General anaesthesia for operative obstetrics

Publication date: Available online 21 August 2019Source: Anaesthesia &Intensive Care MedicineAuthor(s): Naomi Fleming, Rowena CockerhamAbstractGeneral anaesthesia in obstetrics is reducing with a reported use in only 4% of caesarean sections in 2017–2018. Obstetric surgery is often urgent, requiring effective team communication and a rapid, focused preoperative assessment. Physiological changes of pregnancy increase the incidence of aspiration, desaturation and failed intubation. In addition, the rapidly evolving circumstances add additional stress, impacting on performance. Hypotension from aortocaval compression is common and minimized by left lateral tilt or uterine displacement. Rapid sequence induction with tracheal intubation remains gold standard but supraglottic devices are advocated in the event of failed intubation. Awareness remains relatively common and adequate depth of anaesthesia should be maintained and monitored. Complications are more common in obese pregnant patients. Whilst women with pre-eclampsia are at particular risk of hypertensive responses to intubation and extubation, intravenous opiates can ameliorate this. Improved multidisciplinary communication on the delivery suite allows for pre-emptive assessment of patients at risk of requiring an operative delivery. With diminishing individual experience of general anaesthesia in obstetrics and delivery suite often being covered by junior doctors, simulation exercises can improve confidence,...
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research

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We examined small study effects and excess significance. We did analyses under credibility ceilings. This review is registered with PROSPERO, number CRD42018091704.Findings46 eligible articles yielded data on 67 environmental risk factors (544 212 cases, 81 708 787 individuals) and 52 biomarkers (15 614 cases, 15 433 controls). Evidence of association was convincing for maternal age of 35 years or over (relative risk [RR] 1·31, 95% CI 1·18–1·45), maternal chronic hypertension (odds ratio [OR] 1·48, 1·29–1·70), maternal gestational hypertension (OR 1·37,...
Source: The Lancet Psychiatry - Category: Psychiatry Source Type: research
The rising rate of obesity is of worldwide concern. It is predicted that by 2022, 80% of American adults will be overweight or obese1 and obesity is now the most prevalent threat for a healthy pregnancy outcome.2 Of the four million women who give birth in the United States (US) each year, an estimated 1.6 million receive epidural analgesia during delivery.3 Obesity-related diseases such as pre-eclampsia, diabetes, cardiopulmonary diseases and obstructive sleep apnoea reduce the safety margin of anesthetic drugs in obese parturients.
Source: International Journal of Obstetric Anesthesia - Category: Anesthesiology Authors: Tags: Review article Source Type: research
Conditions:   Pre-Eclampsia;   Hypertension in Pregnancy;   Obesity Interventions:   Drug: Aspirin 81 mg;   Drug: Aspirin 162 mg Sponsor:   The University of Texas Health Science Center, Houston Recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Publication date: Available online 15 May 2019Source: Best Practice &Research Clinical Endocrinology &MetabolismAuthor(s): Hanna Hürter, Shane Vontelin van Breda, Lenka Vokalova, Marlene Brandl, Marc Baumann, Irene Hösli, Evelin Annegret Huhn, Christian De Geyter, Simona W. Rossi, Olav LapaireAbstractAlthough an increased risk of pre-eclampsia in pregnancies conceived after infertility treatment has been reported, it remains unknown whether preconceptional minimalisation of known risk factors would help in preventing pre-eclamsia. Obesity and preconceptional blood pressure are discussed as major risks for...
Source: Best Practice and Research Clinical Endocrinology and Metabolism - Category: Endocrinology Source Type: research
Publication date: Available online 2 May 2019Source: Pharmacological ResearchAuthor(s): José Luiz de Brito Alves, Yohanna de Oliveira, Nara Nóbrega Crispim Carvalho, Raíssa Georgianna Silva Cavalcante, Marília Marques Pereira Lira, Luciana Caroline Paulino do Nascimento, Marciane Magnani, Hubert Vidal, Valdir de Andrade Braga, Evandro Leite de SouzaAbstractMaternal cardiometabolic disorders, such as gestational diabetes mellitus, pre-eclampsia, obesity, and dyslipidemia, are the most common conditions that predispose offspring to risk for future cardiometabolic diseases, needing appropriate ther...
Source: Pharmacological Research - Category: Drugs & Pharmacology Source Type: research
Conclusions/interpretationPerinatal factors make small but statistically significant contributions to the overall risk of childhood-onset type 1 diabetes. Some of these risk factors, such as maternal obesity, may be amendable with improved antenatal care. Better perinatal practices may have affected some previously noted risk factors over time.
Source: Diabetologia - Category: Endocrinology Source Type: research
Bianca Cox1†, Maria Tsamou1†, Karen Vrijens1, Kristof Y. Neven1, Ellen Winckelmans1, Theo M. de Kok2, Michelle Plusquin1 and Tim S. Nawrot1,3* 1Center for Environmental Sciences, Hasselt University, Hasselt, Belgium 2Department of Toxicogenomics, Maastricht University, Maastricht, Netherlands 3Department of Public Health, Environment and Health Unit, Leuven University (KU Leuven), Leuven, Belgium Maternal body mass index (BMI) before pregnancy is known to affect both fetal growth and later-life health of the newborn, yet the implicated molecular mechanisms remain largely unknown. As the master reg...
Source: Frontiers in Genetics - Category: Genetics & Stem Cells Source Type: research
We refer to the article on blood pressure measurement in obese pregnant women in the August edition of IJOA.1 On page 68, the statement is made that four devices are currently validated for blood pressure measurement in pre-eclampsia. However, the article in the Journal of Hypertension to which the authors refer, also includes as validated the Microlife 3AS1-2 device, which appears to have been omitted from reference in the article.
Source: International Journal of Obstetric Anesthesia - Category: Anesthesiology Authors: Tags: Correspondence Source Type: research
Conclusions: Findings from our experimental model suggest that the offspring of dams exposed to ozone during implantation had reduced growth compared with controls, possibly as a consequence of ozone-induced vascular dysfunction. https://doi.org/10.1289/EHP2019 Received: 10 April 2017 Revised: 7 November 2017 Accepted: 13 November 2017 Published: 21 December 2017 Address correspondence to C.N. Miller, U.S. Environmental Protection Agency, NHEERL/EPHD/CIB, 109 T.W. Alexander Dr., Mail Code: B105-02, Research Triangle Park, NC 27711. Telephone: 919-541-3469. Email: miller.colette@epa.gov Supplemental Material is availab...
Source: EHP Research - Category: Environmental Health Authors: Tags: Research Source Type: research
(BJOG. 2016;123:588–597) Women who are overweight or obese during pregnancy have an increased risk of gestational diabetes, pregnancy-induced hypertension, pre-eclampsia, and cesarean section, and have a longer hospital stay.
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research
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