Obstetric Anesthesia Workforce Survey

Bucklin, Brenda A.; Hawkins, Joy L.; Anderson, James R.; Ullrich, Fred

doi:10.1097/00000542-200509000-00030

Cited by 303 publications

(177 citation statements)

References 24 publications

Supporting

Mentioning

163

Contrasting

Unclassified

Order By: Relevance

“…7 In a study conducted in the UK, the regional anesthesia rate was 69.4% in 1992, while it reached 94.9% in 2002. 8 A number of factors have played a role in the rise of regional anesthesia rates, such as the increasing experience of anesthesiologists, the fact that newborns do not get exposed to the depressant effect relating to inhalation agents, the low rate of risk of lung aspiration, increasing sociocultural level, the fact that the mother is awake after the cesarean delivery and early establishment of the bond between mother and newborn, given that the mother can see her baby shortly after birth. 17,18 Today, general anesthesia is preferred in emergency obstetric situations, such as cord prolapse, in which there is a need for swift and reliable induction, and also bleeding placenta previa and uterus inversion.…”

Section: Discussionmentioning

confidence: 99%

Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial

Saygı¹,

Özdamar²,

Gün

et al. 2015

Sao Paulo Med. J.

View full text Add to dashboard Cite

CONTEXT AND OBJECTIVE: As the rates of cesarean births have increased, the type of cesarean anesthesia has gained importance. Here, we aimed to compare the effects of general and spinal anesthesia on maternal and fetal outcomes in term singleton cases undergoing elective cesarean section. DESIGN AND SETTING: Prospective randomized controlled clinical trial in a tertiary-level public hospital. METHODS: Our study was conducted on 100 patients who underwent cesarean section due to elective indications. The patients were randomly divided into general anesthesia (n = 50) and spinal anesthesia (n = 50) groups. The maternal pre and postoperative hematological results, intra and postoperative hemodynamic parameters and perinatal results were compared between the groups. RESULTS: Mean bowel sounds (P = 0.036) and gas discharge time (P = 0.049) were significantly greater and 24 th hour hemoglobin difference values (P = 0.001) were higher in the general anesthesia group. The mean hematocrit and hemoglobin values at the 24 th hour (P = 0.004 and P < 0.001, respectively), urine volume at the first postoperative hour (P < 0.001) and median Apgar score at the first minute (P < 0.0005) were significantly higher, and the time that elapsed until the first requirement for analgesia was significantly longer (P = 0.042), in the spinal anesthesia group. CONCLUSION: In elective cases, spinal anesthesia is superior to general anesthesia in terms of postoperative comfort. In pregnancies with a risk of fetal distress, it would be appropriate to prefer spinal anesthesia by taking the first minute Apgar score into account. CLINICAL TRIAL REGISTRY: NTR17990 RESUMOCONTEXTO E OBJETIVO: Como as taxas de partos cesáreos aumentaram, o tipo de anestesia na cesariana ganhou importância. Comparamos os efeitos da anestesia geral e da raquianestesia sobre os resultados maternos e fetais em casos de gestação única e no termo, com cesariana eletiva. TIPO DE ESTUDO E LOCAL: Ensaio clínico prospectivo, randomizado e controlado, em hospital público terciário. MÉTODOS: Estudo realizado com 100 pacientes que se submeteram a cesariana por indicação eletiva. As pacientes foram divididos aleatoriamente em grupos recebendo anestesia geral (n = 50) e raquianestesia (n = 50). Resultados maternos hematológicos pré e pós-operatórios, variáveis hemodinâmicas intra e pós-operatórias e resultados perinatais foram comparados entre os grupos. RESULTADOS: As médias de ruídos intestinais (P = 0,036) e tempo de descarga de gás (P = 0,049) foram significativamente mais elevadas e os valores de diferença de hemoglobina na 24 a hora (P = 0,001) foram maiores no grupo anestesia geral. Os valores médios de hematócrito e hemoglobina na 24 a hora (P = 0,004 e P < 0,001, respectivamente), o volume de urina na primeira hora de pós-operatório (P < 0,001) e a pontuação mediana de Apgar no primeiro minuto (P < 0,0005) foram significativamente maiores, e o tempo até o primeiro requerimento de analgésicos também foi significativamente maior (P = 0,042) no grupo raquianestesia. C...

show abstract

Section: Discussionmentioning

confidence: 99%

Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial

Saygı¹,

Özdamar²,

Gün

et al. 2015

Sao Paulo Med. J.

