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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 review explores the challenges in anaesthetic management and specific considerations for common cancers encountered in pregnant patients. Methods An electronic literature search was carried out using PubMed and Google Scholar to identify peer-reviewed articles published in English from 1 January 1990 to 30 July 2024. Results Two main areas were identified: anaesthetic management related to pregnancy and the peripartum period in patients with cancer; and oncological management during pregnancy. Current data suggest that pregnancy does not worsen cancer prognosis, but diagnosis and treatment are complicated by the overlap of cancer symptoms with physiological changes of pregnancy and concerns about the safety of diagnostic procedures and treatments. Ultrasound and magnetic resonance imaging are preferred imaging modalities, while careful use of ionising radiation is advised. Treatment during pregnancy, including surgery, chemotherapy and radiotherapy is possible, with specific timing and modality considerations to ensure maternal and fetal safety. Anaemia, poor nutrition and preterm birth are significant concerns in managing pregnant patients with cancer. For operative births, neuraxial techniques are preferred, though general anaesthesia may be required in complex cases. Comprehensive multidisciplinary support, including psychosocial care, is essential for optimal outcomes. Oncological surgery during pregnancy should preferably be scheduled for the second trimester, with consideration for fetal monitoring and steroids. Regional anaesthesia should be utilised if possible and uteroplacental perfusion maintained. Increased risks of thromboembolism should be addressed postoperatively, along with psychological support. Discussion Effective and safe anaesthetic management of cancer in pregnancy requires a multidisciplinary approach to balance maternal and fetal safety, with a focus on careful planning and individualised care. [ABSTRACT FROM AUTHOR]

Background: Improvements in diagnostics and clinical care have allowed more women of childbearing age, suffering from neurological diseases, to safely have pregnancy, reducing peripartum complications. However, these patients remain at risk and are a constant challenge for anesthesiologists in the delivery room. Methods: To assess the type of anesthesiologic management performed for delivery in obstetric patients with preexisting neurological disease and who reported significant neurological symptoms during pregnancy, a retrospective observational study was carried out between 1 October 2008 and 30 September 2021. Results: Data from 49,202 pregnant women were assessed over 13 years; 239 pregnant women with a diagnosis of preexisting neurological disease and who reported significant neurological symptoms during pregnancy were identified (prevalence 0.49%). The main neurological disorders that affected pregnant women included vascular abnormalities and intracranial bleeding (N = 42, 17.6%), central nervous system tumors (N = 35, 14.6%), epilepsy and episodic and paroxysmal disorders of the central nervous system (N = 34, 14.2%), diseases of the neuromuscular junction and muscles (N = 26, 10.9%), demyelinating central nervous system diseases (N = 24, 10%). A total of 234 (97.9%) pregnant women with neurological disorders and significant neurological symptoms underwent cesarean section: 192 (80.3% of the total cesarean sections) were elective, 39 (16.3%) were urgent type 2 and 3; 3 (1.2%) were emergency cesarean sections. General anesthesia was administered to 73 patients (30.5%), while 166 patients (69.5%) were managed with neuraxial techniques. 2 patients who had had neuraxial block reported worsening neurological symptoms that required a change in medical therapy. Postoperative multiparameter monitoring was performed for less than 24 h in the recovery room for 226 patients (94.6%). 3 patients (1.2%) were observed with multiparameter monitoring in the post-anesthesia care unit (PACU) for more than 24 hours; 10 patients (4.2%) were moved to the postoperative intensive care unit (ICU). The median hospitalization duration was 4 days (with an interquartile difference of 3–6 days). Conclusions: In our experience, when neuraxial anesthesia was feasible, it proved to be a safe option for pregnant patients with symptomatic neurological disease, resulting in uncommon maternal complications. [ABSTRACT FROM AUTHOR]

Background: Subarachnoid anesthesia is the primary anesthetic method for elective cesarean section surgery, characterized by rapidly taking effect and reliable analgesia. However, subarachnoid anesthesia is prone to cause a high block level, resulting in a high incidence of maternal hypotension. How to reduce the incidence of maternal hypotension under subarachnoid anesthesia is a practical problem that needs to be solved urgently in clinical practice. Methods: This prospective cohort study was performed at Nantong Maternal and Child Health Care Hospital in China between January and July 2023. This study compared the incidence of hypotension in pregnant women undergoing subarachnoid anesthesia during elective cesarean section in four groups, including group A (control group) with 10 mg of 10% glucose solution; Group B with 5 mg 10% glucose solution group; Group C with 4 mg 10% glucose solution group; Group D with 2 mg 10% glucose solution group. Each group was given a dose of 10 mg Ropivacaine with a concentration of 0.5% and a volume of 2 ml. The primary outcome was the incidence of maternal hypotension. The secondary outcomes were the plane of anesthesia, abdominal wall muscle relaxation degree and the incidence of adverse events. Results: Data from 74 (18, A group; 26, B group; 15, C group; 15, D group) participants were analyzed. Hyperbaric combined with hypobaric local anesthetic in subarachnoid anesthesia for cesarean section did not reduce the incidence of intraoperative hypotension in pregnant women (P = 0.152). The plane of anesthesia gradually shifted from T4 to T10 as the specific gravity of ropivacaine decreased (P < 0.01). Satisfaction about abdominal wall muscle relaxation degree gradually decreased with the decrease of the specific gravity of ropivacaine (P = 0.04). And the incidence of adverse events gradually increased with the decrease of the specific gravity of ropivacaine (P = 0.027). Conclusions: Hyperbaric combined with hypobaric local anesthetic in subarachnoid anesthesia for cesarean section did not reduce the incidence of intraoperative hypotension in pregnant women. [ABSTRACT FROM AUTHOR]

Post-dural puncture headache (PDPH) is a debilitating complication of neuraxial anesthesia, particularly prevalent in obstetric patients, usually characterized by a postural headache. PDPH is hypothesized to result from cerebrospinal fluid leakage through a dural puncture, triggering symptoms like neck stiffness and subjective hearing changes. While conservative measures are common for treatment, more refractory cases may require invasive interventions such as an epidural blood patch (EBP). Recent studies have shown promise in using nebulized dexmedetomidine (nDEX) for PDPH, offering a non-invasive alternative to EBP. Two case presentations illustrate the efficacy of nDEX in resolving PDPH symptoms rapidly and completely. These cases underscore the need for exploring novel therapeutic options, especially in obstetric patients where safe and prompt relief is essential for maternal and newborn well-being. While the EBP remains the gold standard, its limitations of accessibility and invasiveness highlight the significance of investigating alternatives like nDEX. [ABSTRACT FROM AUTHOR]

A strong association is reported between the level of sex hormones and an accelerated growth of meningioma in a parturient. Consequently, a rapidly enlarging, symptomatic intracranial meningioma poses grave risk to the mother and fetus, warranting emergency craniectomy as a life-saving measure regardless of the status of pregnancy. Comorbidities such as systemic lupus erythematosus (SLE) may complicate the perinatal management. Raised intracranial pressure (ICP), hemodynamic Instability, maintaining cerebral and utero-placental perfusion coupled with administering general anesthesia (GA) in a parturient with inherent difficult airway are some of the anesthetic challenges. SLE, an autoimmune, multisystem inflammatory disorder presents unique anesthetic implications in obstetrics due to its variable manifestation depending upon the extent of systemic involvement, acute exacerbations and therapeutic interventions. We present a case of emergency lower segment cesarean section (LSCS) with simultaneous decompressive craniectomy for meningioma in a 41-year-old, 32-week-parturient comorbid with SLE. She presented to the emergency room with headache, confusion, right-sided hemiparesis, ptosis of the left eye and bradycardia. Magnetic resonance imaging revealed left frontal–parietal meningioma causing mass effect along with uncal and subfalcine herniation. An urgent multidisciplinary conference decided to perform emergency cesarean delivery followed by decompressive hemicraniectomy in the same sitting under GA. This is a first such case report that discusses the anesthetic management of a parturient comorbid with SLE and intracranial meningioma undergoing emergency decompressive hemicraniectomy and LSCS under GA simultaneously. We aim to highlight the multidisciplinary approach, expert anesthetic management and tertiary care hospital resources which helped to optimize the management of such a complex case. [ABSTRACT FROM AUTHOR]

