1
|
Foster M, Etchin A, Pope C, Hartmann CW, Emidio O, Bosworth HB. The Impact of COVID-19 on Hypertension and Hypertension Medication Adherence Among Underrepresented Racial and Ethnic Groups: A Scoping Review. Curr Hypertens Rep 2023; 25:385-394. [PMID: 37624472 DOI: 10.1007/s11906-023-01262-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE OF REVIEW To conduct a scoping review of articles which examined the impact of COVID-19 on HTN and HTN medication adherence among underrepresented racial/ethnic minorities. RECENT FINDINGS Seven studies were included in this review and impact of COVID-19 was examined at 4 levels: patient, provider, health system and society. The results indicated that patient level factors, such as high unemployment and inequitable access to telemedicine due to society factors- lack of access to high-speed Internet and variation in the offering of telehealth by health systems, were most impactful on adherence. Additionally, provider level clinical inertia may have further impacted adherence to HTN medication. Our review showed that the COVID-19 pandemic did not introduce new barriers but exacerbated preexisting barriers. Ongoing efforts are needed to change policies at the state and local levels to dismantle inequities in underrepresented communities to ensure access to health care with telemedicine to promote health equity.
Collapse
Affiliation(s)
- Marva Foster
- Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, USA.
- Boston University Chobanian & Avedisian School of Medicine, Department of General Internal Medicine, Boston, MA, USA.
- VA Boston Healthcare System, Department of Quality Management, 150 S. Huntington Ave., 02130, Boston, MA, USA.
| | - Anna Etchin
- VA Boston Healthcare System, Department of Quality Management, 150 S. Huntington Ave., 02130, Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Department of Psychiatry, Boston, MA, USA
| | - Charlene Pope
- Health Equity & Rural Outreach Innovation Center (HEROIC)/COIN, Ralph H. Johnson VA Health Care System, Charleston, SC, USA
- Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Christine W Hartmann
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, MA, USA
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Oluwabunmi Emidio
- Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, USA
| | - Hayden B Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Medical Center, Durham, NC, USA
- Duke University School of Medicine, Department of Population Health Sciences, Durham, NC, USA
- Duke University School of Medicine, Department of Medicine, Division of General Internal Medicine, Durham, NC, USA
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA
- Duke University Medical Center, School of Nursing, Durham, NC, USA
| |
Collapse
|
2
|
Moye J, Bashian H, Heintz H, Daks J, Baird L, Kaiser AP, O'Malley K, Etchin A. ADDRESSING TRAUMA IN OLDER VETERANS IN HOME-BASED PRIMARY CARE. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
As Veterans age, confronting illness and role changes, they may experience later adulthood trauma reengagement (LATR). To better understand this process in medically ill Veterans, we completed six focus groups with 21 VA Home Based Primary Care (HBPC) mental health clinicians in rural and urban settings; 14 completed a follow-up survey. Thematic analysis of focus groups confirmed the LATR model with unique presentation and treatment challenges related to medical, physical, and cognitive changes. In surveys, the most challenging symptoms were: intrusive symptoms, dissociative reactions, and psychological/physiological reactivity (79%). In addition to focus group themes, surveys described challenges related limited social engagement, Veteran ambivalence, and lack of empirically supported treatments appropriate to HBPC. Results of these focus group and survey data provide key insights into the unique presentation of trauma in aging medically ill Veterans. Ongoing efforts to adapt materials and resources for this population will be described.
Collapse
Affiliation(s)
- Jennifer Moye
- VA Boston Healthcare System , Boston, Massachusetts , United States
| | | | - Hannah Heintz
- VA Boston Healthcare System , Jamaica Plain, Massachusetts , United States
| | - Jennifer Daks
- VA Boston Healthcare System , Jamaica Plain, Massachusetts , United States
| | - Lola Baird
- Boston VA Medical Center , Jamaica Plain, Massachusetts , United States
| | | | - Kelly O'Malley
- VA Boston Healthcare System , Boston, Massachusetts , United States
| | - Anna Etchin
- VA Boston Medical Center , Jamaica Plain, Massachusetts , United States
| |
Collapse
|
3
|
Weiskittle R, Baird L, Bashian H, Kaiser AP, O'Malley K, Etchin A, Moye J. ADVANCING LATE-LIFE TRAUMA-INFORMED CARE EDUCATION: DEVELOPMENT AND EVALUATION OF AN EDUCATIONAL PODCAST. Innov Aging 2022. [PMCID: PMC9766801 DOI: 10.1093/geroni/igac059.1982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) may emerge or reemerge in the context of life-threatening illness, retirement, and life review, leading to complications in disease management and end-of-life care. Symptoms of PTSD in later life can be misattributed or overlooked by healthcare professionals, caregivers, and the older adults experiencing PTSD themselves. The “Talking Later” podcast was developed as an accessible educational product to improve recognition and trauma-informed responses to late-life PTSD. Each of the ten episodes had distinct goals and content objectives, which were identified through problem identification and needs assessment by a multidisciplinary team of geriatric clinicians. In the first three months of its publication in November 2021, the podcast has been downloaded by 1,473 unique listeners across 19 countries. The podcast was evaluated via feedback survey (N=39). Approximately 97% of respondents reported the episodes as engaging and informational. 87% stated that no more than general knowledge of PTSD was required to enjoy the podcast. Qualitative analysis of open-ended feedback items found that participants were interested in learning about additional comorbidities and diversity issues related to late-life trauma reengagement. The present poster will additionally describe ongoing efforts to address these and other feedback responses with the ongoing development of a second season of the podcast.
