Editorial Board
(Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - October 14, 2019 Category: Anesthesiology Source Type: research

Adverse side effects and route of administration of opioids in combined spinal-epidural analgesia for labour: a meta-analysis of randomised trials
Both epidural (ED) and combined spinal-epidural (CSE) techniques are used to provide effective analgesia during labour.1 The latter has become popular because it provides a faster onset of pain relief and better sacral nerve coverage than epidural analgesia.2 To provide effective analgesia an intrathecal and/or epidural combination of local anaesthetic and opioid is usually used.3 –15 Opioids allow a smaller amount of local anaesthetic to be administered and a longer duration of analgesic effect. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - September 23, 2019 Category: Anesthesiology Authors: L. Grangier, B. Martinez de Tejada, G.L. Savoldelli, O. Irion, G. Haller, B. Martinez de Tejada, O. Irion Tags: Original Article Source Type: research

Ocular sonography in pre-eclampsia: A simple technique to detect raised intracranial pressure?
In the past three decades, ultrasonographic images of the fibro-elastic sheath surrounding the optic nerve have become an important application of point-of-care ultrasound.1,2 There is a close correlation between optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) 3 that is sufficiently dynamic to reflect pressure changes.4,5 The ONSD has been validated as an accurate screening tool to detect raised ICP in patients with idiopathic intracranial hypertension (IIH),6 traumatic brain injury (TBI),7,8 and spontaneous intracranial hemorrhage (ICH). (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - September 20, 2019 Category: Anesthesiology Authors: C.M. Ortner, P. Macias, E. Neethling, V. Krishnamoorthy, B. Carvalho, J.L. Swanevelder, R.A. Dyer Tags: Original Article Source Type: research

Lower-limb neurologic deficit after vaginal delivery; a prospective observational study
Nerve injury resulting in lower-limb neurologic deficits affects ∼1% of women after vaginal delivery.[1] Most of these injuries are transient.[1–3] However, sometimes they last longer than a few days and cause discomfort or even disability; this can result in litigation involving both the obstetrician and the anesthesiologist.[4] (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - September 18, 2019 Category: Anesthesiology Authors: A. Tournier, A.C. Doremieux, E. Drumez, J. Labreuche, F. Cassim, S. Bartolo, P. Richart, C. Garabedian, D. Subtil Tags: Original Article Source Type: research

Management of Cesarean Delivery in a Parturient with Sickle Cell Disease
A 29-year-old woman, gravida1para0 at 35 weeks ’ gestation, and with a history of sickle cell disease (SCD) featuring frequent acute painful episodes, acute chest syndrome and with a right chest port, underwent outpatient transthoracic echocardiogram to evaluate pre-existing moderate pulmonary hypertension. A large right atrial mass (9 cm2) wa s found incidentally and she was sent to the inpatient labor and delivery unit for further evaluation. On examination, she appeared comfortable and had normal vital signs, a body mass index of 30.7 (81 kg) and a Mallampati 3 airway examination score. (Source: International Jour...
Source: International Journal of Obstetric Anesthesia - September 16, 2019 Category: Anesthesiology Authors: D. Romano, H. Craig, D. Katz Tags: Case report Source Type: research

Combatting myths and misinformation about obstetric anesthesia
Myths and misinformation about obstetric anesthesia have long plagued our subspecialty. Flawed or misleading research can contribute towards these myths and misinformation. As an example, we review a recently published study that reported an association between general anesthesia for cesarean delivery and autism. We discuss why this study ’s findings were misleading, the responsibilities of non-anesthesia journal editors who accept such manuscripts, and the role of the media in publicizing findings from these studies. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - September 7, 2019 Category: Anesthesiology Authors: A.J. Butwick, C.F. Weiniger Tags: Editorial Source Type: research

Combatting misinformation and myths about obstetric anesthesia
Myths and misinformation about obstetric anesthesiology have long plagued our subspecialty. Flawed or misleading research can contribute towards these myths and misinformation. As an example, we review a recently published study that reported an association between general anesthesia for cesarean delivery and autism. We discuss why this study ’s findings were misleading, the responsibilities of non-anesthesia journal editors who accept such manuscripts, and the role of the media in publicizing findings from these studies. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - September 7, 2019 Category: Anesthesiology Authors: A.J. Butwick, C.F. Weiniger Tags: Editorial Source Type: research