Objectives: The current state of the art for c-section anesthesia includes the use of regional anesthesia techniques because of their effectiveness, safety, and extended postoperative analgesia. This study aimed to analyze the anesthetic techniques employed for c-section and postoperative analgesic regimens and to identify predictive factors for postoperative pain, postoperative complications, and hospitalization time. Study Design: A retrospective, observational study was conducted on pregnant women who underwent c-section between January and December 2021. Demographic data, medical comorbidities, indications for c-section, anesthetic techniques, and postoperative outcomes (pain, complications, and hospitalization time) were registered. Linear and logistic regression were applied for data analysis. Results: Data from 925 women who underwent c-sections were analyzed. Combined spinal–epidural anesthesia was the most used technique for elective c-sections (423 out of 430 women), while general anesthesia was commonly used in emergent procedures (29 out of 39 women). Epidural analgesia was the most commonly used technique for postoperative pain management (83%), and pruritus (8.9%) and headaches (4.1%) were the most frequently registered complications. Risk factors for moderate/severe pain included lower body mass index, conversion to general anesthesia, and the use of systemic analgesia. Preeclampsia and intrathecal morphine increased postoperative complications. General anesthesia and some postoperative complications were predictors for longer hospitalization times. Conclusions: This study suggests that a multimodal analgesic approach with neuraxial morphine and/or local anesthetics, nonsteroidal anti-inflammatory drugs, and acetaminophen is central to achieve an effective postoperative analgesia after a c-section. However, further studies should investigate the optimal neuraxial analgesic combination to minimize side effects. [ABSTRACT FROM AUTHOR]

Neuraxial anesthesia is an effective method of pain control for various procedures in obstetrics and gynecology, pain medicine, and orthopedic surgery. Spinals and epidurals can greatly enhance a patient's quality of life but there often exists a limited understanding of the mechanics of performing such procedures, thus hindering the troubleshooting of non-functional or partially functional epidurals. Understanding how mechanical factors like patient anatomy, clinical history, anesthetic injection rate, pressure gradients between the epidural and intrathecal spaces, and medication infusion are crucial for preventing complications like false analgesic levels, failed epidurals, or total/high spinal. In addition to reviewing knowledge available in anesthesia textbooks, the present article introduces a simplified model for understanding neuraxial anesthesia and postulates a mechanism of action for epidurals. Additionally, this article aims to identify high-risk situations that could lead to a total spinal, while considering the unique anatomical changes experienced during pregnancy. [ABSTRACT FROM AUTHOR]

The article explores the considerations and challenges of administering neuraxial anaesthesia to parturients with intracranial pathology. Topics discussed include the management of obstetric anaesthesia in patients with intracranial hypertension, the potential risks associated with lumbar puncture, and the complexities of using regional anaesthesia in this clinical setting.

There is a lack of consensus and uniformity about the test dose in epidurals for labor analgesia. We, therefore, conducted a questionnaire-based survey to assess the current practice in India regarding test-dose for labor epidurals among practicing obstetric anesthetists. A Google form based questionnaire was circulated to 300 members of the Association of Obstetric Anesthesiologists (AOA) of India of which 128 (42.7%) responded. According to our survey, labor analgesia is routinely practiced by only 40 (32%) responders. Sixty-eight (53.1%) responders reported placement of an epidural catheter at the patient's request. Less than 50% reported the use of test dose for epidural catheter placement confirmation. Ninety-eight (76.6%) responders give the test dose at the time of catheter placement while 22 (17.1%) give it every time before injecting the local anesthetic as a top-up. The majority preferred using 3–4 mL of 2% lidocaine as test dose. Seventy-three (57%) responders relied on the use of conventional test dose of lidocaine with epinephrine. 8.5% of responders had experienced side effects with epidural test dose during labor analgesia. This survey highlights not just variations in the clinical practice regarding epidural test dose for labor analgesia but gross deviation from the current recommended standard of practice. The issue can be addressed by developing clear practice guidelines. [ABSTRACT FROM AUTHOR]

Background: Vasopressors are effective in managing perioperative hypotension in high-risk parturients undergoing Caesarean section (CS). Nevertheless, the optimal vasopressor for addressing hypotension induced by neuraxial anesthesia remains a subject of investigation. Methods: We compared hypotension episodes among high-risk parturients who received ephedrine, noradrenaline, or phenylephrine by searching four electronic databases and reviewing the relevant references. Inclusion criteria encompassed randomized controlled trials directly comparing two or more vasopressors in the context of managing hypotension in high-risk parturients undergoing neuraxial anesthesia for CS. A network meta-analysis was performed using fixed-effects and Bayesian random-effects models. Results: We analyzed 13 trials involving 1,262 patients. While our direct and indirect comparisons revealed no reveal statistically significant differences in the number of hypotensive episodes among patients treated with different vasopressors, vasopressors were hierarchically ranked. Phenylephrine (Rank of the best choice = 0.81) exhibited the highest effectiveness in preventing hypotension, followed by ephedrine (Rank of the best choice = 0.10) and noradrenaline (Rank of the best choice = 0.09). Bradycardia occurrence was higher in patients administered phenylephrine compared to those given noradrenaline (risk ratio [RR]: 0.23; 95% confidence interval [CI]: 0.03 to 0.85) or ephedrine (RR: 0.01; 95% CI: 0.00 to 0.12). Notably, patients treated with phenylephrine or noradrenaline experienced reduced occurrences of nausea or vomiting compared to those who received ephedrine (RR: 0.37; 95% CI: 0.19 to 0.59 for phenylephrine and RR: 0.28; 95% CI: 0.10 to 0.75 for noradrenaline). Regarding fetal outcomes, no significant differences were noted between noradrenaline and phenylephrine. Overall norepinephrine in maternal outcomes may be more favorable. Conclusions: Our findings suggest the potential advantages of phenylephrine for reducing hypotensive episodes in high-risk parturients undergoing CS. Noradrenalin may emerge as an alternative, particularly for women at high risk of caesarean delivery. Trial registration: This systematic review was registered at PROSPERO (CRD42023397259). [ABSTRACT FROM AUTHOR]

The evaluation and diagnosis of altered mental status in the pregnant or postpartum patient largely parallels the approach used for any other patient; however, there are several critical differences including that some neuroobstetric diagnoses require emergent delivery of the fetus. Being familiar with the physiological changes and medical complications of pregnancy and delivery is therefore essential. This review first addresses pregnancy-specific disorders that may result in altered mental status, such as the hypertensive disorders of pregnancy and pregnancy-related metabolic and endocrinopathies. The focus then shifts to the complex physiologic changes in pregnancy and how these changes contribute to the distinct epidemiology of pregnancy-related cerebrovascular complications like intracranial hemorrhage, ischemic stroke, and reversible cerebral vasoconstriction syndrome. Medical disorders that are not unique to pregnancy, such as infections and autoimmune conditions, may present de novo or worsen during pregnancy and the peripartum period and require a thoughtful approach to diagnosis and management. Finally, the unique nervous system complications of obstetric anesthesia are explored. In each section, there is a focus not only on diagnosis and syndrome recognition but also on the emergent treatment needed to reverse these complications, bearing in mind the unique physiology of the pregnant patient. [ABSTRACT FROM AUTHOR]

The article discusses the significance of simulation-based training (SBT) in obstetric anesthesia, emphasizing its role in improving skills, reducing errors, and enhancing confidence among healthcare providers. Topics include the essential components of a successful SBT program, the importance of interprofessional collaboration in training, and the need for organizational support to ensure effective learning and skill development.

