Edward T Riley

• Professor Emeritus at Stanford University

( Int J Obstet Anesth . 58;2024:103974. https://doi.org/10.1016/j.ijoa.2023.103974) Tubal ligation after childbirth is a popular birth control option in the United States. ACOG views postpartum tubal ligation (PPTL) as a time-sensitive procedure that must be done promptly to avoid unintended pregnancies. Recent limitations on abortion may lead to a...

( J Clin Anesth. 2022;80:110886 | https://doi.org/10.1016/j.jclinane.2022.110886) The imperative need for an operational and prepared environment in labor and delivery (L&D) units, particularly for emergency cesarean delivery (CD), underscores the requirement for a readily available operating room. This preparedness extends to having emergency airw...

Background The role of continuous wound infusion catheters as part of a multimodal analgesia strategy after Caesarean delivery is unclear. We introduced continuous wound infusion catheters to our multimodal analgesia regimen to evaluate the impact on analgesic outcomes after Caesarean delivery. Methods After institutional review board (IRB) approv...

Background Monitoring complications associated with medical procedures requires reliable and accurate record keeping. Nudge reminders executed by way of electronic medical record (EMR) alerts influence clinician behaviour. We hypothesised that the introduction of an EMR nudge would improve documentation of replaced neuraxial blocks by obstetric ana...

Multidisciplinary team management of postpartum hemorrhage (PPH) is needed to optimize care and improve outcomes. Lucile Packard Children's Hospital, Stanford, is a tertiary referral center with 4600 deliveries/y (>70% high-risk deliveries), and there have been times when the obstetric anesthesia team was alerted late or not at all for PPHs. Introd...

( Anesth Analg . 2022;135:1142–1150) Determining appropriate and adequate staffing is essential for obstetric anesthesia care to safeguard favorable maternal and neonatal outcomes. Despite this, the optimal workload of obstetric anesthesia staff has yet to be determined, possibly because of the unpredictable and ever-changing needs within the obste...

Study objective To assess the feasibility, patient tolerance, pharmacokinetics, and potential effectiveness of a randomized controlled trial protocol investigating intravenous calcium chloride for the prevention of uterine atony during cesarean delivery. Design Double-blind, randomized controlled pilot trial with nested population pharmacokinetic...

Background: Optimal workload and staffing for obstetric anesthesia services have yet to be determined. We surveyed Society of Obstetric Anesthesia and Perinatology (SOAP) Centers of Excellence (COE) for Obstetric Anesthesia Care institutions to evaluate procedure-based obstetric anesthesia workload and facility use. Methods: After institutional...

Background The EpiFaith® syringe is a novel loss-of-resistance syringe that utilizes a spring-loaded plunger that automatically moves forward within the syringe when there is a loss of resistance. We evaluated the syringe in a clinical setting, among a cohort of pregnant women receiving neuraxial labor analgesia. Methods In a non-randomized, obser...

( Int J Obstet Anesth . 2020;41:39–46) In current anesthesia practice, a common preventative medication for postoperative nausea and/or vomiting (PONV) is dexamethasone. However, its efficacy when administered as a single intraoperative dose for procedures performed under spinal anesthesia is unclear. Analgesic effects of dexamethasone administered...

Objective: To evaluate whether an order set change that halved the initial dose of oxycodone and allowed the remainder to be given 1 hour later, if requested, was associated with reduced opioid use and side effects after cesarean delivery. Methods: This retrospective, clinical practice study reviewed electronic medical records after implementati...

Background: Dexamethasone is an effective analgesic and anti-emetic in patients undergoing many surgical procedures but its effects on pain after cesarean delivery are poorly studied. The aim of this study was to evaluate if routine intra-operative administration of dexamethasone improved analgesia and decreased postoperative nausea and vomiting a...

During cesarean hysterectomy for a placenta accreta, a 36-year-old parturient underwent a massive resuscitation for profound bleeding and also suffered a pulmonary embolus leading to cardiac arrest. Chest compressions and epinephrine were required for resucitation. When surgery was complete, she was taken to the intensive care unit on an epinephrin...

Objective: Colloid preloading diminishes post-spinal hypotension. However, whether colloid preloading is superior to crystalloid co-loading is uncertain. In this retrospective study, we compared the effects of a colloid preload versus a crystalloid co-load on vasopressor requirements and maternal haemodynamics among women undergoing elective caesa...