Reducing post-caesarean delivery surgical site infections: a narrative review
Infectious complications following labour and delivery are common and can be caused by infection of a surgical incision, endometritis, mastitis, urinary tract infection, pneumonia or drug-induced high temperatures.1 The frequency of infectious complications depends on the mode of delivery, with surgical incision infection most common following caesarean delivery, and mastitis most common following vaginal delivery.2 The United States (US) Centers for Disease Control and Prevention (CDC) provide definitions of surgical site infection (SSI) for a wide range of procedures. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - September 5, 2019 Category: Anesthesiology Authors: S.E. Douville, L.K. Callaway, A. Amoako, J. Roberts, V.A. Eley Tags: Review article Source Type: research

Infrared thermography to assess dermatomal levels of labor epidural analgesia with 1  mg/mL ropivacaine plus 0.5 µg/mL sufentanil: a prospective cohort study
Epidural analgesia is considered the gold standard for labor analgesia1 and is widely used.2 Inadequate and failed epidural analgesia, as shown by more clinician-administered boluses during labor, predicts failed conversion of epidural labor analgesia to anesthesia for cesarean delivery,3 and should be detected early. Although the effectiveness of epidural analgesia may be assessed using verbal pain scores and testing the upper limit of the sensory block using cold sensation, in some women these assessments are unreliable and it would be useful to have a tool for objective assessment of epidural spread of local anesthetic....
Source: International Journal of Obstetric Anesthesia - August 21, 2019 Category: Anesthesiology Authors: L. Bouvet, M. Roukhomovsky, F.-P. Desgranges, B. Allaouchiche, D. Chassard Tags: Original Article Source Type: research

Evaluation of the impact of enhanced recovery after surgery protocol implementation on maternal outcomes following elective cesarean delivery
Enhanced recovery after surgery (ERAS) protocols are care pathways intended to improve patient outcomes and accelerate return to normal pre-surgical function by means of standardization of practice at all stages of the peri-operative period and guided by the best available evidence.[1] Implementation of ERAS protocols for various general, gynecological and orthopedic surgery populations has been shown to improve patient outcomes, including decreasing hospital length of stay (LOS), reducing opioid consumption, and increasing maternal satisfaction. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - August 21, 2019 Category: Anesthesiology Authors: Amanda M. Kleiman, Christian A. Chisholm, Adam J. Dixon, Bethany M. Sariosek, Robert H. Thiele, Traci L. Hedrick, Brendan Carvalho, Mohamed Tiouririne Tags: Original Article Source Type: research

Surgical conditions with rocuronium versus suxamethonium in cesarean section: a randomized trial
While onset time and conditions for intubation with rocuronium versus suxamethonium have been repeatedly evaluated,[1 –3] none of these studies focused on surgical conditions for cesarean section and their effect on the duration of surgery and ease of delivery. Newborn adaptation depends partly on the time between induction of anesthesia (and administration of anesthetics) and umbilical cord ligation,[4–6] beca use the amount of drug crossing the placenta from the maternal to the fetal circulation is determined not only by the drug’s physicochemical and structural properties, but also by the dose and dura...
Source: International Journal of Obstetric Anesthesia - August 21, 2019 Category: Anesthesiology Authors: J. Bl áha, P. Nosková, K. Hlinecká, V. Krakovská, V. Fundová, T. Bartošová, P. Michálek, M. Stříteský Tags: Original Article Source Type: research

Infrared thermography to assess dermatomal levels of labor epidural analgesia with 1 mg/mL ropivacaine plus 0.5 µg/mL sufentanil: a prospective cohort study
Epidural analgesia is considered the gold standard for labor analgesia,[1] and is widely used.[2] Inadequate and failed epidural analgesia, as shown by more clinician-administered boluses during labor, predicts failed conversion of epidural labor analgesia to anesthesia for cesarean delivery,[3] and should be detected early. Although the effectiveness of epidural analgesia may be assessed using verbal pain scores and testing the upper limit of the sensory block using cold sensation, in some women these assessments are unreliable and it would be useful to have a tool for objective assessment of epidural spread of local anes...
Source: International Journal of Obstetric Anesthesia - August 21, 2019 Category: Anesthesiology Authors: L. Bouvet, M. Roukhomovsky, F.-P. Desgranges, B. Allaouchiche, D. Chassard Tags: Original Article Source Type: research

