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Scott Segal - One of the best experts on this subject based on the ideXlab platform.
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serious complications related to Obstetric Anesthesia the serious complication repository project of the society for Obstetric Anesthesia and perinatology
Anesthesiology, 2014Co-Authors: Robert Dangelo, Richard M Smiley, Edward T. Riley, Scott SegalAbstract: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 Anesthesia and to identify risk factors associated with each. METHODS: Serious complications were defined by the Society for Obstetric Anesthesia and Perinatology Research Committee which also coordinated the study. Thirty institutions participated in the approximately 5-yr study period. Data were collected as part of institutional quality assurance and sent to the central project coordinator quarterly. RESULTS: Data were captured on more than 257,000 anesthetics, including 5,000 general anesthetics for cesarean delivery. There were 157 total serious complications reported, 85 of which were Anesthesia related. High neuraxial block, respiratory arrest in labor and delivery, and unrecognized spinal catheter were the most frequent complications encountered. A serious complication occurs in approximately 1:3,000 (1:2,443 to 1:3,782) Obstetric anesthetics. CONCLUSIONS: The Serious Complication Repository Project establishes the incidence of serious complications in Obstetric Anesthesia. Because serious complications related to Obstetric Anesthesia are rare, there were too few complications in each category to identify risk factors associated with each. However, because many of these complications can lead to catastrophic outcomes, it is recommended that the Anesthesia provider remains vigilant and be prepared to rapidly diagnose and treat any complication.
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serious complications related to Obstetric Anesthesia the serious complication repository project of the society for Obstetric Anesthesia and perinatology
Anesthesiology, 2014Co-Authors: Robert Dangelo, Richard M Smiley, Edward T. Riley, Scott SegalAbstract: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 Anesthesia and to identify risk factors associated with each. Methods: Serious complications were defined by the Society for Obstetric Anesthesia and Perinatology Research Committee which also coordinated the study. Thirty institutions participated in the approximately 5-yr study period. Data were collected as part of institutional quality assurance and sent to the central project coordinator quarterly. Results: Data were captured on more than 257,000 anesthetics, including 5,000 general anesthetics for cesarean delivery. There were 157 total serious complications reported, 85 of which were Anesthesia related. High neuraxial block, respiratory arrest in labor and delivery, and unrecognized spinal catheter were the most frequent complications encountered. A serious complication occurs in approximately 1:3,000 (1:2,443 to 1:3,782) Obstetric anesthetics. Conclusions: The Serious Complication Repository Project establishes the incidence of serious complications in Obstetric Anesthesia. Because serious complications related to Obstetric Anesthesia are rare, there were too few complications in each category to identify risk factors associated with each. However, because many of these complications can lead to catastrophic outcomes, it is recommended that the Anesthesia provider remains vigilant and be prepared to rapidly diagnose and treat any complication. (Anesthesiology 2014; 120:1505-12)
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placental tissue enhances uterine relaxation by nitroglycerin
Anesthesia & Analgesia, 1998Co-Authors: Scott Segal, Andrew N Csavoy, Sanjay DattaAbstract:UNLABELLED Nitroglycerin (TNG) has recently gained popularity in Obstetric Anesthesia for facilitating acute uterine relaxation in the treatment of Obstetric emergencies such as retained placenta. Laboratory investigations, however, have consistently found the uterus insensitive to clinically used doses of TNG. We hypothesized that the presence of the placenta in the uterus may be important for TNG to be effective, because it has been present in most clinical reports and has generally been absent in laboratory investigations. Sections of near-term gravid rat uteri were mounted for isometric force recording. We studied spontaneous contractions and acetylcholine-induced sustained contractions both with and without the addition of minced placental tissue in close approximation to the uterine muscle. Phenylephrine-precontracted rings of thoracic aorta were studied as a positive control. Log dose-response curves for TNG, 10(-9) to 10(-5) M, were constructed for each tissue. Uterine muscle alone was resistant to all but the largest doses of TNG, both in spontaneous and sustained contraction models. The addition of placental tissue caused a marked increase in sensitivity, reducing spontaneous uterine contractions by 50% at log -5.92 M (95% confidence interval, -6.49, -5.05), which was comparable to the sensitivity in aorta. Nitric oxide (NO) inhibitors pyrogallol (a superoxide anion generator) and methylene blue (a guanylate cyclase inhibitor) completely blocked the effect of TNG in the presence of placenta. Placental tissue modestly increased the response of aorta to TNG, but not of uterine tissue to the NO-independent uterine relaxants MgSO4 and terbutaline. IMPLICATIONS Nitroglycerin can relax the human uterus during Obstetric emergencies, but the drug has never been proven effective in the laboratory. This study shows that nitroglycerin can relax uterine contractions in the rat, provided that the placenta is adjacent to the uterus. The mechanism seems to be via the release of nitric oxide.
