Intravenous Bolus of Dexmedetomidine for Treatment of Severe Shivering After Caesarean Delivery Under Combined Spinal-Epidural Anaesthesia: A Randomized Dose-Response Study.

Purpose: Shivering occurs frequently after caesarean delivery. The present study aimed to investigate the ED50 and ED95 of an intravenous (i.v.

A randomized double-blinded study assessing the dose-response of ropivacaine with dexmedetomidine for maintenance of labor with epidural analgesia in nulliparous parturients.

The combination of ropivacaine and dexmedetomidine has been used as an epidural analgesic for inducing labor. However, there is limited data regarding the administration of epidural analgesia for labor maintenance, hence, this study aimed to determine the optimum concentration through dose-response curves of ropivacaine plus dexmedetomidine, which could be used along with the Programmed Intermittent Epidural Bolus (PIEB) technique. One hundred parturients were randomized into 4 groups who were administered four different doses of ropivacaine (dexmedetomidine at 0.

Iatrogenic Injury During Intraoperative Transesophageal Echocardiography: Implications for Medical Equipment Storage.

Background: Medical equipment failure is an underappreciated source of iatrogenesis. The authors report a successful root cause analysis and action (RCA) to improve compliance and decrease risks to patients during cardiac anesthesia care.

Methods: A quality and safety team of five content experts performed an RCA after an iatrogenic injury with transesophageal echocardiogram (TEE) probe insertion.

The effect of Mozart music on patient satisfaction during caesarean delivery: a randomised controlled trial.

Background: Music is a low-cost intervention that can improve patient satisfaction.

Methods: This was a prospective, randomised, controlled trial conducted at an urban tertiary care academic medical centre in the United States. Nulliparous women 18-50 years old with a healthy singleton pregnancy at ≥ 37 weeks gestational age undergoing elective caesarean delivery under neuraxial anaesthesia were randomised to the music group (Mozart sonatas) or control group (no music).

Increased Scheduled Intravenous Ketorolac After Cesarean Delivery and Its Effect on Opioid Use: A Randomized Controlled Trial.

Objective: To evaluate the efficacy of scheduled ketorolac in reducing opioid use after cesarean delivery.

Methods: This was a single-center, randomized, double-blind, parallel-group trial to assess pain management after cesarean delivery with scheduled ketorolac compared with placebo. All patients undergoing cesarean delivery with neuraxial anesthesia received two doses of 30 mg intravenous ketorolac postoperatively and then were randomized to receive four doses of 30 mg of intravenous ketorolac or placebo every 6 hours.

Durapore vs. Hy-Tape for securing endotracheal tubes during general anaesthesia: a prospective randomised controlled non-inferiority trial.

Introduction: Adhesive tape is commonly used to secure endotracheal tubes (ETT) during general anaesthesia. Although a variety of adhesives are used in practice, few studies have investigated the likelihood of different adhesives in producing facial skin injury. Given that differences in cost exist between adhesives that are often used interchangeably, it would be prudent to use the most economical option.

Practice variability with syringe labelling practices among anaesthesia residents.

Introduction: Practice variability is associated with human error and adverse drug events. We sought to describe the practice variability that exists with drug labelling among a cohort of anaesthesia residents in an academic medical centre.

Material And Methods: In a controlled, lecture-style environment, residents were instructed to prepare a syringe of atracurium.

The Intraoperative Median Effective Dose of Oxytocin for Preventing Uterine Atony in Parturients with a Prior History of Caesarean Delivery.

Background And Objective: While oxytocin is commonly used for the prevention of uterine atony, its pharmacology may be affected by a prior history of caesarean delivery. The objective of this study was to determine the 50% effective dose (ED) of bolus oxytocin after caesarean delivery in parturients with and without prior caesarean delivery.

Methods: This was a parallel-group, double-blind, dose-response study using Dixon's up-and-down sequential allocation method to estimate the ED of bolus-administered oxytocin in parturients having caesarean delivery under combined spinal-epidural anaesthesia (CSE).

The ED and ED of Prophylactic Norepinephrine for Preventing Post-Spinal Hypotension During Cesarean Delivery Under Combined Spinal-Epidural Anesthesia: A Prospective Dose-Finding Study.

Hypotension commonly occurs with spinal anesthesia during cesarean delivery. Norepinephrine is an alternative to phenylephrine which can be used to prevent or treat hypotension, with better maintained cardiac output and less bradycardia. However, an appropriate initial prophylactic infusion dose of norepinephrine remains unclear.

Improving accuracy of American Society of Anesthesiologists Physical Status using audit and feedback and artificial intelligence: a time-series analysis.

Background: While the American Society of Anesthesiologists (ASA) Physical Status (PS) is used to adjust for greater mortality risk with higher ASA PS classification, inaccurate classification can lead to an inaccurate comparison of institutions.

