Yavor Metodiev

Cardiff and Vale University Health Board | UHW · Department of Anaesthetics

Introduction Cancer complicates approximately 1 in 2000 pregnancies, with increasing incidence due to factors such as increased maternal age, obesity and advancements in antenatal testing. Anaesthetists play a crucial role in managing pregnant patients with cancer, both during delivery and in providing anaesthesia for oncological treatments. This r...

( Eur J Anaesthesiol. 2024;41(2):146–152. doi: 10.1097/EJA.0000000000001855) Though general anesthesia (GA) is used in only a small percentage of cesarean deliveries (CD), the majority of these instances use a rapid induction with an inhalation agent for maintenance. A newer technique that is rising in popularity is total intravenous anesthesia (TI...

The aim of this document is to provide guidance for the management of women and birthing people with a permanent pacemaker (PPM) or implantable cardioverter defibrillator (ICD). Cardiac devices are becoming more common in obstetric practice and a reference document for contemporary evidence‐based practice is required. Where evidence is limited, exp...

We conducted a prospective observational service evaluation across the United Kingdom on the use of total intravenous anaesthesia (TIVA) for obstetric surgery between November 2022 and June 2023. The primary aim was to describe the incidence of TIVA for obstetric surgery within participating units, with secondary aims to describe maternal and neona...

( Int J Obstet Anesth . 2023:54:103650) Accidental awareness while one is under general anesthesia is a large concern that can lead to long-term psychological side effects. One in 670 patients undergoing general anesthesia for cesarean delivery will experience accidental awareness. This is related to inaccurate anesthesia dosages due to pregnancy-r...

The principles of environmentally sustainable healthcare as applied to anaesthesia and peri‐operative care are well documented. Associated recommendations focus on generic principles that can be applied to all areas of practice. These include reducing the use of inhalational anaesthetic agents and carbon dioxide equivalent emissions of modern peri‐...

Kidney transplant recipients are at risk of complications in late pregnancy, with increased rates of pre-eclampsia, intrauterine growth restriction and preterm birth. It is recommended that these women receive more intensive monitoring after 20 weeks’ gestation, ideally provided by a multidisciplinary team in a tertiary centre. This review focuses...

( Int J Obstet Anesth . 2022;51:103548) Neuraxial anesthesia is the most utilized anesthetic technique for obstetric purposes, but general anesthesia (GA) is sometimes used in cesarean deliveries (CD) and rare other scenarios. In obstetric GA cases, the most common scenario is an IV induction followed by maintenance through inhaled volatile halogen...

Accidental awareness under general anaesthesia (AAGA) remains a major complication of anaesthesia. The incidence of AAGA during obstetric anaesthesia is high relative to other specialities. The use of processed electroencephalography (pEEG) in the form of "depth of anaesthesia" monitoring has been shown to reduce the incidence of AAGA in the non-ob...

Purpose of review: To discuss the role of supraglottic airway devices as rescue and primary airway devices in pregnant patients. Recent findings: General anaesthesia in pregnant patients is associated with increased incidence of difficult and failed intubation, especially when performed for caesarean deliveries. The Difficult Airway Society and...

Obstetric general anaesthesia technique usually involves intravenous induction and maintenance with volatile agents. Total intravenous anaesthesia has gained in popularity in non-obstetric practice because of environmental concerns associated with volatile inhalational anaesthetics and evidence of a superior recovery profile. Publications on the us...

A thirty-year-old pregnant woman was admitted to hospital with headache and gastrointestinal discomfort. She developed peripheral oedema and had an emergency caesarean section following an episode of tonic-clonic seizures. Her delivery was further complicated by postpartum haemorrhage and she was admitted to the Intensive Care Unit (ICU) for furthe...

Degloving soft tissue injuries of the back are uncommon in women of child-bearing age. Treatment of such injuries may include split skin grafting of the affected area. We present the case of a 30-year-old primigravid woman who suffered degloving of the skin over the lumbar area that had been treated by split skin grafting three years prior to her p...

In this paper, the authors describe an anesthetic technique for a child with Apert syndrome, presenting to the operating room for a syndactyly separation. The anesthetic approach is innovative for the clinic and is a combination of intravenous anesthesia and two regional techniques (axillary block and transversus abdominis plane block, respectively...

Peripheral nerve blocks are frequently performed as blind techniques, which use anatomical landmarks and the patient's sensation of paresthesias as a guarantee for successful manipulation. In pediatric patients these conditions do not guarantee successful an safe peripheral nerve block. Ultrasound guidance overcomes these limitations in a great deg...