International journal of obstetric anesthesia

Publisher: Elsevier

Journal description

Current impact factor: 1.60

Impact Factor Rankings

2015 Impact Factor Available summer 2016
2014 Impact Factor 1.598
2013 Impact Factor 1.832
2012 Impact Factor 1.799
2011 Impact Factor 1.395
2010 Impact Factor 1.793
2009 Impact Factor 1.847
2008 Impact Factor 1.757
2007 Impact Factor 1.465
2006 Impact Factor 1.621
2005 Impact Factor 1.11
2004 Impact Factor 0.894
2003 Impact Factor 0.927
2002 Impact Factor 0.963
2001 Impact Factor 1.187
2000 Impact Factor 1.274
1999 Impact Factor 0.516

Impact factor over time

Impact factor

Additional details

5-year impact 1.42
Cited half-life 5.90
Immediacy index 0.47
Eigenfactor 0.00
Article influence 0.39
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

Publisher details


  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Authors pre-print on any website, including arXiv and RePEC
    • Author's post-print on author's personal website immediately
    • Author's post-print on open access repository after an embargo period of between 12 months and 48 months
    • Permitted deposit due to Funding Body, Institutional and Governmental policy or mandate, may be required to comply with embargo periods of 12 months to 48 months
    • Author's post-print may be used to update arXiv and RepEC
    • Publisher's version/PDF cannot be used
    • Must link to publisher version with DOI
    • Author's post-print must be released with a Creative Commons Attribution Non-Commercial No Derivatives License
    • Publisher last reviewed on 03/06/2015
  • Classification
    ​ green

