day (interquartile range [IQR] 4). There was no significant change between the night without NDS use and the night with NDS use in respiratory event index (5.30 [IQR 6.20] vs 4.80 [IQR 6.78], P = .8) or pulse transit time drop index (6.8 [IQR 13.3] vs 6.6 [IQR 15.8], P = .360). Subjective measures of sleep did not differ between the 2 nights. CONCLUSIONS Despite the high prevalence of pregnancy-associated rhinitis, NDS do not have a significant impact on measures of SDB. Results from this study support the use of NDS as an appropriate placebo in prenatal clinical trials. CITATION Maxwell M, Sanapo L, Monteiro K, et al. Impact of nasal dilator strips on measures of sleep-disordered breathing in pregnancy. J Clin Sleep Med. 2022;18(2):477-483.
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Affiliation(s)
- Mariko Maxwell
- Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | - Laura Sanapo
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island,Department of Medicine, Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - Kristina Monteiro
- Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | - Maggie Bublitz
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island,Department of Medicine, Warren Alpert Medical School at Brown University, Providence, Rhode Island,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ashanti Avalos
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island
| | - Naya Habr
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island
| | - Ghada Bourjeily
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island,Department of Medicine, Warren Alpert Medical School at Brown University, Providence, Rhode Island,Address correspondence to: Ghada Bourjeily, MD, Professor of Medicine, Department of Medicine, Divisions of Pulmonary, Critical Care and Sleep Medicine, and Obstetric Medicine, Lifespan Hospitals, Warren Alpert Medical School of Brown University, 146 West River Street, Suite 1F, Providence, RI 02904;
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Ragheb JW, Kountanis JA, Shilling BA, Cassidy R, McKinney AM, Pancaro C. Retrospective study evaluating telehealth antenatal anesthesia consults for high-risk obstetric patients. J Matern Fetal Neonatal Med 2021; 35:8836-8843. [PMID: 34806512 DOI: 10.1080/14767058.2021.2005566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Telehealth has gained popularity, particularly in the COVID-19 era. The use of telehealth is now being applied to preoperative evaluation clinics in an effort to overcome barriers to antenatal anesthesia assessment of high-risk obstetrical patients. OBJECTIVES The objective of this study is to determine if the quality of antenatal anesthesia telehealth consults of high-risk obstetric patients is comparable to in-person encounters. This is determined by assessing if telehealth consults are feasible and meet the standards of care, as well as the level of patient satisfaction and ease of use as reported by providers. STUDY DESIGN This retrospective study assessed patients prior to delivery who completed a video-telehealth anesthesia consultation (51 cases) from November 1st, 2019 to November 30th, 2020 and all of those for patients receiving an in-person anesthesia consultation (171 controls) from November 2017 through October 2019. Our primary hypothesis was that telehealth and in-person consultations would not result in different standards of care. The primary outcome was an indicator of meeting the standard of care, and the difference in proportions between the telehealth and in-person consultation was tested by Fisher's exact test. Our secondary hypotheses were that patients reported high levels of satisfaction and could use telehealth easily and providers could use the platform easily. Secondary outcomes were assessed by using the Consultation and Relational Empathy (CARE) and the Telehealth Usability Questionnaire (TUQ) surveys, respectively. RESULTS For the primary outcome, 94.1% (48/51) of telehealth and 89.5% (153/171) of in-person visits met the standard of care, indicating no significant difference between groups (p-value = .4204). The CARE score was 46 [41,50] {median [interquartile range]}, (p-value < .0001), indicating patient satisfaction with telehealth. The use-average scores on the TUQ for the patient and provider were 6.67 [6.33, 7] and 6 [5.33, 7] respectively, indicating great system usability. CONCLUSION This study demonstrates no significant difference in the standard of care between in-person and telehealth visits. Furthermore, telehealth consultation was feasible and associated with high patient satisfaction and platform usability. Preoperative consultation of high-risk obstetric patients using telehealth visits should be routinely considered in clinical practice.Condensation: There is no significant difference in the standard of care between in-person and telehealth antenatal anesthesia consultations, and patients report high satisfaction and platform usability.Telehealth is gaining popularity, but its role in antenatal anesthesia consultation of high risk obstetrical patients has not yet been defined with respect to standard of care, patient satisfaction, and platform usability.There was no significant difference in standard of care between in-person and telehealth antenatal anesthesia consultations, and patients reported high satisfaction and platform usability.Telehealth should be considered as an alternative to in-person antenatal anesthesia consultation of high risk obstetrical patients. It is a particularly attractive alternative to in-person consultation due to cost-savings, increased patient accessibility, and ease of use.
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Affiliation(s)
| | - Joanna A Kountanis
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | | | - Ruth Cassidy
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Amy M McKinney
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Carlo Pancaro
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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Zaw M, Hein L, Martinez AC, Ascher KB, Abreu AR, Chediak AD. Gender Differences in Sleep Disordered Breathing—a Review of Literature. CURRENT PULMONOLOGY REPORTS 2021. [DOI: 10.1007/s13665-021-00278-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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18
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Roig Vazquez F. Trastornos respiratorios del sueño en la gestación y sus implicaciones maternofetales. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2020.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Anjum H, Surani S. Pulmonary Hypertension in Pregnancy: A Review. ACTA ACUST UNITED AC 2021; 57:medicina57030259. [PMID: 33799910 PMCID: PMC8000005 DOI: 10.3390/medicina57030259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 02/05/2023]
Abstract
Pulmonary hypertension (PH) is a disease, which targets the pulmonary vasculature affecting the heart and the lungs, and is characterized by a vast array of signs and symptoms. These manifestations of PH in pregnancy are highly variable and non-specific hence, it is prudent to have a very keen and high index of suspicion while evaluating these patients. This rare disease can be extremely debilitating and can be associated with a poor overall prognosis. Pregnancy in women with PH puts them at an elevated risk because the physiological changes associated with pregnancy are not well endured leading to even higher morbidity and mortality in these patients. Although there are various modalities for evaluation and workup of PH, right heart catheterization (RHC) remains the gold standard. A mean pulmonary artery pressure (PAP) of more than 20 mm of Hg is considered diagnostic. It is indeed heartening to see that in the past decade many novel therapeutic modalities have emerged and along with a better understanding of the disease process have proved to be promising in terms of reducing the adverse outcomes and preventing death in this population of patients.
