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Nichols W, Nicholls J, Bill V, Shelton C. Temperature changes of CoolSticks during simulated use. Int J Obstet Anesth 2023; 55:103890. [PMID: 37169662 DOI: 10.1016/j.ijoa.2023.103890] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/13/2023] [Accepted: 04/12/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Cold sensation is often used to check neuraxial anaesthesia and analgesia. One opportunity to reduce the carbon footprint of anaesthesia is to replace vapo-coolant sprays such as ethyl chloride with a reusable device called the CoolStick, which is cooled in a refrigerator between uses. We designed a study to investigate how long the CoolStick remains at its working temperature, which we defined as <15 °C. METHOD Experiments were undertaken using a thermocouple and digital temperature sensor attached to the CoolStick. We conducted two experiments to assess temperature changes following removal from the refrigerator for 10 min; the first investigated passive re-warming in the ambient theatre environment and the second investigated re-warming in simulated use. In our third experiment, we investigated the time taken to cool the device in the refrigerator, following use. Each experiment was repeated three times. RESULTS In the passive re-warming experiment, the mean CoolStick temperature was 7.3 °C at the start, and 14.3 °C after 10 min. In the simulated use experiment, the mean CoolStick temperature was 7.3 °C at the start, and 18.9 °C at 10 min. In the cooling experiment, the mean CoolStick temperature was 15 °C at the start and 7.6 °C at 40 min. CONCLUSION Our study indicates that it is feasible to use the CoolStick for providing cold sensation in clinical practice. Further study would be required to directly compare the effectiveness of the device to existing methods such as coolant sprays or ice in the clinical setting.
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Affiliation(s)
- W Nichols
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - J Nicholls
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - V Bill
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - C Shelton
- Department of Anaesthesia, Wythenshawe Hospital, Manchester, UK; Lancaster Medical School, Lancaster University, Lancaster, UK.
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Neuraxial and general anaesthesia for caesarean section. Best Pract Res Clin Anaesthesiol 2022; 36:53-68. [PMID: 35659960 DOI: 10.1016/j.bpa.2022.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/16/2022] [Accepted: 04/25/2022] [Indexed: 11/20/2022]
Abstract
Caesarean section (CS) is one of the most performed operations worldwide. In many parts of the world, there has been a reduction in anaesthetic associated obstetric mortality, and this has been attributed to the increased use of neuraxial anaesthesia and improved safety of general anaesthesia, alongside improved training and organisational changes. In resource-limited countries, anaesthesia contributes disproportionately to maternal mortality, with one in seven deaths being due to anaesthesia. A major contributory factor to this is the severe shortage of trained anaesthetic providers. Goals for anaesthesia for CS include the woman's comfort and foetal well-being, focusing on strategies to minimise morbidity and mortality for both. Anaesthetic options for CS include neuraxial techniques (spinal or combined-spinal epidural or epidural extension of labour analgesia) and general anaesthesia. There is increasing evidence of the benefit of neuraxial techniques over general anaesthesia in terms of maternal and foetal outcomes. For elective CS, spinal and combined-spinal anaesthesia predominate. General anaesthesia is mainly reserved for Category 1 CS where there is an immediate threat to the life of the mother or the baby. This review discusses the practical aspects of neuraxial and general anaesthesia for CS.
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Patankar P, Mandour Y. Rapid sequence spinal anaesthesia: a technique reborn during the COVID-19 pandemic. Br J Hosp Med (Lond) 2021; 82:1-2. [PMID: 34726949 DOI: 10.12968/hmed.2021.0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
With the wish to reduce aerosol generation and the shorter time to anaesthetic readiness, this article discusses why rapid sequence spinal anaesthesia could be used in preference to general anaesthesia, for the benefit of both patients and staff during the COVID-19 pandemic.