Richard M Smiley - One of the best experts on this subject based on the ideXlab platform.
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post dural puncture headache the worst common complication in Obstetric Anesthesia
Seminars in Perinatology, 2014Co-Authors: Adam Sachs, Richard M SmileyAbstract:Ever since the first spinal anesthetic in the late 19th century, the problem of "spinal headache" or post-dural puncture headache (PDPH) has plagued clinicians, and more importantly, patients. It has long been realized that the headache and other symptoms that often occur after the entry of a needle into the subarachnoid space is somehow related to fluid loss, although the exact pathophysiology of the headache has really never been defined. With the introduction of pencil-point spinal needles for spinal Anesthesia in pregnant women over the past 2 decades, the problem of PDPH in Obstetrics has been more associated with accidental dural puncture during attempted epidural procedures. Accidental puncture probably occurs in about 1% of procedures, so with over 60% of pregnant women receiving epidural analgesia for labor, there are probably 20,000-50,000 Obstetric patients with PDPH in the United States each year. In this article, we will discuss the current state of knowledge in this area, suggesting that the PDPH syndrome is more severe and often more long-lasting, with some potentially life-threatening complications (cerebral hemorrhage) than usually appreciated or admitted. While prevention and treatment options are still limited, with the only clearly effective treatment being the epidural blood patch, recognition of the PDPH syndrome in postpartum women by anesthesiologists and Obstetricians, with aggressive follow-up and treatment, may help limit the associated morbidity and mortality.
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serious complications related to Obstetric Anesthesia the serious complication repository project of the society for Obstetric Anesthesia and perinatology
Anesthesiology, 2014Co-Authors: Robert Dangelo, Richard M Smiley, Edward T. Riley, Scott SegalAbstract: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 Anesthesia and to identify risk factors associated with each. METHODS: Serious complications were defined by the Society for Obstetric Anesthesia and Perinatology Research Committee which also coordinated the study. Thirty institutions participated in the approximately 5-yr study period. Data were collected as part of institutional quality assurance and sent to the central project coordinator quarterly. RESULTS: Data were captured on more than 257,000 anesthetics, including 5,000 general anesthetics for cesarean delivery. There were 157 total serious complications reported, 85 of which were Anesthesia related. High neuraxial block, respiratory arrest in labor and delivery, and unrecognized spinal catheter were the most frequent complications encountered. A serious complication occurs in approximately 1:3,000 (1:2,443 to 1:3,782) Obstetric anesthetics. CONCLUSIONS: The Serious Complication Repository Project establishes the incidence of serious complications in Obstetric Anesthesia. Because serious complications related to Obstetric Anesthesia are rare, there were too few complications in each category to identify risk factors associated with each. However, because many of these complications can lead to catastrophic outcomes, it is recommended that the Anesthesia provider remains vigilant and be prepared to rapidly diagnose and treat any complication.