Efficacy of the Epidural Positioning Device ® in optimizing the acoustic target window for neuraxial needle placement in term pregnancy
Neuraxial anesthesia is the standard of care for cesarean delivery and labor analgesia in obstetric patients but can be technically challenging due to the anatomical changes of pregnancy.1 In our tertiary care academic obstetric unit, we have an Epidural Positioning Device (EPD ®, PHS Medical, Watertown, SD, USA), designed to facilitate the sitting flexed position in patients having neuraxial anesthesia. On the product information sheet, the manufacturer of the device claims that the “Epidural Positioning Device positions patients correctly and comfortably by encouragin g cervical, thoracic and lumbar flexion whi...
Source: International Journal of Obstetric Anesthesia - August 10, 2019 Category: Anesthesiology Authors: I. Sebbag, F. Qasem, R VedagiriSai, P.M. Jones, S.I. Singh Tags: Original Article Source Type: research

Intrapartum spontaneous pneumomediastinum with subcutaneous emphysema – Management and recommendations to prevent recurrence in future pregnancies
Spontaneous pneumomediastinum with subcutaneous emphysema (SPSE) is an extremely rare complication of labour that occurs when air from the lungs, larynx, trachea, bronchial tree or oesophagus accumulates in the mediastinal cavity.1 Hamman described the condition in 1945.2 (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - August 9, 2019 Category: Anesthesiology Authors: N. Wilson-Baig, K. Bhatia, P. Kochhar, S. Bonner Tags: Correspondence Source Type: research

Intrathecal catheterisation after observed accidental dural puncture in labouring women: up-date of a meta-analysis and trial-sequential analysis
Labour epidural analgesia can be complicated by accidental dural puncture1 which often leads to post-dural puncture headache (PDPH).2,3 In the case of an observed dural puncture the catheter can be inserted intrathecally,4 an approach that has become increasingly popular over the last two decades and that was favoured by more than two-thirds of lead obstetric anaesthetists in the UK, according to a survey in 2013.5 The catheter can plug the dural hole, thereby limiting the efflux of cerebrospinal fluid6 which otherwise results traction on pain-sensitive structures. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - August 9, 2019 Category: Anesthesiology Authors: M. Heesen, N. Hilber, K. Rijs, C. van der Marel, R. Rossaint, L. Sch äffer, M. Klimek Tags: Original Article Source Type: research

Intrapartum spontaneous pneumomediastinum with subcutaneous emphysema - Management and recommendations to prevent recurrence in future pregnancies
Spontaneous pneumomediastinum with subcutaneous emphysema (SPSE) is an extremely rare complication of labour that occurs when air from the lungs, larynx, trachea, bronchial tree or oesophagus accumulates in the mediastinal cavity.1 Hamman described the condition in 1945.2 (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - August 9, 2019 Category: Anesthesiology Authors: N. Wilson-Baig, K. Bhatia, P. Kochhar, S. Bonner Tags: Correspondence Source Type: research

Gastric emptying of carbohydrate drinks in term parturients before elective caesarean delivery: an observational study
Pre-operative carbohydrate (CHO) drinks have become a standard part of most enhanced recovery programmes. The peri-operative fasting guidelines of the European Society of Anaesthesiology (ESA) encourage drinking clear fluids up to two hours before elective surgery and state that CHO-rich fluids before elective surgery improve well-being, reduce thirst and hunger, and reduce postoperative insulin resistance.1 The American Society of Anesthesiologists (ASA) pre-operative fasting guidelines recommend that an uncomplicated patient undergoing elective surgery may have moderate amounts of clear fluids up to two hours before indu...
Source: International Journal of Obstetric Anesthesia - August 6, 2019 Category: Anesthesiology Authors: P. Popivanov, R. Irwin, M.Walsh, M. Leonard, T. Tan Tags: Original Article Source Type: research