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Affiliation(s)
- Pushkar Patankar
- Department of Anaesthesia, University College Hospital, London, UK
| | - Yasser Mandour
- Department of Anaesthesia, University College Hospital, London, UK
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Bhatia K, Columb M, Bewlay A, Tageldin N, Knapp C, Qamar Y, Dooley A, Kamath P, Hulgur M. Decision-to-delivery interval and neonatal outcomes for category-1 caesarean sections during the COVID-19 pandemic. Anaesthesia 2021; 76:1051-1059. [PMID: 33891311 PMCID: PMC8251307 DOI: 10.1111/anae.15489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 01/29/2023]
Abstract
General anaesthesia is known to achieve the shortest decision‐to‐delivery interval for category‐1 caesarean section. We investigated whether the COVID‐19 pandemic affected the decision‐to delivery interval and influenced neonatal outcomes in patients who underwent category‐1 caesarean section. Records of 562 patients who underwent emergency caesarean section between 1 April 2019 and 1 July 2019 in seven UK hospitals (pre‐COVID‐19 group) were compared with 577 emergency caesarean sections performed during the same period during the COVID‐19 pandemic (1 April 2020–1 July 2020) (post‐COVID‐19 group). Primary outcome measures were: decision‐to‐delivery interval; number of caesarean sections achieving decision‐to‐delivery interval < 30 min; and a composite of adverse neonatal outcomes (Apgar 5‐min score < 7, umbilical arterial pH < 7.10, neonatal intensive care unit admission and stillbirth). The use of general anaesthesia decreased significantly between the pre‐ and post‐COVID‐19 groups (risk ratio 0.48 (95%CI 0.37–0.62); p < 0.0001). Compared with the pre‐COVID‐19 group, the post‐COVID‐19 group had an increase in median (IQR [range]) decision‐to‐delivery interval (26 (18–32 [4–124]) min vs. 27 (20–33 [3–102]) min; p = 0.043) and a decrease in the number of caesarean sections meeting the decision‐to‐delivery interval target of < 30 min (374/562 (66.5%) vs. 349/577 (60.5%); p = 0.02). The incidence of adverse neonatal outcomes was similar in the pre‐ and post‐COVID‐19 groups (140/568 (24.6%) vs. 140/583 (24.0%), respectively; p = 0.85). The small increase in decision‐to‐delivery interval observed during the COVID‐19 pandemic did not adversely affect neonatal outcomes.
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Affiliation(s)
- K Bhatia
- Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK.,Manchester Medical School, University of Manchester, Manchester, UK
| | - M Columb
- Department of Anaesthesia, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK.,Department of Intensive Care Medicine, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - A Bewlay
- Department of Anaesthesia, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - N Tageldin
- Department of Anaesthesia and Peri-operative Medicine, Saint Mary's Hospital, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - C Knapp
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - Y Qamar
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - A Dooley
- Department of Anaesthesia, Liverpool Women's Hospital, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - P Kamath
- Department of Anaesthesia, Royal Bolton Hospital, Bolton NHS Foundation Trust, Bolton, UK
| | - M Hulgur
- Department of Anaesthesia, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh NHS Hospital Foundation Trust, Wigan, UK
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Russell R, Lucas DN. The effect of COVID-19 disease on general anaesthesia rates for caesarean section. Anaesthesia 2020; 76 Suppl 3:24. [PMID: 33300126 DOI: 10.1111/anae.15346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 01/24/2023]
Affiliation(s)
- R Russell
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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6
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Varandas JS, Dias R, Mendes AB, Lages N, Machado H. New indication for an old anesthetic technique: could we consider now rapid sequence spinal anesthesia in a COVID-19 time? Reg Anesth Pain Med 2020; 46:191. [PMID: 32381730 PMCID: PMC7239652 DOI: 10.1136/rapm-2020-101572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Joana Santos Varandas
- Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Raquel Dias
- Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Angela Barbosa Mendes
- Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Neusa Lages
- Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Humberto Machado
- Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Bidon C, Desgranges FP, Riegel AC, Allaouchiche B, Chassard D, Bouvet L. Retrospective cohort study of decision-to-delivery interval and neonatal outcomes according to the type of anaesthesia for code-red emergency caesarean sections in a tertiary care obstetric unit in France. Anaesth Crit Care Pain Med 2019; 38:623-630. [DOI: 10.1016/j.accpm.2019.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/09/2019] [Accepted: 05/11/2019] [Indexed: 10/26/2022]
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Abstract
As major stakeholders in the labor and delivery suite, obstetric anesthesiologists are frequently called upon to provide their unique skill sets and expertise to the management of postpartum hemorrhage, whether anticipated or not. Essential contributions of the anesthesia team ideally begin in the antenatal period with referral of women at high risk of postpartum hemorrhage to an outpatient obstetric anesthesia clinic where a tailored plan for both urgent or scheduled delivery for women with an anticipated complex delivery can be formulated. Maternal safety can be greatly improved if comorbidities are identified early and strategies to address these issues are proposed and known by the obstetric anesthesia team. Participation of the obstetric anesthesiology team is crucial in the development of systematic approaches that are customized to each institution and should comprise the creation and dissemination of algorithms and guidelines that are anesthesia specific, including detailed protocols for the labor and delivery unit and operating rooms, at large. Because management of postpartum hemorrhage requires a coordinated team effort, and may not always be planned, the anesthesia team should be prepared at all times to provide the appropriate anesthetic management and advanced cardiovascular support. The involvement of the anesthesia team should not only be limited to the immediate intrapartum period, but should also extend to the postpartum period where adequate anesthetic/analgesic plans will enhance maternal safety and recovery.