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serious complications related to Obstetric Anesthesia the serious complication repository project of the society for Obstetric Anesthesia and perinatology
Anesthesiology, 2014Co-Authors: Robert Dangelo, Richard M Smiley, Edward T. Riley, Scott SegalAbstract: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 Anesthesia and to identify risk factors associated with each. Methods: Serious complications were defined by the Society for Obstetric Anesthesia and Perinatology Research Committee which also coordinated the study. Thirty institutions participated in the approximately 5-yr study period. Data were collected as part of institutional quality assurance and sent to the central project coordinator quarterly. Results: Data were captured on more than 257,000 anesthetics, including 5,000 general anesthetics for cesarean delivery. There were 157 total serious complications reported, 85 of which were Anesthesia related. High neuraxial block, respiratory arrest in labor and delivery, and unrecognized spinal catheter were the most frequent complications encountered. A serious complication occurs in approximately 1:3,000 (1:2,443 to 1:3,782) Obstetric anesthetics. Conclusions: The Serious Complication Repository Project establishes the incidence of serious complications in Obstetric Anesthesia. Because serious complications related to Obstetric Anesthesia are rare, there were too few complications in each category to identify risk factors associated with each. However, because many of these complications can lead to catastrophic outcomes, it is recommended that the Anesthesia provider remains vigilant and be prepared to rapidly diagnose and treat any complication. (Anesthesiology 2014; 120:1505-12)
Ruth Landau - One of the best experts on this subject based on the ideXlab platform.
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Obstetric Anesthesia during the covid 19 pandemic
Anesthesia & Analgesia, 2020Co-Authors: Melissa E Bauer, Jill M Mhyre, Pervez Sultan, Kyra Bernstein, E Dinges, C Delgado, Nadir Elsharawi, Ruth LandauAbstract:With increasing numbers of coronavirus disease 2019 (COVID-19) cases due to efficient human-to-human transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the United States, preparation for the unpredictable setting of labor and delivery is paramount. The priorities are 2-fold in the management of Obstetric patients with COVID-19 infection or persons under investigation (PUI): (1) caring for the range of asymptomatic to critically ill pregnant and postpartum women; (2) protecting health care workers and beyond from exposure during the delivery hospitalization (health care providers, personnel, family members). The goal of this review is to provide evidence-based recommendations or, when evidence is limited, expert opinion for anesthesiologists caring for pregnant women during the COVID-19 pandemic with a focus on preparedness and best clinical Obstetric Anesthesia practice.
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the society for Obstetric Anesthesia and perinatology consensus statement on the anesthetic management of pregnant and postpartum women receiving thromboprophylaxis or higher dose anticoagulants
Anesthesia & Analgesia, 2017Co-Authors: Lisa Leffert, Brendan Carvalho, Alexander J Butwick, Katherine W Arendt, Shannon M Bates, Alexander M Friedman, Terese T Horlocker, Timothy T Houle, Ruth Landau, Heloise DuboisAbstract:Venous thromboembolism is recognized as a leading cause of maternal death in the United States. Thromboprophylaxis has been highlighted as a key preventive measure to reduce venous thromboembolism-related maternal deaths. However, the expanded use of thromboprophylaxis in Obstetrics will have a major impact on the use and timing of neuraxial analgesia and Anesthesia for women undergoing vaginal or cesarean delivery and other Obstetric surgeries. Experts from the Society of Obstetric Anesthesia and Perinatology, the American Society of Regional Anesthesia, and hematology have collaborated to develop this comprehensive, pregnancy-specific consensus statement on neuraxial procedures in Obstetric patients receiving thromboprophylaxis or higher dose anticoagulants. To date, none of the existing Anesthesia societies' recommendations have weighed the potential risks of neuraxial procedures in the presence of thromboprophylaxis, with the competing risks of general Anesthesia with a potentially difficult airway, or maternal or fetal harm from avoidance or delayed neuraxial Anesthesia. Furthermore, existing guidelines have not integrated the pharmacokinetics and pharmacodynamics of anticoagulants in the Obstetric population. The goal of this consensus statement is to provide a practical guide of how to appropriately identify, prepare, and manage pregnant women receiving thromboprophylaxis or higher dose anticoagulants during the ante-, intra-, and postpartum periods. The tactics to facilitate multidisciplinary communication, evidence-based pharmacokinetic and spinal epidural hematoma data, and Decision Aids should help inform risk-benefit discussions with patients and facilitate shared decision making.
