Risk Factors for Atonic Postpartum Hemorrhage: A Systematic Review and Meta-analysis.

Objective: To identify and quantify risk factors for atonic postpartum hemorrhage.

Data Sources: PubMed, CINAHL, EMBASE, Web of Science, and and ClinicalTrials.gov databases were searched for English language studies with no restrictions on date or location.

A qualitative analysis of parturients' experiences using nitrous oxide for labor analgesia: It is not just about pain relief.

Background: A vast majority of women who choose nitrous oxide for labor report high satisfaction despite variable analgesic effectiveness. We analyzed comments provided by women who used nitrous oxide for labor, to identify determinants of satisfaction in this population, and to better understand reasons for continuing with nitrous oxide despite variable analgesic effectiveness.

Methods: We conducted qualitative content analysis of comments in a quality improvement database of routine follow-up assessments of women who delivered vaginally, using nitrous oxide as the sole labor analgesic.

On the Road to Professionalism.

Many observers have concluded that we have a crisis of professionalism in the practice of medicine. In this essay, the author identifies and discusses personal attributes and commitments important in the development and maintenance of physician professionalism: humility, servant leadership, self-awareness, kindness, altruism, attention to personal well-being, responsibility and concern for patient safety, lifelong learning, self-regulation, and honesty and integrity. Professionalism requires character, but character alone is not enough.

Nitrous Oxide During Labor: Maternal Satisfaction Does Not Depend Exclusively on Analgesic Effectiveness.

Background: Evidence on the analgesic effectiveness of nitrous oxide for labor pain is limited. Even fewer studies have looked at patient satisfaction. Although nitrous oxide appears less effective than neuraxial analgesia, it is unclear whether labor analgesic effectiveness is the most important factor in patient satisfaction.

Tracheobronchopathia osteochondroplastica and difficult intubation: case report and perioperative recommendations for anesthesiologists.

Tracheobronchopathia osteochondroplastica is a rare disorder characterized by cartilaginous or ossified submucosal nodules that project into the tracheobronchial lumen. It is typically discovered in the evaluation of chronic upper respiratory symptoms. A case of a completely asymptomatic man diagnosed with extensive disease throughout his upper airway after unanticipated difficult endotracheal intubation for elective surgery, is presented.

Acute hypotension associated with intraoperative cell salvage using a leukocyte depletion filter during management of obstetric hemorrhage due to amniotic fluid embolism.

Amniotic fluid embolism (AFE) is a rare but catastrophic obstetric complication that can lead to profound coagulopathy and hemorrhage. The role of cell salvage and recombinant human Factor VIIa (rFVIIa) administration in such cases remains unclear. We present a case of AFE and describe our experience with the use of cell salvage and rFVIIa administration during the resuscitation.

Local and paravertebral block anesthesia for outpatient elective breast cancer surgery.

Most breast cancer operations in the United States are performed with the patient given general anesthesia. We retrospectively reviewed our prospective breast cancer database to determine the percentage of patients who underwent breast cancer operations with either local or paravertebral block regional anesthesia from January 1 through June 30, 2008. Fifty-two of 70 patients (74%) were able to undergo breast cancer surgery with local or paravertebral block regional anesthesia.

A randomized trial of intrapartum analgesia in women with severe preeclampsia.

Objective: To estimate whether the cesarean delivery rate differs between women with severe preeclampsia who receive intrapartum epidural analgesia versus patient-controlled intravenous opioid analgesia.

Methods: Women with severe preeclampsia at at least 24 weeks' gestation were randomly assigned to receive either intrapartum epidural (n = 56) versus patient-controlled intravenous opioid analgesia (n = 60), and each was administered by a standardized protocol. The sample size was selected to have 80% power to detect at least a 50% difference in the predicted intergroup cesarean delivery rates.

Intrathecal opioids versus epidural local anesthetics for labor analgesia: a meta-analysis.

Background And Objectives: Some anesthesiologists contend that intrathecal opioid administration has advantages over conventional epidural techniques during labor. Randomized clinical trials comparing analgesia and obstetric outcome using single-injection intrathecal opioids versus epidural local anesthetics suggest that intrathecal opioids provide comparable analgesia with few serious side effects. This meta-analysis compared the analgesic efficacy, side effects, and obstetric outcome of single-injection intrathecal opioid techniques versus epidural local anesthetics in laboring women.