Practice Guidelines for Obstetric Anesthesia

Apfelbaum, Jeffrey L.; Hawkins, Joy L.; Agarkar, Madhulika; Bucklin, Brenda A.; Connis, Richard T.; Gambling, David R.; Mhyre, Jill M.; Nickinovich, David G.; Sherman, Heather; Tsen, Lawrence C.; Yaghmour, Edward

doi:10.1097/aln.0000000000000935

Cited by 470 publications

(71 citation statements)

References 209 publications

(220 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Nausea and vomiting are the main adverse effects of tramadol. Antiemetics (either pharmacological or acupressure) should be offered to reduce the incidence of nausea and vomiting 24. Respiratory depression evaluated by ventilator use was not observed in this study.…”

Section: Discussionmentioning

confidence: 62%

Comparison of patient-controlled intravenous analgesia with sufentanil versus tramadol in post–cesarean section pain management and lactation after general anesthesia – a prospective, randomized, double-blind, controlled study

Chi

Mei

et al. 2017

JPR

View full text Add to dashboard Cite

IntroductionAcute pain is a common complication following cesarean section under general anesthesia. Post–cesarean section pain management is important for both the mother and the newborn. This study compared the effects of patient-controlled intravenous analgesia (PCIA) using sufentanil or tramadol on postoperative pain control and initiation time of lactation in patients who underwent cesarean section under general anesthesia.MethodsPrimiparas (n=146) scheduled for cesarean section under general anesthesia were randomized to receive PCIA with sufentanil or tramadol. Movement-evoked and rest-pain intensity were assessed by the Numerical Rating Scale (NRS) postoperatively. The number of PCIA attempts, amount of drug consumed, initiation time of lactation, and Quality of Recovery Score 40 (QoR-40) were recorded at 4, 8, 12, and 24 h postoperatively. Pre- and postoperative serum prolactin levels were recorded.ResultsNo between-group difference existed in the NRS at rest at any time point postoperatively. Patients on sufentanil had more movement-evoked pain and a higher sedation score at 4, 8, and 12 h postoperatively, as compared with the tramadol group. At 24 h, the QoR-40 was higher in the tramadol group compared with the sufentanil group. No significant between-group differences were present in patient satisfaction and nausea/vomiting scores. Postpartum prolactin levels were significantly higher in the tramadol group versus the sufentanil group, corresponding with a significant delay in initiation of lactation in the latter.ConclusionPCIA with tramadol may be preferred due to lower movement-evoked pain, higher quality of recovery, and earlier lactation in patients following cesarean section under general anesthesia.

show abstract

Section: Discussionmentioning

confidence: 62%

Comparison of patient-controlled intravenous analgesia with sufentanil versus tramadol in post–cesarean section pain management and lactation after general anesthesia – a prospective, randomized, double-blind, controlled study

Chi

Mei

et al. 2017

JPR

View full text Add to dashboard Cite

show abstract

“…The significantly longer catheter dwell time and insertion at an earlier cervical dilatation, were not associated with extension failure. This result is important, given suggestions by experts and international guidelines, that epidurals be inserted early in labor, for obese women 9, 25, 26…”

Section: Discussionmentioning

confidence: 99%

“…These cohort studies have identified a significantly higher rate of cesarean section, general anesthesia and problems or failure of neuraxial anesthesia in this group 28, 29. International maternity care guidelines make recommendations regarding the care of pregnant women with a BMI > 40 kg/m 2 , but do not differentiate between levels of BMI greater than 40 kg/m 2 25, 26, 30. Pregnant women with a BMI > 50 kg/m 2 may present specific management difficulties, necessitating different ‘ideal’ obstetric and anesthetic management.…”

Section: Discussionmentioning

confidence: 99%

Epidural extension failure in obese women is comparable to that of non‐obese women