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the impact of genetics and other factors on intra and post partum pain
Current Anesthesiology Reports, 2013Co-Authors: Ruth Landau, Clemens M Ortner, Pascal Henri VuilleumierAbstract:In an attempt to provide some explanation for the observed differences in pain perception and analgesic requirements during labor and delivery between women, the idea that genetic variability is an important factor has emerged over the past decade. Bearing in mind the challenges posed when evaluating pain during childbirth as a phenotype, recent findings in the field of genetics and Obstetric Anesthesia are presented in this review; in particular those related to differences in labor analgesia requirements between women, the response to opioids after cesarean delivery, as well as theories on why post-cesarean pain may be different from other types of post-surgical pain.
Ronald B George - One of the best experts on this subject based on the ideXlab platform.
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sexual and gender minorities educational content within Obstetric Anesthesia fellowship programs a survey
Obstetric Anesthesia Digest, 2021Co-Authors: Hilary Maccormick, Ronald B GeorgeAbstract:Improved patient-provider relationships can positively influence patient outcomes. Sexual and gender minorities (SGM) represent a wide variety of marginalized populations. There is an absence of studies examining the inclusion of SGM-related health education within postgraduate training in Anesthesia. This study’s objective was to perform an environmental scan of the educational content of North American Obstetric Anesthesia fellowship programs. An online survey was developed based on a review of the existing literature assessing the presence of SGM content within other healthcare-provider curricula. The survey instrument was distributed electronically to 50 program directors of North American Obstetric Anesthesia fellowship programs. Survey responses were summarized using descriptive statistics. Survey responses were received from 30 of the 50 program directors (60%). Of these, 54% (14/26) felt their curriculum adequately prepares fellows to care for SGM patients, yet only 19% (5/26) of participants stated that SGM content was part of their curriculum and 31% (8/26) would like to see more incorporated in the future. Perceived lack of need was chosen as the biggest barrier to curricular inclusion of SGM education (46%; 12/26), followed by lack of available/interested faculty (19%; 5/26) and time (19%; 5/26). Our results suggest that, although curriculum leaders appreciate that SGM patients are encountered within the practice of Obstetric Anesthesia, most fellowship programs do not explicitly include SGM curricular content. Nevertheless, there appears to be interest in developing SGM curricular content for Obstetric Anesthesia fellowship training. Future steps should include perspectives of trainees and patients to inform curricular content.
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sexual and gender minorities educational content within Obstetric Anesthesia fellowship programs a survey
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2020Co-Authors: Hilary Maccormick, Ronald B GeorgeAbstract:Author(s): MacCormick, Hilary; George, Ronald B | Abstract: PURPOSE:Improved patient-provider relationships can positively influence patient outcomes. Sexual and gender minorities (SGM) represent a wide variety of marginalized populations. There is an absence of studies examining the inclusion of SGM-related health education within postgraduate training in Anesthesia. This study's objective was to perform an environmental scan of the educational content of North American Obstetric Anesthesia fellowship programs. METHODS:An online survey was developed based on a review of the existing literature assessing the presence of SGM content within other healthcare-provider curricula. The survey instrument was distributed electronically to 50 program directors of North American Obstetric Anesthesia fellowship programs. Survey responses were summarized using descriptive statistics. RESULTS:Survey responses were received from 30 of the 50 program directors (60%). Of these, 54% (14/26) felt their curriculum adequately prepares fellows to care for SGM patients, yet only 19% (5/26) of participants stated that SGM content was part of their curriculum and 31% (8/26) would like to see more incorporated in the future. Perceived lack of need was chosen as the biggest barrier to curricular inclusion of SGM education (46%; 12/26), followed by lack of available/interested faculty (19%; 5/26) and time (19%; 5/26). CONCLUSIONS:Our results suggest that, although curriculum leaders appreciate that SGM patients are encountered within the practice of Obstetric Anesthesia, most fellowship programs do not explicitly include SGM curricular content. Nevertheless, there appears to be interest in developing SGM curricular content for Obstetric Anesthesia fellowship training. Future steps should include perspectives of trainees and patients to inform curricular content.