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In recent years there has been an increase in the number of women undergoing surgical intervention to facilitate birth or in the immediate postnatal period. This review describes the types of anaesthesia employed for various obstetric interventions, including caesarean birth, assisted vaginal birth, repair of a perineal tear and manual removal of placenta. It provides a comparison between the different techniques used within obstetric anaesthesia and discusses the principles of the decision-making process when selecting a specific anaesthetic technique. An understanding of the factors influencing the anaesthetic and an appreciation of the potential anaesthetic risks and complications is key for those involved in caring for women undergoing an obstetric surgical procedure. [ABSTRACT FROM AUTHOR]

BACKGROUND: The number of cesarean sections performed is increasing every year, and obstetric anesthesia is of great interest to physicians and research scholars because of its specificity, high risk, and high complication rate. OBJECTIVE: To investigate the effects of combined spinal epidural anesthesia (CSEA) with different intervertebral spaces during cesarean section on anesthesia effect, anesthesia onset time, anesthesia recovery time, maternal adverse reactions, and neonates. METHODS: Ninety-two women who underwent cesarean section in our hospital from September 2022 to February 2023 were selected as the study subjects and randomly divided them into two groups (group A and group B), 46 women in each group. Group A underwent CSEA via an L2-3 gap and group B underwent CSEA via an L3-4 gap puncture. The anesthesia effect, anesthesia onset time, sensory recovery time, adverse effects, and neonatal Apgar score were compared between the two groups. RESULTS: When CSEA was performed from L2-3, the anesthesia efficiency was higher, but the difference was not statistically significant. When anesthesia was performed by puncture from L2-3, the onset of anesthesia and recovery time was shorter, and the incidence of intraoperative maternal nausea and vomiting, hypotension, respiratory depression, and other adverse reactions was low with a statistically significant difference. However, the Apgar scores of the neonates in the two groups have no difference. CONCLUSIONS: When CSEA is induced via L2-3 interspace, anesthesia has a rapid onset of action, shorter recovery time, and few maternal adverse effects, without affecting the final anesthetic outcome. [ABSTRACT FROM AUTHOR]

Introduction: Millions of women worldwide annually undergo manual vacuum aspiration (MVA) with no pain medication, which is a violation of their basic human dignity. We designed a novel device (Chloe SED®) to administer paracervical block (PCB) during MVA in countries where pain medication is not typically given due to the high cost of the necessary tools. Methods: We conducted a single-blinded, randomized controlled non-inferiority trial including 61 patients at two hospitals in Kisumu, Kenya, to validate Chloe SED® for administration of PCB during MVA. PCB administered with Chloe SED® was compared to PCB administered with a standard spinal needle. Patients requiring MVA were block randomized in blocks of six, each provider completing six PCBs--three with the Chloe SED® and three with the standard spinal needle. The trial was registered with the Kenya Pharmacy and Poisons Board, ECCT/19/03/01 (https://ctr.pharmacyboardkenya.org/applications/index/protocol_no: RUNDVC8xOS8wMy8wMQ__/filter:/investigator:/sites:/pages:5/start_date:/end_ date:/disease_condition:/users:/ercs:/stages). An intention-to-treat analysis was completed. The primary outcome was the non-inferiority of the pain score during uterine evacuation with a non-inferiority margin of 2 points on an 11-point numerical rating scale. Secondary outcomes included the non-inferiority of the pain score at four other time points and patient satisfaction. Results: Chloe SED® showed non-inferiority of the primary outcome with a mean pain score during evacuation of 3.8 [90% confidence interval (CI): 3.1-4.6] compared with the spinal needle at 4.1 (90% CI: 3.5-4.7). Non-inferiority of the pain score was shown at all time points. Most patients expressed a desire for the continued use of the device toadministerPCBforMVA.Noadverse eventswere noted. Conclusion: In summary, the Chloe SED® appears non-inferior to the spinal needle and desirable for the administration of PCB during MVA. [ABSTRACT FROM AUTHOR]

Background: Point-of-care ultrasound (POCUS) has gained popularity as a bedside diagnostic imaging modality. In obstetrical populations, particularly in acute care settings, POCUS serves as a valuable complement to clinical assessment. Despite its many applications, only a few have been defined and validated in the obstetric population. This scoping review aims to delineate literature on the diagnostic applications of POCUS in obstetric anesthesia and critical care. Methods: This review will adhere to the Joanna Briggs Institute methodology for scoping reviews, as updated by Arksey and O'Malley and in stages elaborated by Levac et al. Relevant literature will be identified using Medical Subject Headings (MeSH), keyword, and proximity searches and combined using Boolean operators in PubMed, Embase, and Web of Science from January 1, 2000, to the present. Two independent reviewers will screen literature against predefined eligibility criteria in abstract and full-text forms. A third reviewer will be consulted if consensus cannot be reached. Data extraction will be systematic, focusing on pre-specified variables aligned with the review's aims. Descriptive statistical and thematic analysis will follow data extraction, with findings presented in graphical and tabular forms. The reporting will follow Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). Conclusion: This review will present the scope of the current literature on diagnostic POCUS in obstetric anesthesia and critical care, highlighting both strengths and gaps in existing knowledge. The insights gained will support future research, knowledge synthesis, and development of educational programs. The findings will be disseminated through peer-reviewed journal publications, conferences, and social media platforms. Systematic review registration: Not applicable. [ABSTRACT FROM AUTHOR]

During the preanesthetic assessment of the obstetric patient, it is critical to assess the patient's cardiovascular baseline condition, identify any potential risks, and facilitate behavioral modification to develop an individualized management strategy aimed at minimizing complications. Cardiac point-ofcare ultrasound (POCUS) is a valuable instrument for assessing the morphology and function of the heart prior to surgery. Cardiac POCUS is not designed to replace comprehensive transthoracic echocardiography, which is the realm of cardiovascular anesthesiology and cardiology. However, when used in conjunction with anamnesis, physical examination, electrocardiogram, and previous laboratory results, cardiac POCUS is a valuable adjunct in the diagnostic toolbox of anesthesiologists. It allows for direct visualization of the heart and great vessels, with added benefits of speed, availability, and low risk for the patient. The purpose of this manuscript is to explore and describe the advantages of cardiac POCUS in the preanesthetic period of obstetric patients and its potential value for anesthesiologists through the identification of potentially hazardous conditions that may require individualized preoperative management. [ABSTRACT FROM AUTHOR]

Background: Neuraxial anesthesia remains the preferred choice for Caesarean deliveries across the world. Hypotension is the physiologic consequence and perhaps the most common complication of neuraxial anesthesia in obstetric patients. In this study, we compared the effectiveness of vasopressors, ephedrine versus phenylephrine in the treatment of hypotension after spinal anesthesia and also the fetal outcome. Materials and Methods: Patients aged group between 18-and 35 years posted for elective cesarean section with term pregnancy were allocated randomly to the two groups, Group-1 (E) Ephedrine and Group-II (P) Phenylephrine. Changes in maternal blood pressure, heart rate, and saturation were monitored and noted till the end of the surgery. The total dose of vasopressor and number of boluses used, total volume of fluids infused, the time of spinal anesthesia given, the delivery of the fetus, and the duration of the procedure were documented. Umbilical artery cord blood for determination of the acid-base status of the fetus. APGAR scores 1 min and 5 min of delivery of all newborns were noted and a score of <8 was considered low. Results: In our study, all patients in the two groups were comparable concerning age, height, weight, gestational age, and ASA status. The differences observed in baseline values of mean arterial blood pressure and saturation between the two groups were statistically insignificant. Also, there was a statistically insignificant difference between the duration of surgery, the total volume of fluid used intra-operatively, and the time of spinal to the delivery of the fetus in both groups. Further in my study, it was observed that there was a statistically significant difference in mean arterial blood pressure between the two groups up to 20 minutes post spinal anesthesia, but beyond the 25th minute, there was no statistical difference in mean arterial blood pressure between the two groups till the end of the surgery. Conclusion: The use of phenylephrine or ephedrine to correct maternal hemodynamic changes during spinal block for cesarean section does not show any marked difference in the outcome. The effect on fetal pH fetal acid-base status is comparable with both groups. The results of my study show that phenylephrine and ephedrine are both efficient and suitable vasopressors for the treatment of hypotension following spinal block in patients undergoing cesarean section. [ABSTRACT FROM AUTHOR]