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: A range of strategies including physical interventions, intravenous fluids and vasopressor drugs have been used to minimize or prevent spinal anesthesia-induced hypotension. Recent studies suggest that ondansetron, a commonly used antiemetic, also affects hypotension. This systematic review investigated the effects of prophylactic ondansetron on hemodynamic changes following spinal anesthesia. Methods: Medline, Embase, Cochrane Library databases and were searched for randomized controlled trials studying the effects of ondansetron on hemodynamic changes induced by spinal anesthesia. The primary outcome was hypotension. Relative risk (RR) or mean difference, with 95% confidence intervals (CI), were used to analyze outcomes. Results: Ten randomized controlled trials with 863 patients were included in the analysis. Prophylactic ondansetron reduced the incidence of spinal anesthesia-induced hypotension in both obstetric and non-obstetric patients. The RR of spinal anesthesia-induced hypotension after ondansetron administration was 0.53 (95% CI 0.32 to 0.86) in obstetric patients and 0.16 (95% CI 0.05 to 0.51) in non-obstetric patients. There was significant heterogeneity among obstetric studies (I(2) = 71%). Ondansetron also reduced the incidence of bradycardia, nausea and vomiting after spinal anesthesia with RRs of 0.27 (95% CI 0.16 to 0.47), 0.24 (95% CI 0.14 to 0.42) and 0.48 (95% CI 0.08 to 3.08), respectively. The doses of ephedrine and phenylephrine required to treat hypotension were reduced by ondansetron with mean differences of -2.35mg (95% CI -4.14 to -0.55mg) and -31.16μg (95% CI -57.46 to -4.87μg), respectively. Conclusion: This review suggests that prophylactic ondansetron reduces the incidence of spinal anesthesia-induced hypotension and vasopressor consumption in both obstetric and non-obstetric patients. In addition, ondansetron can also reduce related adverse outcomes such as bradycardia, nausea and vomiting. However, given the relatively large heterogeneity and small sample sizes in current studies, further large and strict randomized clinical trials investigating the effects of ondansetron on spinal anesthesia-induced hemodynamic changes and side effects are still needed, especially among obstetric patients.
    International journal of obstetric anesthesia 09/2015; DOI:10.1016/j.ijoa.2015.08.012
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: A head-elevation pillow places a patient in a ramped posture, which maximises the view of the larynx during laryngoscopy, particularly in obese parturients. In our institution an elevation pillow is used pre-emptively for neuraxial anaesthesia. We hypothesised that head-elevation may impair cephalad spread of local anaesthetic before caesarean section resulting in a lower block or longer time to achieve a T6 level. We aimed to investigate the effect of head-elevation on spread of intrathecal local anaesthetics during anaesthesia for caesarean section. Methods: One-hundred parturients presenting for caesarean section under combined spinal-epidural anaesthesia were randomised to either the standard supine position with lateral displacement or in the supine position with lateral displacement on an head-elevation pillow. Each patient received intrathecal hyperbaric bupivacaine 11mg, morphine 100μg and fentanyl 15μg. Patients were assessed for adequacy of sensory block (T6 or higher) at 10min. Results: Sensory block to T6 was achieved within 10min in 65.9% of parturients in the Elevation Pillow Group compared to 95.7% in the Control Group (P<0.05). Compared to the Control Group, patients in the Elevation Pillow Group had greater requirements for epidural supplementation (43.5% vs 2.1%, P<0.001) or conversion to general anaesthesia (9.3% vs 0%, P<0.04). Conclusions: Use of a ramped position with an head-elevation pillow following injection of the intrathecal component of a combined spinal-epidural anaesthetic for scheduled caesarean section was associated with a significantly lower block height at 10min.
    International journal of obstetric anesthesia 09/2015; DOI:10.1016/j.ijoa.2015.08.004
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: A continuous spinal catheter is a reliable alternative to standard neuraxial techniques in obstetric anesthesia. Despite the potential advantages of intrathecal catheters, they remain underutilized due to fear of infection, nerve damage or post-dural puncture headache. In our tertiary care center, intrathecal catheters are either placed intentionally in high-risk obstetric patients or following inadvertent dural puncture using a 19-gauge macrocatheter passed through a 17-gauge epidural needle. Methods: A retrospective review of 761 intrathecal catheters placed from 2001 to 2012 was conducted. An institutional obstetric anesthesia database was used to identify patients with intrathecal catheters. Medical records were reviewed for procedural details and complications. Results: There were no serious complications, including meningitis, epidural or spinal abscess, hematoma, arachnoiditis, or cauda equina syndrome, associated with intrathecal catheters. The failure rates were 2.8% (3/108) for intentional placements and 6.1% (40/653) for placements following accidental dural puncture. The incidence of post-dural puncture headache was 41% (312/761) and the epidural blood patch rate was 31% (97/312). Conclusions: This review demonstrates that intrathecal catheters are dependable and an option for labor analgesia and surgical anesthesia for cesarean delivery. Serious long-lasting complications are rare.
    International journal of obstetric anesthesia 09/2015; DOI:10.1016/j.ijoa.2015.08.006