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society for Obstetric Anesthesia and perinatology consensus statement monitoring recommendations for prevention and detection of respiratory depression associated with administration of neuraxial morphine for cesarean delivery analgesia
Anesthesia & Analgesia, 2019Co-Authors: Jeanette R Bauchat, Pervez Sultan, Carolyn F Weiniger, Ronald B George, Ashraf S Habib, Kazuo Ando, John J Kowalczyk, Rie Kato, Craig M Palmer, Brendan CarvalhoAbstract:The majority of women undergoing cesarean delivery in the United States receive neuraxial morphine, the most effective form of postoperative analgesia for this surgery. Current American Society of Anesthesiologists (ASA) and American Society of Regional Anesthesia and Pain Medicine (ASRA) recommend respiratory monitoring standards following neuraxial morphine administration in the general surgical population that may be too frequent and intensive when applied to the healthy Obstetric population receiving a single dose of neuraxial morphine at the time of surgery. There is limited evidence to support or guide the optimal modality, frequency, and duration of respiratory monitoring in the postoperative cesarean delivery patient receiving a single dose of neuraxial morphine. Consistent with the mission of the Society for Obstetric Anesthesia and Perinatology (SOAP) to improve outcomes in pregnancy for women and neonates, the purpose of this consensus statement is to encourage the use of this highly effective analgesic technique while promoting safe practice and patient-centered care. The document aims to reduce unnecessary interruptions from respiratory monitoring in healthy mothers while focusing vigilance on monitoring in those women at highest risk for respiratory depression following neuraxial morphine administration. This consensus statement promotes the use of low-dose neuraxial morphine and multimodal analgesia after cesarean delivery, gives perspective on the safety of this analgesic technique in healthy women, and promotes patient risk stratification and perioperative risk assessment to determine and adjust the intensity, frequency, and duration of respiratory monitoring.
Brendan Carvalho - One of the best experts on this subject based on the ideXlab platform.
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Antibiotic Prophylaxis for Cesarean Delivery: A Survey of Anesthesiologists
'Hindawi Limited', 2020Co-Authors: Emily S. Reiff, Brendan Carvalho, Ashraf S Habib, Karthik RaghunathanAbstract:Background. The most common complication after cesarean delivery is surgical site infection. Antibiotic prophylaxis reduces infectious morbidity and current anesthetic quality metrics include preincision antibiotic prophylaxis. Recently, studies suggest reductions in infectious morbidity with the addition of azithromycin for unscheduled cesarean delivery. Larger doses of cefazolin are recommended for morbidly obese women, but evidence is conflicting. The aim of this study was to survey anesthesiologists to assess current practice for antibiotic prophylaxis for cesarean delivery. Methods. We invited a random sample of 10,000 current members of the American Society of Anesthesiologists to complete an online survey about their current practice of antibiotic prophylaxis for cesarean delivery in November 2017. The survey included questions similar to a previous survey on this topic in 2012. Results. The response rate was 12.2% (n = 1223). Most respondents had at least 15 years of experience (684, 55.9%), work at a nonteaching or community hospital (729, 59.6%), with >500 cesarean deliveries annually (619, 50.6%), and administer Obstetric Anesthesia several times a week (690, 56.4%). Routine preincision antibiotic prophylaxis was reported by 1162 (95.0%) of the 1223 respondents, a substantial improvement versus the 63.5% reported in the previous study in 2012. For intrapartum cesarean deliveries, 141 (11.5%) administer azithromycin for unscheduled cesarean deliveries. Those who use cefazolin, 509 (42.5%) administer 3 g for morbidly obese women. Conclusion. Adherence to preincision antibiotic prophylaxis for cesarean delivery is very high, a significant improvement within 5 years. A minority of anesthesiologists utilize azithromycin for intrapartum cesarean deliveries. The dose of cefazolin for morbidly obese women varies widely