Eley

Chin

Tham

et al. 2018

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

BackgroundManagement of labor epidurals in obese women is difficult and extension to surgical anesthesia is not always successful. Our previous retrospective pilot study found epidural extension was more likely to fail in obese women. This study used a prospective cohort to compare the failure rate of epidural extension in obese and non‐obese women and to identify risk factors for extension failure.MethodsOne hundred obese participants (Group O, body mass index ≥ 40 kg/m2) were prospectively identified and allocated two sequential controls (Group C, body mass index ≤ 30 kg/m2). All subjects utilized epidural labor analgesia and subsequently required anesthesia for cesarean section. The primary outcome measure was failure of the labor epidural to be used as the primary anesthetic technique. Risk factors for extension failure were identified using Chi‐squared and logistic regression.ResultsThe odds ratio (OR) of extension failure was 1.69 in Group O (20% vs. 13%; 95% CI: 0.88–3.21, P = 0.11). Risk factors for failure in obese women included ineffective labor analgesia requiring anesthesiologist intervention, (OR 3.94, 95% CI: 1.16–13.45, P = 0.028) and BMI > 50 kg/m2 (OR 3.42, 95% CI: 1.07–10.96, P = 0.038).ConclusionThe failure rate of epidural extension did not differ significantly between the groups. Further research is needed to determine the influence of body mass index > 50 kg/m2 on epidural extension for cesarean section.

show abstract

“…Even the very recent (2016) guidelines for obstetrical anesthesia from the American Society of Anesthesiologists (ASA)14 avoid suggesting a clear guidance and just state: “A specific platelet count predictive of neuraxial anesthetic complications has not been determined.” In general, a platelet count of ≥50×10 9 /L is recommended for safe delivery 4. Therefore, in most cases, general anesthesia is preferred, due to severe thrombocytopenia and considering the risk of possible spinal or epidural hematoma 14–16…”

Section: Discussionmentioning

confidence: 99%

Epidural anesthesia for labor and delivery in a patient with May–Hegglin anomaly: a case report

Muzannara

Harbi

Rathore

et al. 2017

LRA

View full text Add to dashboard Cite

We report a case of May–Hegglin anomaly (MHA) in a woman who had a successful labor and delivery under epidural anesthesia. MHA is an inherited thrombocytopenia easily misdiagnosed as idiopathic (immune) thrombocytopenic purpura (ITP). Early and appropriate diagnosis of MHA during pregnancy is essential for optimal maternal and neonatal delivery outcome. Additionally, it can avoid unnecessary diagnostic studies, such as bone marrow aspiration and biopsy, and even harmful therapies with corticosteroids, immunosuppressive agents, and splenectomy. Consequently, the most serious impacts of this disease are iatrogenic managements due to misdiagnosis. It seems that in patients with MHA, adequate clinical coagulation is far more dependent on adequate platelet function than any particular platelet count. The diagnosis of MHA may pose a challenge for clinicians managing pregnant women with thrombocytopenia.

show abstract

Practice Guidelines for Obstetric Anesthesia

Cited by 470 publications

References 209 publications

Comparison of patient-controlled intravenous analgesia with sufentanil versus tramadol in post–cesarean section pain management and lactation after general anesthesia – a prospective, randomized, double-blind, controlled study

Comparison of patient-controlled intravenous analgesia with sufentanil versus tramadol in post–cesarean section pain management and lactation after general anesthesia – a prospective, randomized, double-blind, controlled study

Epidural extension failure in obese women is comparable to that of non‐obese women

Epidural anesthesia for labor and delivery in a patient with May–Hegglin anomaly: a case report

Contact Info

Product

Resources

About

Practice Guidelines for Obstetric Anesthesia

Cited by 470 publications

References 209 publications

Comparison of patient-controlled intravenous analgesia with sufentanil versus tramadol in post&ndash;cesarean section pain management and lactation after general anesthesia &ndash; a prospective, randomized, double-blind, controlled study

Comparison of patient-controlled intravenous analgesia with sufentanil versus tramadol in post&ndash;cesarean section pain management and lactation after general anesthesia &ndash; a prospective, randomized, double-blind, controlled study

Epidural extension failure in obese women is comparable to that of non‐obese women

Epidural anesthesia for labor and delivery in a patient with May&ndash;Hegglin anomaly: a case report

Contact Info

Product

Resources

About

Comparison of patient-controlled intravenous analgesia with sufentanil versus tramadol in post–cesarean section pain management and lactation after general anesthesia – a prospective, randomized, double-blind, controlled study

Comparison of patient-controlled intravenous analgesia with sufentanil versus tramadol in post–cesarean section pain management and lactation after general anesthesia – a prospective, randomized, double-blind, controlled study

Epidural anesthesia for labor and delivery in a patient with May–Hegglin anomaly: a case report