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Affiliation(s)
- Laurence Ring
- Department of Anesthesiology, Columbia University Medical Center, Columbia University College of Physicians and Surgeons, 630 West 168th St PH-5, New York, NY 10032, United States
| | - Ruth Landau
- Department of Anesthesiology, Columbia University Medical Center, Columbia University College of Physicians and Surgeons, 630 West 168th St PH-5, New York, NY 10032, United States.
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Abstract
PURPOSE OF REVIEW Simulation training in obstetric anesthesia has become widespread in recent years. Simulations are used to train staff and trainees, assess and improve team performance, and evaluate the work environment. This review summarizes current research in these categories. RECENT FINDINGS Simulation to improve individual technical skills has focused on induction of general anesthesia for emergent cesarean delivery, an infrequently encountered scenario by anesthesia trainees. Low- and high-fidelity simulation devices for the learning and practicing neuraxial and non-neuraxial procedures have been described, and both are equally effective. The use of checklists in obstetric emergencies has become common as and post-scenario debriefing techniques have improved. Although participant task performance improves, whether participants retain learned skills or whether simulation improves patient outcomes has not yet been established. Tools to assess teamwork during simulation have been developed, but none have been rigorously validated. In-situ vs. offsite simulations do not differ in effectiveness. SUMMARY Simulation allows for practice of tasks and teamwork in a controlled manner. There is little data whether simulation improves patient outcomes and metrics to predict the long-term retention of skills by simulation participants have not been developed.
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Palmer E, Ciechanowicz S, Reeve A, Harris S, Wong DJN, Sultan P. Operating room-to-incision interval and neonatal outcome in emergency caesarean section: a retrospective 5-year cohort study. Anaesthesia 2018; 73:825-831. [DOI: 10.1111/anae.14296] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2018] [Indexed: 11/29/2022]
Affiliation(s)
- E. Palmer
- Department of Anaesthesia; University College London Hospital; London UK
- Division of Medicine; University College London; London UK
| | - S. Ciechanowicz
- Department of Anaesthesia; University College London Hospital; London UK
| | - A. Reeve
- Department of Anaesthesia; University College London Hospital; London UK
| | - S. Harris
- Department of Anaesthesia; University College London Hospital; London UK
- Division of Medicine; University College London; London UK
| | - D. J. N. Wong
- Surgical Outcomes Research Centre; University College London / University College London Hospital; London UK
| | - P. Sultan
- Department of Anaesthesia; University College London Hospital; London UK
- Division of Medicine; University College London; London UK
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Butwick A, Palanisamy A. Mode of anaesthesia for Caesarean delivery and maternal morbidity: can we overcome confounding by indication? Br J Anaesth 2018; 120:621-623. [DOI: 10.1016/j.bja.2018.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 01/02/2018] [Indexed: 10/18/2022] Open
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13
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Polin CM, Hambright AA, McConville PO. Anesthesia for Cesarean Delivery. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_51] [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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Abstract
Labor causes severe pain for many women. There is no other circumstance in which it is considered acceptable for an individual to experience untreated severe pain that is amenable to safe intervention while the individual is under a physician's care. Many women desire pain management during labor and delivery, and there are many medical indications for analgesia and anesthesia during labor and delivery. In the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor. A woman who requests epidural analgesia during labor should not be deprived of this service based on the status of her health insurance. Third-party payers that provide reimbursement for obstetric services should not deny reimbursement for labor analgesia because of an absence of "other medical indications." Anesthesia services should be available to provide labor analgesia and surgical anesthesia in all hospitals that offer maternal care (levels I-IV) (). Although the availability of different methods of labor analgesia will vary from hospital to hospital, the methods available within an institution should not be based on a patient's ability to pay.The American College of Obstetricians and Gynecologists believes that in order to allow the maximum number of patients to benefit from neuraxial analgesia, labor nurses should not be restricted from participating in the management of pain relief during labor. Under appropriate physician supervision, labor and delivery nursing personnel who have been educated properly and have demonstrated current competence should be able to participate in the management of epidural infusions.The purpose of this document is to review medical options for analgesia during labor and anesthesia for surgical procedures that are common at the time of delivery. Nonpharmacologic options such as massage, immersion in water during the first stage of labor, acupuncture, relaxation, and hypnotherapy are not covered in this document, though they may be useful as adjuncts or alternatives in many cases.