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society for Obstetric Anesthesia and perinatology consensus statement monitoring recommendations for prevention and detection of respiratory depression associated with administration of neuraxial morphine for cesarean delivery analgesia
Anesthesia & Analgesia, 2019Co-Authors: Jeanette R Bauchat, Pervez Sultan, Carolyn F Weiniger, Ronald B George, Ashraf S Habib, Kazuo Ando, John J Kowalczyk, Rie Kato, Craig M Palmer, Brendan CarvalhoAbstract:The majority of women undergoing cesarean delivery in the United States receive neuraxial morphine, the most effective form of postoperative analgesia for this surgery. Current American Society of Anesthesiologists (ASA) and American Society of Regional Anesthesia and Pain Medicine (ASRA) recommend respiratory monitoring standards following neuraxial morphine administration in the general surgical population that may be too frequent and intensive when applied to the healthy Obstetric population receiving a single dose of neuraxial morphine at the time of surgery. There is limited evidence to support or guide the optimal modality, frequency, and duration of respiratory monitoring in the postoperative cesarean delivery patient receiving a single dose of neuraxial morphine. Consistent with the mission of the Society for Obstetric Anesthesia and Perinatology (SOAP) to improve outcomes in pregnancy for women and neonates, the purpose of this consensus statement is to encourage the use of this highly effective analgesic technique while promoting safe practice and patient-centered care. The document aims to reduce unnecessary interruptions from respiratory monitoring in healthy mothers while focusing vigilance on monitoring in those women at highest risk for respiratory depression following neuraxial morphine administration. This consensus statement promotes the use of low-dose neuraxial morphine and multimodal analgesia after cesarean delivery, gives perspective on the safety of this analgesic technique in healthy women, and promotes patient risk stratification and perioperative risk assessment to determine and adjust the intensity, frequency, and duration of respiratory monitoring.
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postpartum tubal ligation a retrospective review of anesthetic management at a single institution and a practice survey of academic institutions
Journal of Clinical Anesthesia, 2017Co-Authors: Christine Mckenzie, Seden Akdagli, G Abir, Brendan CarvalhoAbstract:Abstract Study objective The primary aim was to evaluate institutional anesthetic techniques utilized for postpartum tubal ligation (PPTL). Secondarily, academic institutions were surveyed on their clinical practice for PPTL. Design An institutional-specific retrospective review of patients with ICD-9 procedure codes for PPTL over a 2-year period was conducted. Obstetric Anesthesia fellowship directors were surveyed on anesthetic management of PPTL. Setting Labor and delivery unit. Internet survey. Patients 202 PPTL procedures were reviewed. 47 institutions were surveyed; 26 responses were received. Measurements Timing of PPTL, anesthetic management, postoperative pain and length of stay. Main results There was an epidural catheter reactivation failure rate of 26% (18/69 epidural catheter reactivation attempts). Time from epidural catheter insertion to PPTL was a significant factor associated with failure: median [IQR; range] time for successful versus failed epidural catheter reactivation was 17h [10–25; 3–55] and 28h [14–33; 5–42], respectively ( P =0.028). Epidural catheter reactivation failure led to significantly longer times to provide surgical Anesthesia than successful epidural catheter reactivation or primary spinal technique: median [IQR] 41min [33–54] versus 15min [12–21] and 19min [15–24], respectively ( P 8h and >24h post-delivery, respectively. Conclusions Epidural catheter reactivation failure increases with longer intervals between catheter placement and PPTL. Failed epidural catheter reactivation increases anesthetic and operating room times. Our results and the significant variability in practice from our survey suggest recommendations on the timing and anesthetic management are needed to reduce unfulfilled PPTL procedures.
