The abstract does not do justice to the facts of the article. Yes, although the difference in the CI was approximately 8% higher in the lateral position than in the sitting position (statistically significant), BWe found no difference in healthy fetal blood flow indices among positions, suggesting these changes are not clinically significant.[ Statistical significance does not indicate clinical significance. The results of this study confirm to me that the sitting position for spinal or epidural placement in the obese parturient is the position of choice. I would have found it interesting had the investigators randomly assigned patients to either the lateral or sitting position for block placement and then compared the time in the positions to initiate the block and to obtain surgical anesthesia.I note that the supine position with 15-degree left lateral tilt had the lowest CI of the 4 positions, but again with no impairment in FHR, umbilical artery pulsatility, and resistivity indexes. This is a great relief to me. Now I do not have to Beat crow[ from the obstetricians whom I continually berate to maintain the supine position with 15-degree left lateral tilt until the baby is born. Even better, based on the results, I would not have to insist that the mother must be in the full lateral position until the baby is born by cesarean delivery. It would be excruciatingly difficult to convince obstetricians of the need for this! T ransversus abdominis plane (TAP) block is a regional technique used to block T6-L1 nerve branches and is increasingly used for postoperative analgesia after surgery on the lower abdomen. It has the potential to be an alternative to spinal opioid for analgesia after cesarean section. However, few data have been published on its comparative efficacy. This prospective, randomized, double-blinded, placebo-controlled trial compared the efficacy of the TAP block with and without spinal morphine after cesarean section in 80 women.Patients received a standard spinal anesthetic of 11 to 12.5 mg hyperbaric bupivacaine with 10 Hg fentanyl and then were randomized to 1 of 4 groups to a combination of spinal morphine or saline with TAP block containing local anesthetic or saline: S m T s , S m Tla, S s Tla, or S s T s , with 20 patients in each group. Patients also received 100 Hg spinal morphine or an equivalent volume (0.1 mL of saline. The bilateral TAP blockade was performed with bupivacaine 2 mg/kg, based on her weight when the patient first appeared at the hospital. All patients had standard monitoring and received rectal paracetamol and diclofenac immediately after surgery. All had standard postoperative analgesia with oral paracetamol, rectal diclofenac, and morphine via patient-controlled analgesia. The primary outcome was pain on movement; secondary outcomes were pain at rest, morphine consumption, proportion of patients who had adequate analgesia, satisfaction, sedation, nausea, and pruritus. Patients were evaluated at 6, 12, 24, 36, and 48 hours after TAP block.All patients completed the study...
Summary To better understand outcomes in postpartum patients who receive peripartum anaesthetic interventions, we aimed to assess quality of recovery metrics following childbirth in a UK‐based multicentre cohort study. This study was performed during a 2‐week period in October 2021 to assess in‐ and outpatient post‐delivery recovery at 1 and 30 days postpartum. The following outcomes were reported: obstetric quality of recovery 10‐item measure (ObsQoR‐10); EuroQoL (EQ‐5D‐5L) survey; global health visual analogue scale; postpartum pain scores at rest and movement; length of hospital stay; readmission rates; and self‐reported complications. In total, 1638 patients were recruited and responses analysed from 1631 (99.6%) and 1282 patients (80%) at one and 30 days postpartum, respectively. Median (IQR [range]) length of stay postpartum was 39.3 (28.5–61.0 [17.7–513.4]), 40.3 (28.5–59.1 [17.8–220.9]), and 35.9 (27.1–54.1 [17.9–188.4]) h following caesarean, instrumental and vaginal deliveries, respectively. Median (IQR [range]) ObsQoR‐10 score was 75 ([62–86] 4–100) on day 1, with the lowest ObsQoR‐10 scores (worst recovery) reported by patients undergoing caesarean delivery. Of the 1282 patients, complications within the first 30 days postpartum were reported by 252 (19.7%) of all patients. Readmission to hospital within 30 days of discharge occurred in 69 patients (5.4%), with 49 (3%) for maternal reasons. These data can be used to inform patients regarding expected recovery trajectories; facilitate optimal discharge planning; and identify populations that may benefit most from targeted interventions to improve postpartum recovery experience.
BACKGROUND COVID-19 continues to present challenges to both patient management and the protection of the airway management team involved, in particular in resource-constrained low-income countries. Among the most concerning complications in affected patients is rapid hypoxemic respiratory failure requiring tracheal intubation and mechanical ventilation. Videolaryngoscopy without peri-intubation oxygenation is the recommended approach in COVID-19 patients. However, the absence of peri-intubation oxygenation during intubation attempts can lead to hypoxia, and result in life-threatening complications in already critically ill patients. OBJECTIVE To develop low-cost disposable 3D printed videolaryngoscope designs with integrated channels for oxygen, suction, WIFI-enabled camera and tracheal tube channels, as well as a flexible transparent barrier anchor to offer optional additional protection to the user and airway management team. DESIGN A manikin study. SETTING AND PARTICIPANTS Three experienced consultant anaesthetists in the Mater Misericordiae University Hospital, Dublin, Ireland. MAIN OUTCOME MEASURES To generate novel co-axial videolaryngoscopes that meet International Standards, ISO7376 : 2020 standards for anaesthetic and respiratory equipment (laryngoscopes for tracheal intubation), and to demonstrate successful tracheal intubation of a manikin trainer in a range of configurations (‘easy’ to ‘difficult’) in accordance with the Cormack-Lehane grading of laryngeal view. RESULTS Final design prototypes met the minimum criteria for strength and rigidity according to ISO7376 : 2020, including blade tip displacement under load (65 N and 150 N). Preliminary validation has demonstrated successful tracheal intubation of a manikin trainer in all configurations including ‘difficult’ (Cormack-Lehane Grade 3 view). CONCLUSIONS This low-cost, rapid in-house manufacture could offer a mitigation of supply chain disruptions that can arise during global pandemics. Furthermore, it could offer a low-cost solution in low-income countries where there is an infection risk caused by re-using most current videolaryngoscopes requiring sterilisation before re-use, as well as limitations in the availability of personal protective equipment.
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