Objective: High quality obstetric anaesthetic care is integral to reducing preventable maternal deaths in Low-and-Middle-Income-Countries (LMICs). We applied behavioural science to evaluate SAFE Obstetrics, a 3-day Continuing Professional Development (CPD) course, on physician and non-physician anaesthetists' practice behaviours across 3 LMICs.Methods: Seven anaesthetist Fellows from Bangladesh, Nepal and Tanzania were trained in qualitative methods and behavioural science. Structured interviews were undertaken by Fellows and two UK behavioural scientists with course participants. Interviews were based on the Theoretical Domains Framework: a comprehensive framework of influences on behaviour change. Interviews were recorded, transcribed and analysed using content and thematic analysis.Results: 78 physician and non-physician anaesthetists participated (n = 26 Bangladesh, n = 24 Nepal and n = 28 Tanzania). Participants reported positive improvements in patient-centered working, safety, teamwork and confidence. Across countries, we found similar barriers and facilitators: environmental resources, a strong professional identity and positive social influences were key facilitators of change.Conclusion: This multi-country theory-based evaluation highlighted the impact of SAFE Obstetrics on participants' clinical practice. A supportive work environment was crucial for implementing learning following training; CPD courses in LMICs must furnish participants with skills and equipment to address training implementation challenges. Building local behavioural science capacity can strengthen LMIC health intervention evaluations. [ABSTRACT FROM AUTHOR]

Background and Aims: This study aimed to highlight differences in success rates and patient outcomes during epidural insertion among anesthesia staff, junior trainees, and staff anesthesiologists. Methods: We included all women who received a labor epidural between January 1, 2020 and April 30, 2022. The cases were divided into three groups: junior residents, senior residents, and staff anesthesiologists. Results: Among 822 cases included in analysis, 92, 240, and 490 catheters were placed by junior residents, senior residents, and staff anesthesiologists, respectively. Although the success rate among junior residents (90.7%) was lower than those of senior residents (97%) and staff anesthesiologists (95.1%), the difference was not significant (P = 0.067). The mean procedural time in minutes was significantly longer in the junior resident’s group (18.1 min) compared to the senior residents (14.18 min) and staff anesthesiologists (14.87 min) (P < 0.001). A significant difference was observed in the number of needle pricks and catheter insertion attempts when comparing the junior residents, senior residents, and staff anesthesiologists’ groups (P < 0.001). In the logistic regression analysis, procedural time remained the only predictor of epidural success. Conclusions: With the success rate above 90%, junior anesthesia trainees require more time and attempts to insert labor epidurals. It is essential that training programs provide opportunities for anesthesia trainees to become proficient in their epidural insertion techniques prior to clinical practice. [ABSTRACT FROM AUTHOR]

Background: Spinal anesthesia is one of the most commonly used regional anesthesia techniques. Post-dural puncture headache (PDPH) is a well-known iatrogenic consequence of spinal anesthetic and diagnostic lumbar puncture, primarily caused by loss of cerebral spinal fluid. To reduce complications, spinal needles have undergone modifications. The two most important modifiable risk variables for PDPH were needle shape and size. In young expecting mothers, post-cesarean sections are associated with an increased incidence of PDPH. Aims and Objectives: The aims and objectives of the study are to compare the incidence of PDPH in obstetric patients using cutting and pencil-point spinal needles following spinal anesthesia. Materials and Methods: This 1-year double-blind study was carried out in the Department of Anaesthesia from August 2021 to July 2022. The study comprised obstetric patients who were scheduled for elective-segment cesarean section. The subarachnoid block needle was divided into Groups A and B at random: Group A 25-gauge Whitacre spinal needle with a pencil point, whereas Group B 25-gauge Quincke spinal needle with a cutting bevel. Records were kept on age, height, weight, and gestational age. A follow-up was conducted up until the discharge date. The incidence and severity of PDPH after spinal anesthesia were examined in both groups. The results were analyzed with SPSS 20.0, and the Fischer exact and Chi-square tests were used to look for statistical significance. Results: The current study included 120 patients in total, 60 patients in each of Groups A and B. When a pencil point Whitacre was used, the incidence of PDPH was 2 (3.3%), however, when a cutting Quincke needle was used, the incidence was 7 (10.8%). With a P < 0.05, the relationship between the two was considered statistically significant. The pain severity was mild in both patients of Group A. Of the seven patients in Group B, four had mild pain, two had moderate pain, and one had severe pain. Conclusion: The pencil-point 25-G Whitacre spinal needle has a lower incidence of PDPH than the traditional 25-G Quincke needle and was suggested for patients at risk of PDPH. In light of this, the current study suggested using pencil-point spinal needles for lumbar punctures and spinal anesthesia in obstetric patients. [ABSTRACT FROM AUTHOR]

Although it is widely known that various pharmaceuticals affect the methylome, the knowledge of the effects from anesthesia is limited, and nearly nonexistent regarding the effects of obstetric anesthesia on the newborn child. Using sequencing based-methylation data and a reference-based statistical deconvolution approach we performed methylome-wide association studies (MWAS) of neonatal whole blood, and for each cell-type specifically, to detect methylation variations that are associated with the pain relief administered to the mother during delivery. Significant findings were replicated in a different dataset and followed-up with gene ontology analysis to pinpoint biological functions of potential relevance to these neonatal methylation alterations. The MWAS analyses detected methylome-wide significant (q<0.1) alterations in the newborn for laughing gas in granulocytes (two CpGs, p<5.50x10-9, q = 0.067), and for pudendal block in monocytes (five CpGs across three loci, p<1.51 x10-8, q = 0.073). Suggestively significant findings (p<1.00x10-6) were detected for both treatments for bulk and all cell-types, and replication analyses showed consistent significant enrichment (odds ratios ranging 3.47–39.02; p<4.00×10−4) for each treatment, suggesting our results are robust. In contrast, we did not observe any overlap across treatments, suggesting that the treatments are associated with different alterations of the neonatal blood methylome. Gene ontology analyses of the replicating suggestively significant results indicated functions related to, for example, cell differentiation, intracellular membrane-bound organelles and calcium transport. In conclusion, for the first time, we investigated and detected effect of obstetric pain-relief on the blood methylome in the newborn child. The observed differences suggest that anesthetic treatment, such as laughing gas or pudendal block, may alter the neonatal methylome in a cell-type specific manner. Some of the observed alterations are part of gene ontology terms that previously have been suggested in relation to anesthetic treatment, supporting its potential role also in obstetric anesthesia. [ABSTRACT FROM AUTHOR]