Collapse
Affiliation(s)
- Rachel Weiskittle
- University of Colorado Colorado Springs, Colorado Springs, Colorado, United States
| | - Lola Baird
- Boston VA Medical Center, Jamaica Plain, Massachusetts, United States
| | | | | | - Kelly O'Malley
- VA Boston Healthcare System, Boston, Massachusetts, United States
| | - Anna Etchin
- VA Boston Medical Center, Jamaica Plain, Massachusetts, United States
| | - Jennifer Moye
- VA Boston Healthcare System, Boston, Massachusetts, United States
| |
Collapse
|
4
|
Fix GM, Reisinger HS, Etchin A, McDannold S, Eagan A, Findley K, Gifford AL, Gupta K, McInnes DK. Health care workers' perceptions and reported use of respiratory protective equipment: A qualitative analysis. Am J Infect Control 2019; 47:1162-1166. [PMID: 31182235 PMCID: PMC7115305 DOI: 10.1016/j.ajic.2019.04.174] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/21/2019] [Accepted: 04/22/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Little is known about health care workers' (HCW) perceptions of, or experiences using, respiratory protective equipment (RPE). We sought to characterize their perceptions and identify reasons underlying inappropriate use. METHODS We conducted 12 focus groups with nurses and nursing assistants at 4 medical centers. We analyzed the thematic content of 73 discrete "stories" told by focus group participants. RESULTS We identified 5 story types surrounding RPE use: 1) policies are known and seen during work routines; 2) during protocol lapses, use is reinforced through social norms; 3) clinical experiences sometimes supersede protocol adherence; 4) when risk perception is high, we found concern regarding accessing RPE; and 5) HCWs in emergency departments were viewed as not following protocol because risk was ever-present. DISCUSSION HCWs were aware of the importance of RPE and protocols for using it, and these supported use when protocol lapses occurred. However, protocol adherence was undermined by clinical experience, perceived risk, and the distinct context of the emergency department where patients continually arrive with incomplete or delayed diagnoses. CONCLUSIONS Protocols, visual cues, and social norms contribute to a culture of safety. This culture can be undermined when HCWs experience diagnostic uncertainty or they mistrust the protocol and instead rely on their clinical experiences.
Collapse
Affiliation(s)
- Gemmae M Fix
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VA Hospital, Bedford, MA; Boston University School of Public Health, Boston, MA.