Erector Spinae Plane Block for Post-Cesarean Delivery Analgesia
Cesarean delivery (CD) is the most common surgical procedure in the world, with rates of up to 40% in some countries.1 Post-operative pain is an important complication and a great fear for this patients.2 It is a modifiable risk factor for the development of chronic postsurgical pain, which can affect up to 18% of cesarean deliveries.3 Effective analgesia can mitigate adverse effects, and facilitate early mobilization, increase breastfeeding success and improve patient satisfaction. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - August 6, 2019 Category: Anesthesiology Authors: C. Rinc ón, D.A. Moreno, A. Moore Tags: Correspondence Source Type: research

Comparing videolaryngoscopes with direct laryngoscopy in obstetric patients
In the recent article by Blajic et al.1 comparing videolaryngoscopy with direct laryngoscopy for tracheal intubation in obstetric patients, the investigators showed that the intubation time, first-attempt and overall success rates did not differ among the three devices studied, but that the difficulty of intubation was less when using the C-MAC ™ videolaryngoscope than with the King Vision® videolaryngoscope. The King Vision® videolaryngoscope required the longest time to achieve the best laryngeal view and hadthe highest rate of a grade 1 Cormack and Lehane view and the greatest need for optimisation manoeuv...
Source: International Journal of Obstetric Anesthesia - August 3, 2019 Category: Anesthesiology Authors: Shao-Hua Liu, Liu-Jia-Zi Shao, Fu-Shan Xue Tags: Correspondence Source Type: research

Comparing videolaryngoscopes with direct laryngoscopy in obstetric patients
We thank Liu et al. for their interest in our article1 and we are pleased to be given the opportunity to provide further clarification. We do not agree with the assertion that the performance of direct laryngoscopy was underestimated in our study. All operators were experienced obstetric anaesthesiologists, very skilled in using Macintosh, C-MACTM and King Vision ® videolaryngoscopes and would adjust head, neck and the operating table position for each patient to optimise the laryngoscopy. Consequently, the factors that Liu et al. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - August 3, 2019 Category: Anesthesiology Authors: T. Stopar Pintaric, I. Blajic, I. Hodzovic Tags: Correspondence Source Type: research

Use of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) to facilitate the management of subglottic stenosis in pregnancy
Subglottic stenosis is characterised by narrowing of the lower larynx and upper trachea. Conventional intubation can be impossible, whilst in the parturient the anatomical and physiological changes of pregnancy further complicate management. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - July 19, 2019 Category: Anesthesiology Authors: S. Bourn, P. Milligan, A.F. McNarry Tags: Case report Source Type: research

A population-based analysis of French transfusion practices for women experiencing severe postpartum hemorrhage
Severe postpartum hemorrhage (SPPH) occurs in 1% of deliveries in high-resource countries and is the leading cause of severe maternal morbidity and mortality worldwide.1 –3 Individual risk factors are poor predictors of postpartum hemorrhage (PPH).4 Consequently, interest has focused on care practices, since changes in management may affect maternal morbidity and mortality.5 Blood transfusion is an essential component of SPPH management by maintaining the circulat ing blood volume and tissue oxygenation, and for hemostatic support. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - July 19, 2019 Category: Anesthesiology Authors: F. Deleu, C. Deneux-Tharaux, C. Chiesa-Dubruille, A. Seco, M.P. Bonnet, for the EPIMOMS study group (see Appendix) Tags: Original Article Source Type: research

A retrospective analysis of French transfusion practices for women experiencing severe postpartum hemorrhage
Severe postpartum hemorrhage (SPPH) occurs in 1% of deliveries in high-resource countries and is the leading cause of severe maternal morbidity and mortality worldwide.1 –3 Individual risk factors are poor predictors of postpartum hemorrhage (PPH).4 Consequently, interest has focused on care practices, since changes in management may affect maternal morbidity and mortality.5 Blood transfusion is an essential component of SPPH management by maintaining the circulat ing blood volume and tissue oxygenation, and for hemostatic support. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - July 19, 2019 Category: Anesthesiology Authors: F. Deleu, C. Deneux-Tharaux, C. Chiesa-Dubruille, A. Seco, M.P. Bonnet Tags: Original Article Source Type: research