Background: This article gives the pediatric anesthesia perspective from Cameroon, Nigeria, Ghana, Liberia, and Gambia, five out of six countries in Anglophone West Africa. Over 40% of the population of most of these countries are younger than 14 years and there is an increasing need for paediatric anesthesia services. Findings: Workforce density ranges from 0.08 to 0.58 physician anesthesia providers per 100,000 population. There are only 13 trained pediatric anesthetists; ratios range from 0 to 0.4 per 100,000 children, thus pediatric anesthesia services are provided by various cadres of physician and non‐physician anesthesia providers. Physician anesthesia training is mostly carried out by the West African College of Surgeons as well as national postgraduate colleges. Pediatric anesthesia services are provided in tertiary (teaching), secondary (general), district, faith‐based, military, private hospitals and through surgical missions. Challenges include lack of trained personnel, high morbidity from late presentation to health facilities and financial constraints, lack of health insurance for pediatric anesthesia services, unavailability of appropriate equipment and consumables, a narrow range of medications, very few pediatric‐specific operating theaters, and inadequate critical care services. Solutions: The lack of opportunities for sub‐specialty training in pediatric anesthesia in West Africa is currently being addressed in Nigeria and Ghana. Non‐governmental agencies fund programs and courses related to pediatric anesthesia and have also provided fully equipped operating theaters. Advocacy for pediatric anesthesia can be achieved through the National Surgical Obstetric Anesthesia and Nursing Plans Implementation Committee of the various countries. There is an urgent need for prioritization of health in the budgets of Anglophone West African countries and governments must deliberately provide support for anesthesia and surgical services. More international collaborations towards workforce training and creation of children's hospitals are needed. [ABSTRACT FROM AUTHOR]

The article highlights and discusses several current topics that have been published in the field of anaesthesiology in obstet‑ rics in the Czech Republic and abroad last year It summarizes new challenges in the field of obstetric anesthesia including the use of AI and simulations in this area. It also presents new developments in systemic and neuroaxial obstetric analgesia, Caesarean Section anaesthesia and emergencies in peripartum period. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the effect of different routes of norepinephrine (NE) administration on maternal hypotension in pregnant females undergoing spinal anesthesia for caesarean section. 208 pregnant women were divided randomly into 4 groups (n=52). Bolus 4 µg/ml NE was administered intravenous (iv) immediately after spinal anesthesia in Group PB (Prophylactic Bolus). In Group PI (Prophylactic Infusion), 1 ml of saline solution was applied promptly after spinal anesthesia and then the NE infusion was started at 1 ml/min. In Group TB (Treatment Bolus), 1 ml Physiological Saline (PS) was administered after 1 ml/min infusion of PS immediately after spinal anesthesia and then 1 ml/min NE bolus when blood pressure decreased by 20% after the entry. In Group TBI (Treatment Bolus Infusion), 1 ml PS was administered after 1 ml/min infusion of PS immediately after spinal anesthesia, 1 ml NE and then 1 ml/min NE infusion was initiated when blood pressure decreased by 20% after the entry. At the 4th, 6th, and 8th minutes, the PI Group exhibited higher systolic and mean blood pressures than the other groups (p<.001). Additionally, hypotension was statistically lower in the PI Group than in PB, TB, TBI groups (p<.001), and episodes of hypotension, ephedrine required and extra NE boluses given were statistically lower in the PI Group than in the other groups (p<.001). Umbilical vein (UV) pH values were lower in the TBI Group at compared to the other groups (p<.001). It is suggested that a prophylactic infusion of 4 µg/min of NE in the prevention of hypotension following spinal anesthesia for cesarean section will reduce the possibility of maternal hypotension and better maintain fetal well-being than a prophylactic bolus, a treatment bolus or a posttreatment bolus infusion at the same dose. [ABSTRACT FROM AUTHOR]

Background: Respiratory functions may be impaired in cesarean section (C/S) delivery performed under spinal anesthesia (SA) and oxygen supplementation may be required. Therefore, we conducted a randomized controlled study aimed to evaluate the effects of different oxygen administrations in pregnant women on the lungs during C/S under SA using ultrasound and oxygen reserve index (ORI). Methods: We conducted a randomized, controlled, single-center study from May 1, 2021, to March 31, 2022. A total of 90 patients scheduled for C/S under SA were randomly divided into 3 groups. Following the SA, patients in group 0 were treated with room air, in Group 3 were administered 3 L/min O₂ with a nasal cannula (NC), in Group 6 were administered 6 L/min O₂ with a simple face mask. In addition to routine monitoring, ORI values were measured. Lung aeration was evaluated through the modified lung ultrasound score (LUS) before the procedure (T0), at minute 0 (T1), 20 (T2), and hour 6 (T3) after the procedure, and ∆LUS values were recorded. Results: After SA, the ORI values of Group 3 were higher than Group 0 at all times (p < 0.05), while the intraoperative 1st minute and the 10th, 25th and 40th minutes after delivery (p = 0.001, p = 0.027, p = 0.001, p = 0.019) was higher than Group 6. When the LUS values of each group were compared with the T0 values a decrease was observed in Group 3 and Group 6 (p < 0.001, p = 0.016). While ∆LUS values were always higher in Group 3 than in Group 0, they were higher only in T1 and T2 in Group 6. Conclusion: We determined that it would be appropriate to prefer 3 L/min supplemental oxygen therapy with NC in C/S to be performed under SA. [ABSTRACT FROM AUTHOR]

Background: To reduce maternal-fetal morbidity and mortality, it is becoming increasingly important for anesthetists to understand and implement enhanced recovery after surgery (ERAS) cesarean delivery guidelines. Our aim was to reveal the knowledge of anesthesia assistants in Turkey about ERAS during cesarean delivery and to increase their awareness of ERAS. Methods: This descriptive study was conducted in the city of Isparta, Turkey in 2023. The survey, which was approved by the ethics committee, was distributed to participants across Turkey via e-mail and online messages. The survey comprises of a total of 42 questions evaluating perioperative ERAS recommendations. Results: Of the 404 participants in our survey, 59.9% were associated with university hospitals and 65.8% had completed three or more years of education. A total of 87.9% of the participants were familiar with ERAS; however, only 42.8% had received ERAS training. Although 93.8% of the participants' institutions performed a cesarean delivery, ERAS recommendations were only implemented at a rate of 48%. This may be due to the absence of an ERAS team, which was identified in our survey at a high rate of 66.6%. Conclusion: Awareness about ERAS was high among the participants, but the implementation rates of some recommendations were low. The reason for this may be the inability to form a multidisciplinary team and inadequate training of participants. For this purpose, we recommend the formation of a multidisciplinary team for ERAS protocol implementation and increased participant training opportunities. [ABSTRACT FROM AUTHOR]

AbstractPremedication with sedative drugs is one of the most preferred methods to reduce anxiety. Due to concerns about maternal and fetal side effects, their use in obstetric anesthesia is not preferred. The primary aim of the authors of this study is to investigate the effect of music on perioperative anxiety in pregnant. The patients were randomized into three groups; Group M was listened to music during the surgery, Group S isolated from ambient noise and Group C was the control group. Anxiety status was measured at the preoperative anesthesia examination, on the morning of surgery, and at the first hour postoperatively. Although we observed the lowest postoperative anxiety in Group M, it wasn’t statistically significant. Music is an easy-to-apply and no-side-effect method. Therefore, we believe that more clinical studies with more patients are needed for clearer results. [ABSTRACT FROM AUTHOR]

This study aimed to review the peri-operative management of pregnant women affected by Brugada syndrome (BrS) undergoing spontaneous deliveries or C-sections. Few studies in literature have explored this issue in pregnant women, and the safety of anesthetic agents in BrS is under debate. We collected data from 11 pregnant patients, with confirmed or suspected BrS, who gave birth at Sant'Anna Hospital in the City of Health and Science of Turin between 2013 and 2022. In all the patients, we did not report any arrhythmic complications either during spontaneous deliveries or during cesarean section (C-section). [ABSTRACT FROM AUTHOR]

The subspecialty of obstetric anaesthesiology is different from other subspecialties in anaesthesiology in that, at any point of time, two lives are at stake, making drug errors particularly critical. This narrative review explores the incidence, contributing factors, and preventive strategies for medication errors in Obstetric Anaesthesia. Key contributors of medication errors include distractions, fatigue, look-alike/sound-alike drugs, lack of standardized protocols, poor communication strategies, inadequate training and education. Effective strategies for reducing errors include double-check procedures, bar-coded medication administration systems, implementing "Tall Man lettering for look-alike/sound-alike drugs, structured communication tools, continuous education and training. The review also introduces the mnemonic "SAFE-LABEL CHECK" to encapsulate best practices for minimizing drug errors. Future directions suggest integrating advanced technologies and fostering a multidisciplinary approach to enhance patient safety in obstetric anaesthesia. [ABSTRACT FROM AUTHOR]