| | - Heather Schacht Reisinger
- Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA; University of Iowa Carver College of Medicine, Iowa City, IA
| | - Anna Etchin
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VA Hospital, Bedford, MA; Center for Healthcare Organization and Implementation Research (CHOIR), Boston University School of Medicine, VA Boston Healthcare System, Boston, MA
| | - Sarah McDannold
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VA Hospital, Bedford, MA
| | - Aaron Eagan
- VHA Office of Public Health, National Center for Occupational Health and Infection Control, Gainesville, FL
| | - Kimberly Findley
- VHA Office of Public Health, National Center for Occupational Health and Infection Control, Gainesville, FL
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research (CHOIR), Boston University School of Medicine, VA Boston Healthcare System, Boston, MA; Boston University School of Public Health, Boston, MA
| | - Kalpana Gupta
- Center for Healthcare Organization and Implementation Research (CHOIR), Boston University School of Medicine, VA Boston Healthcare System, Boston, MA
| | - D Keith McInnes
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VA Hospital, Bedford, MA; Center for Healthcare Organization and Implementation Research (CHOIR), Boston University School of Medicine, VA Boston Healthcare System, Boston, MA; Boston University School of Public Health, Boston, MA
| |
Collapse
|
5
|
Goldenberg M, Cohen SB, Etchin A, Mashiach S, Seidman DS. A randomized prospective comparative study of general versus epidural anesthesia for transcervical hysteroscopic endometrial resection. Am J Obstet Gynecol 2001; 184:273-6. [PMID: 11228472 DOI: 10.1067/mob.2001.108997] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was undertaken to compare general versus epidural anesthesia during hysteroscopic endometrial resection for dysfunctional uterine bleeding. STUDY DESIGN In a prospective comparative study, 24 women with abnormal uterine bleeding that was unresponsive to conservative medical management were randomly assigned to undergo hysteroscopic endometrial resection with either general or epidural anesthesia. RESULTS The durations of the endometrial resection procedure were similar for women who had general and epidural anesthesia (28.3 +/- 4.2 minutes vs 27.5 +/- 5.4 minutes, respectively). However, there was a statistically significantly lower absorption of distention fluid in women who underwent the procedure with general rather than epidural anesthesia (380.8 +/- 158.2 mL vs 648.3 +/- 157.1 mL, respectively; P < .0005). CONCLUSION A significantly lower amount of glycine distention fluid was absorbed during endometrial resection in women who underwent the procedure with general rather than epidural anesthesia.
Collapse
Affiliation(s)
- M Goldenberg
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
| | | | | | | | | |
Collapse
|
6
|
Goldenberg M, Zolti M, Bider D, Etchin A, Sela BA, Seidman DS. The effect of intracervical vasopressin on the systemic absorption of glycine during hysteroscopic endometrial ablation. Obstet Gynecol 1996; 87:1025-9. [PMID: 8649684 DOI: 10.1016/0029-7844(96)00063-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To examine the effect of paracervical injection of vasopressin on the absorption of glycine during transcervical endometrial ablation. METHODS Thirty-three consecutive women scheduled for elective hysteroscopic endometrial ablation were randomized to either the study or control group. All procedures were performed with a myoma resectoscopy using 1.5% glycine as the irrigating medium at a flow rate of 100 mL/minute. In the study group, a solution of 0.2 mg vasopressin diluted with 20 mL saline was injected paracervically. Blood samples were obtained through an indwelling intravenous catheter every 5 minutes until the completion of the operation. Serum sodium, potassium, and magnesium levels were measured at 20-minute intervals. In addition, glycine concentrations were determined by both rapid screening and quantitative amino acid analysis. RESULTS Plasma glycine maximal concentrations were significantly lower (P < .001) in patients who received vasopressin, compared with controls (8.8 +/- 4.5 versus 16.0 +/- 6.3 mmol/L, respectively). The calculated extent of glycine absorption within the first 20 minutes of the procedure was 59.6 +/- 30.0 versus 179.8 +/- 66.2 mmol/L.minute in the study and control groups, respectively (P < .001). The differences in plasma sodium, potassium, and magnesium levels were not significant. CONCLUSION Intracervical vasopressin administration significantly decreased systemic glycine absorption in patients undergoing hysteroscopic endometrial ablation.
Collapse
Affiliation(s)
- M Goldenberg
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | | | | |
Collapse
|
7
|
Goldenberg M, Zolti M, Seidman DS, Bider D, Mashiach S, Etchin A. Transient blood oxygen desaturation, hypercapnia, and coagulopathy after operative hysteroscopy with glycine used as the distending medium. Am J Obstet Gynecol 1994; 170:25-9. [PMID: 8296830 DOI: 10.1016/s0002-9378(94)70377-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Our purpose was to report transient complications associated with operative hysteroscopy with glycine used as the distending medium. STUDY DESIGN All the operative hysteroscopies performed over a 6-month period by a single operator were examined. The blood oxygenation and end-tidal carbon dioxide concentrations were monitored in all cases with a pulse oximeter and a capnograph. Blood samples were obtained during the operation and over the next day to determine coagulation functions, sodium levels, and a complete blood cell count. RESULTS Oxygen desaturation accompanied by a simultaneous increase in blood carbon dioxide levels occurred in six of the 46 patients. In addition, four of these patients were found to have a significant blood coagulopathy. Hyponatremia was observed in only two of the latter patients. CONCLUSION Patients undergoing transcervical resection of the endometrium or submucous myomectomy must be closely monitored because disturbances in oxygenation and coagulation functions are not rare. The possibility of avoiding these complications by careful control of intrauterine pressure and the absorption of glycine should be further examined.