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Affiliation(s)
- Humayun Anjum
- Internal Medicine, University of North Texas, Fort Worth, TX 76107, USA
- Correspondence:
| | - Salim Surani
- Internal Medicine, Texas A&M University, College Station, TX 77843, USA;
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20
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Affiliation(s)
- Bei Bei
- Melbourne School of Psychological Sciences, University of Melbourne,
- Centre for Women's Mental Health, Royal Women's Hospital,
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University,
| | - Soledad Coo
- Melbourne School of Psychological Sciences, University of Melbourne,
| | - Fiona C Baker
- Center for Health Sciences, SRI International,
- Brain Function Research Group, School of Physiology, University of the Witwatersrand,
| | - John Trinder
- Melbourne School of Psychological Sciences, University of Melbourne,
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21
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Lim MJ, Tan HS, Tan CW, Li SY, Yao WY, Yuan YJ, Sultana R, Sng BL. The effects of labor on airway outcomes with Supreme™ laryngeal mask in women undergoing cesarean delivery under general anesthesia: a cohort study. BMC Anesthesiol 2020; 20:213. [PMID: 32847548 PMCID: PMC7449044 DOI: 10.1186/s12871-020-01132-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/20/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pregnancy is associated with higher incidence of failed endotracheal intubation and is exacerbated by labor. However, the influence of labor on airway outcomes with laryngeal mask airway (LMA) for cesarean delivery is unknown. METHODS This is a secondary analysis of a prospective cohort study on LMA use during cesarean delivery. Healthy parturients who fasted > 4 h undergoing Category 2 or 3 cesarean delivery with Supreme™ LMA (sLMA) under general anesthesia were included. We excluded parturients with BMI > 35 kg/m2, gastroesophageal reflux disease, or potentially difficult airway (Mallampati score of 4, upper respiratory tract or neck pathology). Anesthesia and airway management reflected clinical standard at the study center. After rapid sequence induction and cricoid pressure, sLMA was inserted as per manufacturer's recommendations. Our primary outcome was time to effective ventilation (time from when sLMA was picked up until appearance of end-tidal carbon dioxide capnography), and secondary outcomes include first-attempt insertion failure, oxygen saturation, ventilation parameters, mucosal trauma, pulmonary aspiration, and Apgar scores. Differences between labor status were tested using Student's t-test, Mann-Whitney U test, or Fisher's exact test, as appropriate. Quantitative associations between labor status and outcomes were determined using univariate logistic regression analysis. RESULTS Data from 584 parturients were analyzed, with 37.8% in labor. Labor did not significantly affect time to effective ventilation (mean (SD) for labor: 16.0 (5.75) seconds; no labor: 15.3 (3.35); mean difference: -0.65 (95%CI: - 1.49 to 0.18); p = 0.1262). However, labor was associated with increased first-attempt insertion failure and blood on sLMA surface. No reduction in oxygen saturation or pulmonary aspiration was noted. CONCLUSIONS Although no significant increase in time to effective ventilation was noted, labor may increase the number of insertion attempts and oropharyngeal trauma with sLMA use for cesarean delivery in parturients at low risk of difficult airway. Future studies should investigate the effects of labor on LMA use in high risk parturients. TRIAL REGISTRATION The study was prospectively registered at clinicaltrials.gov ( NCT02026882 ) on 3 January 2014.
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Affiliation(s)
- Ming Jian Lim
- Department of Women's Anesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Hon Sen Tan
- Department of Women's Anesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Chin Wen Tan
- Department of Women's Anesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Shi Yang Li
- Department of Anesthesiology and Perioperative Medicine, Quanzhou Macare Women's Hospital, Quanzhou, Fujian Province, China
| | - Wei Yu Yao
- Department of Anesthesiology and Perioperative Medicine, Quanzhou Macare Women's Hospital, Quanzhou, Fujian Province, China
| | - Yong Jing Yuan
- Department of Anesthesiology, Qinghai University Affiliated Hospital, Xining, Qinghai Province, China
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Ban Leong Sng
- Department of Women's Anesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
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22
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Lentz S, Grossman A, Koyfman A, Long B. High-Risk Airway Management in the Emergency Department: Diseases and Approaches, Part II. J Emerg Med 2020; 59:573-585. [PMID: 32591298 DOI: 10.1016/j.jemermed.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Successful airway management is critical to the practice of emergency medicine. Thus, emergency physicians must be ready to optimize and prepare for airway management in critically ill patients with a wide range of physiologic challenges. Challenges in airway management commonly encountered in the emergency department are discussed using a pearl and pitfall discussion in this second part of a 2-part series. OBJECTIVE This narrative review presents an evidence-based approach to airway and patient management during endotracheal intubation in challenging cases commonly encountered in the emergency department. DISCUSSION Adverse events during emergent airway management are common with postintubation cardiac arrest, reported in as many as 1 in 25 intubations. Many of these adverse events can be avoided by proper identification and understanding the underlying physiology, preparation, and postintubation management. Those with high-risk features including trauma, elevated intracranial pressure, upper gastrointestinal bleed, cardiac tamponade, aortic stenosis, morbid obesity, and pregnancy must be managed with airway expertise. CONCLUSIONS This narrative review discusses the pearls and pitfalls of commonly encountered physiologic high-risk intubations with a focus on the emergency clinician.