Use of Transnasal Rapid-Insufflation Ventilatory Exchange (THRIVE) to facilitate the management of subglottic stenosis in pregnancy
Subglottic stenosis is characterised by narrowing of the lower larynx and upper trachea. Conventional intubation can be impossible, whilst in the parturient the anatomical and physiological changes of pregnancy further complicate management. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - July 19, 2019 Category: Anesthesiology Authors: S. Bour, P. Milligan, A.F. McNarry Tags: Case report Source Type: research

An educational intervention about the classification of penicillin allergies: effect on the appropriate choice of antibiotic therapy in pregnant women
Worldwide, infection is one of the leading causes of both maternal and neonatal mortality.1 Antibiotics have made maternal sepsis-related mortality a rare event and the frequency of maternal-fetal infections has fallen substantially.2 Overall, 15% of pregnant women receive antibiotics during pregnancy3 and 55% receive them at delivery.4 β-lactams are among the most useful antibiotics because of their efficacy, tolerability and safety during pregnancy. Streptococcus agalactiae is responsible for more than half the maternal-fetal infections,5 and almost all isolates are highly susceptible to penicillins. (Source: Intern...
Source: International Journal of Obstetric Anesthesia - July 18, 2019 Category: Anesthesiology Authors: C. Thellier, D. Subtil, D. Pelletier de Chambure, B. Grandbastien, C. Catteau, A. Beaugendre, D. Poitrenaud, A. Prevotat, P. Richart, K. Faure, R. Le Guern Tags: Original Article Source Type: research

Efficiency of leukocyte depletion filters and micro-aggregate filters following intra-operative cell salvage during cesarean delivery
Allogenic and autologous blood transfusions have been used for the treatment of severe obstetric hemorrhage associated with placenta accreta, placenta previa, and atonic bleeding. However, allogenic transfusion is associated with the risk of infection and allergic reactions, and there is a limit to the amount of autologous blood that can be collected before delivery. Intra-operative cell salvage (ICS), used in cardiovascular, orthopedic and gynecological surgery involves use of blood from the bleeding site collected through a heparinised tube, separation of cells by hemoconcentration, differential centrifugation in 0.9% sa...
Source: International Journal of Obstetric Anesthesia - July 9, 2019 Category: Anesthesiology Authors: I. Fujioka, Y. Ichikawa, Y. Nakajima, M. Kasahara, M. Hattori, T. Nemoto Tags: Original Article Source Type: research

Maternal and neonatal characteristics in obstetric intensive care unit admissions
The objective of this study was to evaluate the course of pregnancy and delivery of obstetric patients admitted for intensive care, and determine the health status of their infants. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - July 6, 2019 Category: Anesthesiology Authors: P.M. Sepp änen, R.T. Sund, J.T. Uotila, M.T. Helminen, T.M. Suominen Tags: Original Article Source Type: research

Anaesthetic Considerations in a Parturient with Jarcho-Levin Syndrome
Jarcho-Levin syndrome (JLS) was first described in 1938 by Jarcho and Levin as the hereditary malformation of vertebral bodies. It occurs in 1 in 40,000 births,1 and has since been used as an “umbrella” term to describe a broad range of congenital defects affecting the spine and ribs, such as spondylocostal dysplasia (SCD) and spondylothoracic dysplasia (STD).2,3 Such deformities result in a short neck, short trunk, protuberant abdomen and scoliosis. Depending on the severity of the skeletal malformation, respiratory and cardiac function may be affected due to poor lung development and restrictive respiratory f...
Source: International Journal of Obstetric Anesthesia - July 5, 2019 Category: Anesthesiology Authors: S. Sabaretnam, J. Chin, P. Kajekar Tags: Correspondence Source Type: research

Systemic adjunct analgesics for cesarean delivery: a narrative review
Postoperative pain arises both from direct tissue injury caused by an operation and the inflammation that surrounds the healing process afterwards.1 Because the pain itself has multiple facets, the treatment should be multimodal. Pain after cesarean delivery (CD) is often reported to be worse than after vaginal delivery but it is quite variable.2 While neuraxial opioids have consistently been shown to be superior to other routes of opioid administration when treating post-CD pain, many patients still require more pharmacologic pain relief3 and reducing or eliminating opioid use should also be a goal. (Source: International...
Source: International Journal of Obstetric Anesthesia - July 4, 2019 Category: Anesthesiology Authors: J. Hamburger, Y. Beilin Tags: Review article Source Type: research