Collapse
Affiliation(s)
- M Goldenberg
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | | | | | | | | |
Collapse
|
8
|
Goldenberg M, Zolti M, Seidman D, Bider D, Mashiach S, Etchin A. Transient blood oxygen desaturation, hypercapnia, and coagulopathy after operative hysteroscopy with glycine used as the distending medium. Am J Obstet Gynecol 1994. [DOI: 10.1016/s0002-9378(13)70273-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
9
|
Abstract
The induction dose-response of propofol was compared with the dose-response of its combination with fentanyl and with that of fentanyl alone in three groups of 60 women undergoing minor gynaecological surgery. Dose-response curves were determined for each group using bootstrap and isobolographic analyses. Propofol was found to act additively with fentanyl for induction of anaesthesia. Twenty-three percent of the ED50 of fentanyl was required in combination with 75% of the ED50 for propofol to achieve the ED50 of the combination. This indicates that, for induction of anaesthesia, propofol and fentanyl are not synergistic.
Collapse
Affiliation(s)
- I Ben-Shlomo
- Department of Anaesthesia, Rebecca Sieff Hospital, Safed, Israel
| | | | | | | | | | | |
Collapse
|
10
|
Ben-Shlomo I, Amodai I, Levran D, Dor J, Etchin A, Perl AZ. Midazolam-fentanyl sedation in conjunction with local anesthesia during oocyte retrieval for in vitro fertilization. J Assist Reprod Genet 1992; 9:83-5. [PMID: 1617257 DOI: 10.1007/bf01204121] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- I Ben-Shlomo
- Department of Obstetrics and Gynaecology, Sheba Medical Center, Tel Aviv, Israel
| | | | | | | | | | | |
Collapse
|
11
|
Dan U, Rabinovici Y, Barkai G, Modan M, Etchin A, Mashiach S. Intravenous pethidine and nalbuphine during labor: a prospective double-blind comparative study. Gynecol Obstet Invest 1991; 32:39-43. [PMID: 1765317 DOI: 10.1159/000292990] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The perfect analgesic regimen is constantly sought, no matter how labor is conducted. The quest for an effective drug that will afford maximum relaxation and pain relief with minimum interruption of any natural homeostatic mechanism is a foremost subject in present obstetric analgesics research. Synthetic alternatives are being offered, promising perfect compatibility with the clinician's demands. Nalbuphine, a semisynthetic narcotic agonist-antagonist analgesic of the penanthren series, is supposed not to be liable to cause respiratory depression and is expected to have fewer side effects. A double-blind, randomised prospective study of 137 patients who received 10 mg nalbuphine or 50 mg pethidine i.v. during the active phase of labor in term was carried out. Maternal cardiovascular variables, pain intensity, progress of labor and fetal heart rate during labor were related to side effect and neonatal outcome (1- and 5-min Apgar scores and umbilical venous pH). Neither regimen showed an advantage over the other. Data analysis points to a possible transient depressive effect induced by nalbuphine on the fetal or neonatal central nervous system.
Collapse
Affiliation(s)
- U Dan
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | | | | |
Collapse
|
12
|
Abstract
Myocardial infarction during pregnancy is rare. This report presents a 28-year-old parturient with no risk factors for coronary heart disease, in whom an acute anterior myocardial infarction occurred in the 34th gestational week. A cesarean section was performed at term due to an obstetrical cause and under hemodynamic monitoring without complications. Coronary angiography performed 4 months after delivery revealed the presence of normal coronary arteries and mild regional left ventricular dysfunction.
Collapse
Affiliation(s)
- Y Frenkel
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | | | | |
Collapse
|
13
|
Dor J, Ben-Shlomo I, Lipitz S, Levran D, Etchin A, Rudak E, Mashiach S. Ovarian stimulation with gonadotropin-releasing hormone (GnRH) analogue improves the in vitro fertilization (IVF) pregnancy rate with both transvaginal and laparoscopic oocyte recovery. J In Vitro Fert Embryo Transf 1990; 7:351-4. [PMID: 2150203 DOI: 10.1007/bf01130589] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The relative impact of ovarian stimulation protocol and oocyte retrieval technique on success rates of in vitro fertilization program was studied in 200 patients. Sixty-three patients received gonadotropin-releasing hormone analogue (GnRHa) with human menopausal gonadotropin (hMG), and 137 received hMG only. The GnRHa + hMG protocol resulted in higher pregnancy rates than the hMG-only protocol (19.0 vs 9.5%, respectively; P less than 0.01) despite a lower cleavage rate. Oocyte retrieval was performed via laparoscopy in 100 patients and transvaginally in 100 patients. The number of oocytes recovered per cycle was 6.1 +/- 3.9 with laparoscopy and 7.0 +/- 3.1 transvaginally. Pregnancy rates were similar for both retrieval techniques (13 and 12%, respectively). A breakdown of these results showed that the advantage for the GnRHa + hMG protocol was not affected by the oocyte retrieval technique. A comparison of simultaneous blood and follicular fluid pH measured every 10 min during laparoscopy and transvaginal oocyte recovery revealed a constant decline in follicular fluid pH during laparoscopy, while no changes were observed during the vaginal procedure. We conclude that the improvement in in vitro fertilization results during the period of our study is due primarily to the introduction of GnRHa + hMG protocol rather than the method of oocyte retrieval.