To review the findings of the Optimizing Management of the Second Stage of Labor randomized controlled trial in the context of prior and subsequent obstetric literature. A multi-database search was performed in addition to a review of the parent trial and secondary studies. Nulliparous patients with neuraxial anesthesia randomized to either immediate or delayed pushing showed no difference in vaginal delivery rates. However, delayed pushing is associated with an increased duration of the second stage and perinatal morbidity. Patients should be appropriately counseled on the timing of second-stage pushing and the risks of prolonged second-stage labor. [ABSTRACT FROM AUTHOR]

This document is a commentary on a meta-analysis that examined the effect of a gluten-free diet on the progression of autoimmune thyroiditis in patients without symptoms or histology of celiac disease. The authors of the commentary raised concerns about the quality of the systematic review conducted in the meta-analysis. They pointed out issues such as the lack of a rigorous and well-defined process for selecting and analyzing data, the use of inappropriate assessment tools, and the absence of important information in the review. The authors concluded that the research lacks robustness and methodological flaws need to be addressed. [Extracted from the article]

Background: The anesthetic management of parturients with ascending aortic aneurysm for cesarean section can be particularly challenging, primarily because of increased risk for aortic dissection or aneurysm rupture. Case presentation: We present some aspects of the anesthetic management of two parturients with ascending aortic aneurysm for cesarean sections; amongst, the use of remifentanil with its effects on patient and newborn. We emphasize the importance of a cardio-obstetric team in the context of preoperative planning of such patients. Also, we reviewed some literature on the anesthetic management with its effect on peri-operative hemodynamic stability. Conclusion: Maintaining hemodynamic stability is paramount in the prevention of the rupture or dissection of ascending aortic aneurysm during labor of parturient. [ABSTRACT FROM AUTHOR]

Introduction There are significant disparities in access to safe and affordable surgery, particularly in LMICs. National Surgical Obstetric and Anesthesia Plans (NSOAPs) emerged as crucial national policy frameworks to address this gap. Although some Sub-Saharan African countries have developed and launched NSOAPs, there is limited information on evaluation of the progress and effectiveness of these plans. This study aimed to assess progress and challenges in implementing Tanzania's NSOAP. Methodology We sent an electronic survey to all 26 Regional Health Management Teams (RHMTs) in mainland Tanzania to record their insights and understanding of the NSOAP and the state of Surgical Obstetric and Anesthesia (SOA). The RHMTs are key stakeholders in the NSOAP implementation as they oversee day-to-day implementation of all health interventions at the regional level. Results Only 4% of the surveyed RHMTs reported participating in the NSOAP development process, and 58% were unaware of the policy. The WHO Surgical Safety Checklist was rarely used, and surgical outreach programs were non-existent. There were gaps in the availability of SOA equipment and lack of radiological, intensive care and biomedical services. SOA specialists were few (1.96 specialists per 100,000 population). Most regions were excluded during the NSOAP dissemination meetings with no dedicated NSOAP coordinators at the regional level. Conclusion The NSOAP implementation faced various challenges in service delivery, infrastructure, equipment, human resources, information management and governance. Although slow progress has been made, there is a need for concerted efforts to achieve the NSOAP objectives. Future research should focus on comprehensive NSOAP evaluation and the establishment of an effective monitoring and evaluation framework. [ABSTRACT FROM AUTHOR]

Introduction: Phenylephrine is considered the vasopressor of choice in hypotension associated with obstetric spinal anesthesia. But the dose and mode of administration that is effective yet safe in mother as well as fetus remains controversial. We studied the hemodynamics of parturients who received prophylactic infusion of phenylephrine 50µg/min following spinal anesthesia. Methods: Patients posted for elective cesarean section received a prophylactic phenylephrine infusion of 50µg/min immediately after spinal anesthesia for 30 minutes. Parturients were also co-loaded with lactated Ringer's solution 1 litre. Blood pressure and heart rate was monitored at an interval of 3min initially and after the delivery of baby interval was increased to 5min. Episodes of hypotension, reactive hypertension and bradycardia in mother were recorded. Neonatal APGAR score at 1 and 5min was also recorded. Results: One hundred and forty parturients were included in the study. Twenty patients (14.28%) developed hypotension. Out of 20 patients who developed hypotension, 3 patients (15%) had a single episode, 11 patients (55%) had 2 episodes and 6 patients (30%) had 3 episodes of hypotension. Three patients (2.14%) had reactive hypertension. None of the patients had bradycardia. There was no episode of hypotension induced nausea vomiting. Mean APGAR score at 1min and 5min was 8 and 9 respectively. Conclusion: The prevalence of hypotension with prophylactic phenylephrine infusion was low. We found minimal episodes of reactive hypertension, no episodes of bradycardia and no adverse effect on fetus. It can be regarded a safe means to minimize hypotension in obstetric spinal anesthesia. [ABSTRACT FROM AUTHOR]

The article focuses on the occurrence and management of hypotension induced by neuraxial anesthesia during Caesarean section procedures. Topics include the etiology of neuraxial anesthesia-induced hypotension, various pharmacological and non-pharmacological interventions to prevent and treat it, and the potential impact of hypotension on maternal and fetal outcomes.

Background: Approximately 85% of women experience an obstetric tear at delivery and up to 25% subsequently experience wound dehiscence and/or infection. Previous publications suggest that intravenous antibiotics administrated during delivery reduces this risk. We do not know if oral antibiotics given after delivery can reduce the risk of wound dehiscence or infection. Our aim is to investigate whether three doses of oral antibiotics (amoxicillin 500 mg/clavulanic acid 125 mg) given after delivery can reduce the risk of wound dehiscence and infection in patients with a second-degree obstetric tear or episiotomy. Methods: We will perform a randomized, controlled, double-blinded study including 221women in each arm with allocation 1:1 in relation to the randomization. The study is carried out at Department of Obstetrics & Gynecology, Herlev University Hospital, Copenhagen, Denmark. The women will be included after delivery if they have had a second-degree tear or episiotomy. After inclusion, the women will have a clinical follow-up visit after 1 week. The tear and healing will be evaluated regarding signs of infection and/or dehiscence. The women will again be invited for a 1-year clinical examination including ultrasound. Questionnaires exploring symptoms related to the obstetric tear and possible complications will be answered at both visits. Our primary outcome is wound dehiscence and/or wound infection, which will be calculated using χ2 tests to compare groups. Secondary outcomes are variables that relate to wound healing, as pain, use of painkillers and antibiotics, need for further follow-up, as well as outcomes that may be related to the birth or healing process, urinary or anal incontinence, symptoms of prolapse, female body image, and sexual problems. Discussion: Reducing the risk of wound dehiscence and/or infection would decrease the number of control visits, prevent the need for longer antibiotic treatment, and possibly also decrease both short-term and long-term symptoms. This would be of great importance so the mother, her partner, and the baby could establish and optimize their initial family relation. Trial registration: The conduction of this study is approved the 2/2–2023 with the EU-CT number: 2022–501930-49–00. ClinicalTrials.gov Identifier: NCT05830162. [ABSTRACT FROM AUTHOR]

The ex-utero intrapartum treatment (EXIT) is a rare surgical procedure performed in cases of expected postpartum fetal airway obstruction. This procedure technique lies in a safe establishment of a patent airway during labor in anticipation of a critical respiratory event, without the interruption of maternal-fetal circulation. Anesthetic management in the EXIT procedure is substantially different from that of the standard cesarean delivery and its main goals include uterine relaxation, fetal anesthesia, and placental blood flow preservation. We report the first case of an EXIT procedure performed on a fetus with a prenatal diagnosis of multiple oral masses at King Khalid University Hospital, Riyadh, Saudi Arabia. [ABSTRACT FROM AUTHOR]