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Checklists can optimize team performance during medical crises. However, there has been limited examination of checklist use during obstetric crises. In this simulation study we exposed multidisciplinary teams to checklist training to evaluate checklist use and team performance during a severe postpartum hemorrhage. Methods: Fourteen multidisciplinary teams participated in a postpartum hemorrhage simulation occurring after vaginal delivery. Before participating, each team received checklist training. The primary study outcome was whether each team used the checklist during the simulation. Secondary outcomes were the times taken to activate our institution-specific massive transfusion protocol and commence red blood cell transfusion, and whether a designated checklist reader was used. Results: The majority of teams (12/14 (86%)) used the checklist. Red blood cell transfusion was administered by all teams. The median [IQR] times taken to activate the massive transfusion protocol and transfuse red blood cells were 5min 14s [3:23-6:43] and 14min 40s [12:56-17:28], respectively. A designated checklist reader was used by 7/12 (58%) teams that used the checklist. Among teams that used a checklist with versus without a designated reader, we observed no differences in the times to activate the massive transfusion protocol or to commence red blood cell transfusion (P>0.05). Conclusions: Although checklist training was effective in promoting checklist use, multidisciplinary teams varied in their scope of checklist use during a postpartum hemorrhage simulation. Future studies are required to determine whether structured checklist training can result in more standardized checklist use during a postpartum hemorrhage.
    International journal of obstetric anesthesia 09/2015; DOI:10.1016/j.ijoa.2015.08.011
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Oxytocin causes clinically significant hypotension and tachycardia. This study examined whether prior administration of phenylephrine obtunds these unwanted haemodynamic effects. Methods: Forty pregnant women undergoing elective caesarean section under spinal anaesthesia were randomised to receive either an intravenous 50μg bolus of phenylephrine (Group P) or saline (Group S) immediately before oxytocin (3U over 15s). Systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate were recorded using a continuous non-invasive arterial pressure device. Baseline values were averaged for 20s post-delivery. Between-group comparisons were made of the mean peak changes in blood pressure and heart rate, and the mean percentage changes from baseline, during the 150s after oxytocin administration. Results: The mean±SD peak percentage change in systolic blood pressure was -16.9±2% in Group P, and -19.0±1.9% in Group S and the estimated mean difference was 2.1% (95% CI -3.5% to 7.8%; P=0.44); corresponding changes in heart rate were 13.5±2.3% and 14.0±1.5% and the mean estimated difference was 0.5% (95% CI -6.0% to 5%; P=0.87). The mean percentage change from the baseline measurements during the 150s period of measurement was greater for Group S than Group P: systolic blood pressure -5.9% vs -3.4% (P=0.149); diastolic blood pressure -7.2% vs -1.5% (P=0.014); mean arterial pressure -6.8% vs -1.5% (P=0.007); heart rate 2.1% vs -2.4% (P=0.033). Conclusion: Intravenous phenylephrine 50μg immediately before 3U oxytocin during elective caesarean section does not prevent maternal hypotension and tachycardia.
    International journal of obstetric anesthesia 09/2015; DOI:10.1016/j.ijoa.2015.08.003
  • International journal of obstetric anesthesia 09/2015; DOI:10.1016/j.ijoa.2015.08.005
  • International journal of obstetric anesthesia 09/2015; DOI:10.1016/j.ijoa.2015.08.002
  • International journal of obstetric anesthesia 09/2015; DOI:10.1016/j.ijoa.2015.08.008
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Spinal anesthesia is widely used for cesarean section, but the factors that affect the spread of the block in pregnant patients are still not fully explained. This study was designed to investigate the effect of postural changes on sensory block level. Methods: Thirty patients scheduled for elective cesarean section under combined spinal-epidural anesthesia were randomly allocated into three groups. After intrathecal injection of 0.5% plain bupivacaine 7.5mg, patients in group S were immediately placed in the supine position with left tilt, patients in group L5 were kept lateral for 5min and then turned to the supine position with left tilt, and patients in group L10 were kept lateral for 10min and then turned to the supine position with left tilt. Results: At 5min, median cephalad level of sensory block was lower in groups L5 and L10 compared with group S (corrected P<0.001); at 10min, median cephalad sensory block level was lower in group L10 compared with group S (corrected P<0.001) and group L5 (corrected P<0.001), and lower in group L5 compared with group S (corrected P=0.033); at 15 min, median cephalad level of sensory block was lower in group L10 compared with group S (corrected P=0.003) and group L5 (corrected P=0.015). Conclusions: In our population, using 0.5% plain bupivacaine 7.5mg, postural change from the lateral position to the supine position is an important mechanism enhancing cephalic spread of spinal anesthesia during late pregnancy.
    International journal of obstetric anesthesia 09/2015; DOI:10.1016/j.ijoa.2015.06.010
  • International journal of obstetric anesthesia 09/2015; DOI:10.1016/j.ijoa.2015.07.001
  • International journal of obstetric anesthesia 09/2015; DOI:10.1016/j.ijoa.2015.08.001
