International journal of obstetric anesthesia

Publisher: Elsevier

Description

  • Impact factor
    1.85
  • 5-year impact
    1.68
  • Cited half-life
    5.10
  • Immediacy index
    0.34
  • Eigenfactor
    0.00
  • Article influence
    0.36
  • Other titles
    International journal of obstetric anesthesia (Online), International journal of obstetric anesthesia
  • ISSN
    1532-3374
  • OCLC
    45287992
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

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Elsevier

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    • Publisher last contacted on 18/10/2013
  • Classification
    ​ green

Publications in this journal

  • International journal of obstetric anesthesia 08/2014;
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    ABSTRACT: Background Data are scarce on the advantage of ultrasound-guided spinal anaesthesia in patients with easily identifiable bony landmarks. In this study, we compared the use of ultrasound to the landmark method in patients with no anticipated technical difficulty, presenting for caesarean delivery under spinal anaesthesia. Methods A total of 150 pregnant women were recruited in this randomized, controlled study. Ultrasound examination and spinal anaesthesia were performed by three anaesthetists with experience in ultrasound-guided neuraxial block. Patients were randomized to either the Ultrasound Group (n=75) or the Landmark Group (n=75). In both groups the level of L3-4 or L4-5 was identified by ultrasound (transverse and longitudinal approach) or palpation. The primary outcome was the procedure time, measured from the time of skin puncture by the introducer to the time of viewing cerebrospinal fluid at the hub of the spinal needle. Secondary outcomes were the number of skin punctures, number of passes, and incidence of successful spinal blockade. Results The average procedure time, number of skin punctures and needle passes, were similar in both groups. The number of patients with successful spinal anaesthesia after one puncture was not statistically different between the groups. Conclusion The present results indicate that when performed by anaesthetists experienced in both ultrasound and landmark techniques, the use of ultrasound does not appear to increase the success rate of spinal anaesthesia, or reduce the procedure time or number of attempts in obstetric patients with easily palpable spines.
    International journal of obstetric anesthesia 08/2014;
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    ABSTRACT: Background Increasing awareness of the risks of blood transfusion has prompted examination of red cell transfusion practice in obstetrics. A six-month prospective observational study was performed to examine blood transfusion practices in patients undergoing caesarean delivery at three hospitals in Pakistan. Methods In the three hospitals (two private, one public) 3438 caesarean deliveries were performed in the study period. Data were collected on patient demographics, indications for transfusion, ordering physicians, consent, associations with obstetric factors, estimated allowable blood loss, calculated blood loss, pre and post-transfusion haemoglobin and discharge haemoglobin. Results A total number of 397 (11.5%) patients who underwent caesarean section received a blood transfusion. The highest transfusion rate of 16% was recorded in the public tertiary care hospital compared to 5% in the two private hospitals. Emergency caesarean delivery and multiparity were associated with blood transfusion (P<0.05). More emergency caesarean sections were performed in the public compared to the private hospitals (85.4% vs. 41.6%). More multiparous patients underwent caesarean section in the public hospital (57.8% vs. 40.4%). Attending physicians took the decision for transfusion in 98% of cases. In 343 (86%) patients, blood transfusion was given even when the haemoglobin was >7 g/dL. The method for documenting the indication or consent for transfusion was not found in any of the three hospitals. Conclusion Blood transfusion was prescribed more readily in the public hospital. Identification of a transfusion trigger and the development of institutional guidelines to reduce unnecessary transfusion are required.
    International journal of obstetric anesthesia 08/2014;
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    ABSTRACT: Posterior reversible encephalopathy syndrome (PRES) is a rare neurological condition associated with a variety of underlying conditions, including preeclampsia. The headache associated with PRES may be indistinguishable from post-dural puncture headache, which may result in diagnostic delay. We report a case of PRES that was initially diagnosed as post-dural puncture headache. The case was unique because there were no features of preeclampsia, initial presentation was typical of post-dural puncture headache, and there was a five-day interval between the onset of headache and the development of seizures and cortical blindness, pathognomonic of PRES. It remains unclear whether this was an atypical presentation of PRES, initially misdiagnosed as post-dural puncture headache, or whether delayed treatment of headache triggered PRES.
