Crisis Resource Management in the Delivery Room: Development of Behavioral Markers for Team Performance in Emergency Simulation.

Human factors are the most relevant issues contributing to adverse events in obstetrics. Specific training of Crisis Resource Management (CRM) skills (i.e.

Adaptation of non-technical skills behavioural markers for delivery room simulation.

Background: Simulation in healthcare has proved to be a useful method in improving skills and increasing the safety of clinical operations. The debriefing session, after the simulated scenario, is the core of the simulation, since it allows participants to integrate the experience with the theoretical frameworks and the procedural guidelines. There is consistent evidence for the relevance of non-technical skills (NTS) for the safe and efficient accomplishment of operations.

Rebuilding the labor curve during neuraxial analgesia.

Aim: The aim of this study was to examine the pattern of labor progression among nulliparous women under neuraxial analgesia to obtain a new, specific reference labor curve and to compare the different effects of epidural and combined spinal epidural (CSE) analgesia on the progression of labor.

Material And Methods: This perspective cohort study was carried out in the Obstetrics and Gynecology tertiary care unit. Six hundred nulliparous parturients were enrolled.

Intrapartum sonography for occiput posterior detection in early low dose combined spinal epidural analgesia by sufentanil and ropivacaine.

Aim: To evaluate the incidence of occiput posterior position in labour with and without combined spinal epidural analgesia (CSE) by low dose of sufentanyl and ropivacaine.

Material And Methods: This study focused on 132 women subdivided in two groups, patients in spontaneous and in labour analgesia, administered by a low dose CSE by sufentanyl and ropivacaine; all women were evaluated by digital examinations and ultrasound till delivery. All data were collected and analyzed by an independent reviewer.

Adding sufentanil to levobupivacaine or ropivacaine intrathecal anaesthesia affects the minimum local anaesthetic dose required.

Background: We carried out this prospective, randomized, double-blind study in order to evaluate whether the intrathecal addition of sufentanil 3.3 mcg affects both the minimum local anaesthetic dose (MLAD) of spinal levobupivacaine and ropivacaine for a caesarean section and enhances the spinal block characteristics.

Methods: One hundred and eighty women were randomly allocated into four groups: levobupivacaine (Group L), levobupivacaine plus sufentanil (Group L+S), ropivacaine (Group R) and ropivacaine plus sufentanil (Group R+S).

Long-term epidural analgesia treatment in pre-eclamptic women: a preliminary trial.

Pre-eclampsia (PE) is a clinical pregnancy-related condition, characterised by an elevated blood pressure and proteinuria. The author treated selected cases of PE with long-term epidural analgesia (LTEA), that reduced labour pain and operated directly on the PE aetiopathogenesis, not on the symptoms. A total of 15 women with PE were hospitalised at 35-37 weeks of pregnancy, checked for blood pressure, liver and renal function, platelet count and had an epidural catheter inserted for a continuous administration of an analgesic mixture of Naropin, Sufentanil and Clonidine.

Spontaneous splenic vein aneurysm rupture in the puerperium.

A case of intra- and retroperitoneal haemorrhage after a splenic vein aneurysm rupture is described. A 27-year-old woman complained of chest pain on her first postpartum day. Symptoms were initially suggestive of pulmonary embolism, but within 3 h she developed severe acute abdominal pain, abdominal distension and haemodynamic instability.

Regional blocks for cesarean section.

Recent researches in the field of regional anesthesia for cesarean section have focused on spinal anesthesia, including prophylaxis of maternal hypotension, the use of opioids to improve intra- and postoperative analgesia and the use of ropivacaine.

Efficacy and comparison of 0.5% levobupivacaine with 0.75% ropivacaine for peribulbar anaesthesia in cataract surgery.

Background And Objective: The low cardiovascular and neurological toxicity of levobupivacaine has led to its application as a local anaesthetic in a wide variety of specialist applications including peribulbar block for cataract surgery. The aim of this study was to evaluate the efficacy of levobupivacaine 0.5% and to compare block quality vs.

Minimum local anaesthetic dose (MLAD) of intrathecal levobupivacaine and ropivacaine for Caesarean section.

We determined the minimum local anaesthetic dose (MLAD) of spinal levobupivacaine and ropivacaine for Caesarean section. Ninety women were randomly allocated to two groups and received 3 ml of study solution by a combined spinal/epidural technique. The initial dose was 12 mg for levobupivacaine and 17 mg for ropivacaine groups.

Minimum local analgesic dose: effect of different volumes of intrathecal levobupivacaine in early labor.

Background: This double-blind, randomized study was aimed at detecting the effect of three different volumes of intrathecal levobupivacaine on the minimum local analgesic dose in early labor.

Methods: Ninety-three nulliparous women requesting combined spinal-epidural analgesia, at more than 37 weeks gestation, with spontaneous onset of labor, cervical dilatation from 2 to 5 cm, were enrolled. Parturients received 10 ml (group 10), 5 ml (group 5), or 2.

Effect of different anesthesia techniques on red blood cell endogenous recovery in hip arthroplasty.