Collapse
Affiliation(s)
- J Dor
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | | | | | | | | | | | | |
Collapse
|
14
|
Ziskind Z, Etchin A, Frenkel Y, Mashiach S, Lusky A, Goor DA, Smolinsky A. Epidural anesthesia with the Trendelenburg position for cesarean section with or without a cardiac surgical procedure in patients with severe mitral stenosis: a hemodynamic study. J Cardiothorac Anesth 1990; 4:354-9. [PMID: 2131885 DOI: 10.1016/0888-6296(90)90045-h] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The hemodynamic effects of epidural anesthesia (EA) with the Trendelenburg position were studied in seven patients with severe mitral stenosis undergoing emergency cesarean section (CS) because of hemodynamic deterioration. In six patients, the CS was immediately followed by an open mitral commissurotomy under general anesthesia, whereas in one patient, the CS was performed alone. A significant reduction in heart rate (120 +/- 5 to 83 +/- 7 beats/min; P less than 0.001) was observed after induction of EA. Mean arterial pressure (MAP) decreased (78 +/- 9 to 55 +/- 5 mm Hg; P less than 0.01) simultaneously with reduction of the pulmonary capillary wedge pressure (PCWP) (37 +/- 4 to 15 +/- 4 mm Hg, P less than 0.001) and cardiac index (CI) (2.4 +/- 0.3 to 1.8 +/- 0.32 L/min/m2; P less than 0.001). However, PCWP could be adjusted by selecting the appropriate angle of the Trendelenburg position. When the PCWP was approximately 25 mm Hg, MAP and Cl increased to 72 +/- 7 mm Hg and 3.1 +/- 0.4 L/min/m2, respectively, and a satisfactory hemodynamic state was achieved. Systemic vascular resistance decreased after induction of EA (2,250 +/- 250 to 1,750 +/- 450 dyne.s.cm-5; P less than 0.001), and remained unchanged during the perioperative period. It is concluded that the combination of epidural anesthesia with tilting of the table is a safe method for urgent CS in pregnant women with critical mitral stenosis in whom termination of pregnancy is indicated because of hemodynamic deterioration.
Collapse
Affiliation(s)
- Z Ziskind
- Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | | | | | | |
Collapse
|
15
|
Etchin A, Perl A, Bider D, Ben Rafael Z. Prevention of a side effect of epidural morphine by epidural steroid administration in cesarean section. Gynecol Obstet Invest 1990; 29:305-6. [PMID: 2193858 DOI: 10.1159/000293341] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In order to evaluate the effect of preventive corticosteroid on the occurrence of pruritus after epidural anesthesia with morphine, we studied 95 patients undergoing cesarean section. Thirty-seven patients (group I) were given 20 mg of bupivacaine 0.5% for the operation and 2 mg of morphine hydrochloride with 50 mg of Ultracortene-H immediately after the operation and 24 h later, and 58 patients (group II) were given epidural bupivacaine during the operation and epidural morphine hydrochloride immediately after the operation and 24 h later without Ultracortene-H. Only 8.1% of group I patients had pruritus after the injection compared to 20.6% in group II. We suggest that the addition of 50 mg Ultracortene-H to 2 mg epidural morphine analgesia after the operation might prevent severe forms of pruritus.
Collapse
Affiliation(s)
- A Etchin
- Department of Anesthesia, Chaim Sheba Medical Center, Ramat Aviv, Israel
| | | | | | | |
Collapse
|
16
|
Etchin A, Mamet Y. Electrochemical skin burn after transcutaneous electronerve analgesia. Anesth Analg 1982; 61:801-2. [PMID: 6980607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|