    International journal of obstetric anesthesia 08/2014;
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    ABSTRACT: Background Acute aortic dissection in pregnant women is a rare but potentially life-threatening event. Our aim was to evaluate maternal and fetal outcomes of acute aortic dissection during pregnancy. Methods We conducted a review of literature of the PubMed database to identify publications related to pregnant women with acute aortic dissections during the period 2003 to 2013: 59 articles were included in the study. Results A total of 75 patients were included in the analyses. Stanford type A dissections were the most common form, accounting for 77% of all cases. The majority (78%) occurred in the third trimester and immediate postpartum period. Inherited connective tissue disorders were causative in 49% of patients. Maternal mortality was not statistical different between type A and type B dissections (21% vs. 23%), but fetal outcomes were worse in type B dissections (35% vs. 10.3%; P<0.05). Fetal mortality in type A dissections was dependent on the timing of aortic repair, with antepartum aortic repair associated with a higher mortality (36%). Conclusion Despite advances in diagnostic and surgical techniques, maternal and fetal mortalities in pregnant patients with aortic dissection remain high. Patients undergoing combined cesarean section with aortic repair had favorable fetal outcomes.
    International journal of obstetric anesthesia 05/2014;
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    ABSTRACT: Postpartum headache is a common occurrence with a broad differential diagnosis. Sheehan syndrome, or postpartum pituitary necrosis, is not typically recognized as a cause of postpartum headache. We present a case of Sheehan syndrome that initially presented as severe headache after vaginal delivery complicated by retained placenta and postpartum hemorrhage. The patient was discharged home on postpartum day three but continued to have headaches and returned to hospital on postpartum day six with severe headache, failure to lactate, edema, dizziness, fatigue, nausea and vomiting. Cranial magnetic resonance imaging revealed pituitary infarction consistent with Sheehan syndrome. We discuss the differential diagnosis for postpartum headache, the pathophysiological features of Sheehan syndrome, and headache as an atypical acute presentation.
    International journal of obstetric anesthesia 05/2014;
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    ABSTRACT: Background Intrathecal morphine is used for post-cesarean analgesia, but pruritus is a common side effect. Ondansetron would be an attractive treatment because it prevents nausea, is non-sedative or has no anti-analgesic effect. We undertook a study to assess the efficacy of ondansetron for treatment or prophylaxis of intrathecal morphine-induced pruritus. Methods Healthy paturients undergoing cesarean delivery with intrathecal morphine 250 μg and fentanyl 25 μg were randomized to receive: prophylaxis (ondansetron 8 mg at cord clamping, normal saline 4 mL for treatment of pruritus in the post-anaesthesia care unit); treatment (normal saline 4 mL at cord clamping, ondansetron 8 mg as required in the post-anesthesia care unit) or control (normal saline 4 mL in both). Visual analogue scale scores for pruritus, nausea and pain were recorded preoperatively, on arrival to, at 30, 60, and 120 min and on discharge from the post anesthesia care unit. The primary outcome was peak the pruritus score. ANOVA with Bonferroni correction or Fisher’s exact test were used to analyze data; P<0.05 was considered significant. Results The study was terminated early when interim analysis indicated no effect. Eighty-two of the intended 180 paturients completed the protocol (26 in control group, 32 in treatment group and 24 in prophylaxis). There were no differences in the rate or severity of pruritus at any assessment point, or the request for treatment. Pruritus was reduced after administration of treatment syringe. Conclusion Prophylactic ondansetron did not reduce pruritus when compared with placebo. The use of ondansetron as a treatment did not decrease the severity of pruritus when compared with placebo.