During a cesarean hysterectomy for placenta percreta, transesophageal echocardiography was used to monitor volume status and guide resuscitation. After delivery of the neonate but before massive surgical hemorrhage, a thrombus appeared in the inferior vena cava. Roughly 3 hours later, the patient had hemodynamic changes consistent with an intraoper...

Background: The Malignant Hyperthermia Association of the United States recommends that dantrolene be available for administration within 10 min. One approach to dantrolene availability is a malignant hyperthermia cart, stocked with dantrolene, other drugs, and supplies. However, this may not be of cost benefit for maternity units, where triggerin...

( Anesth Analg . 2017;124(3):857–862) Oxytocin is routinely used for prophylaxis against uterine atony after vaginal or cesarean delivery (CD), as it has been shown to decrease the risk of postpartum hemorrhage (PPH). In fact, a low dose delivered during elective CD can initiate adequate uterine tone after placental delivery. However, consensus is...

We describe a case of intrathecal migration of a wire-reinforced epidural catheter in a parturient who received epidural labor analgesia. Epidural analgesia was initiated with a combined-spinal epidural technique and maintained by programmed intermittent epidural boluses. Epidural catheter aspiration after insertion was negative for cerebrospinal f...

( Anesth Analg. 2016;123(4):965–971) Patients can still experience breakthrough pain under patient-controlled epidural analgesia (PCEA) with continuous epidural infusion (CEI). An alternative to PCEA with or without CEI is programmed intermittent epidural bolus (PIEB) of epidural analgesia. In the present study, the authors reviewed the potential f...

( Reg Anesth Pain. Med 2016;41:405) Two of the most effective methods used for providing intrapartum pain relief are epidural analgesia and combined spinal-epidural analgesia. Some of the advantages that spinal analgesia has over epidural analgesia include more rapid onset, a definitive endpoint for placement, usage of lower doses of local anesthet...

( IJOA. 2016;26:32–38) Maintenance of epidural labor analgesia has evolved from manual boluses to continuous infusions to patient-controlled boluses. Patient-controlled epidural analgesia (PCEA) in the presence or absence of a background continuous epidural infusion (CEI) is a common technique for providing labor analgesia. Programmed intermittent...

Background: Women who undergo intrapartum caesarean delivery (CD) are at increased risk of postpartum hemorrhage (PPH) compared with those undergoing prelabor CD. To determine whether the presence and strength of the associations between individual risk factors and severe PPH vary among women undergoing prelabor CD or intrapartum CD, stratified an...

Background: Compared to vaginal delivery, women undergoing cesarean delivery are at increased risk of postpartum hemorrhage. Management approaches may differ between those undergoing prelabor cesarean delivery compared to intrapartum cesarean delivery. We examined surgical interventions, blood component use, and maternal outcomes among those exper...

Cesarean delivery is the single most important risk factor for developing postpartum infection.¹ Surgical site infection (SSI), including wound infection and endometritis, remains a significant cause of morbidity and mortality in the obstetric population undergoing cesarean delivery.2, 3 Anti-microbial prophylaxis, the most important factor in prev...

Background: Oxytocin is routinely used as prophylaxis against uterine atony. During elective cesarean delivery (CD), an oxytocin bolus is used to initiate adequate uterine tone, followed by an oxytocin infusion to maintain uterine contractility. However, it is unclear whether oxytocin maintenance infusion rate influences total estimated blood loss...

Programmed intermittent epidural bolus (PIEB) is an exciting new technology that has the potential to improve the maintenance of epidural labor analgesia. PIEB compared with a continuous epidural infusion (CEI) has the potential advantage of greater spread within the epidural space and therefore better sensory blockade. Studies have demonstrated a...

Letter to the editor. No abstract.

( Int J Obstet Anesth. 2015;24:210–216) Postoperative multimodal regimens like oral opioid-acetaminophen combination drugs can produce adverse maternal opioid-related side effects. Uncoupling these 2 drugs and administering them separately on a scheduled basis (acetaminophen plus as-needed opioids) may thereby be advantageous and lead to decreased...

Intrathecal catheter devices using a catheter-over-needle design and softer flexible material have been introduced to clinical practice with the aim of reducing some of the complications such as postdural puncture headaches and paresthesias seen with previous versions of intrathecal catheters. We present a case series of 5 cesarean deliveries using...

Introduction: The aim of this impact study was to compare the analgesic efficacy and side effect profile of programmed intermittent epidural boluses (PIEB)+patient-controlled epidural analgesia (PCEA) to continuous epidural infusion (CEI)+PCEA for maintenance labor analgesia after the introduction of PIEB at our institution. Methods: We conducte...