View full text Add to dashboard Cite

show abstract

“…It is the anesthetic route proven to be the safest for the parturient while at the same time providing optimal post-operative pain control. This is true in both normal weight and bariatric parturients [24][25][26][27]. The first inference that can be made from our bariatric parturient study sample is that spinal anesthesia continues to be used more often than CSE and epidural anesthesia for caesarean sections even in the morbidly obese parturients.…”

Section: Citation: Faris As Chaput Aj Goheen S Gallant C (2014) Anmentioning

confidence: 99%

Anesthesia for Cesarean Delivery in the Morbidly Obese Parturient - Comparison of Commonly used Anesthesia Techniques

Faris¹

2014

ACC

View full text Add to dashboard Cite

Background: Obesity in pregnancy can add significantly to obstetric and anesthetic complications. The objective of this study is to identify and compare anesthesia-related complications in different types of elective cesarean anesthetics in morbidly obese parturients. Methods:Retrospective review was done on 205 records of elective cesareans for pregnants with Body Mass Index (BMI) ≥ 40. Data extracted include: type of anesthesia, intraoperative and early postoperative complications, duration of surgery, newborn birth weight, cord blood pH and Apgar scores. Results: The incidence of significant intra-operative hypotension: 65.0%, bradycardia 3.04%, nausea and vomiting 14.21%. Intraoperative hypotension: 67% in spinal and CSE group vs. 34.8% in epidural group (p = 0.0022). Super Morbid Obese (SMO) patients (BMI > 50) had a greater number of attempts at placement for regional techniques compared to Morbidly Obese (MO) patients (BMI 40−49.9) (2.02 vs. 2.61, p = 0.0255). SMO patients had longer mean surgical times (86.6 vs. 107.55 min, p = 0.0001), received more intraoperative crystalloids (1887 vs. 1699 ml, p = 0.0376) and colloids (33.9 vs. 12.6%, p = 0.0007) compared to MO patients. No other complications were significantly different between the 2 compared anesthetic techniques or BMI classes. Conclusion:Spinal anesthesia was the most commonly used technique. It resulted in more hypotension. Parturients with BMI ≥ 50 were more challenging to manage with more regional anesthesia placement attempts, larger fluid volumes and longer surgery times. A well-organized RCT could prove beneficial in validating the most profitable and safe anesthetic technique for bariatric parturients.

show abstract

“…To date, while there appears to have been a decline in the use of parenteral analgesia in developed countries (from 37-53% to 37-42% over 20 years in USA), an increase in the use of remifentanil IVPCA has been observed in Northern Ireland with a concomitant decline in the use of neuraxial methods (Bucklin et al 2005, Foley & Hill 2009). …”

Section: Remifentanilmentioning

confidence: 99%

“…Neuraxial labour analgesia is widely available in developed countries with an increase of use reaching 57-77% of deliveries by 2001 in the USA (Bucklin et al 2005). In Finland, the use of neuraxial labour analgesia increased from 8.2% in 1987 to 60.1% in 2008 (National Institute for Health and Welfare 2008).…”

Section: Epidural Analgesiamentioning

confidence: 99%

Intravenous patient-controlled analgesia with remifentanil in early labour

Volmanen¹

2011

Acta Anaesthesiologica Scandinavica

View full text Add to dashboard Cite

Cover design Raimo Ahonen JUVENES PRINT TAMPERE 2010Volmanen, Petri, Intravenous patient controlled analgesia with remifentanil in early labour. AbstractIn four prospective clinical trials, 114 parturients used intravenous patient-controlled remifentanil analgesia during the 1 st stage of labour. The median effective dose per bolus was ascertained to be 0.4 μg/kg and the pain scores were reduced with this by a median of 2 on a numerical scale (0-10). Compared with nitrous oxide, 15 parturients included in a cross-over study reported a larger reduction in pain scores during remifentanil analgesia (1.5 vs. 0.5, p = 0.001) and better pain relief scores (2.5 vs. 0.5 on a ranked five point scale 0-4, p < 0.001). In a parallel study including 45 parturients, epidural analgesia (EDA, 20 ml bupivacaine 0.625 mg/ml and fentanyl 2 μg/ml) was associated with lower pain scores (5.2 vs. 7.3 with remifentanil, p = 0.004) but variables related to satisfaction with analgesia (pain relief score, proportion of mothers with desire to continue with the given medication and termination of the study due to inadequate pain relief) were similar. A comparison of two methods for timing the remifentanil bolus during the uterine contraction cycle suggested that delaying the bolus does not improve analgesia. A period effect was noted in the cross-over trial with higher pain scores and increased drug consumption during the second study period suggesting acute hyperalgesia.Side effects of remifentanil analgesia included respiratory depression warranting oxygen supplementation in 33% of parturients. Sedation was experienced by the parturients using remifentanil and this was scored as stronger than sedation during nitrous oxide and EDA. The number of parturients with nausea did not increase during remifentanil analgesia. Other maternal side effects included dizziness, a difficulty in visual focusing and itching. Foetal heart rate tracing abnormalities were noted. The incidence of abnormal tracings and decreased UapH were not different, however, from that observed during nitrous oxide or EDA. Apgar scores at 1 and 5 minute indicated no neonatal depression. Keywords

show abstract

Obstetric Anesthesia Workforce Survey

Cited by 303 publications

References 24 publications

Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial

Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial

Anesthesia for Cesarean Delivery in the Morbidly Obese Parturient - Comparison of Commonly used Anesthesia Techniques

Intravenous patient-controlled analgesia with remifentanil in early labour

Contact Info

Product

Resources

About