Editor's Choice Articles
What is new in Obstetric Anesthesia in 2020: a focus on research priorities for maternal morbidity, mortality, and postpartum healthThe annual Gerard W. Ostheimer lecture aims to update Society of Obstetric Anesthesia and Perinatology members on the relevant literature published in the preceding year. In this lecture, papers from the anesthesiology, obstetric, perinatology, neonatology, and health services literature published between January and December 2020 were evaluated and selected based on significance and relevance to clinicians and scientists. There were over 2000 articles in 90 medical journals that met this initial screening criteria for review.
The role of total intravenous anaesthesia for caesarean deliveryNeuraxial anaesthesia is established as the preferred mode of anaesthesia in obstetrics, but general anaesthesia remains necessary in certain situations. It is estimated that 9% of women in the United Kingdom (UK) who have a caesarean delivery (CD) receive general anaesthesia, with the corresponding figure for the United States of America (USA) being 5.8%.1,2 Obstetric general anaesthesia usually entails intravenous anaesthetic induction, a neuromuscular blocking drug, cricoid pressure, and intubation with volatile anaesthetic maintenance.
The venous system during pregnancy. Part 2: clinical implicationsA dynamic reservoir for blood volume, the venous system possesses a virtual point of conversion between unstressed volume (Vu) and stressed volume (Vs). Understanding the physiologic implications of this conversion during pregnancy, particularly as it relates to the maternal and fetal consequences of hypotension (e.g. supine and neuraxial technique-induced), hypertension (e.g. preeclampsia), and fluid administration (e.g. early recovery after cesarean delivery protocols), provides opportunities to understand and develop clinical options (Table 1).
Rescue supraglottic airway devices at caesarean delivery: What are the options to consider?The rate of caesarean delivery (CD) has tripled in the last three decades.1 Most CDs are performed under regional anaesthesia because of its various advantages: better parental experience associated with the delivery; avoidance of exposure to general anaesthetic agents that have a risk of causing anaphylaxis and uterine atony; avoidance of intra-operative awareness; and reduced mortality.2 Importantly, regional anaesthesia avoids or minimizes the risks of airway management and its associated complications such as failed intubation, oesophageal intubation and aspiration.
Reducing post-caesarean delivery surgical site infections: a narrative reviewInfectious complications following labour and delivery are common and can be caused by infection of a surgical incision, endometritis, mastitis, urinary tract infection, pneumonia or drug-induced high temperatures.1 The frequency of infectious complications depends on the mode of delivery, with surgical incision infection most common following caesarean delivery and mastitis most common following vaginal delivery.2 The United States (US) Centers for Disease Control and Prevention (CDC) provide definitions of surgical site infection (SSI) for a wide range of procedures.