Systemic Adjunct Analgesics for Cesarean Delivery:A Narrative Review
Post-operative pain arises both from direct tissue injury caused by an operation and the inflammation that surrounds the healing process afterwards.1 Because the pain itself has multiple facets, the treatment should be multimodal. Pain after cesarean delivery (CD) is often reported as worse than after vaginal delivery but it is quite variable.2 While neuraxial opioids have consistently been shown to be superior to other routes of opioid administration when treating post CD pain, many patients still require more pharmacologic pain relief3 and reducing or eliminating opioid use should also be a goal. (Source: International J...
Source: International Journal of Obstetric Anesthesia - July 4, 2019 Category: Anesthesiology Authors: J. Hamburger, Y. Beilin Tags: Review article Source Type: research

Impact of intra-operative dexamethasone after scheduled cesarean delivery: a retrospective study
Dexamethasone is commonly used to prevent or reduce postoperative nausea and/or vomiting (PONV) in contemporary anesthesia practice.1 Although its anti-emetic effect has been well demonstrated after surgery performed under general anesthesia, the efficacy of a single intra-operative dose of dexamethasone for procedures under spinal anesthesia is less clear. A recent systematic review and meta-analysis showed benefit when intravenous (IV) dexamethasone is used to prevent PONV in patients receiving long-acting neuraxial opioids. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - June 24, 2019 Category: Anesthesiology Authors: J.A. Nanji, N. Guo, E.T. Riley, B. Carvalho Tags: Original Article Source Type: research

Impact of intraoperative dexamethasone after scheduled cesarean delivery: a retrospective study
Dexamethasone is an effective analgesic and antiemetic in patients undergoing many surgical procedures, but its effects on pain after cesarean delivery are poorly studied. The aim of this study was to evaluate if routine intraoperative administration of dexamethasone improved pain and decreased postoperative nausea/vomiting after scheduled cesarean delivery. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - June 24, 2019 Category: Anesthesiology Authors: Jalal A. Nanji, Nan Guo, Edward T. Riley, Brendan Carvalho Tags: Original Article Source Type: research

A triple-blinded randomized trial comparing spinal morphine with posterior quadratus lumborum block after cesarean section
Cesarean section (CS) is one of the most common surgical procedures and postoperative pain control is an important aspect of postoperative management.1 Generally, spinal anesthesia is performed for the peri-operative management of CS. Spinal anesthesia with opioids has gained popularity for postoperative pain relief because it reportedly results in improved analgesia, and ultrasound-guided nerve blocks have also been performed as part of multimodal analgesia after CS.2 (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - June 24, 2019 Category: Anesthesiology Authors: T. Tamura, S.Yokota, M. Ando, Y. Kubo, K. Nishiwaki Tags: Original Article Source Type: research

Carbetocin reduces the need for additional uterotonics in elective caesarean delivery: a systematic review, meta-analysis and trial sequential analysis of randomised controlled trials
Primary postpartum haemorrhage (PPH) is a major cause of morbidity and the leading cause of direct maternal death worldwide,[1] with uterine atony accounting for approximately 70% of all cases.[2] Oxytocin is the most commonly used uterotonic in the developed world, with recent Cochrane reviews showing that it is effective at treating PPH.[3,4] However, failure of PPH prophylaxis with oxytocin, as shown by the need for a rescue uterotonic, has been demonstrated to be as high as 13% in women having an elective caesarean delivery (CD). (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - June 24, 2019 Category: Anesthesiology Authors: D.N. Onwochei, J. Van Ross, P.M. Singh, A. Salter, D.T. Monks Tags: Original Article Source Type: research

Dexmedetomidine nebulization: an answer to post-dural puncture headache?
We report the apparently successful use of a novel method; namely the nebulization of dexmedetomidine in five patients suffering from post-dural puncture headache (PDPH). (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - June 18, 2019 Category: Anesthesiology Authors: A. Kumar, A. Kumar, C. Sinha, M. Anant, J.K. Singh Tags: Correspondence Source Type: research