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Affiliation(s)
- Skyler Lentz
- Division of Emergency Medicine, Department of Surgery, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Alexandra Grossman
- Department of Emergency Medicine, Harbor-University of California, Los Angeles Medical Center, Torrance, California
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
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Johns EC, Denison FC, Reynolds RM. Sleep disordered breathing in pregnancy: A review of the pathophysiology of adverse pregnancy outcomes. Acta Physiol (Oxf) 2020; 229:e13458. [PMID: 32087033 DOI: 10.1111/apha.13458] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 12/11/2022]
Abstract
Sleep disordered breathing (SDB) is a common obesity-related co-morbidity with strong associations to cardiometabolic disease. The risk of SDB is increased during pregnancy, particularly among obese pregnant women. Accumulating evidence suggests that an association exists between maternal SDB and the development of adverse pregnancy outcomes, particularly gestational diabetes and hypertensive disorders of pregnancy. Intermittent hypoxia, a central characteristic of SDB, has been shown in animal and clinical studies to dysregulate several biological pathways. This includes the promotion of oxidative stress, increased inflammation, activation of the hypothalamic-pituitary-adrenal axis, increased sympathetic activity and impaired glucose and insulin metabolism. This review considers how, during pregnancy, these pathophysiological processes are plausible mechanisms through which SDB may contribute to an increased risk of adverse outcomes, for the mother and perhaps also the offspring. However, a lack of robust evidence specific to the pregnant population, including limited evaluation of the placental function in affected pregnancies, limits our ability to draw definite conclusions on mechanisms contributing to adverse pregnancy outcomes and, indeed, the strength of association between SDB and certain pregnancy complications.
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Affiliation(s)
- Emma C. Johns
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health University of Edinburgh, Queen's Medical Research Institute Edinburgh United Kingdom
| | - Fiona C. Denison
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health University of Edinburgh, Queen's Medical Research Institute Edinburgh United Kingdom
| | - Rebecca M. Reynolds
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health University of Edinburgh, Queen's Medical Research Institute Edinburgh United Kingdom
- BHF/University Centre for Cardiovascular Science University of Edinburgh, Queen's Medical Research Institute Edinburgh United Kingdom
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24
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Arkenbosch JHC, van Ruler O, de Vries AC. Non-obstetric surgery in pregnancy (including bowel surgery and gallbladder surgery). Best Pract Res Clin Gastroenterol 2020; 44-45:101669. [PMID: 32359684 DOI: 10.1016/j.bpg.2020.101669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/21/2020] [Accepted: 03/05/2020] [Indexed: 01/31/2023]
Abstract
Non-obstetric surgery during pregnancy is required in 0.75-2% of pregnancies. Physiologic changes during pregnancy, both hormonal and anatomic, can have interactions with surgery and anesthesia. Indication, timing as well as risks of anesthesia and surgery should be considered in surgical decision making. The health status of the mother should always be put first. A preoperative multidisciplinary approach, also including an obstetrician and neonatologist, is mandatory. Delay in diagnosis and treatment carry risks of complications in all septic visceral indications. Considerations should be individualized.
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Affiliation(s)
- J H C Arkenbosch
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
| | - O van Ruler
- Department of Surgery, IJsselland Hospital, Prins Constantijnweg 2, Room M1-109, 2906 ZC, Capelle aan den IJssel, the Netherlands.
| | - A C de Vries
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
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25
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Lee SY, Bae SI, Do SH, Sohn JT, Park JW. The effect of brief pre-anesthetic exercise therapy of jaw and neck joints on mouth opening, neck extension, and intubation conditions during induction of general anesthesia: a randomized controlled trial. BMC Anesthesiol 2020; 20:28. [PMID: 31996130 PMCID: PMC6990593 DOI: 10.1186/s12871-020-0939-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The effort to improve tracheal intubation process is clinically valuable. We hypothesized that a preoperative brief exercise therapy would increase mouth opening and neck extension, enhancing intubation conditions during general anesthesia. METHODS Patients undergoing general anesthesia were randomized into two groups. The exercise group performed the exercise regimen including masseter muscle massage and stretching of jaw and neck joints before anesthetic induction, while the control did not. Before (baseline) and after the intervention, we evaluated Mallampati score, mouth aperture size, and sternomental distance. After tracheal intubation, intubation difficulty scale with direct laryngoscope and oropharyngeal soft tissue injury were also evaluated. RESULTS A total of 138 patients completed the analysis (control = 68, exercise = 70). Baseline characteristics did not differ between groups. At anesthetic induction, there was a significant difference in Mallampati score between the two groups (P = 0.039) and the incidence of Mallampati scores of 1 was higher in the exercise group (odds ratio [95% CI]: 2.1 [1.0-4.3], P = 0.043). Mouth opening after the intervention was greater in the exercise group than in the control group (estimated difference [95% CI]: - 2.4 [- 4.8 - -0.1], P = 0.042) and sternomental distance was similar between the two groups (estimated difference [95% CI]: - 3.7 [- 9.0-1.7, P = 0.175). The exercise group showed less soft tissue injuries (odds ratio [95% CI]: 0.2 [0.1-0.8], P = 0.009), however, intubation difficulty scale did not differ between the study groups (P = 0.112). CONCLUSIONS The brief pre-anesthetic exercise improved intubation conditions and enabled faster tracheal intubation with less injury to oropharyngeal soft tissue. TRIAL REGISTRATION Clinical Research Information Service (registration number: KCT0002618), registered at December 28, 2017.