Combination opioid-acetaminophen drugs are commonly used for pain management after cesarean delivery. The aim of this study was to determine if scheduled acetaminophen decreases opioid use compared to as-needed combination acetaminophen-opioid administration. We performed a retrospective chart review of women who underwent cesarean delivery before...

Background Because of the lack of large obstetric anesthesia databases, the incidences of serious complications related to obstetric anesthesia remain unknown. The Society for Obstetric Anesthesia and Perinatology developed the Serious Complication Repository Project to establish the incidence of serious complications related to obstetric anesthesi...

Background: Because of the lack of large obstetric anesthesia databases, the incidences of serious complications related to obstetric anesthesia remain unknown. The Society for Obstetric Anesthesia and Perinatology developed the Serious Complication Repository Project to establish the incidence of serious complications related to obstetric anesthe...

Cesarean deliveries comprise approximately 30% of all births, many of which are scheduled. Given the labile nature of labor and delivery units, scheduled cesarean deliveries are often delayed. Our aim was to improve on-time scheduled cesarean delivery start times. A multidisciplinary team (obstetrician-gynecologist, nursing, anesthesia, and hospita...

BackgroundA wide range of doses has been suggested for intrathecal clonidine, but no dose-ranging study has examined analgesic effects below 100 μg. The primary aim of this volunteer study was to assess the dose vs analgesic effect relationship for doses of intrathecal clonidine below 100 μg.Methods After IRB approval and signed informed consent, 1...

IntroductionIntrathecal morphine is highly effective for post-cesarean analgesia; however, the optimal dose is yet to be established. The aim of this study was to compare analgesia and side effects after a change in institutional practice to give 200 μg rather than 100 μg.Methods We conducted a retrospective chart review of 241 patients who had an...

Introduction The aims of this study were to assess racial/ethnic disparities for neuraxial labor analgesia utilization and to determine if preferred spoken language mediates the association between race/ethnicity and neuraxial labor analgesia utilization. Methods We performed a retrospective cohort study of 3129 obstetric patients who underwent va...

We performed a retrospective cohort analysis of pregnancies among women with moderate to complex congenital heart disease or pulmonary hypertension over a 12-year period, resulting in a cohort of 107 cases in 65 women. Neuraxial analgesia or anaesthesia was provided in 84%, 89% and 95% of spontaneous vaginal, operative vaginal and caesarean deliver...

(Anesth Analg. 2011;112(5):1041–1047)

(Int J Obstet Anesth. 2011;20(3):240–245)

We report the case of a 37-year-old postpartum patient who developed a contained subacute spinal subdural hematoma causing mass effect on the cauda equina and severe spinal stenosis after undergoing an epidural blood patch for postdural puncture headache. Recovery occurred following administration of oral steroids.

We present a case of a parturient with babesiosis and Lyme disease who was scheduled for elective caesarean section. The caesarean section was performed under spinal anaesthesia, and the patient had a coronary artery dissection 4 days postoperatively. Neuraxial anaesthesia and possible mechanisms for the coronary artery dissection in a patient with...

(Anesthesiology. 2011;114(3):529–35)

Previous studies have demonstrated that the addition of intrathecal fentanyl to a spinal anesthetic for cesarean delivery improves intraoperative analgesia. However, intrathecal fentanyl may induce acute tolerance to opioids. The objective of this study was to investigate whether the addition of intrathecal fentanyl to spinal anesthesia with intrat...

Obstetric patients diagnosed with abnormal placentation (placenta accreta, increta or percreta) are at increased risk of major postpartum hemorrhage and cesarean hysterectomy. Obstetric anesthesiologists are primarily involved in intraoperative transfusion management in these cases. Hemoglobin assessment is invaluable for assisting transfusion deci...

In this study, we assessed the relationship between coagulation parameters using kaolin-activated thromboelastography (TEG®) and total estimated blood loss (EBL) in patients undergoing elective cesarean delivery (CD). TEG® parameters were recorded in 52 patients before and after elective CD. Laboratory markers of coagulation (prothrombin time, acti...

The contribution of internal loading from the sediments to the total phosphorus (TP) budget and to the [TP] in the surface water was investigated from May to November in Nakamun and Halfmoon lakes, Alberta. During the summer, Nakamun Lake was intermittently stratified and Halfmoon Lake was weakly, thermally stratified. During the stratified periods...

Data from the literature were used to calculate separate regressions of summer chlorophyll a concentration ([Chl a]) on spring total phosphorus concentration ([TP]) for lakes that remain thermally stratified during the summer and lakes that mix intermittently during the summer. Significant differences were found in the spring [TP] – summer [Chl a]...

