Editor's Choice Articles
Investigating the use of non-loss of resistance syringes for epidural insertion: experience on a mannequinThe Obstetric Anaesthetists’ Association (OAA) has recently released a statement outlining the disruption to the supply of the Portex® Loss of Resistance (LOR) Syringe (Smiths Medical, UK) which is commonly used for epidural catheter insertion in our Trust and many Trusts around the country.1
The incidence of breakthrough pain associated with programmed intermittent bolus volumes for labor epidural analgesia: a randomized controlled trialMaintenance of epidural labor analgesia using programmed intermittent epidural bolus (PIEB) may be superior to continuous epidural infusion (CEI) analgesia in respects such as reducing the use of local anesthetic, improving the quality of analgesia, reducing motor block, and improving maternal satisfaction.1–4 In previous studies the incidence of breakthrough pain, defined as the woman complaining of pain or stress requiring supplemental treatment, was as high as 62.3%.5 Breakthrough pain may adversely affect the maternal labor experience.
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.
Cardiac ultrasonography in obstetrics: a necessary skill for the present and future anesthesiologistIn high-income countries, cardiovascular disease is the leading cause of maternal death,1 and the incidence of postpartum hemorrhage continues to increase.2 Point-of-care ultrasonography (POCUS) has emerged as a valuable tool in the assessment of high-risk obstetric patients and women who experience bleeding or other complications during childbirth. The increasing burden in morbidity and obstetric critical illness over recent decades has led anesthesia experts to advocate for the use of POCUS on all high-acuity obstetric units.
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).
The effect of two groups of intrathecal fentanyl doses on analgesic outcomes and adverse effects in parturients undergoing cesarean delivery: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysisCesarean delivery (CD) is one of the most common surgical procedures worldwide,1 mainly performed under spinal anesthesia. The addition of intrathecal opioids to local anesthetics for spinal anesthesia helps improve analgesia in the intra-operative and postoperative periods.2 Intrathecal morphine is recognized as a gold standard to provide a prolonged duration of postoperative analgesia.3 However, the drug has a delayed onset of action and cannot provide intra-operative analgesia.4,5 Further, there is limited availability of preservative-free morphine in developing countries, so it is common to use short-acting intrathecal opioids like fentanyl instead of morphine to enhance peri-operative analgesia after CD.