Modern Neuraxial Anesthesia for Labor and Delivery.
Ontology highlight
ABSTRACT:
SUBMITTER: Meng ML
PROVIDER: S-EPMC5531153 | biostudies-other | 2017
REPOSITORIES: biostudies-other
Similar Datasets
Project description:IntroductionRecent animal and human epidemiological studies suggest that early childhood exposure to anesthesia may have adverse effects on brain development. As more than 50% of pregnant women in the United States and one-third in the United Kingdom receive regional anesthesia during labor and delivery, understanding the effects of perinatal anesthesia on postnatal brain development has important public health relevance.MethodsWe used high-resolution magnetic resonance imaging (MRI) to assess the effects of regional anesthesia during labor and delivery as part of a larger study of perinatal exposures on the morphological features of the neonatal brain. We mapped morphological features of the cortical surface in 37 healthy infants, 24 exposed and 13 unexposed to regional anesthesia at delivery, who were scanned within the first 6 weeks of life.ResultsInfants exposed to maternal anesthesia compared with unexposed infants had greater local volumes in portions of the frontal and occipital lobes bilaterally and right posterior portion of the cingulate gyrus. Longer durations of exposure to anesthesia correlated positively with local volumes in the occipital lobe.ConclusionsAnesthesia exposure during labor and delivery was associated with larger volumes in portions of the frontal and occipital lobes and cingulate gyrus in neonates. Longitudinal MRI studies are needed to determine whether these morphological effects of anesthesia persist and what their consequences on cognition and behavior may be.
| S-EPMC4293264 | biostudies-literature
Project description:AimThis study aimed to examine the association between clinically diagnosed chorioamnionitis and failed conversion of epidural labor analgesia to cesarean delivery anesthesia.MethodsThis retrospective, single-center cohort study, conducted in a university hospital, enrolled term parturients undergoing emergency cesarean section after induction of epidural labor analgesia between September 2015 and May 2019. For the purpose of this study, all cases were re-examined to ensure that they fulfilled the criteria of chorioamnionitis, regardless of the actual indication for cesarean section proposed by obstetricians at the time of application. The primary outcome was failure of conversion of epidural labor analgesia to cesarean delivery anesthesia. Multivariable logistic regression analysis was performed to investigate the association between chorioamnionitis and failure of anesthesia for cesarean section.ResultsAmong the 180 parturients reviewed, 58 (43.9%) fulfilled the criteria for chorioamnionitis. Failure of epidural conversion in the chorioamnionitis (+) group was significantly higher than in the chorioamnionitis (-) group (46.6% [27/58] vs. 18.9% [14/74], crude odds ratio = 3.7, 95% confidence interval: 1.7-8.3). After adjustment for potential confounders (age, body mass index, multiparity, and duration for epidural labor analgesia), chorioamnionitis was found to be associated with failure of anesthesia for cesarean sections (adjusted odds ratio = 3.6, 95% confidence interval: 1.6-8.4).ConclusionsChorioamnionitis is associated with the failed conversion of epidural labor analgesia to cesarean delivery anesthesia.
| S-EPMC8099088 | biostudies-literature
Project description:Permanent nerve damage caused by anesthesia is a rare but critical issue, and the mechanism of it remains unclear. Large-scale analysis of changes in noncoding RNA such as circRNA and microRNA in anesthesia-related nerve damage may provide insight into the mechanism of anesthesia-induced nerve injury.
2022-08-02 | GSE135297 | GEO
Project description:Women׳s choice to use epidural anesthesia (EA) for relief of labor pain varies from one culture to another. A descriptive cross-sectional design was used to gather data from a sample of 200 women in childbearing age. Data was gathered from general population in Lebanon. Demographic data, knowledge and attitudes questionnaires towards EA were used to gather data for this study. The data in this article provides demographic data about Lebanese women and their awareness and attitudes towards epidural anesthesia. The analyzed data is provided in the tables included in this article.
| S-EPMC5997907 | biostudies-literature
Project description:BackgroundPregnancy is associated with higher incidence of failed endotracheal intubation and is exacerbated by labor. However, the influence of labor on airway outcomes with laryngeal mask airway (LMA) for cesarean delivery is unknown.MethodsThis is a secondary analysis of a prospective cohort study on LMA use during cesarean delivery. Healthy parturients who fasted > 4 h undergoing Category 2 or 3 cesarean delivery with Supreme™ LMA (sLMA) under general anesthesia were included. We excluded parturients with BMI > 35 kg/m2, gastroesophageal reflux disease, or potentially difficult airway (Mallampati score of 4, upper respiratory tract or neck pathology). Anesthesia and airway management reflected clinical standard at the study center. After rapid sequence induction and cricoid pressure, sLMA was inserted as per manufacturer's recommendations. Our primary outcome was time to effective ventilation (time from when sLMA was picked up until appearance of end-tidal carbon dioxide capnography), and secondary outcomes include first-attempt insertion failure, oxygen saturation, ventilation parameters, mucosal trauma, pulmonary aspiration, and Apgar scores. Differences between labor status were tested using Student's t-test, Mann-Whitney U test, or Fisher's exact test, as appropriate. Quantitative associations between labor status and outcomes were determined using univariate logistic regression analysis.ResultsData from 584 parturients were analyzed, with 37.8% in labor. Labor did not significantly affect time to effective ventilation (mean (SD) for labor: 16.0 (5.75) seconds; no labor: 15.3 (3.35); mean difference: -0.65 (95%CI: - 1.49 to 0.18); p = 0.1262). However, labor was associated with increased first-attempt insertion failure and blood on sLMA surface. No reduction in oxygen saturation or pulmonary aspiration was noted.ConclusionsAlthough no significant increase in time to effective ventilation was noted, labor may increase the number of insertion attempts and oropharyngeal trauma with sLMA use for cesarean delivery in parturients at low risk of difficult airway. Future studies should investigate the effects of labor on LMA use in high risk parturients.Trial registrationThe study was prospectively registered at clinicaltrials.gov ( NCT02026882 ) on 3 January 2014.