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15
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Krom AJ, Cohen Y, Miller JP, Ezri T, Halpern SH, Ginosar Y. Choice of anaesthesia for category-1 caesarean section in women with anticipated difficult tracheal intubation: the use of decision analysis. Anaesthesia 2016; 72:156-171. [DOI: 10.1111/anae.13729] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 12/29/2022]
Affiliation(s)
- A. J. Krom
- Department of Anesthesiology; Hadassah Hebrew University Medical Center; Jerusalem Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Y. Cohen
- Post-Anesthesia Care Unit; Department of Anesthesiology; Chaim Sheba Medical Center; Tel-Hashomer Ramat-Gan Israel
| | - J. P. Miller
- Washington University School of Medicine; St Louis MO USA
| | - T. Ezri
- Department of Anesthesia; Wolfson Medical Center; Holon Israel
- Outcomes Research Consortium; Cleveland OH USA
| | - S. H. Halpern
- Department of Anesthesia; Sunnybrook Health Sciences Centre; University of Toronto; Toronto Canada
| | - Y. Ginosar
- Department of Anesthesiology and Director; Mother and Child Anesthesia Unit; Hadassah Hebrew University Hospital; Jerusalem Israel
- Department of Anesthesiology and Director; Division of Obstetric Anesthesiology; Washington University School of Medicine; St Louis MO USA
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Dunn CN, Zhang Q, Sia JT, Assam PN, Tagore S, Sng BL. Evaluation of timings and outcomes in category-one caesarean sections: A retrospective cohort study. Indian J Anaesth 2016; 60:546-51. [PMID: 27601736 PMCID: PMC4989804 DOI: 10.4103/0019-5049.187782] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background and Aims: A decision-to-delivery interval (DDI) of 30 min for category-one caesarean section (CS) deliveries is the standard of practice recommended by clinical guidelines. Our institution established a protocol for category-one (‘crash’) CS to expedite deliveries. The aim of this study is to evaluate DDI, factors that affect DDI and the mode of anaesthesia for category-one CS. Methods: This retrospective cohort study evaluated 390 women who underwent category-one CS in a tertiary obstetric centre. We analysed the factors associated with DDI, mode of anaesthesia and perinatal outcomes. Summary statistics were performed for the outcomes. The association factors were considered significant at P < 0.05. Results: The mean (standard deviation) DDI was 9.4 (3.2) min with all deliveries achieved within 30 min. The longest factor in the DDI was time taken to transfer patients. A shorter DDI was not significantly associated with improved perinatal outcomes. The majority (88.9%) of women had general anaesthesia (GA) for category-one CS. Of those who had an epidural catheter already in situ (34.4%), 25.6% had successful epidural extension. GA was associated with shorter DDI, but worse perinatal outcomes than regional anaesthesia (RA). Conclusions: Our ‘crash’ CS protocol achieved 100% of deliveries within 30 min. The majority (88.9%) of the patients had GA for category-one CS. GA was found to be associated with shorter anaesthesia and operation times, but poorer perinatal outcomes compared to RA.