Study Objective: To compare the magnitude of postoperative red blood cell (RBC) recovery with 3 different anesthetic techniques, general anesthesia (GA), epidural anesthesia (EA) alone, and the combination of these 2 techniques (CA), in patients undergoing total hip arthroplasty.

Design: Randomized, controlled study.

Setting: Seven university or hospital departments of anesthesia.

High volume of subarachnoid levobupivacaine decreases drug requirement in first stage labor analgesia.

Aim: Using the statistic method of sequential allocation, we realized a prospective double-blind study in order to establish the minimum local anesthetic concentration (MLAC) of large intrathecal volume of levobupivacaine, during the first stage labour analgesia in spontaneous and induced laboring women.

Methods: Seventy-five nulliparous, at term, with cervical dilatation <5 cm parturients requesting combined spinal/epidural analgesia, were enrolled. The starting concentration was chosen according to recent literature.

A comparison between low-dose ropivacaine and bupivacaine at equianalgesic concentrations for epidural analgesia during the first stage of labor.

The aim of this study was to evaluate the efficacy, onset and duration of analgesia of two equianalgesic epidural doses of ropivacaine and bupivacaine during the first stage of labor. The study included 190 healthy nulliparous parturients who presented spontaneous onset of labor and required epidural analgesia. They were divided randomly to receive epidural analgesia with an initial dose 0.

Postpartum cerebral ischaemia after accidental dural puncture and epidural blood patch.

Puerperal women are reported to have a rate of cerebral infarction 13 times greater than non-pregnant females. We report a case of cerebral ischaemia in a 30-yr-old healthy parturient after epidural analgesia for labour, complicated by dural puncture treated with two epidural blood patches. Investigations showed the development of cerebral ischaemia on postpartum day 14.

[Epidural vs general anaesthesia].

Background: Aim of this study is to determine if and how the anaesthesia technique can significantly influence the outcome in patients after major orthopaedic surgery in terms of: patrimony of red blood cells (blood loss and erythropoiesis), incidence of intra and postoperative complications, postoperative pain control and hospital stay.

Methods: 210 patients, ASA physical status I-III, undergoing elective primary total hip replacement were randomly allocated in three groups of 70 patients to receive either epidural anaesthesia (Group EA), general anaesthesia (GA), or epidural anaesthesia integrated with mild general anaesthesia (IA).

Results: Data show a significant difference between the amount of pain measured by VRS immediately after surgery: prevalently absent in groups IA (84.

Intraoperative fetal oxygen saturation during Caesarean section: general anaesthesia using sevoflurane with either 100% oxygen or 50% nitrous oxide in oxygen.

Background And Objective: The study was designed to evaluate whether the administration of sevoflurane in 100% oxygen for anaesthesia during Caesarean section would improve fetal and neonatal oxygenation compared with the administration of sevoflurane with 50% nitrous oxide in oxygen.

Methods: The randomized, single-blind controlled study examined 24 mothers, ASA I-II, at term undergoing Caesarean section who were allocated to receive sevoflurane in either 100% oxygen (n = 13) or 50% nitrous oxide in oxygen (n= 11). General anaesthesia was induced in both groups with thiopental 4-5 mg kg(-1) followed by succinylcholine 1.

Frequency of hypotension and bradycardia during general anesthesia, epidural anesthesia, or integrated epidural-general anesthesia for total hip replacement.

Study Objective: To evaluate the frequency of hypotension and bradycardia during integrated epidural-general anesthesia as compared with general anesthesia or epidural anesthesia alone.

Design: Prospective, randomized, open, multicenter study.

Setting: Inpatient anesthesia at 7 University or Hospital Departments of anesthesia.

[Prehydratation and anaesthesia in obstetrics: state of the art].

All epidural or spinal techniques using local anaesthetics causes some degree of sympathetic blockade resulting in peripheral vasodilatation and possibly hypotension or reduction in cardiac output. In the practical clinic, administration of fluids intravenously prior spinal and epidural anaesthesia is required to prevent maternal hypotension and fetal hypoxia. We evaluated in this review the efficacy of volume preloading on the incidence of hypotension after spinal or epidural anaesthesia for caesarean delivery.

[Motor block determination for the identification of accidental spinal injection of levobupivacaine: a study on the minimum efficient test-dose (ED50)].

Background: The aim of this study was to determine the ED50 for the dose of levobupivacaine 0,5% that, if given intrathecally will not cause total spinal anesthesia but will give a reliable and reproducible clinical sign to differentiate intrathecal from epidural injection.

Methods: Thirty women at term undergoing elective cesarean section under a combined spinal-epidural technique (CSE) were enrolled into this sequential allocation study. The dose in each test dose was determined by the response of the previous patient to the higher or lower dose in her test syringe, according to up-down sequential allocation.

[Levobupivacaine in obstetric analgesia and anaesthesia].

Methods: Published studies, including abstracts, has been reviewed and summarized.

Results: Studies in sheep have demonstrated no significant differences in pharmacokinetic and placental transfer of levobuvacaine when compared with bupivacaine. Clinical studies on cesarean section confirmed similar performance between these two drugs.