| S-EPMC7449044 | biostudies-literature
Project description:A paradigm shift in drug delivery systems have been noted recently. The focus nowadays is to obtain maximum benefit with lower side effects. It is a monetary burden to launch newer molecules hence the industry is concentrating on improving the efficacy of existing molecules. Thus controlled release, target controlled infusion and closed loop infusion have entered the scene. Applying pharmacokinetic principles, instead of mathematically calculating drug dose could improve safety and maintain steady drug levels in the body. When computers are applied to an efficient operating system, it will only magnify the efficiency. Most of these technologies which were earlier limited to research only have entered clinical practice. This has made it mandatory for the practicing clinician to familiarize themselves with these technologies. Our focus in this review has been to discuss newer drug delivery systems available for anesthesiology practice.
| S-EPMC5520586 | biostudies-other
Project description:The conversion of epidural labor analgesia (ELA) to epidural surgical anesthesia (ESA) for intrapartum cesarean section (CS) often fails, resulting in intraoperative pain. Spinal anesthesia (SA) can provide a denser sensory block than ESA. The purpose of this prospective, non-blinded, parallel-arm, randomized trial was to compare the rate of pain-free surgery between ESA and SA following ELA for intrapartum CS.Both groups received continuous epidural infusions for labor pain at a rate of 10 ml/h. In the ESA group (n = 163), ESA was performed with 17 ml of 2% lidocaine mixed with 100 µg fentanyl, 1 : 200,000 epinephrine, and 2 mEq bicarbonate. In the SA group (n = 160), SA was induced with 10 mg of 0.5% hyperbaric bupivacaine and 15 µg fentanyl. We investigated the failure rate of achieving pain-free surgery and the incidence of complications between the two groups.The failure rate of achieving pain-free surgery was higher in the ESA group than the SA group (15.3% vs. 2.5%, P < 0.001). There was no statistical difference between the two groups in the rate of conversion to general anesthesia; however, the rate of analgesic requirement was higher in the ESA group than in the SA group (12.9% vs. 1.3%, P < 0.001). The incidence of high block, nausea, vomiting, hypotension, and shivering and Apgar scores were comparable between the two groups.SA after ELA can lower the failure rate of pain-free surgery during intrapartum CS compared to ESA after ELA.
| S-EPMC5548943 | biostudies-other
Project description:The objective was to assess sustainability of a statewide program of HIV rapid testing (RT) for pregnant women presenting for delivery with unknown HIV status. This is a population-based retrospective cohort study of women delivered in Illinois hospitals (2012-15). Deidentified data on RT metrics from state-mandated surveillance reports were compared using descriptive statistics and non-parametric tests of trend. Over 95% of the 608,408 women delivered had documented HIV status at presentation. The rate of undocumented HIV status rose from 4.19 to 4.75% (p < 0.001). However, overall 99.60% of women with undocumented status appropriately received RT and the proportion who did not receive RT declined (p = 0.003). The number of neonates discharged with unknown HIV status declined (p = 0.011). RT identified 23 new HIV diagnoses, representing 4.62% of maternal HIV diagnoses. In conclusion, statewide perinatal HIV RT resulted in nearly 100% of Illinois mother-infant dyads with known HIV status. Sustained RT completion represents an important prevention safety net.
| S-EPMC6003703 | biostudies-literature
Project description:To evaluate labor and delivery complications and delivery modes between physicians and white-collar workers in Taiwan, this retrospective population-based study used data from Taiwan's National Health Insurance Research Database. We compared 1530 physicians aged 25 to 50 years old who worked and had singleton births between 2007 and 2013 with 3060 white-collar workers matched by age groups, groups of monthly insured payroll-related premiums, previous cesarean delivery, perinatal history anemia, and gestational diabetes mellitus. The logistic regression models were used to assess the labor and delivery complications between the two groups. Multivariate analysis revealed that physicians had a significantly higher risk of placenta previa (odds ratio (OR) 1.35, 95% confidence interval (CI) 1.08-1.69) and other malpresentation (OR 1.86, 95% CI 1.45-2.39) than white-collar workers, whereas they had a significantly lower risk of placental abruption (OR 0.53, 95% CI 0.40-0.71), preterm delivery (OR 0.75, 95% CI 0.61-0.92), and premature rupture of membranes (OR 0.72, 95% CI 0.59-0.88). Increased risks of some adverse labor and delivery complications were observed among physicians, when compared to white-collar workers. These findings suggest that working women should take preventative action to manage occupational risks during pregnancy.
| S-EPMC7400700 | biostudies-literature
Project description: Not available
| S-EPMC7857363 | biostudies-literature