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Affiliation(s)
- Clare Newton Dunn
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - Qianpian Zhang
- Sing Health Anaesthesiology Residency Programme, Singapore Health Services, Singapore
| | - Josh Tjunrong Sia
- International Bacclaureate Diploma Programme, Anglo-Chinese School (Independent), Singapore
| | - Pryseley Nkouibert Assam
- Centre for Quantitative Medicine, Duke NUS Graduate Medical School, Singapore; Department of Biostatistics, Singapore Clinical Research Institute, Singapore
| | - Shephali Tagore
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Ban Leong Sng
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore; Anaesthesiology Program, Duke-NUS Graduate Medical School, Singapore
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Butwick AJ, El-Sayed YY, Blumenfeld YJ, Osmundson SS, Weiniger CF. Mode of anaesthesia for preterm Caesarean delivery: secondary analysis from the Maternal-Fetal Medicine Units Network Caesarean Registry. Br J Anaesth 2015; 115:267-74. [PMID: 25956901 DOI: 10.1093/bja/aev108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Preterm delivery is often performed by Caesarean section. We investigated modes of anaesthesia and risk factors for general anaesthesia among women undergoing preterm Caesarean delivery. METHODS Women undergoing Caesarean delivery between 24(+0) and 36(+6) weeks' gestation were identified from a multicentre US registry. The mode of anaesthesia was classified as neuraxial anaesthesia (spinal, epidural, or combined spinal and epidural) or general anaesthesia. Logistic regression was used to identify patient characteristic, obstetric, and peripartum risk factors associated with general anaesthesia. RESULTS Within the study cohort, 11 539 women had preterm Caesarean delivery; 9510 (82.4%) underwent neuraxial anaesthesia and 2029 (17.6%) general anaesthesia. In our multivariate model, African-American race [adjusted odds ratio (aOR)=1.9; 95% confidence interval (CI)=1.7-2.2], Hispanic ethnicity (aOR=1.5; 95% CI=1.2-1.8), other race (aOR=1.4; 95% CI=1.1-1.9), and haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome or eclampsia (aOR=2.8; 95% CI=2.2-3.5) were independently associated with receiving general anaesthesia for preterm Caesarean delivery. Women with an emergency Caesarean delivery indication had the highest odds for general anaesthesia (aOR=3.5; 95% CI=3.1-3.9). For every 1 week decrease in gestational age at delivery, the adjusted odds of general anaesthesia increased by 13%. CONCLUSIONS In our study cohort, nearly one in five women received general anaesthesia for preterm Caesarean delivery. Although potential confounding by unmeasured factors cannot be excluded, our findings suggest that early gestational age at delivery, emergent Caesarean delivery indications, hypertensive disease, and non-Caucasian race or ethnicity are associated with general anaesthesia for preterm Caesarean delivery.
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Affiliation(s)
- A J Butwick
- Department of Anaesthesia, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Y Y El-Sayed
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Y J Blumenfeld
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - S S Osmundson
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - C F Weiniger
- Department of Anaesthesia, Stanford University School of Medicine, Stanford, CA 94305, USA Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Heinrich S, Irouschek A, Prottengeier J, Ackermann A, Schmidt J. Adverse airway events in parturient compared with non-parturient patients. Is there a difference? Results from a quality management project. J Obstet Gynaecol Res 2015; 41:1032-9. [PMID: 25772267 DOI: 10.1111/jog.12677] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 12/18/2014] [Indexed: 11/30/2022]
Abstract
AIM The fear of airway problems often leads to prolonged attempts to obtain neuroaxial (spinal anesthesia or epidural anesthesia) anesthesia in obstetric anesthesia. The aim of this institutional quality management study was to revisit existing anesthesia care in the obstetric department, focusing on the frequency of delayed or failed neuroaxial anesthesia as well as the risk of airway problems in parturient and non-obstetric patients. METHODS The clinical records from 8 consecutive years (2005-2013) were analyzed retrospectively. Cases of cesarean delivery with general anesthesia were analyzed and compared with an age-matched group of female patients undergoing non-obstetric abdominal or gynecological surgery with rapid sequence induction. Poor laryngeal visualization (Cormack-Lehane grade III or IV) and failed intubation were recorded. RESULTS The records of 6393 cesarean deliveries including 851 with general anesthesia were analyzed. In 175 cases insufficient or delayed onset of regional anesthesia led to requirement for general anesthesia. The rate of poor laryngoscopic view in parturient women undergoing cesarean delivery was 14/851, and 4/814 in the reference group (P = 0.023). Failed intubation occurred in three patients undergoing cesarean delivery (0.4%) and in one non-obstetric patient (0.1%; P = 0.339). CONCLUSION The rate of failed intubations in patients undergoing cesarean delivery may be equivalent to non-obstetric patients. In time-challenging cesarean deliveries, delay of conversion from non-successful neuroaxial anesthesia to general anesthesia in order to avoid adverse airway events does not appear to be justified.
