Predictors of difficult epidural placement in pregnant women: A trainees' perspective

Rajagopalan, Suman; Shah, Krishna B.; Guffey, Danielle; Tran, Connie K.; Suresh, S.; Wali, Ashutosh

doi:10.4103/joacp.joacp_340_18

Cited by 7 publications

(5 citation statements)

References 15 publications

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“…Nine studies were reported from the USA. These 16 studies reported a total of 5702 participants ( Table 1 ) [ 9 , 24 ].…”

Section: Results Generationmentioning

confidence: 99%

Safety and complications of labour epidural analgesia in obese parturients: worrying is not worth the weight!

Saxena,

Sharma,

Goyal

et al. 2024

ait

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The physiological transformations accompanying pregnancy, compounded by the implications of obesity, pose intricate challenges for anaesthesiologists attending to obese parturients. Obesity makes it harder to successfully provide epidural analgesia to a parturient. This narrative review explains the most recent data on the safety and complications of providing labour epidural analgesia in obese expectant mothers. We have emphasised the evidence-based approaches that are the most effective for obese pregnant mothers receiving labour epidural analgesia.

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“…Nine studies were reported from the USA. These 16 studies reported a total of 5702 participants ( Table 1 ) [ 9 , 24 ].…”

Section: Results Generationmentioning

confidence: 99%

Safety and complications of labour epidural analgesia in obese parturients: worrying is not worth the weight!

Saxena,

Sharma,

Goyal

et al. 2024

ait

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“…In our case, epidural failure was 8% and the reason was the impossibility of identifying the epidural space, which is common for beginners. The epidural technique is complex, but obstetric patients also have their own specificities, such as obesity, a smaller diameter of epidural space due to increased intra-abdominal pressure, and an inability to palpate the bony landmarks [ 5 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

Establishment of Labor Epidural Analgesia Service and its Assessment: An Experience in a Hospital of a Middle-Income Country

Djurdjevic Svraka,

Svraka,

Pejic

et al. 2024

Cureus

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Objectives: Even though the idea of painless birth is more than 100 years old, it is still underrepresented in some parts of the world despite progress in science, education, anesthesia, spinal and epidural needles, development of catheters, new drugs, and infusion pumps. Maternal care should basically be the safety of the patient (in this case two patients) and also provide all kinds of protection in the form of a multidisciplinary team with an anesthesiologist, especially when it comes to pain therapy and anesthesia for women in labor. In this direction, our hospital departments with low or moderate volume of annual births made the decision to educate ourselves for painless childbirth and contribute more to the care of women in labor. The enthusiasm and dedication of our clinical team prevailed and today we have a high standard of labor epidural service. The aim of this study was to evaluate the establishment of the epidural labor service by comparing the effects of epidural analgesia on labor pain and the course of labor. The secondary objectives were to compare satisfaction with epidural analgesia and the impact of epidural analgesia on the delivery mode. Material and methods: This was a prospective observational hospital-based study conducted on 100 patients after the establishment of epidural service. Parturients who were signed to receive epidural analgesia formed Group A and parturients who did not request epidural analgesia formed Group B. All parturients are induced in the delivery room with a Bishop score of 5 or higher. Results: Pain intensity measured through the visual analog scale of pain (VAS score) was significantly lower in Group A (n = 46) compared to Group B (n = 50) at measured points of time (p<0.001) . There was a fall in the mean VAS score in Group A from 7.94 to 3.86 within 20 minutes of the bolus dose and starting a continuous infusion. Labor progress according to the Bishop score and till the end of the second stage of labor, or to the transfer to the operating theatre, according to the monitored time in Group A was 176 minutes and it was lower in Group B with 155 minutes; however, by test of linearity we do not gain significance (p = 0.2 ) . There were eight parturients in each group (17% vs 16%) who were indicated for surgical delivery. According to Pearson's correlation test for the outcome of labor between parturients receiving epidural analgesia and parturients without epidural analgesia (p = 0.8), we cannot say that epidural analgesia in labor is correlated with the outcome of surgical delivery. Conclusion: Establishing a new hospital procedure such as an epidural painless service for childbirth in low or moderate-volume settings of annual births is very challenging. By evaluating epidural labor services in our hospital, we created the best environment for continuous improvement and long-term efficacy and safety of our analgesic techniques aimed at pro...

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“…Refining technical skills for procedures such as tracheal intubation and insertion of lumbar drains, epidural catheters, central venous lines, and arterial lines is an essential facet of neuroanesthesia training. Epidural anesthesia is among the most challenging procedures for anesthesia trainees to learn, 25 and residents found the use of a 3D-printed thoracic spine model helpful for learning lumbar epidural placement, central line insertion, and cricothyroidotomy techniques 13 …”

Section: Scenarios In Neuroanesthesia Simulationmentioning

confidence: 99%

Simulation in Anesthesia for Perioperative Neuroscience: Present and Future

Nakatani,

Patel,

Chowdhury

2023

Journal of Neurosurgical Anesthesiology

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The brain’s sensitivity to fluctuations in physiological parameters demands precise control of anesthesia during neurosurgery, which, combined with the complex nature of neurosurgical procedures and potential for adverse outcomes, makes neuroanesthesia challenging. Neuroanesthesiologists, as perioperative physicians, work closely with neurosurgeons, neurologists, neurointensivists, and neuroradiologists to provide care for patients with complex neurological diseases, often dealing with life-threatening conditions such as traumatic brain injuries, brain tumors, cerebral aneurysms, and spinal cord injuries. The use of simulation to practice emergency scenarios may have potential for enhancing competency and skill acquisition amongst neuroanesthesiologists. Simulation models, including high-fidelity manikins, virtual reality, and computer-based simulations, can replicate physiological responses, anatomical structures, and complications associated with neurosurgical procedures. The use of high-fidelity simulation can act as a valuable complement to real-life clinical exposure and training in neuroanesthesia.

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Predictors of difficult epidural placement in pregnant women: A trainees' perspective

Cited by 7 publications

References 15 publications

Safety and complications of labour epidural analgesia in obese parturients: worrying is not worth the weight!

Safety and complications of labour epidural analgesia in obese parturients: worrying is not worth the weight!

Establishment of Labor Epidural Analgesia Service and its Assessment: An Experience in a Hospital of a Middle-Income Country

Simulation in Anesthesia for Perioperative Neuroscience: Present and Future

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