Dexmedetomidine nebulization: an answer to postdural puncture headache??
We report the apparently successful use of a novel method; namely the nebulization of dexmedetomidine in five patients suffering from post-dural puncture headache (PDPH). (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - June 18, 2019 Category: Anesthesiology Authors: Amarjeet Kumar, Ajeet Kumar, Chandni Sinha, Monika Anant, Jitendra Kumar Singh Tags: Correspondence Source Type: research

A broadening choice for labor analgesia: remifentanil on the á la carte menu
How wonderful to be Queen Victoria as she chose an á la carte labor analgesia option from her physician, Dr. John Snow. Chloroform was not routinely available for labor analgesia in 1853, yet Queen Victoria was able to enjoy comfortable labor using it. A vision for the future could be a laboring woman ordering her desired labor analgesia from the á la carte menu options on her mobile device according to the strength of analgesia desired and the risk/benefit profile she preferred. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - June 17, 2019 Category: Anesthesiology Authors: I. Ronel, C.F. Weiniger Tags: Editorial Source Type: research

Persistent Pain after Cesarean Delivery
Tissue trauma and nerve injury from surgery are common causes of debilitating chronic pain.1 Persistent pain after surgery affects 10 to 50% of people after various common surgical procedures, such as groin hernia repair, breast and thoracic surgery, leg amputation, and coronary artery bypass surgery.1 It was initially thought that persistent pain after cesarean delivery (CD) was an understudied and under-reported phenomenon, with one of the first prospective studies showing that the prevalence of persistent pain was similarly low for both CD and vaginal delivery (VD). (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - June 9, 2019 Category: Anesthesiology Authors: K.W. Sun, P.H. Pan, Peter H. Pan Tags: Original Article Source Type: research

Local anaesthetic techniques for post-caesarean delivery analgesia
Caesarean delivery (CD) is the most commonly performed operation in the United States (U.S.).1 Women undergoing this procedure typically have postoperative pain2 and may require opioid analgesics in hospital and upon discharge.3 Reduced postoperative pain and opioid consumption following CD improves recovery, aids early mobilisation, improves ability to care for the neonate, and can expedite hospital discharge. Many institutions within the United Kingdom (U.K.) and U.S. are implementing “enhanced recovery after surgery” protocols. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - June 8, 2019 Category: Anesthesiology Authors: S.D. Patel, N. Sharawi, P. Sultan Tags: Review article Source Type: research

Local anaesthetic techniques for post caesarean delivery analgesia
Caesarean delivery (CD) is the most commonly performed operation in the United States (U.S.).1 Women undergoing this procedure typically have postoperative pain2 and may require opioid analgesics in hospital and upon discharge.3 Reduced postoperative pain and opioid consumption following CD improves recovery, aids early mobilisation, improves ability to care for the neonate, and can expedite hospital discharge. Many institutions within the United Kingdom (U.K.) and U.S. are implementing “enhanced recovery after surgery” protocols. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - June 8, 2019 Category: Anesthesiology Authors: S.D. Patel, N. El Sharawi, P. Sultan Tags: Review article Source Type: research

Benign Paroxysmal Positional Vertigo Presenting as Persistent Vomiting in a Parturient using Epidural Analgesia
A healthy 26-year-old woman, G1P0, was admitted in labor and an epidural catheter was inserted uneventfully. Maintenance of epidural analgesia was with levobupivacaine 1.25 mg/ml and fentanyl 1.25 µg/ml at a rate of 6 mL/h, with patient-controlled epidural analgesia (6 mL on demand at a 15 min lockout interval). This proved effective and without significant complication. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - June 6, 2019 Category: Anesthesiology Authors: Meng-Sheng Sun, Shih-Si Chen, Liang-Tsai Yeh Tags: Correspondence Source Type: research

Corrigendum to “Ephedrine versus phenylephrine as a vasopressor for spinal anaesthesia-induced hypotension in parturients undergoing high-risk caesarean section: meta-analysis, meta-regression and trial sequential analysis” [Int. J. Obstet. Anesth. 37 (2019) 16–28]
The authors regret that in Table 1 the ‘Definition for hypotension’ was incorrectly listed for the authors Dyer et al. IJOA and Dyer et al. ANAE (row 2 and 3). The ‘Definition for hypotension’ for these authors should have been listed as follows: (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - June 6, 2019 Category: Anesthesiology Authors: M. Heesen, K. Rijs, N. Hilber, W.D. Ngan Kee, R. Rossaint, C. van der Marel, M. Klimek Tags: Corrigendum Source Type: research