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Affiliation(s)
- Sebastian Heinrich
- Department of Anesthesia, University Hospital Erlangen, Erlangen, Germany
| | - Andrea Irouschek
- Department of Anesthesia, University Hospital Erlangen, Erlangen, Germany
| | | | - Andreas Ackermann
- Department of Anesthesia, University Hospital Erlangen, Erlangen, Germany
| | - Joachim Schmidt
- Department of Anesthesia, University Hospital Erlangen, Erlangen, Germany
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Pulmonary embolism in the setting of HELLP syndrome. Int J Obstet Anesth 2015; 24:184-90. [PMID: 25794414 DOI: 10.1016/j.ijoa.2015.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 01/12/2015] [Accepted: 01/20/2015] [Indexed: 12/17/2022]
Abstract
HELLP syndrome (hemolysis, elevated liver enzymes and low platelets) complicates 0.5-0.9% of pregnancies and is frequently associated with multiorgan dysfunction. Treatment relies on prompt diagnosis, delivery and supportive care. The clinical presentation may make the concurrent diagnosis and management of other disease entities challenging. This case report describes a patient with postpartum HELLP syndrome complicated by severe multiorgan dysfunction and pulmonary embolism.
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Jigajinni SV, Rajala B, El Sharawi N. The rapid sequence spinal for category 1 caesarean section: anaesthetic trainee knowledge and practice. J Perioper Pract 2015; 25:24-26. [PMID: 26016261 DOI: 10.1177/1750458915025001-205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Rapid sequence induction of general anaesthesia (GA) is the fastest anaesthetic technique in a category-1 caesarean section (C1CS) for foetal distress. Recently rapid sequence spinal anaesthesia (RSS) has been explored as a technique to avoid the potential risks of GA in such cases. Out of hours, trainee anaesthetists are often required to provide anaesthesia for these emergencies. We surveyed their practices when performing a RSS. The aim of a RSS is to rapidly and safely achieve anaesthesia for C1CS, while optimising foetal oxygenation and preparing for possible GA. It requires anaesthetic skill, team work and communication. Many trainees understood the principles of the RSS, however, a significant number did not. Practice varied widely and no trainee had received any formal RSS training. Training for junior anaesthetists and those working in obstetric theatres, in the conduct of the RSS is crucial, to ensure safe practice, avoid delays in delivery and safely avoid the risks associated with GA in the C1CS.
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Zhang Q, Dunn CN, Sia JT, Sng BL. Category one caesarean section: A team-based approach. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2014. [DOI: 10.1016/j.tacc.2014.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Effects of a head elevated ramped position during elective caesarean delivery after combined spinal-epidural anaesthesia. Int J Obstet Anesth 2014; 23:106-12. [DOI: 10.1016/j.ijoa.2014.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 11/28/2013] [Accepted: 01/15/2014] [Indexed: 11/23/2022]
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Buettner AU. Speed of onset of spinal vs general anaesthesia for caesarean section. Anaesthesia 2013; 68:1203. [PMID: 24128033 DOI: 10.1111/anae.12468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chikkabbaiah V, McCahon R. Speed of spinal vs general anaesthesia. Anaesthesia 2013; 68:976-7. [PMID: 24047359 DOI: 10.1111/anae.12401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- V Chikkabbaiah
- Nottingham University Hospitals NHS Trust, Nottingham, UK.
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