It has been suggested that morbidly obese parturients may require less local anesthetic for spinal anesthesia. The aim of this study was to determine the effective dose (ED(50)/ED(95)) of intrathecal bupivacaine for cesarean delivery in morbidly obese patients. Morbidly obese parturients (body mass index equal to or more than 40) undergoing electiv...

To examine the relationship between body mass index (BMI), perioperative times, and anesthetic interventions in patients undergoing elective cesarean delivery. Retrospective chart review. University-affiliated hospital. All patients were ranked according to BMI (kg/m(2)) at the time of delivery. The BMI groups were designated a priori: ≤ 29.9 kg/m(...

The aim of this study was to determine the lowest effective bolus dose of oxytocin to produce adequate uterine tone (UT) during elective Caesarean delivery (CD). Seventy-five pregnant patients undergoing elective CD under spinal anaesthesia were randomized to receive oxytocin (0.5, 1, 3, 5 units) or placebo. UT was assessed by a blinded obstetricia...

Objectives. The purpose of this study was to determine the factors associated with whether a woman received an epidural in labor and to determine the main source used to obtain information about labor epidurals. Methods. Over a one-month period, we surveyed all patients who labored, the day after their delivery. We used multiple logistic regressio...

Studies examining the effects of various analgesics and anesthetics on postoperative pain following cesarean delivery conventionally use the scheduled cesarean population. This study compares postoperative analgesic requirements and recovery profiles in women undergoing scheduled cesarean compared to unplanned cesarean delivery following labor. We...

The decision to use red blood cell transfusion and/or blood products (fresh frozen plasma, platelets, cryoprecipitate) to manage obstetric hemorrhage or treat postpartum anemia is often made empirically by physicians. We performed a retrospective study to review transfusion outcomes in pregnant and postpartum patients at a large obstetric center. A...

We report a case study of a 22-year-old woman with mitochondrial thymidine kinase 2 deficiency and chronic respiratory failure due to severe neuromuscular weakness requiring noninvasive positive pressure ventilation (NIPPV) since 12 years of age. During pregnancy and cesarean delivery, she was successfully supported with NIPPV. A multidisciplinary...

Pre-loading with hetastarch decreases the incidence and severity of hypotension after spinal anesthesia for cesarean delivery. However, pharmacokinetic studies with crystalloid predict that fluid loading should be more efficacious if rapidly administered immediately after induction of spinal anesthesia. The aim of this study was to compare pre- and...

Previous studies have shown more extensive cephalad sensory blockade in women receiving combined spinal-epidural (CSE) anesthesia compared with single-shot spinal (SSS) anesthesia for elective cesarean delivery. It has been postulated that introduction of the epidural needle during CSE disturbs the negative pressure in the epidural space, resulting...

A laboring woman was accidentally given 45 microg of sufentanil intrathecally in the course of combined spinal-epidural analgesia. She experienced intense pruritus and transient swallowing difficulty without respiratory depression, but still had incomplete pain relief, with delivery and episiotomy repair requiring additional analgesia. This case hi...

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The purpose of this study was to compare terbutaline and nitroglycerin for acute intrapartum fetal resuscitation. Women between 32-, 42 weeks' gestation were assigned randomly to 250 microg of terbutaline or 400 microg nitroglycerin intravenously for nonreassuring fetal heart rate tracings in labor. The rate of successful acute intrapartum fetal re...

The Episure syringe is a unique spring-loaded loss-of-resistance (LOR) syringe with a coaxial compression spring within a Portex Pulsator LOR syringe. This syringe supplies a constant pressure while the operator is advancing the Tuohy needle. We evaluated the syringe using an artificial model of the ligamentum flavum, an anesthetized pig, and women...

Fetal oxygen saturation (FSpo(2)) is an emerging technology for intrapartum fetal monitoring. We monitored FSpo(2) before and after combined spinal-epidural analgesia in 8 laboring women requesting neuraxial analgesia. Fetal heart rate (FHR) and FSpo(2) (using the Nellcor N400/FS14 system [Nellcor, Pleasanton, CA]) were recorded at baseline and eve...

A single-dose of neuraxial morphine sulfate provides good post-Cesarean analgesia; however, its efficacy is limited to the first postoperative day. In a recent phase III study, extended-release epidural morphine (EREM) formulation provided more effective, prolonged analgesia after Cesarean delivery, compared to conventional epidural morphine. Howev...