Objective: The purpose of this study was to assess the effect of audit and feedback with a rule-based artificial intelligence algorithm on the accuracy of ASA PS classification.

Methods: We reviewed 78 121 anesthetic records from 1 January 2017 to 19 February 2020.

Association between Paravertebral Block and Pain Score at the Time of Hospital Discharge in Oncoplastic Breast Surgery: A Retrospective Cohort Study.

Background: Using nonopioid analgesics may decrease the risk of patients chronically using opioids postoperatively. The authors evaluated the relationship between paravertebral block and pain score at the time of hospital discharge.

Methods: The authors performed a retrospective cohort study of 89 women with American Society of Anesthesiologists Physical Status I to III undergoing oncoplastic breast surgery with 20 to 50 percent breast tissue removal and immediate contralateral reconstruction between August of 2015 and August of 2018.

A retrospective review of clinical and non-clinical factors associated with unscheduled cesarean deliveries at one urban medical center.

Objective: To investigate factors associated with unscheduled cesarean delivery at one urban tertiary medical center.

Methods: A retrospective chart review was performed on 11 162 deliveries between 2009 and 2019. The dependent variable was unscheduled cesarean delivery.

Implementing structured handoffs to verify operating room blood delivery using a quality academy training program: an interrupted time-series analysis.

Background: Blood transfusion is a complex process at risk for error.

Objective: To implement a structured handoff during the blood transfusion process to improve delivery verification.

Methods: A multidisciplinary team participated in the quality academy training program at an academic medical center and implemented a structured handoff of blood delivery to the operating room (OR) using Plan-Do-Study-Act cycles between 28 October 2019 and 1 December 2019.

Identifying high dose neostigmine as a risk factor for post-operative respiratory complications: a case-control study.

Introduction: Neostigmine, an acetylcholinesterase inhibitor, is used to reverse the effects of non-depolarizing neuromuscular blocking agents. Inappropriate dosing of neostigmine can lead to post-operative respiratory complications. Post-operative respiratory complications are associated with major morbidity and mortality.

Factors associated with neonatal resuscitation knowledge and comfort across academic anesthesia institutions.

Background: Neonatal resuscitation training is a requirement for all obstetric anesthesia fellows. However, while the majority of anesthesiologists who work on labor and delivery report having been involved in the resuscitation of a newborn, most do not have NRP training.

Objective: By studying a national cohort of anesthesiologists, our objective was to identify factors associated with knowledge and comfort with neonatal resuscitation and to inform decisions about neonatal resuscitation in obstetric anesthesia fellowship training.

Dose dependent reduction in median effective concentration (EC) of ropivacaine with adjuvant dexmedetomidine in labor epidural analgesia: An up-down sequential allocation study.

Study Objective: Adjuvant dexmedetomidine can be used to reduce the required concentration of ropivacaine for labor epidural analgesia. However, the potency of dexmedetomidine has not been fully studied. The purpose of this study was to determine the median effective concentration (EC) of ropivacaine with adjuvant dexmedetomidine.

The Effect of the No Pain Labor & Delivery-Global Health Initiative on Cesarean Delivery and Neonatal Outcomes in China: An Interrupted Time-Series Analysis.

Background: The proportion of live births by cesarean delivery (CD) in China is significant, with some, particularly rural, provinces reporting up to 62.5%. The No Pain Labor & Delivery-Global Health Initiative (NPLD-GHI) was established to improve obstetric and neonatal outcomes in China, including through a reduction of CD through educational efforts.

The effect of Tegaderm™ versus EyeGard® on eyelid erythema during general anesthesia: a randomized-controlled trial.

Purpose: Application of adhesive tape to the eyelids during general anesthesia decreases the risk of corneal abrasion but may increase the risk of eyelid injury. The aim of this study was to determine if there is a difference in eyelid erythema when covering the eyelid with either Tegaderm™ or an EyeGard®.

Methods: We conducted a prospective, randomized, double-blind, split-face study of patients undergoing general anesthesia at an urban tertiary care academic medical centre.

The ED and ED of oxytocin infusion rate for maintaining uterine tone during elective caesarean delivery: a dose-finding study.

Background: The 90% effective dose (ED) of oxytocin infusion has been previously estimated to be 16.2 IU h. However, bolus administration of oxytocin prior to the infusion may decrease the infusion dose required.

Effect of a Cognitive Aid on Reducing Sugammadex Use and Associated Costs: A Time Series Analysis.

Background: The authors observed increased pharmaceutical costs after the introduction of sugammadex in our institution. After a request to decrease sugammadex use, the authors implemented a cognitive aid to help choose between reversal agents. The purpose of this study was to determine if sugammadex use changed after cognitive aid implementation.