    International journal of obstetric anesthesia 05/2014;
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    ABSTRACT: Postdural puncture headache (PDPH) is an important complication of obstetric epidural anaesthesia and analgesia. Though often self-limiting, PDPH is unpleasant, at times incapacitating, and associated with complications, some of which are serious. Despite this, treatment options are few and of limited efficacy. The epidural blood patch (EBP) has been used for PDPH treatment for over 50 years.(1) It is probably the most efficacious of therapies, although this is unproven, and plays an important part in the management of this condition.(2) However, PDPH is often complex, of variable severity and duration, and merits a cautious and individualized approach to its diagnosis and treatment. An EBP may be part of that treatment but administering it to all women with PDPH is not the optimal management approach.
    International journal of obstetric anesthesia 01/2014;
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    ABSTRACT: Elevating the torso in a Head Elevated Ramped Position during caesarean delivery benefits the mother by improving comfort and ventilation while reducing reflux symptoms and providing a better airway position. We hypothesised that using an elevation pillow for an elective caesarean delivery under combined spinal-epidural anaesthesia would not significantly increase the time to achieve a T4 block. Following ethical approval and informed consent, 60 women undergoing elective caesarean delivery under combined spinal-epidural anaesthesia were randomised to one of three groups: Control - horizontal with a small pillow under the head; Head Elevated Ramped Position - torso on an elevation pillow; and Head Elevated Ramped Position with initial position horizontal. Data collected were time to T4, block height at 30 and 120min, adequate block at 12min, need for epidural supplementation, maternal comfort and airway position assessment. Time to T4 among the three groups was not significantly different (P=0.14). However, there was a significant difference in achievement of block height of T4 at 12 min and greater need for epidural supplementation in the intervention groups compared to the control group (P=0.021). Non-inferiority analyses of time to T4 of both head elevated ramped positions were inconclusive about inferiority relative to the control. Head Elevated Ramped Position was significantly more comfortable than control (P=0.007). Using the level of the external auditory meatus to the sternal notch as an indicator for ease of laryngoscopy, Head Elevated Ramped Position provided a significantly better position than control (P<0.001). Elevating the parturient undergoing elective caesarean delivery into the Head Elevated Ramped Position immediately or once the block had been established did not appear to significantly alter time to an adequate block height of T4; however, the need for epidural supplementation was greater in the intervention groups. Cautious use of this novel position change can provide a more comfortable experience and provide a better airway position should conversion to general anaesthesia be required.
    International journal of obstetric anesthesia 01/2014;
  • International journal of obstetric anesthesia 01/2014;
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    ABSTRACT: We report a novel circumstance of brachial plexus anesthesia in a parturient. A 25-year-old woman at 34weeks of gestation presented with a pathologic proximal right humerus fracture from an intramedullary mass. She was scheduled for tumor biopsy which was performed using a two-site ultrasound-guided brachial plexus block to maximize odds of complete anesthesia while minimizing the risk of phrenic nerve paresis. After a supraclavicular block with 0.5% ropivacaine 20mL, we translated our ultrasound probe cephalad, inferior to the root of C7 where the divisions of the superior trunk could be seen in a tightly compact arrangement. An additional injection of 0.5% ropivacaine 20mL was administered at this site, and the patient subsequently underwent successful biopsy without sedatives or analgesics, aside from local anesthetics. In the post-anesthesia care unit, she had normal respirations and oxygen saturations breathing room air, denied any shortness of breath or difficulty breathing, and was discharged shortly after her arrival. While we did not pursue radiologic examination to rule out hemidiaphragm paralysis, we assumed, as evidenced in a previous case report, that unlike most healthy patients, a parturient would demonstrate some clinical signs and/or symptoms of hemidiaphragm paralysis, given that the diaphragm is almost totally responsible for inspiration in the term parturient. This represents only the second brachial plexus block in a parturient reported in the literature; the first using ultrasound guidance and without respiratory embarrassment.
