PurposeTo compare maternal and fetal effects of intravenous phenylephrine and ephedrine administration during spinal anesthesia for cesarean delivery in high-risk pregnancies.SourceAn extensive literature search was conducted using the US National Library of Medicine, MEDLINE search engine, Cochrane review, and Google Scholar using search terms “ephedrine and phenylephrine,” “preterm and term and spinal hypotension,” “preeclampsia and healthy parturients,” or “multiple and singleton gestation and vasopressor.” Society of Obstetric Anesthesia and Perinatology meeting abstracts for the past 4 years were also searched for relevant studies.Principle findingsBoth phenylephrine and ephedrine can be safely used to counteract hypotension after spinal anesthesia in patients with uteroplacental insufficiency, pregnancy-induced hypertension, and in non-elective cesarean deliveries. Vasopressor requirements before delivery in high-risk cesarean sections are reduced compared to healthy parturients. Among the articles reviewed, there were no statistically significant differences in umbilical arterial pH, umbilical venous pH, incidence of fetal acidosis, Apgar scores, or maternal hypotension when comparing maternal phenylephrine and ephedrine use.ConclusionFrom the limited existing data, phenylephrine and ephedrine are both appropriate selections for treating or preventing hypotension induced by neuraxial blockade in high-risk pregnancies. There is no clear evidence that either medication is more effective at maintaining maternal blood pressure or has a superior safety profile in this setting. Further investigations are required to determine the efficacy, ideal dosing regimens, and overall safety of phenylephrine and ephedrine administration in high-risk obstetric patients, especially in the presence uteroplacental insufficiency.

Objectives Dental students require basic life support (BLS) training to build their competency in cardiac arrest response. Online learning differs from the types of learning commonly practiced in Asia. We compared online learning and didactic lecture for BLS training in Thai dental students on knowledge, skill, and satisfaction. Methods This was a randomized controlled, single‐blinded, non‐inferiority trial in fifth‐year students from Khon Kaen University's Faculty of Dentistry from August 2015 to February 2016. Online learning was conducted using Modular Object‐Oriented Dynamic Learning Environment (Moodle) 2.9 and required 90 min. Those in the didactic lecture group received a 90‐min lecture covering similar content. Both groups received 2 h of skill training. After training, we evaluated their ability to pass a skills test, knowledge scores (immediately after training and 3 months later), and course satisfaction (5‐point Likert scale). Results We included 78 students and randomized them to online learning (39) or didactic lecture (39). The difference in proportion (95% confidence interval [CI]) of students passing the skills test on their first attempt was −1.5 (−20.8, 23.8), and all passed on their second attempt. The mean differences (95% CI) between the groups’ immediate and 3 months knowledge scores were −2.5 (−6.2, 1.2), and −1.3 (−4.9, 2.3), respectively. The mean difference (95% CI) in satisfaction score was 0.02 (−0.28, 0.32). Conclusion Online learning and didactic lectures yielded comparable knowledge and skills, including satisfaction in Thai dental students. Online BLS training may alternatively aim for self‐paced learning and increase flexibility. The recommendation is to increase online BLS learning in Thai culture.

Background: Oxytocin is used for initiating uterine contraction and preventing postpartum hemorrhage during caesarean delivery. Using a lower dosage of oxytocin may lower the risk of adverse effects while still being effective in stimulating initial uterine contraction. We aimed to compare the effectiveness and side effects of the standard 10 IU bolus of oxytocin with those of a 5 IU bolus during caesarean delivery. Patients and Methods: We enrolled women in a randomized, double-blind, study comparing intravenous injections of high-dose (10 IU) and low-dose (5 IU) oxytocin administered after clamping of the umbilical cord. The primary outcome was adequate uterine contraction within the first 3 mins after administration. Secondary outcomes included uterine tone, use of additional uterotonic agents, additional obstetrics procedures, and oxytocin-related adverse events. Results: A total of 155 women underwent randomization, with 78 in the low-dose group and 77 in the high-dose group. The proportion of women with adequate uterine contraction during the first 3 mins was 84.6% in the low-dose group and 77.9% in the high-dose group (relative risk, 1.09; 95% CI, 0.93 to 1.26). Methylergonovine maleate was used in 14.1% of cases in the low-dose group and 36.4% in the high-dose group (relative risk, 0.40; 95% CI, 0.22 to 0.73). The necessity for additional obstetric procedures, estimated blood loss >500 mL, neonatal outcomes, and oxytocinrelated adverse effects did not differ significantly between the two groups. Conclusion: The 5 IU bolus of oxytocin was noninferior to the standard 10 IU bolus of oxytocin for initiating adequate uterine contraction, required fewer additional uterotonic agents, and led to fewer oxytocin-related adverse events.