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Affiliation(s)
- Sue Young Lee
- Department of Anesthesiology and Pain Medicine, ThanQ Seoul Thyroid-Head & Neck Surgery Center, Seoul, South Korea
| | - Sung Il Bae
- Department of Anesthesiology and Pain Medicine, Jinju Gyeongsang National University Hospital, Jinju, South Korea
| | - Sang-Hwan Do
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Ju-Tae Sohn
- Department of Anesthesiology and Pain Medicine, Jinju Gyeongsang National University Hospital, Jinju, South Korea
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University College of Medicine, Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
| | - Jin-Woo Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea.
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26
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Evaluation of Nocturnal Respiratory Complaints in Pregnant Women. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020. [PMID: 31916232 DOI: 10.1007/5584_2019_469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Snoring during pregnancy increases the risk of low Apgar score and low birth weight of newborns. Snoring women are twice as likely to be diagnosed as having preeclampsia when compared to non-snoring ones. Snoring may also be linked to, albeit it is not a prerequisite for, apneic events at sleep. The aim of this survey-type study was to evaluate the occurrence and severity of nocturnal respiratory complaints in a group of 312 pregnant women. Problems associated with snoring and other nasopharyngeal symptoms were reported by 60% of women. Complaints were more frequent in patients with a higher body mass index. The symptoms were significantly more frequent in the group of snorers. The results of this study suggest a pattern of basic features in pregnancy, such as snoring, overweight, and upper airway symptoms, which all ought to direct attention of care givers to the diagnostics of sleep-related breathing disorders. The early diagnosis would enable to undertake the measures to prevent preterm labor and to avoid postpartum complications in both mother and newborn.
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Esquinas AM, Fiorentino G, Insalaco G, Mina B, Duan J, Mondardini MC, Caramelli F. Application of Noninvasive Ventilation in the ObstetricalPatient. NONINVASIVE VENTILATION IN SLEEP MEDICINE AND PULMONARY CRITICAL CARE 2020. [PMCID: PMC7254544 DOI: 10.1007/978-3-030-42998-0_40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute respiratory failure in pregnancy is considered a common indication for ICU admissions in the obstetrical population. NIV (i.e., NIPPV and HFNC), although controversial, have been shown to be safe and effective in the treatment of acute respiratory failure and can help prevent invasive mechanical ventilation during pregnancy in a variety of scenarios. However, evidence is limited with mainly case reports and case series reported in the literature, NIV modalities have similar indications and contraindications in the pregnant patient as the general population. Methodology: Case reports, prospective RCTs, and meta-analysis involving adult patients with the application of NIPPV as a support strategy for obstetric patients with acute respiratory failure were reviewed. To increase the sensitivity of the search, a combination of terms was utilized such as “high flow nasal canula” with “noninvasive ventilation” and “pregnancy” or “obstetrics” and “acute respiratory failure” or “Acute hypoxic respiratory failure” or “Acute hypercapnic respiratory failure” as keywords. Three electronic databases were searched (Google Scholar, PubMed, and Cochrane Library) from 2017 to 2019. Abstracts and full text publications were screened to fit the search criteria.
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Affiliation(s)
- Antonio M. Esquinas
- Intensive Care Unit, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Giuseppe Fiorentino
- Department of Pathophysiology and Pulmonary Rehab, Azienda Ospedaliera dei Colli PO Monaldi, Napoli, Italy
| | - Giuseppe Insalaco
- Innovative Technologies for the Study of Sleep Breathing Disorders, Institute for Biomedical Research and Innovation (IRIB), Italian National Research Council, Palermo, Italy
| | - Bushra Mina
- Department of Pulmonary and CC Medicine, Lenox Hill Hospital, New York, NY USA
| | - Jun Duan
- Department of Respiratory and CC Medicine, First Affiliated Hospital of Chongqing M, Chongqing, China
| | - Maria Cristina Mondardini
- Anestesia and Pediatric Intensive Care Department, University Hospital Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Fabio Caramelli
- Anestesia and Pediatric Intensive Care Department, University Hospital Policlinico S. Orsola-Malpighi, Bologna, Italy
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The measurement of skin to epiglottis length for difficult airway prediction by ultrasonography in obese pregnant women: Prospective cohort study. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.605123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Izci-Balserak B, Zhu B, Gurubhagavatula I, Keenan BT, Pien GW. A Screening Algorithm for Obstructive Sleep Apnea in Pregnancy. Ann Am Thorac Soc 2019; 16:1286-1294. [PMID: 31162952 PMCID: PMC6812170 DOI: 10.1513/annalsats.201902-131oc] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/04/2019] [Indexed: 01/15/2023] Open
Abstract
Rationale: Obstructive sleep apnea (OSA) is common in pregnancy and associated with maternal and fetal complications. Early detection of OSA may have important implications for maternal-fetal well-being. A screening tool combining several methods of assessment may better predict OSA among pregnant women compared with tools that rely solely on self-reported information.Objectives: To develop a screening tool combining subjective and objective measures to predict OSA in pregnant women.Methods: This study is a secondary analysis using data collected from a completed cohort of pregnant women (n = 121 during the first and n = 87 during the third trimester). Participants underwent full polysomnography and completed the Multivariable Apnea Prediction Questionnaire. The Obstructive Sleep Apnea/Hypopnea Syndrome Score and Facco apnea predictive model were obtained. Logistic regression analysis and area under the curve (AUC) were used to identify models predicting OSA risk.Results: Participants' mean age was 27.4 ± 7.0 years. The prevalence of OSA during the first and third trimester was 10.7% and 24.1%, respectively. The final model predicting OSA risk consisted of body mass index, age, and presence of tongue enlargement. During the first trimester, the AUC was 0.86 (95% confidence interval [CI], 0.76-0.96). During the third trimester, the AUC was 0.87 (95% CI, 0.77-0.96). When the first-trimester data were used to predict third-trimester OSA risk, the AUC was 0.87 (95% CI, 0.77-0.97). This model had high sensitivity and specificity when used during both trimesters. The negative posttest probabilities (probability of OSA given a negative test result) ranged from 0.03 to 0.07.Conclusions: A new model consisting of body mass index, age, and presence of tongue enlargement provided accurate screening of OSA in pregnant women, particularly African-Americans. This tool can be easily and rapidly administered in busy clinical practices without depending on patients' awareness of experiencing apnea symptoms.
