ICU management of the obstetric patient

Publication date: Available online 15 February 2020Source: Trends in Anaesthesia and Critical CareAuthor(s): Sima Patel, Andrea Estevez, Nicholas Nedeff, Jose Gascon, Ilde LeeAbstractAcross the United States (U.S.), very few centers exist with an intensive care unit (ICU) solely dedicated to obstetrics (OB) and gynecology (GYN) patients. The management of obstetric patients, who are admitted to a general intensive care unit, can often be accompanied by a fair share of apprehension owing to the intricacy of care. Rather than discussing common obstetric emergencies and their management, we would like to call attention to basic principles that are fundamental in the care of a complicated OB intensive care patient. Understanding the physiologic changes of each trimester and the layers of management is imperative. Having a strong, fundamental knowledge of the plethora of medications and their safety profiles will ensure optimal patient care and dissolve the uncertainty surrounding this unique patient population. What follows is a literature review on sedation, analgesia, airway management, mechanical ventilation and cardiovascular support for critically ill obstetric patients.
Source: Trends in Anaesthesia and Critical Care - Category: Anesthesiology Source Type: research

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Conclusion: Previous knowledge and experience in airway management are required when performing conventional endotracheal intubation; moreover, its success rate is low. Contrastingly, using proper instruments and the 3D mouth-piece facilitated easier and quicker airway management regardless of previous experience. PMID: 32228200 [PubMed - as supplied by publisher]
Source: Journal of Investigative Surgery - Category: Surgery Tags: J Invest Surg Source Type: research
AbstractUltrasonography is a simple, reliable, non-invasive technique which helps in real-time assessment of airway anatomy and contributes to safer airway management in various settings like operating rooms, intensive care units and emergency departments. It also helps us to plan the appropriate anesthetic technique especially in difficult airway cases. Here, we discuss the importance of styleted tracheal tube in improving the accuracy of ultrasound guided tracheal intubation in anticipated difficult airway.
Source: Journal of Clinical Monitoring and Computing - Category: Information Technology Source Type: research
Abstract Using deep sedation, adjunct airway devices such as oral or nasal airways are frequently required to maintain airway patency. Traditional oral airways (TOAs, made of rigid plastic) or nasal airways (made of pliable materials) can be associated with adverse effects, contributing to a trend of anesthesia providers placing nasal airways orally. A clinical observational study and an electronic provider survey were conducted to examine this emerging practice. The observation study objective was to investigate reported postoperative sore throat occurrence associated with use of either a nontraditional airway (n...
Source: AANA Journal - Category: Anesthesiology Authors: Tags: AANA J Source Type: research
Abstract The presence of gastric content before induction of general anesthesia is the primary modifiable risk factor in the prevention of pulmonary aspiration. The purpose of this project was to determine if ultrasonography could be routinely used to measure gastric content and assign aspiration risk in patients undergoing general anesthesia. Preoperative gastric ultrasonography was performed in a convenience sample of 100 patients. A group of Certified Registered Nurse Anesthetists, anesthesia residents, and anesthesiologists were asked their plan for airway management before and after receiving the results of t...
Source: AANA Journal - Category: Anesthesiology Authors: Tags: AANA J Source Type: research
Sheila Nainan Myatra, Apeksh Patwa, Jigeeshu Vasishtha DivatiaIndian Journal of Anaesthesia 2020 64(4):275-279 Clear language should be used during emergency airway management to aid communication and understand the nature of the emergency. Unfortunately, during emergency airway management, there is no uniform language used for communication. Various difficult airway guidelines use different terminologies. Terminologies like “can't intubate, can't oxygenate” (CICO) and “can't intubate, can't ventilate” (CICV) have certain limitations. Though terminology like “Front of Neck Acc...
Source: Indian Journal of Anaesthesia - Category: Anesthesiology Authors: Source Type: research
Authors: Shionoya Y, Yamamoto M, Sunada K, Nakamura K Abstract Cardiofaciocutaneous (CFC) syndrome is a rare condition characterized by congenital heart disease, craniofacial dysmorphology, and dermatological abnormalities. CFC syndrome is one of the RASopathies, a family of syndromes that also includes Noonan and Costello syndromes, all with underlying gene mutations involving the Ras/mitogen-activated protein kinase pathways. Important considerations for anesthesiologists caring for these patients include the need to evaluate for possible cardiac defects, anticipating and planning for potentially difficult airway...
Source: Anesthesia Progress - Category: Anesthesiology Tags: Anesth Prog Source Type: research
Authors: Matsui R, Wong M, Waters B Abstract Transoral application of a nasopharyngeal airway (NPA) is a novel technique for difficult airway management. Clinically, it is an effective alternative for use in nonintubated dental cases under total intravenous anesthesia. This technique can help improve oxygenation and ventilation in clinical situations in which the conventional use of NPAs is ineffective, such as in patients who have findings of obesity; mandibular retrognathia or hypoplasia; maxillary hypoplasia; macroglossia; nasal obstruction secondary to hypertrophic tonsillar, adenoid, and/or lymphoid tissues or...
Source: Anesthesia Progress - Category: Anesthesiology Tags: Anesth Prog Source Type: research
Authors: Shionoya Y, Kamiga H, Tsujimoto G, Nakamura E, Nakamura K, Sunada K Abstract Systemic sclerosis (SSc) is an autoimmune disease that can cause fibrosis in vital organs, often resulting in damage to the skin, blood vessels, gastrointestinal system, lungs, heart, and/or kidneys. Patients with SSc are also likely to develop microstomia, which can render dental treatment difficult and painful, thereby necessitating advanced anesthetic management. This is a case report of a 61-year-old woman with a history of SSc with microstomia, interstitial pneumonia, and gastroesophageal reflux disease in whom intravenous mo...
Source: Anesthesia Progress - Category: Anesthesiology Tags: Anesth Prog Source Type: research
This article provides a brief overview of the indications, techniques for image acquisition, and general principles in interpreting basic images.Recent FindingsWhole-body POCUS can provide quick diagnoses and impact clinical management across relevant pre-, intra-, and post-operative settings. Anesthesia providers need to understand different applications for POCUS, including focused cardiac ultrasound (FoCUS), lung ultrasound (LUS), gastric ultrasound, abdominopelvic ultrasound, and the use of ultrasound for airway management. Currently, there is no standard ultrasound curriculum for anesthesiology residents, and teaching...
Source: Current Pain and Headache Reports - Category: Neurology Source Type: research
Conclusions: This study provides an overview of the intubation practices in a single-center ED. Non-ED physicians perform the majority of intubations, with a variety of induction and paralyzing agents being used. It adds to the growing call for better standardization and provision of care to patients with a deteriorating airway and the continued auditing of practice.
Source: Journal of Emergencies, Trauma and Shock - Category: Emergency Medicine Authors: Source Type: research
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