    International journal of obstetric anesthesia 01/2014;
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    ABSTRACT: Breech presentation occurs in up to 3% of pregnancies at term and may be an indication for caesarean delivery. External cephalic version can be effective in repositioning the fetus in a cephalic presentation, but may be painful for the mother. Our aim was to assess the efficacy of remifentanil versus placebo for pain relief during external cephalic version. A randomized, double-blind, controlled trial that included women at 36-41weeks of gestation with non-cephalic presentations was performed. Women were randomized to receive either a remifentanil infusion at 0.1μg/kg/min and demand boluses of 0.1μg/kg, or saline placebo. The primary outcome was the numerical rating pain score (0-10) after external cephalic version. Sixty women were recruited, 29 in the control group and 31 in the remifentanil group. There were significant differences in pain scores at the end of the procedure (control 6.5±2.4 vs. remifentanil 4.7±2.5, P=0.005) but not 10min later (P=0.054). The overall success rate for external cephalic version was 49% with no significant differences between groups (remifentanil group 54.8% vs. control group 41.3%, P=0.358). In the remifentanil group, there was one case of nausea and vomiting, one of drowsiness and three cases of fetal bradycardia. In the control group, there were three cases of nausea and vomiting, one of dizziness and nine cases of fetal bradycardia. Intravenous remifentanil with bolus doses on demand during external cephalic version achieved a reduction in pain and increased maternal satisfaction. There were no additional adverse effects, and no difference in the success rate of external cephalic version or the incidence of fetal bradycardia.
    International journal of obstetric anesthesia 01/2014;
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    ABSTRACT: Paracetamol is the most frequently used analgesic during pregnancy and the most common drug involved in suicidal overdose in the UK. Manifestation of toxicity classically occurs over four phases with clinical and laboratory features resembling HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome. We report a case that was erroneously managed as HELLP syndrome before a paracetamol overdose was diagnosed. This case highlights current practice in managing paracetamol overdose and focuses on the importance of addressing mental health issues to mitigate the risk of self-harm in pregnancy.
    International journal of obstetric anesthesia 01/2014;
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    ABSTRACT: Introduction Recovery of balance after neuraxial anaesthesia can remain delayed after simple clinical tests have demonstrated motor recovery. Dynamic posturography tracks the small movements or sway of a person standing as still as possible on a force platform and has been investigated as an objective measure of the ability to walk following anaesthesia. These are expensive laboratory devices, limiting their clinical utility. One measured variable is path length, the cumulative distance travelled in the horizontal plane by the centre of pressure of a person standing on the platform over one minute. Path length can be measured using the Nintendo Wii-Fit Balance Board™. Methods The feasibility of intercepting raw wireless data from a Nintendo® Wii-Fit Balance Board™ using custom software to calculate path length was explored. Subsequently, path lengths were measured using both this and a laboratory platform simultaneously. In a random order 20 volunteers(a) stood for 1 min, feet together, eyes open (conventional baseline test); and (b) stood for 1 min, feet together, eyes closed (simulating residual anaesthesia with increased sway). For each device, the ratio b:a was calculated as an index of performance reduction when eyes were closed. Results Path lengths ranged from 58.50 to 242.99 cm, mean bias 9cm (Wii-Fit < laboratory platform) and 95% confidence limits of 2.5 to 15.4 cm. Ratios ranged from 1.09 to 2.68, mean bias -0.04 (Wii-Fit > laboratory platform) and 95% confidence limits of 0.04 to -0.13. Conclusions The path lengths were in close agreement and the Wii-Fit Balance Board™ may be worthy of further investigation as a tool to objectively assess readiness to ambulate following neuraxial anaesthesia.
    International journal of obstetric anesthesia 01/2014;
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    ABSTRACT: Oral-Facial-Digital syndrome or Mohr syndrome is a rare congenital disorder characterized by malformations of face, oral cavity, laryngeal structures, trachea, and digits, muscular-skeletal abnormalities, and congenital cardiac defects. In this case report, we describe the anesthetic management of a parturient with Oral-Facial-Digital syndrome type II and repaired tetralogy of Fallot with left ventricular dysfunction.