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Affiliation(s)
- Bilgay Izci-Balserak
- Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Bingqian Zhu
- Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Indira Gurubhagavatula
- Center for Sleep and Circadian Neurobiology and
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | | | - Grace W. Pien
- School of Medicine, John Hopkins University, Baltimore, Maryland
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30
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Dominguez JE, Krystal AD, Habib AS. Obstructive Sleep Apnea in Pregnant Women: A Review of Pregnancy Outcomes and an Approach to Management. Anesth Analg 2019; 127:1167-1177. [PMID: 29649034 DOI: 10.1213/ane.0000000000003335] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Among obese pregnant women, 15%-20% have obstructive sleep apnea (OSA) and this prevalence increases along with body mass index and in the presence of other comorbidities. Prepregnancy obesity and pregnancy-related weight gain are certainly risk factors for sleep-disordered breathing in pregnancy, but certain physiologic changes of pregnancy may also increase a woman's risk of developing or worsening OSA. While it has been shown that untreated OSA in postmenopausal women is associated with a range of cardiovascular, pulmonary, and metabolic comorbidities, a body of literature is emerging that suggests OSA may also have serious implications for the health of mothers and fetuses during and after pregnancy. In this review, we discuss the following: pregnancy as a vulnerable period for the development or worsening of OSA; the associations between OSA and maternal and fetal outcomes; the current screening modalities for OSA in pregnancy; and current recommendations regarding peripartum management of OSA.
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Affiliation(s)
| | - Andrew D Krystal
- Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.,Department of Psychiatry, University of California, San Francisco, San Francisco, California
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Behrents RG, Shelgikar AV, Conley RS, Flores-Mir C, Hans M, Levine M, McNamara JA, Palomo JM, Pliska B, Stockstill JW, Wise J, Murphy S, Nagel NJ, Hittner J. Obstructive sleep apnea and orthodontics: An American Association of Orthodontists White Paper. Am J Orthod Dentofacial Orthop 2019; 156:13-28.e1. [DOI: 10.1016/j.ajodo.2019.04.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 10/26/2022]
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Toker MK, Altıparmak B, Karabay AG. Comparison of the McGrath video laryngoscope and macintosh direct laryngoscope in obstetric patients: A randomized controlled trial. Pak J Med Sci 2019; 35:342-347. [PMID: 31086512 PMCID: PMC6500838 DOI: 10.12669/pjms.35.2.646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: In obstetric patients’ airway, guidelines have recommended the availability of advanced airway equipment. Our aim was to compare the larynx visualization provided by the Macintosh direct laryngoscope and McGrath video laryngoscope and the intubation time of patients undergoing cesarean section. Methods: This study was conducted at a private obstetrics and gynecology hospital during one month between June and July 2018. A hundred patients scheduled for elective cesarean section under general anesthesia were randomized into two different group’s as intubated using either McGrath VL or Macintosh DL. The intubation times, Cormack–Lehane grade, percentage of glottic opening, mean arterial blood pressure, and heart rates before and after intubation were compared among the groups. Results: The McGrath VL significantly reduced the intubation time compared to the Macintosh DL. In the McGrath VL group, better glottic view set the time of tracheal intubation as assessed using the Cormack-Lehane classification system and POGO scores were recorded. After intubation, hemodynamic parameters were significantly higher in the Macintosh DL group than in the McGrath VL group. Conclusion: The McGrath VL significantly lowered intubation time relative to the Macintosh DL, which may be a critical finding considering the importance of maintaining the mother’s airway for the health of both mother and baby.