Recent years have witnessed remarkable strides in the domain of obstetric anesthesia and critical care, revolutionizing approaches to maternal and fetal well-being during pregnancy, labor, and delivery. This review synthesizes the latest advancements, highlighting significant developments in regional anesthesia techniques, perioperative care enhancements, emerging trends in critical care, advances in anesthetic pharmacology, and the integration of technology. Advancements in regional anesthesia techniques, including refined neuraxial approaches and emerging alternatives like TAP and ESP blocks, have transformed pain management strategies, prioritizing maternal comfort while ensuring safety for both mother and fetus. Perioperative care improvements encompass comprehensive preoperative assessments, optimized intraoperative management, and tailored postoperative care, optimizing outcomes for obstetric patients undergoing surgery. Emerging trends in critical care underscore the importance of multidisciplinary approaches, focusing on managing obstetric emergencies like hemorrhage and hypertensive disorders. Advances in anesthetic pharmacology emphasize personalized dosing regimens, safety profiles of anesthetic agents, and novel drug delivery systems to optimize pain relief while minimizing risks. Furthermore, the integration of technology, such as ultrasound-guided techniques, telemedicine, and digital health platforms, has enhanced precision in procedures, facilitated remote monitoring, and streamlined communication among healthcare providers. This comprehensive review sheds light on the evolving landscape of obstetric anesthesia and critical care, emphasizing the multidimensional advancements that contribute to improved maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Hysteroscopy is considered the “gold standard” for endoscopic visualization of the uterine cavity. Various methods of anesthesia and analgesia for the hysteroscopy procedure are described, including general anesthesia, sedation, local anesthesia, oral analgesics, and inhalation anesthesia. The objective: to assess the use of inhalation sedation with methoxyflurane during office hysteroscopy. Materials and methods. A prospective clinical study was performed in 109 patients during 2022-2024 who admitted to the reproductive health center “Damia” for the treatment of infertility. During office hysteroscopy, all patients had examination of the uterine cavity and biopsy of the endometrium with forceps. I group included 57 women who were prescribed rectal ketoprofen 100 mg and per os paracetamol 500 mg as analgesia during hysteroscopy in outpatient settings; II group involved 52 patients who received methoxyflurane for analgesia through an individual device for inhalation use. The Spielberger–Hanin scale was used to determine the levels of personal and reactive anxiety; assessment of psychoemotional status for the study of depressive disorders was carried out using the Beck depression scale and determination of the effectiveness of analgesic therapy. Statistical processing of the research results was performed using the program “STATISTICA 10”. Results. The spread of chronic endometritis, which was diagnosed for the first time, was established in more than half of the patients (56.9%). When using methoxyflurane for analgesia by the inhalation method, the examined patients subjectively assessed the pain at a rather low level (0.14±0.05 points), and the intensity of pain in the I group was significantly higher (0.41±0.08 points; p=0.005). In the postoperative period in the patients of the I group there were significantly higher levels of depressive disorders (7.84±0.86 points vs 4.54±0.62 points in the II group; p=0.002), personal (27.12±2.32 points vs 19.64±2.04 points; p=0.017) and situational (21.92±2.14 vs 15.56±1.72 points; p=0.022) anxiety, a reduced level of mood and emotionality, which differed from the indicators of women of the II group. Among the most frequent complaints in the I group, dyspeptic disorders (31.6%) and pain in the epigastric area (21.05%) were observed. When using methoxyflurane, the most frequent complaints were headache and drowsiness (11.5% each). Conclusions. The use of inhalation anesthesia with methoxyflurane during hysteroscopy allows to reduce negative pain sensations, anxiety and can be the optimal method for anesthesia for its performance in outpatient conditions. [ABSTRACT FROM AUTHOR]

Objective: An emergency cesarean section (CS), which is extremely life-threatening to the mother or fetus, seems to be performed within an adequate time horizon to avoid negative fetal-maternal denouement. An effective and vigilant technique for anesthesia remains vital for emergency cesarean delivery. Therefore, this study aimed to validate the impact of various anesthesia tactics on maternal and neonatal outcomes. Method: This was a retrospective cohort study of parturient patients who were selected for emergency CS with the assistance of general or neuraxial anesthesia between January 2015 and July 2021 at our institution. The 5-min Apgar score was documented as the primary outcome. Secondary outcomes, including the 1 min Apgar score, decision-to-delivery interval (DDI), onset of anesthesia to incision interval (OAII), decision to incision interval (DII), duration of operation, length of hospitalization, height and weight of the newborn, use of vasopressors, blood loss, neonatal resuscitation rate, admission to neonatal intensive care unit (NICU), duration of NICU and complications, were also measured. Results: Of the 539 patients included in the analysis, 337 CSs were performed under general anesthesia (GA), 137 under epidural anesthesia (EA) and 65 under combined spinal-epidural anesthesia (CSEA). The Apgar scores at 1 min and 5 min in newborns receiving GA were lower than those receiving intraspinal anesthesia, and no difference was found between those receiving EA and those receiving CSEA. The DDI of parturients under GA, EA, and CSE were 7[6,7], 6[6,7], and 14[11.5,20.5], respectively. The DDI and DII of GA and EA were shorter than those of CSE, and the DDI and DII were similar between GA and EA. Compared to that in the GA group, the OAII in the intraspinal anesthesia group was significantly greater. GA administration correlated with more frequent resuscitative interventions, increased admission rates to NICU, and a greater incidence of neonatal respiratory distress syndrome (NRDS). Nevertheless, the duration of NICU stay and the incidence rates of neonatal hypoxic ischemic encephalopathy (HIE) and pneumonia did not significantly differ based on the type of anesthesia performed. Conclusion: Compared with general anesthesia, epidural anesthesia may not be associated with a negative impact on neonatal or maternal outcomes and could be utilized as an alternative to general anesthesia in our selected patient population following emergency cesarean section; In addition, a comparably short DDI was achieved for emergency cesarean delivery under epidural anesthesia when compared to general anesthesia in our study. However, the possibility that selection bias related to the retrospective study design may have influenced the results cannot be excluded. [ABSTRACT FROM AUTHOR]

Context: Central neuraxial blockade is widely practiced in obstetric anesthesia. The prevention of maternal systemic hypotension is of importance. Aim: To compare between crystalloid preloading and prophylactic intravenous ephedrine in the prevention of maternal systemic hypotension after spinal anesthesia for cesarean section. Settings and Design: Study was conducted in a tertiary care hospital; comparative observational study. Methods and Materials: One hundred fifty six healthy parturients, posted for elective cesarean section. The parturients who were preloaded with 10 mL/kg of Ringer Lactate over 20 minutes before spinal anesthesia by treating anesthesiologist were included in Group P. Parturients were administered prophylactic ephedrine 0.125 mg/kg infusion after spinal anesthesia at the onset of sympathetic block by treating anesthesiologist were included in Group E. Statistical Analysis Used: Data were entered in Microsoft excel and analyzed using SPSS software version 25 (IBM). Results: In our study, we found that fall in blood pressure was statistically significant from fourth to 14th minute in Group P compared to Group E. The mean arterial pressure became significantly low in Group P compared to Group E. Heart rate was found to increase in Group P from second minute compared to sixth minute in Group E. Fetal wellbeing assessed by appearance (colour), pulse, grimace (response to touch), activity (tone) and respiration (APGAR) score was better in Group E compared to Group P and was statistically significant. Nausea and vomiting were more in Group P compared to Group E and was statistically significant. Conclusions: We conclude that prophylactic ephedrine infusion has better control over maternal hemodynamic than crystalloid preloading in cesarean section under spinal anesthesia. [ABSTRACT FROM AUTHOR]