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Advances in understanding the pathogenesis, diagnosis and management of hypertrophic cardiomyopathy have resulted in increased longevity and a better quality of life of affected patients considering pregnancy. Several case series which focused predominantly on obstetric details have reported generally good outcomes. However, there remains a paucity of data on the specifics of obstetric anesthesia in women with hypertrophic cardiomyopathy. Methods: After Institutional Review Board approval, we reviewed antepartum transthoracic echocardiograms, cardiology, obstetric, anesthetic, and nursing labor records with a focus on anesthesia for labor and delivery and early postpartum complications in patients with hypertrophic cardiomyopathy who delivered between January 1993 and December 2013. Results: There were 23 completed pregnancies in 14 patients: 12 parturients (52%) delivered vaginally, of whom seven (30%) required assistance (forceps, vacuum), and 11 (48%) had a cesarean delivery. In 17 cases (74%) delivery was uneventful, but six patients (26%) had complications including congestive heart failure (n=3) and postpartum hemorrhage (n=3). All patients had neuraxial labor anesthesia/analgesia, and none received general anesthesia. No hemodynamic instability or fetal distress directly related to anesthesia was documented. Conclusion: The database search of approximately 160000 deliveries over 20years revealed only a small number of hypertrophic cardiomyopathy patients with completed pregnancies. No maternal or neonatal deaths were documented. Overall morbidity rate was 26% with a 13% incidence of peripartum congestive heart failure. In patients with mild to moderate disease, neuraxial anesthesia was safe, effective and well tolerated with no hemodynamic instability related to administration of local anesthetics.
    International journal of obstetric anesthesia 09/2015; DOI:10.1016/j.ijoa.2015.07.002
  • [Show abstract] [Hide abstract]
    ABSTRACT: Morquio syndrome, a congenital mucopolysaccharidosis, presents several challenges for the provision of effective labor analgesia. We report the case of a woman admitted for induction of labor who received an early epidural and subsequently required cesarean delivery. Optimal bilateral labor analgesia was not achieved despite multiple adjustments, and systemic analgesia was needed for cesarean delivery.
    International journal of obstetric anesthesia 08/2015; DOI:10.1016/j.ijoa.2015.08.015
  • [Show abstract] [Hide abstract]
    ABSTRACT: We reviewed the literature on obstetric failed tracheal intubation from 1970 onwards. The incidence remained unchanged over the period at 2.6 (95% CI 2.0 to 3.2) per 1000 anaesthetics (1 in 390) for obstetric general anaesthesia and 2.3 (95% CI 1.7 to 2.9) per 1000 general anaesthetics (1 in 443) for caesarean section. Maternal mortality from failed intubation was 2.3 (95% CI 0.3 to 8.2) per 100000 general anaesthetics for caesarean section (one death per 90 failed intubations). Maternal deaths occurred from aspiration or hypoxaemia secondary to airway obstruction or oesophageal intubation. There were 3.4 (95% CI 0.7 to 9.9) front-of-neck airway access procedures (surgical airway) per 100000 general anaesthetics for caesarean section (one procedure per 60 failed intubations), usually carried out as a late rescue attempt with poor maternal outcomes. Before the late 1990s, most cases were awakened after failed intubation; since the late 1990s, general anaesthesia has been continued in the majority of cases. When general anaesthesia was continued, a laryngeal mask was usually used but with a trend towards use of a second-generation supraglottic airway device. A prospective study of obstetric general anaesthesia found that transient maternal hypoxaemia occurred in over two-thirds of cases of failed intubation, usually without sequelae. Pulmonary aspiration occurred in 8% but the rate of maternal intensive care unit admission after failed intubation was the same as that after uneventful general anaesthesia. Poor neonatal outcomes were often associated with preoperative fetal compromise, although failed intubation and lowest maternal oxygen saturation were independent predictors of neonatal intensive care unit admission. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
    International journal of obstetric anesthesia 06/2015; DOI:10.1016/j.ijoa.2015.06.008
  • International journal of obstetric anesthesia 06/2015; DOI:10.1016/j.ijoa.2015.06.006
  • [Show abstract] [Hide abstract]
    ABSTRACT: Epidural analgesia and remifentanil patient-controlled analgesia are two popular techniques for the treatment of labour pain, each with its own efficacy and toxicity. Parturients requesting analgesia were randomly assigned to either patient-controlled intravenous remifentanil or epidural analgesia. Control patients consisted of parturients not requesting pain medication. The primary objective was to compare the incidence of maternal fever (temperature ⩾38°C); secondary outcomes included the incidence of low oxygen saturation, pain scores, nausea and vomiting, sedation scores, pruritus and neonatal outcome. Data from 140 parturients were analysed: 49 received remifentanil analgesia, 49 epidural analgesia and 42 no analgesia (controls). Fever (temperature ⩾38°C) developed in 10% of remifentanil patients compared to 37% of epidural patients and 7% of control patients (P<0.001). One or more hypoxaemic events (oxygen saturation <90% for at least 1min) occurred in 48% of patients on remifentanil versus 15% of patients on epidural analgesia and 20% of control patients (P=0.003). Although pain intensity scores differed significantly between the two groups in favour of the epidural, mean satisfaction scores were similar in both analgesia groups (remifentanil 8.1±1.2 vs. epidural 8.4±1.2). Remifentanil analgesia was associated with a higher incidence of nausea and deeper levels of sedation. The differences in haemodynamic parameters between groups were small and clinically insignificant. During treatment of labour pain, epidural analgesia is associated with a higher incidence of maternal fever, while remifentanil analgesia results in more frequent and deeper hypoxaemic events. Copyright © 2015 Elsevier Ltd. All rights reserved.
    International journal of obstetric anesthesia 06/2015; DOI:10.1016/j.ijoa.2015.06.003
  • International journal of obstetric anesthesia 06/2015; 24(3). DOI:10.1016/j.ijoa.2015.06.004
  • International journal of obstetric anesthesia 06/2015; DOI:10.1016/j.ijoa.2015.06.002