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Affiliation(s)
- Melike Korkmaz Toker
- Melike Korkmaz Toker, Mugla Sitki Kocman University Research and Training Hospital, Anesthesiology and Reanimation Department, Mugla, Turkey
| | - Basak Altıparmak
- Basak Altiparmak, Mugla Sıtkı Kocman University, Department of Anesthesiology and Reanimation, Mugla, Turkey
| | - Ayse Gul Karabay
- Ayse Gul Karabay, Ota-Jine Med Private Hospital, Anesthesiology Clinic, Istanbul, Turkey
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Screening extremely obese pregnant women for obstructive sleep apnea. Am J Obstet Gynecol 2018; 219:613.e1-613.e10. [PMID: 30217579 PMCID: PMC6733412 DOI: 10.1016/j.ajog.2018.09.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/29/2018] [Accepted: 09/04/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Obesity is prevalent among pregnant women in the United States; obstructive sleep apnea is highly comorbid with obesity and is associated with adverse pregnancy outcomes. Screening for obstructive sleep apnea in pregnant women has remained a challenge because of a lack of validated screening tools. OBJECTIVE The purpose of this study was to evaluate established obstructive sleep apnea screening tools, a sleepiness scale, and individual component items in a cohort of pregnant women with extreme obesity in mid pregnancy with the use of objective testing to determine obstructive sleep apnea status and to describe the prevalence of obstructive sleep apnea among women with extreme obesity. STUDY DESIGN Adult pregnant subjects, between 24 and 35 weeks gestation, with a body mass index ≥40 kg/m2 at the time of enrollment completed obstructive sleep apnea screening tools (Berlin Questionnaire, American Society of Anesthesiologists checklist, and STOP-BANG questionnaire) and the Epworth Sleepiness Scale; they also underwent physical examination of the neck, mouth, and airway. The published obstructive sleep apnea in pregnancy prediction score was calculated for each subject. Obstructive sleep apnea status for each subject was determined by the results of an overnight, unattended type III home sleep apnea test. RESULTS Twenty-four percent of pregnant women with extreme obesity had obstructive sleep apnea on home sleep apnea testing in mid pregnancy (Apnea-Hypopnea Index, ≥5 events per hour]. Established obstructive sleep apnea screening tools performed very poorly to screen for obstructive sleep apnea in this cohort. Age, body mass index, neck circumference, frequently witnessed apneas, and highly likely to fall asleep while driving were associated most strongly with obstructive sleep apnea status in this cohort. CONCLUSION We found that 24% of pregnant women with body mass index ≥40 kg/m2 between 24 and 35 weeks gestation have obstructive sleep apnea, defined as Apnea-Hypopnea Index ≥5 events per hour on an overnight type III home sleep apnea test. We found the Berlin Questionnaire, American Society of Anesthesiologists checklist, STOP-BANG, obstructive sleep apnea in pregnancy score by Facco et al, and the Epworth Sleepiness Scale were not useful screening tools for obstructive sleep apnea in a cohort of obese pregnant women. However, age, body mass index, neck circumference, frequently witnessed apneas, and likely to fall asleep while driving were associated with obstructive sleep apnea in this cohort. Further studies are needed to adjust the criteria and thresholds within the available screening tools to better predict obstructive sleep apnea in pregnant women with obesity.
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Abstract
Sleep-disordered breathing (SDB) in pregnancy can present as snoring and/or obstructive sleep apnea (OSA), and the prevalence is increasing due to the increase in maternal obesity. Pregnant women often present with fatigue and daytime sleepiness rather than the classic symptoms. Habitual snoring, older age, chronic hypertension, and high prepregnancy body mass index are reliable indicators of increased risk for SDB and should trigger further testing. The gold standard for diagnosis of OSA is an overnight laboratory polysomnography. Although there are no studies linking SDB to poor fetal outcomes, fetal well-being remains paramount throughout the course of pregnancy.
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Affiliation(s)
- Lakshmy Ayyar
- Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Fidaa Shaib
- Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Kalpalatha Guntupalli
- Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
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Theoretical optimal cricothyroidotomy incision length in female subjects, following identification of the cricothyroid membrane by digital palpation. Int J Obstet Anesth 2018; 36:42-48. [DOI: 10.1016/j.ijoa.2018.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/30/2018] [Accepted: 06/07/2018] [Indexed: 12/17/2022]
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Webb MP, Helander EM, Meyn AR, Flynn T, Urman RD, Kaye AD. Preoperative Assessment of the Pregnant Patient Undergoing Nonobstetric Surgery. Anesthesiol Clin 2018; 36:627-637. [PMID: 30390783 DOI: 10.1016/j.anclin.2018.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The anesthetic management of pregnant patients can present a variety of challenges and a thorough preoperative assessment is necessary before initiating any anesthetic services. Both the mother and the fetus need to be considered when formulating an anesthetic plan and discussing informed consent. The overall aims in assessing a pregnant patient are to identity potential issues that can lead to catastrophic complications, provide adequate information allowing the mother to make informed decisions, and to obtain knowledge for tailoring an anesthetic that maintains maternal and fetal homeostasis.
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Affiliation(s)
- Michael P Webb
- Department of Anesthesiology, North Shore Hospital, 124 Shakespeare Road, Takapuna, Auckland 0620, New Zealand
| | - Erik M Helander
- Department of Anesthesiology, LSU School of Medicine, Room 656, 1542 Tulane Avenue, New Orleans, LA 70112, USA
| | - Ashley R Meyn
- Department of Anesthesiology, Oschner Clinic, 1514 Jefferson Highway, Jefferson, LA 70121, USA
| | - Trevor Flynn
- Department of Anesthesiology, LSU School of Medicine, Room 656, 1542 Tulane Avenue, New Orleans, LA 70112, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital Main Campus, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Alan David Kaye
- Department of Anesthesiology, LSU School of Medicine, Room 656, 1542 Tulane Avenue, New Orleans, LA 70112, USA.