Background: Spinal hypotension in a parturient can occur precipitously and may contribute significantly to regional anesthesia-related maternal mortality. The primary research within the field of obstetric anesthesia has been about the prevention of spinal hypotension. The objective of the present study is to compare the patients not receiving phenylephrine infusion and those receiving prophylactic phenylephrine infusion of 50 µg/min, and those of 100 µg/min. Material and Methods: This prospective randomized comparative study done on 75 ASA I and II patients, undergoing elective cesarean section under spinal anesthesia, randomly divided into three groups of 25 each, control group (Group-A), phenylephrine-50mcg group (Group-B), and phenylephrine- 100mcg group (Group-C). All the patients were preloaded with 500ml of ringer lactate. According to the group, phenylephrine infusion of 50 µg/min or 100 µg/min was started immediately after spinal anesthesia and continued till baseline vitals were achieved. All the vitals are monitored and studied. Results: Demographic variables are comparable among the groups. There was a statistically significant difference in mean heart rates between three groups at 5, 10, and 20 minutes point of time for heart rate. There was a statistically significant difference in systolic, diastolic and mean blood pressure between the three groups from 3 minutes to 25 minutes. Hypotension and nausea were more in the control group than in the phenylephrine-50 and phenylephrine-100 groups. Bradycardia and maternal hypertension were more in the phenylephrine-100 group compared to the other two groups. No significant adverse effects in the both the groups. Conclusion: Prophylactic phenylephrine infusion is an effective and simple method of reducing the incidence and magnitude of spinal hypotension for cesarean delivery compared to the control group. Phenylephrine 50 mcg/min group had comparatively fewer adverse events like hypertension, bradycardia than the phenylephrine 100 mcg/min group. [ABSTRACT FROM AUTHOR]

Coronavirus disease (COVID-19) pandemic is an unprecedented public health calamity that has caused an immense setback to maternal health services in developing countries. In addition to morbidity and mortality caused by COVID-19 disease in parturient directly, the indirect adverse impact of lockdown imposed during pandemic causing loss of follow-up of patients with coexisting illness is significant. There are no standard protocols to manage COVID-19 patients with comorbid medical illness, who are not optimized during antenatal visits. We report an interesting case of an antenatal patient with COVID-19, with prosthetic aortic valve on warfarin with elevated International Normalized Ratio (INR) and severe pre-eclampsia, posted for emergency cesarean section. [ABSTRACT FROM AUTHOR]

Background: Maternal and child health outcomes are positively influenced by early intervention, and digital health (DH) tools provide the potential for a low-cost and scalable solution such as informational platforms or digital tracking tools. Despite the wide availability of DH tools out there for women from before to after pregnancy, user engagement remains low. Objective: This study aims to explore the factors that shape women's DH adoption and sustained use across the maternal journey from preconception to postbirth, to improve user engagement with DH tools. Methods: One-hour semistructured qualitative interviews were conducted with 44 women from before to after pregnancy (age range 21-40 years) about their experiences with DH. This study is part of a larger study on women's maternal experiences with health care and DH and focuses on the factors that affected women's DH adoption and sustained use. Interviews were audio recorded, transcribed verbatim, and analyzed using inductive thematic analysis. Results: Five main themes and 10 subthemes were identified that affected women's adoption and sustained use of DH tools. These included themes on their preexisting attitudes to DH, perceived ease of use, perceived usefulness, perceived credibility, and perceived value of the tool. Conclusions: The themes that emerged were fully or partially mapped according to the Unified Theory of Acceptance and Use of Technology 2 model. The applicability of the model and the need to consider specific cultural nuances in the Asian context (such as the importance of trust and social influence) are discussed. The interaction of the 5 themes with DH adoption and sustained use are explored with different themes being relevant at various points of the DH adoption journey. The insights gained serve to inform future DH design and implementation of tools for women to optimize their DH engagement and the benefits they derive from it. Trial Registration: ClinicalTrials.gov NCT05099900; https://clinicaltrials.gov/study/NCT05099900 [ABSTRACT FROM AUTHOR]

The article focuses on Glanzmann's thrombasthenia (GT), an autosomal recessive platelet function disorder, providing insights into its genetic basis, diagnostic criteria, and clinical manifestations. It further discusses the challenges and considerations in anaesthesia for patients with GT, emphasizing the need for meticulous planning, avoidance of certain anaesthetic procedures, and the importance of pre-operative testing to ensure safe perioperative management.

Introduction: The pain of childbirth is often rated by women as being most painful experience of their lives. It is estimated that about two third of normal healthy pregnant women, suffer severe intolerable pain during labour and only 2% describe it as little or no discomfort. There are several factors which influence parturition pain and its severity varies widely. It is influenced by parity, primiparous women experience more pain during early labour while multiparous women feel greater pain in the second stage. Materials and Methods: This prospective, comparative study was conducted at Department of Anaesthesia, ESIC Medical College and Hospital, Kalaburagi during the period of January 2022 to December 2022, written consent was obtained from all parturients in the study. The sample size obtained was 60 for each group. So final sample size estimated was 120. Group RS received 0.2% ropivacaine epidurally as bolus dose of 8 mL followed by intermittent top ups as and when required and Group RD received 0.2% ropivacaine with 0.5 mcg/mL of dexmedetomidine epidurally 8 mL as bolus dose followed by intermittent top ups as and when required. A complete history of each patient was obtained, and clinical examination was done. Routine investigations along with coagulation profile was obtained and noted. All baseline parameters like Heart Rate, Blood Pressure, ECG, SpO2, Foetal Heart Rate were recorded Results: Demographic and obstetric variables were comparable in both the groups and with no statistical significance which was calculated by calculated by independent sample t-test with Levene's test for equality of variances. To assess the neonatal status APGAR score (table 1) at 1 and 5 mins was evaluated. It was found that there was NO statistically significant difference in mean APGAR score at1 min (p=1.000) and 5 mins (p=0.309). Conclusion: Epidural labour analgesia is considered to be a gold standard for pain management during labour, when ropivacaine along with dexmedetomidine is used. Many studies have been conducted to prove the use of dexmedetomidine in obstetric anesthesia in optimal doses. This wonder drug provides excellent maternal satisfaction and good progress of labour with minimal side effects to mother and foetus. [ABSTRACT FROM AUTHOR]

With the increasing number of pediatric surgeries and the transfer of caregiving roles to parents, appropriate preparation and reduction of their stress levels for proper care of children before and after surgery is essential. If parental anxiety can be reduced through various methods, not only can it improve parental performance and their comfort, but it can also prevent the impact of anxiety on the child. Therefore, we aimed to investigate the effect of educational film presentation on the anxiety level of mothers visiting the obstetric anesthesia clinic at the Children's Medical Center in 2020. This study was a randomized double-blind controlled trial conducted as an intervention. Sampling was done randomly, and the study population consisted of two groups of 38 individuals, whose children were candidates for MRI. The intervention group watched the educational film, while the second group served as the control group. Subsequently, their anxiety levels were assessed and compared using the Beck Anxiety Inventory. The data were entered into SPSS Ver. 21 software and analyzed accordingly. The mean age of mothers in this study was 33.41 years with a standard deviation of 7 years. The mean age of children was 3.79 years with a standard deviation of 3.4 years. Among the children, 30 were girls (39.5%) and 46 were boys (60.5%). The mean age of girls was 4.35 years with a standard deviation of 4.16 years, while the mean age of boys was 3.433 years with a standard deviation of 2.787 years. Overall, 39 participants (50.6%) watched the educational film, while 38 participants (49.4%) were in the control group. The mean score of anxiety level according to the Beck Anxiety Inventory (BAI) was 9.47 with a standard deviation of 9.77. The level of anxiety was significantly higher in the intervention group who watched the educational film compared to the control group (P=0.012). The results of the present study indicated that parental anxiety increased after watching the educational video on anesthesia methods. It is recommended that alternative strategies be considered for reducing parental anxiety in future studies. [ABSTRACT FROM AUTHOR]