    International journal of obstetric anesthesia 01/2014;
  • International journal of obstetric anesthesia 01/2014;
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    ABSTRACT: Background Spinal anaesthesia for caesarean delivery is frequently associated with adverse effects such as maternal hypotension and bradycardia. Prophylactic administration of ondansetron has been reported to provide a protective effect. We studied the effect of different doses of ondansetron in obstetric patients. Methods This prospective double-blind, randomised, placebo-controlled study included 128 healthy pregnant women scheduled for elective caesarean delivery under spinal anaesthesia. Women were randomly allocated into four groups (n=32) to receive either placebo or ondansetron 2, 4 or 8 mg intravenously before induction of spinal anaesthesia. Demographic, obstetric, intraoperative timing and anaesthetic variables were assessed at 16 time points. Anaesthetic variables assessed included blood pressure, heart rate, oxygen saturation, nausea, vomiting, electrocardiographic changes, skin flushing, discomfort or pruritus and vasopressor requirements. Results There were no differences in the number of patients with hypotension in the placebo (43.8%) and ondansetron 2 mg (53.1%), 4 mg (56.3%) and 8 mg (53.1%) groups (P=0.77), nor the percentage of time points with systolic hypotension (7.3% in the placebo group and 11.1%, 15.7% and 12.6% in the ondansetron 2, 4 and 8 mg groups, respectively, P=0.32). There were no differences between groups in ephedrine (P=0.11) or phenylephrine (P=0.89) requirements and the number of patients with adverse effects. Conclusions In our study, prophylactic ondansetron had little effect on the incidence of hypotension in healthy parturients undergoing spinal anaesthesia with bupivacaine and fentanyl for elective caesarean delivery.
    International journal of obstetric anesthesia 01/2014;
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    ABSTRACT: Pregnancy in women with achondroplasia presents major challenges for anaesthetists and obstetricians. We report the case of a woman with achondroplasia who underwent general anaesthesia for an elective caesarean section. She was 99 cm in height and her condition was further complicated by severe kyphoscoliosis and previous back surgery. She was reviewed in the first trimester at the anaesthetic high risk clinic. A multidisciplinary team was convened to plan her peripartum care. Because of increasing dyspnoea caesarean section was performed at 32 weeks of gestation. She received a general anaesthetic using a modified rapid-sequence technique with remifentanil and rocuronium. The intraoperative period was complicated by desaturation and high airway pressures. The woman’s postoperative care was complicated by respiratory compromise requiring high dependency care.
    International journal of obstetric anesthesia 01/2014;
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    ABSTRACT: Background In obstetrics, post-dural puncture headache is a well-recognised complication. Typical symptoms include fronto-temporal or occipital headache, worsening with ambulation and improving in the decubitus position. Occasionally, patients present with non-postural headache, although relatively little is known about this atypical presentation. The purpose of this study was to determine the incidence, associated signs and risk factors for this atypical manifestation of post-dural puncture headache. Methods We analysed a series of 27 064 parturients having a neuraxial procedure between January 2001 and December 2010. Using data from electronic anaesthesia patient records, medical charts and a postpartum quality audit, we identified all parturients with atypical post-dural puncture headache. We assessed the incidence and used uni- and multivariate analysis to identify associated risk factors. Results Amongst 142 parturients with post-dural puncture headache, eight [5.6% (95% CI 1.7–9.4%)] had atypical non-postural headache. Associated symptoms were stiffness and pain in the cervical, thoracic or lumbar vertebral area, visual disturbances and vertigo. Significant risk factors for developing atypical signs were previous migraine, odds ratio 6.1 (95% CI 1.2–28.7), a more cephalad level of needle insertion, odds ratio 17.2 (95% CI 1.4–210.1) and identification of dural puncture by aspiration of cerebrospinal fluid from the epidural catheter, odds ratio 5.5 (95%CI 1.2–24.4). Following multivariate analysis, recognition of dural puncture by aspiration of cerebrospinal fluid from the epidural catheter was the most significant predictor of non-orthostatic postdural puncture headache. Conclusion Anaesthetists should be aware of this atypical clinical presentation, particularly if there is a past history of migraine, a more cephalad level of needle insertion or identification of dural puncture by aspiration of cerebrospinal fluid from the epidural catheter.
    International journal of obstetric anesthesia 01/2014;
  • International journal of obstetric anesthesia 01/2014; 23:S1.