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Padhy S, Jonnavithula N, Ramachandran G. Evaluation of changes in mallampati class in patients undergoing percutaneous nephrolithotomy surgeries in the prone position: A prospective observational study. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2018. [DOI: 10.1016/j.tacc.2018.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Johnson SM, Randhawa KS, Epstein JJ, Gustafson E, Hocker AD, Huxtable AG, Baker TL, Watters JJ. Gestational intermittent hypoxia increases susceptibility to neuroinflammation and alters respiratory motor control in neonatal rats. Respir Physiol Neurobiol 2018; 256:128-142. [PMID: 29174411 PMCID: PMC5963968 DOI: 10.1016/j.resp.2017.11.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/13/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
Abstract
Sleep disordered breathing (SDB) and obstructive sleep apnea (OSA) during pregnancy are growing health concerns because these conditions are associated with adverse outcomes for newborn infants. SDB/OSA during pregnancy exposes the mother and the fetus to intermittent hypoxia. Direct exposure of adults and neonates to IH causes neuroinflammation and neuronal apoptosis, and exposure to IH during gestation (GIH) causes long-term deficits in offspring respiratory function. However, the role of neuroinflammation in CNS respiratory control centers of GIH offspring has not been investigated. Thus, the goal of this hybrid review/research article is to comprehensively review the available literature both in humans and experimental rodent models of SDB in order to highlight key gaps in knowledge. To begin to address some of these gaps, we also include data demonstrating the consequences of GIH on respiratory rhythm generation and neuroinflammation in CNS respiratory control regions. Pregnant rats were exposed to daily intermittent hypoxia during gestation (G10-G21). Neuroinflammation in brainstem and cervical spinal cord was evaluated in P0-P3 pups that were injected with saline or lipopolysaccharide (LPS; 0.1mg/kg, 3h). In CNS respiratory control centers, we found that GIH attenuated the normal CNS immune response to LPS challenge in a gene-, sex-, and CNS region-specific manner. GIH also altered normal respiratory motor responses to LPS in newborn offspring brainstem-spinal cord preparations. These data underscore the need for further study of the long-term consequences of maternal SDB on the relationship between inflammation and the respiratory control system, in both neonatal and adult offspring.
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Affiliation(s)
- Stephen M Johnson
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706, United States.
| | - Karanbir S Randhawa
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Jenna J Epstein
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Ellen Gustafson
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Austin D Hocker
- Department of Human Physiology, University of Oregon, Eugene, OR 97401, United States
| | - Adrianne G Huxtable
- Department of Human Physiology, University of Oregon, Eugene, OR 97401, United States
| | - Tracy L Baker
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Jyoti J Watters
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706, United States
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Ravindra GL, Madamangalam AS, Seetharamaiah S. Anaesthesia for non-obstetric surgery in obstetric patients. Indian J Anaesth 2018; 62:710-716. [PMID: 30237597 PMCID: PMC6144550 DOI: 10.4103/ija.ija_463_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Anaesthesia for pregnant patients presenting for non-obstetric surgery needs a thorough understanding of the physiological changes and altered pharmacokinetics of pregnancy. Considering the effects of surgery and anaesthesia on the foetus, only essential and emergency surgeries are performed during pregnancy. Surgical procedures in second trimester have the advantage of better foetal outcome. The primary concerns of maternal and foetal safety are achieved by a focused multidisciplinary team-based approach with respect to the surgical condition. Meticulous attention to preoperative patient counselling, airway management, haemodynamic stability, and thromboprophylaxis are the key factors in anaesthetic management. Choice of anaesthesia or anaesthetic drugs has minimal impact on the foetus provided utero-placental perfusion and uterine relaxation are maintained. Foetal monitoring when feasible and when done by a trained person enables to diagnose and treat the factors responsible for foetal heart rate variability. Anaesthetic technique needs to be modified according to the type of surgery.
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Affiliation(s)
- GL Ravindra
- Janani Anaesthesia and Critical Care Services, Shimoga, Karnataka, India
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Mir F, McNarry A, Asai T. Role of the Difficult Airway Society in improving airway management. Br J Anaesth 2018; 121:12-15. [DOI: 10.1016/j.bja.2018.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 12/17/2022] Open
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Snoring and markers of fetal and placental wellbeing. Clin Chim Acta 2018; 485:139-143. [PMID: 29958890 DOI: 10.1016/j.cca.2018.06.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/30/2018] [Accepted: 06/25/2018] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Snoring, the symptom of partial airway obstruction during sleep, is a common complaint during pregnancy and is associated with adverse perinatal outcomes. Mechanisms underlying this association have not been studied. We investigated the relationship between snoring in pregnancy and maternal serum markers of feto-placental wellbeing. METHODS We conducted a secondary analysis of a cross sectional study designed to investigate perinatal outcomes of sleep-disordered breathing. Women admitted for delivery were systematically selected and answered a questionnaire about snoring using the Multivariable Apnea Prediction Index. Participants who had screening markers measured were included and divided into snorers and non -snorers. Markers measured included first and second trimester Down syndrome screening markers, reported as multiples of the median (MoM). An additional analysis was performed with snorers categorized as acute or chronic snorers based on duration of snoring in relation to pregnancy. RESULTS While significant differences were noted in co-morbid maternal medical conditions between snorers and non-snorers, there were no significant differences in the neonatal outcomes assessed between the two groups. No significant differences were noted in any of the first trimester (PAPP-A) or second trimester (AFP, uE3, hCG, inhibin-A) markers between snorers and non-snorers, p > 0.25. In addition, no significant differences in marker levels were noted between acute and chronic snorers. CONCLUSION Snoring is not associated with alterations in the markers of fetal or placental wellbeing tested here and suggests that there are alternative mechanisms underlying the association between snoring and adverse perinatal outcomes.