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the society for Obstetric Anesthesia and perinatology consensus statement on the anesthetic management of pregnant and postpartum women receiving thromboprophylaxis or higher dose anticoagulants
Anesthesia & Analgesia, 2017Co-Authors: Lisa Leffert, Brendan Carvalho, Alexander J Butwick, Katherine W Arendt, Shannon M Bates, Alexander M Friedman, Terese T Horlocker, Timothy T Houle, Ruth Landau, Heloise DuboisAbstract:Venous thromboembolism is recognized as a leading cause of maternal death in the United States. Thromboprophylaxis has been highlighted as a key preventive measure to reduce venous thromboembolism-related maternal deaths. However, the expanded use of thromboprophylaxis in Obstetrics will have a major impact on the use and timing of neuraxial analgesia and Anesthesia for women undergoing vaginal or cesarean delivery and other Obstetric surgeries. Experts from the Society of Obstetric Anesthesia and Perinatology, the American Society of Regional Anesthesia, and hematology have collaborated to develop this comprehensive, pregnancy-specific consensus statement on neuraxial procedures in Obstetric patients receiving thromboprophylaxis or higher dose anticoagulants. To date, none of the existing Anesthesia societies' recommendations have weighed the potential risks of neuraxial procedures in the presence of thromboprophylaxis, with the competing risks of general Anesthesia with a potentially difficult airway, or maternal or fetal harm from avoidance or delayed neuraxial Anesthesia. Furthermore, existing guidelines have not integrated the pharmacokinetics and pharmacodynamics of anticoagulants in the Obstetric population. The goal of this consensus statement is to provide a practical guide of how to appropriately identify, prepare, and manage pregnant women receiving thromboprophylaxis or higher dose anticoagulants during the ante-, intra-, and postpartum periods. The tactics to facilitate multidisciplinary communication, evidence-based pharmacokinetic and spinal epidural hematoma data, and Decision Aids should help inform risk-benefit discussions with patients and facilitate shared decision making.
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survey of external cephalic version for breech presentation and neuraxial blockade use
Journal of Clinical Anesthesia, 2016Co-Authors: Carolyn F Weiniger, Pervez Sultan, Ashley L Dunn, Brendan CarvalhoAbstract:Abstract Study objective Neuraxial blockade may increase external cephalic version (ECV) success rates. This survey aimed to assess the frequency and characteristics of neuraxial blockade used to facilitate ECV. Setting and design We surveyed Society for Obstetric Anesthesia and Perinatology members regarding ECV practice using a 15-item survey developed by 3 Obstetric anesthesiologists and tested for face validity. The survey was e-mailed in January 2015 and again in February 2015 to the 1056 Society of Obstetric Anesthesiology and Perinatology members. We present descriptive statistics of responses. Participants Our survey response rate was 322 of 1056 (30.5%). Main result Neuraxial blockade was used for ECV always by 18 (5.6%), often by 52 (16.1%), sometimes by 98 (30.4%), rarely by 78 (24.2%), and never by 46 (14.3%) of respondents. An anesthetic sensory block target was selected by 141 (43.8%) respondents, and analgesic by 102 (31.7%) respondents. Epidural drug doses ranged widely, including sufentanil 5-25 μg; lidocaine 1% or 2% 10-20 mL, bupivacaine 0.0625% to 0.5% 6-15 mL, and ropivacaine 0.2% 20 mL. Intrathecal bupivacaine was used by 182 (56.5%) respondents; the most frequent doses were 2.5 mg used by 24 (7.5%), 7.5 mg used by 35 (10.9%), and 12 mg used by 30 (9.3%). Conclusions Neuraxial blockade is not universally offered to facilitate ECV, and there is wide variability in neuraxial blockade techniques, in drugs and doses administered, and in the sensory blockade (anesthetic or analgesic) targeted. Future studies need to evaluate and remove barriers to allow for more widespread use of neuraxial blockade for pain relief and to optimize ECV success rates.