Remifentanil patient-controlled intravenous analgesia during labour: A retrospective observational study of 10 years ’ experience
Intravenous remifentanil patient-controlled analgesia (PCA) was first used in our unit in 2001 following a feasibility study and has been routinely available on request as an analgesic option for labouring women since 2004.1 Since then, remifentanil PCA has become a popular choice, resulting in a one-third decline in our unit ’s epidural analgesia rate from 41% to 25%.Fig 1. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - June 5, 2019 Category: Anesthesiology Authors: H Murray, P Hodgkinson, D Hughes Tags: Original Article Source Type: research

Re: ‘A study of factors influencing surgical cesarean delivery times in an academic tertiary center’
We read with interest the article by Gonzales Fiol et al.1 published online in the journal in January 2018. The authors conducted a retrospective review of caesarean deliveries over a 12-month period to determine caesarean delivery times and identify factors influencing operative time and preference for a particular anaesthetic method. Although the authors examined the influence of several pertinent variables on operative time, we consider that premature conclusions were drawn that were not supported by the data. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - June 1, 2019 Category: Anesthesiology Authors: S. Singh, A. Clark Tags: Correspondence Source Type: research

Need for additional anesthesia after single injection spinal analgesia for labor: a retrospective cohort study
Most women who choose neuraxial analgesia for labor receive a continuous epidural or combined spinal-epidural technique.1 Although single injection spinal anesthesia is routinely used as primary anesthesia for cesarean delivery, the single injection technique is employed less frequently for labor analgesia.2 The inability to extend the duration of analgesia is one of the major drawbacks to using it for women with labor pain. Data on the use and efficacy of single injection spinal analgesia for labor are sparse. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - June 1, 2019 Category: Anesthesiology Authors: E.E. Sharpe, G.Y. Kim, N.J. Vinzant, K.W. Arendt, A.C. Hanson, D.P. Martin, H.P. Sviggum Tags: Original Article Source Type: research

Re: 'A study of factors influencing surgical cesarean delivery times in an academic tertiary center'
We read with interest the article by Gonzales Fiol et al. 1 published online in the journal in January 2018. The authors conducted a retrospective review of caesarean deliveries over a 12-month period to determine caesarean delivery times and identify factors influencing operative time and preference for a particular anaesthetic method. Although the authors examined the influence of several pertinent variables on operative time, we consider that premature conclusions were drawn that were not supported by the data. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - June 1, 2019 Category: Anesthesiology Authors: S. Singh, A. Clark Tags: Correspondence Source Type: research

Difficult epidural placement in obese and non-obese pregnant women: a systematic review and meta-analysis
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 anaesthetic drugs in obese parturients. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - May 29, 2019 Category: Anesthesiology Authors: N. Uyl, E. de Jonge, C. Uyl-de Groot, C. van der Marel, J. Duvekot Tags: Original Article Source Type: research

Difficult epidural placement in obese and non-obese pregnant women – a systematic review and meta-analysis
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)
Source: International Journal of Obstetric Anesthesia - May 29, 2019 Category: Anesthesiology Authors: N. Uyl, E. de Jonge, C. Uyl-de Groot, C. van der Marel, J. Duvekot Tags: Review article Source Type: research

Abstracts of free papers presented at the annual meeting of the Obstetric Anaesthetists' Association, 2019
(Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - May 23, 2019 Category: Anesthesiology Source Type: research

Obstetric Anaesthesia 2019: Newcastle/Gateshead
The International Journal of Obstetric Anesthesia (IJOA) is pleased to publish the best 112 abstracts submitted for presentation at the annual scientific meeting of the Obstetric Anaesthetists ’ Association (OAA) in Newcastle/Gateshead. 2019 is the 50th anniversary of the OAA and it would seem a pertinent time to reflect on the journal’s history. IJOA was launched as the first journal devoted exclusively to obstetric anaesthesia and has played an important role in the development of t he sub-speciality. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - May 23, 2019 Category: Anesthesiology Authors: Nuala Lucas, Robin Russell Tags: Editorial Source Type: research