Search

(Anaesthesia. 2023;78:1256–1261)Previous studies have come to different conclusions about whether insertion of an intrathecal (IT) catheter after accidental dural puncture (ADP) during epidural anesthesia reduces complications. The most common complication is postdural puncture headache (PDPH), which can have short-term and long-term effects, including decreased breastfeeding and increased risk for postpartum depression, chronic headache, and backache. The usual treatment for PDPH is an epidural blood patch (EBP), which itself can have serious complications. Accidental dural puncture occurs in ∼0.5% to 1.0% of all epidurals. The authors of this study investigated whether IT catheter insertion was associated with a decreased risk of PDPH and a decreased need for EBP.

(Reg Anesth Pain Med. 2022;47:249–250)While risk factors for an accidental dural puncture (ADP) have been identified, we need a better understanding of modifiable etiologies. This survey of anesthesiologists aimed to collect clinician perspectives on contributing factors to ADP.

(Reg Anesth Pain Med. 2022;47:249–250. doi: 10.1136/rapm-2021-103285)Accidental dural puncture (ADP) is a persistent concern among anesthesiologists as a serious obstetric anesthesia complication yet there remains a need to investigate modifiable risk factors. The aim of this study was to survey anesthesiologists who performed an ADP and describe their perspectives on the patient, proceduralist, task, and organization-related risk factors that may contribute to ADP.

(Anesth Analg. 2018;126:1590–1597)At the Beilinson Campus of the Rabin Medical Center in Petach Tikva, Israel, a proportion of women who intend to deliver with labor epidural analgesia (LEA) are often unable to receive it due to a lack of available nursing staff, labor rooms, or anesthesiologists at the time of request. As there is no study to date that has specifically examined the relationship between birth plan, satisfaction with LEA, and development of postpartum depression (PPD), the authors of the present study examined the impact of delivering without analgesia when such was not the intended plan. They hypothesized that the PPD rate at 6 weeks would be highest among women who intended to deliver with LEA but who actually delivered without.

(Eur J Anaesthesiol. 2021;38:130–137)Accidental dural puncture (ADP) occurs in 0.4% to 6% of patients who receive neuraxial analgesia, and a significant number of ADP patients develop postdural puncture headache (PDPH). PDPH is associated with impaired maternal-neonatal bonding, longer hospital stay, limited ambulation and maternal morbidity. While previous studies have investigated long-term physical outcomes associated with PDPH, limited data exists on the associations between PDPH and long-term psychological outcomes, like postpartum depression (PPD) and postpartum posttraumatic stress disorder (PTSD). This study compared the frequency of these outcomes in women with PDPH with a control group of women without PDPH.

Purpose: The majority of patients dying in intensive care units (ICUs) do so after the forgoing of life-sustaining therapies (FLST). Communication between physicians, patients, and their families regarding the decision to FLST has not been evaluated in Israel. Materials and Methods: All patients who had FLST in a general ICU were enrolled in the study. We evaluated whether physicians communicated and documented the FLST decisions with patients or the patients' families. We also assessed the effect of the physician's geographic place of training on communication behavior. Results: Over a period of 8.5 months, 385 patients were admitted to a general ICU in Israel. Fifty-seven patients died or had FLST. Twelve of these 57 were excluded from the study. Thus, 45 (79%) patients had FLST and were enrolled in the study. All patients were deemed medically incompetent to make FLST decisions. In 24 (53%) patients, FLST was discussed with the family before the decision to forgo therapy. Discussion occurred later with 6 other families, who were unavailable at the time the FLST decision was made. In 15 patients, there were no discussions with families. American-trained physicians discussed FLST with 22 of 29 families initially and 5 other families later (93%), whereas the Eastern European-trained physicians discussed FLST with only 3 of 16 (19%) families (P < .001). Documentation of FLST was present in 26 (90%) patients of American-trained physicians and 8 (50%) patients of Eastern European-trained physicians (P < .001). Conclusions: FLST is common in an Israeli ICU. Patients are not medically competent to make FLST decisions. American-trained physicians discuss and document FLST more often than Eastern European-trained physicians. Copyright 2003 Elsevier, Inc. All rights reserved.

Purpose: To investigate the associations between specific preoperative 12-lead electrocardiogram (ECG) abnormalities, perioperative ischemia, and postoperative myocardial infarction or cardiac death in major vascular surgery. Methods: Two prospective studies on perioperative myocardial ischemia performed in two tertiary university hospitals were combined to include 405 patients. All preoperative ECGs were analyzed according to the Sokolow-Lyon criteria for left ventricular hypertrophy by investigators who were blinded to the patients' perioperative clinical course. Perioperative myocardial ischemia was detected by continuous ECG recording, and postoperative cardiac complications included myocardial infarction and cardiac death. Results: A total of 19 postoperative cardiac complications occurred (two cardiac deaths and 17 myocardial infarctions). Voltage criteria for left ventricular hypertrophy (78 patients, 19%) and ST segment depression greater than 0.5 mm (98 patients, 24.2%) on preoperative ECGs were both significantly associated with postoperative myocardial infarction or cardiac death (odds ratio, 4.2 and 4.7; p = 0.001 and 0.0005, respectively) and with longer intraoperative and postoperative myocardial ischemia. In each of the two study groups, a preoperative ECG abnormality that involved voltage criteria, ST segment depression, or both (134 patients, 33.1%) was more predictive of postoperative cardiac complications than any other preoperative clinical variable, including a history of myocardial infarction or angina pectoris, diabetes mellitus, pathologic Q-wave by ECG, or preoperative myocardial ischemia. The combined duration of intraoperative and postoperative ischemia and the preoperative ECG with either voltage criteria or ST segment depression were the only independent factors associated with adverse cardiac events by multivariate analysis (p @? 0.0001 and p = 0.02, respectively). Conclusion: Left ventricular hypertrophy and ST segment depression on preoperative 12-lead ECGs are important markers of increased risk for myocardial infarction or cardiac death after major vascular surgery. (J Vasc Surg 1997;26:570-8.)