Associations between anaesthetic techniques and pregnancy outcomes were assessed among 129,742 pregnancies delivered by caesarean section (cS) in low-and middle-income countries (LMics) using two WHo databases. Anaesthesia was categorized as general anaesthesia (GA) and neuraxial anaesthesia (nA). outcomes included maternal death (MD), maternal near miss (MnM), severe maternal outcome (SMo), intensive care unit (icU) admission, early neonatal death (enD), neonatal near miss (nnM), severe neonatal outcome (Sno), Apgar score <7 at 5 minutes, and neonatal ICU (NICU) admission. A two-stage approach of individual participant data meta-analysis was used to combine the results. Adjusted odds ratio (OR) with 95% confidence intervals (CIs) were presented. Compared to GA, NA were associated with decreased odds of MD (pooled OR 0.28; 95% CI 0.10, 0.78), MNM (pooled OR 0.25; 95% CI 0.21, 0.31), SMO (pooled OR 0.24; 95% CI 0.20,0.28), ICU admission (pooled OR 0.17; 95% CI 0.13, 0.22), NNM (pooled OR 0.63; 95% CI 0.55, 0.73), SNO (pooled OR 0.55; 95% CI 0.48, 0.63), Apgar score <7 at 5 minutes (pooled OR 0.35; 95% CI 0.29, 0.43), and NICU admission (pooled OR 0.53; 95% CI 0.45, 0.62). NA therefore was associated with decreased odds of adverse pregnancy outcomes in LMICs. Caesarean section (CS) can be a life-saving procedure for women and babies when potentially life-threatening complications occur during pregnancy or childbirth, such as abnormal fetal presentation, non-reassuring foetal condition, abnormal placentation, obstetric haemorrhage, and obstructed labor 1. CS can be performed under either neuraxial anaesthesia (NA) including spinal anaesthesia (SA) and epidural anaesthesia (EA), or general anaesthesia (GA). The choice of anaesthesia for CS generally depends on clinical indications, experience of the anaesthesiologist, as well as maternal preferences. NA offers the benefit of the woman being awake during the procedure, with minimal anaesthetic exposure to the neonate. NA also

Background Labour pain has been identified as an important reason for women to prefer caesarean section (CS). Fentanyl is one of the short acting opioids recommended by World Health Organization for pain relief during labour. This study aimed to identify and describe the available evidence on the use of fentanyl (monotherapy) for labour pain management by any routes of administration or regime. Methods We included the records published until 31 December 2021 which reported administration of fentanyl to women with normal labour for labour pain relief. Data were extracted by one reviewer and checked by another reviewer using a standardised agreement form. We mapped and presented data descriptively in figure and tabular format. Results We included 51 records from 49 studies in our scoping review. The studies were conducted in 12 countries, mostly high-income countries. The study designs of the 51 included records were varied as follows: 38 (74.5%) experimental studies (35 randomised controlled trials and three quasi-experimental studies), and 12 (23.5%) observational studies (five retrospective cohort studies, four prospective cohort studies, two retrospective descriptive studies, and one descriptive study) and one qualitative study. Of the included records, six used intranasal fentanyl, five used subcutaneous fentanyl, 18 (35.3%) used intravenous fentanyl, 18 (35.3%) used intrathecal fentanyl, and nine used epidural fentanyl. Many records compared fentanyl with another analgesic agent while five records (9.8%) had no comparison group and seven records (13.7%) compared with no analgesia group. The doses of fentanyl varied by routes, study and the requirement depended on the women. Pain assessment was the most frequent outcome measure presented in the records (78.4%). Only nine records (17.6%) investigated women’s satisfaction about labour pain relief using fentanyl and seven records (13.7%) reported the effect of fentanyl on breastfeeding. The most common reported neonatal outcomes were foetal heart rate (33 records, 64.7%) and Apgar score (32 records, 62.7%). Conclusion There is limited primary evidence especially randomised controlled trials to evaluate the effectiveness and harms of different routes of fentanyl in low- or middle-income countries. There is a need for high-quality research to establish the most effective route of fentanyl and associated effects for evidence-based international guidelines.