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The Role of the Anesthesiologist in Preventing Severe Maternal Morbidity and Mortality. Clin Obstet Gynecol 2018; 61:372-386. [DOI: 10.1097/grf.0000000000000350] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dominguez JE, Habib AS, Krystal AD. A review of the associations between obstructive sleep apnea and hypertensive disorders of pregnancy and possible mechanisms of disease. Sleep Med Rev 2018; 42:37-46. [PMID: 29929840 DOI: 10.1016/j.smrv.2018.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 12/11/2022]
Abstract
Obesity is prevalent among pregnant women in the United States; 15-20% of obese pregnant women have obstructive sleep apnea. The prevalence of obstructive sleep apnea increases along with body mass index, age and in the presence of other co-morbidities. Untreated obstructive sleep apnea in women is associated with a range of cardiovascular, pulmonary and metabolic co-morbidities; recent studies suggest that women with obstructive sleep apnea in pregnancy may be at significantly greater risk of entering pregnancy with chronic hypertension and/or of developing hypertensive disorders of pregnancy: gestational hypertension; preeclampsia; or eclampsia. This has serious public health implications; hypertensive disorders of pregnancy are a major cause of maternal and neonatal morbidity and mortality and are associated with a greater lifetime risk for cardiovascular disease. The mechanisms that associated obstructive sleep apnea with hypertensive disorders of pregnancy have not been defined, but several pathways are scientifically plausible. In this review, we will present a comprehensive literature review of the following: the associations between obstructive sleep apnea and hypertensive disorders of pregnancy; the proposed mechanisms that may connect obstructive sleep apnea and hypertensive disorders of pregnancy; and the effectiveness of treatment at mitigating these adverse outcomes.
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Affiliation(s)
| | - Ashraf S Habib
- Duke Department of Anesthesiology, Durham, NC, 27710, USA
| | - Andrew D Krystal
- Duke Department of Psychiatry and Behavioral Sciences, Durham, NC 27710, USA; University of California, San Francisco Department of Psychiatry, San Francisco, CA 94143, USA
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Raza D, Ismail S. Change in Mallampati class during labor: Hypertensive versus normotensive parturients. Acta Anaesthesiol Scand 2018; 62:1086-1091. [PMID: 29790158 DOI: 10.1111/aas.13153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/22/2018] [Accepted: 04/15/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mallampati class has been shown to increase during labor. There are no prospective studies evaluating airway changes in hypertensive parturients during labor. The aim of our study was to observe the frequency of change in Mallampati class during labor in hypertensive compared to normotensive parturients. METHODS In this prospective observational cohort study, 60 parturients were enrolled and divided into two groups of 30 each: hypertensive parturients and normotensive parturients. The Mallampati class was evaluated in each parturient at two points; during early labor (cervical dilation 1-3 cm and regular contractions) taken as T1 and at 20 minutes after delivery taken as T2. The change in Mallampati class from T1 to T2 was compared between the two groups. Post-stratification chi-square test was applied and P value <.05 was considered as significant. RESULTS The change in Mallampati class was significantly more frequent in hypertensive group as compared to normotensive group [80% (24/30) vs 46.7% (14/30); P = .002]. Overall, an increase in Mallampati class during labor was found with statistically significant difference between the hypertensive and normotensive group [80% (24/30) vs 42.9% (12/28); P = .004]. The risk of increase in Mallampati class was 2 times higher in hypertensive women as compared to normotensive 2.44; 95% CI: 1.19 to 5.02]. CONCLUSION Mallampati class showed 2-fold increase in hypertensive compared to normotensive parturients during labor; requiring additional caution during airway management.
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Affiliation(s)
- D Raza
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
| | - S Ismail
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
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46
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Oliveira KD, Abdel-Razeq SS. Physiology of Pregnancy. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0134-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Kristensen M, Teoh W. Front of neck: continued discovery of this anatomy essential for airway management. Br J Anaesth 2018; 120:895-898. [DOI: 10.1016/j.bja.2018.02.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 02/12/2018] [Accepted: 02/14/2018] [Indexed: 12/20/2022] Open
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Belin O, Espitalier F, Remerand F, Perrotin F, Laffon M. Transverse subglottic diameter assessment in the third gestation trimester: Preeclampsia versus control. Anaesth Crit Care Pain Med 2018; 38:81-82. [PMID: 29627430 DOI: 10.1016/j.accpm.2018.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/16/2018] [Accepted: 03/11/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Olivier Belin
- Anaesthesiology and Critical Care Department, CHRU de Tours, 37000 Tours, France
| | - Fabien Espitalier
- Anaesthesiology and Critical Care Department, CHRU de Tours, 37000 Tours, France
| | - Francis Remerand
- Anaesthesiology and Critical Care Department, CHRU de Tours, 37000 Tours, France; Medical University, François Rabelais University, 37000 Tours, France
| | - Franck Perrotin
- Obstetric and Gynaecology Department, CHRU de Tours, 37000 Tours, France; Medical University, François Rabelais University, 37000 Tours, France
| | - Marc Laffon
- Anaesthesiology and Critical Care Department, CHRU de Tours, 37000 Tours, France; Medical University, François Rabelais University, 37000 Tours, France.
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Pamidi S, Kimoff RJ. Maternal Sleep-Disordered Breathing. Chest 2018; 153:1052-1066. [DOI: 10.1016/j.chest.2017.10.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 01/11/2023] Open
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Ahuja P, Jain D, Bhardwaj N, Jain K, Gainder S, Kang M. Airway changes following labor and delivery in preeclamptic parturients: a prospective case control study. Int J Obstet Anesth 2018; 33:17-22. [DOI: 10.1016/j.ijoa.2017.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 10/24/2017] [Accepted: 10/26/2017] [Indexed: 11/30/2022]
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