Anesthetic Considerations and Blood Utilization for Placenta Accreta Spectrum.

The anesthetic management of the patient with placenta accreta spectrum begins before surgery by assessing the patient and their comorbidities and providing psychological preparation for the perioperative period. Choosing neuraxial or general anesthesia for surgery balances the procedure's clinical needs with the patient's desires. Intraoperatively, management of homeostasis during acute blood loss requires assessments of central volume to avoid over-transfusion.

A randomized controlled trial of spinal morphine with an enhanced recovery pathway and its effect on duration of analgesia after cesarean delivery.

Background: Intrathecal morphine is frequently administered after cesarean delivery to provide pain relief lasting up to 24 h. An enhanced recovery after cesarean pathways reduces the amount of postoperative opioids needed. The ideal dose of intrathecal morphine when combined with a pathway has not been determined.

Anesthesia Considerations for Placenta Accreta Spectrum.

Anesthesiologists are critical members of the multidisciplinary team managing patients with suspected placenta accreta spectrum (PAS). Preoperatively, anesthesiologists provide predelivery consultation for patients with suspected PAS where anesthetic modality and invasive monitor placement is discussed. Additionally, anesthesiologists carefully assess patient and surgical risk factors to choose an anesthetic plan and to prepare for massive intraoperative hemorrhage.

Placenta Accreta Spectrum Disorders: Knowledge Gaps in Anesthesia Care.

Placenta accreta spectrum (PAS) disorder is a potentially life-threatening condition that can occur during pregnancy. PAS puts pregnant individuals at a very high risk of major blood loss, hysterectomy, and intensive care unit admission. These patients should receive care in a center with multidisciplinary experience and expertise in managing PAS disorder.

Geographic variation in management of patients with placenta accreta spectrum: An international survey of experts (GPASS).

Objective: To describe global geographic variations in the diagnosis and management of placenta accreta spectrum (PAS).

Methods: An international cross-sectional study was conducted among PAS experts practicing at medical institutions in member states of the United Nations. Survey questions focused on diagnostic evaluation and management strategies for PAS.

Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery.

Background: Preparedness efforts for a COVID-19 outbreak required redesign and implementation of a perioperative workflow for the management of obstetric patients. In this report we describe factors which influenced rapid cycle implementation of a novel comprehensive checklist for the perioperative care of the COVID-19 parturient.

Methods: Within our labour and delivery unit, implementation of a novel checklist for the COVID-19 parturient requiring perioperative care was accomplished through rapid cycling, debriefing and on-site walkthroughs.

Epidural Blood Patch does not Contribute to the Development of Chronic Low Back Pain in Patients who Undergo Lumbar Punctures: A Pilot Study.

Purpose Of Review: Post dural puncture headache (PDPH) is a known and relatively common complication which may occur in the setting of patients undergoing lumbar punctures (LP) for diagnostic or therapeutic purposes, and is commonly treated with an epidural blood patch (EBP). There have been few publications regarding the long-term safety of EBP for the treatment of PDPH.

Recent Findings: The aim of this pilot study was to examine any association of chronic low back pain (LBP) in patients who experienced a PDPH following a LP, and were treated with an EBP.

Adaptation of an Obstetric Anesthesia Service for the Severe Acute Respiratory Syndrome Coronavirus-2 Pandemic: Description of Checklists, Workflows, and Development Tools.

Background: Care of the pregnant patient during the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic presents many challenges, including creating parallel workflows for infected and noninfected patients, minimizing waste of materials, and ensuring that clinicians can seamlessly transition between types of anesthesia. The exponential community spread of disease limited the time for development and training.

Methods: The goals of our workflow and process development were to maximize safety for staff and patients, minimize the risk of contamination, and reduce the waste of unused supplies and materials.

Transthoracic echocardiographic assessment of the right ventricle before and after caesarean delivery: A preliminary investigation.

Transthoracic echocardiographic evaluation of the right ventricle is more difficult than the left ventricle and has not been well characterised in the parturient during delivery. As a preliminary investigation, our goal was to use bedside transthoracic echocardiography to evaluate right ventricular myocardial function before and after caesarean delivery. Term parturients undergoing caesarean delivery under spinal anaesthesia were enrolled.

Post Dural Puncture Headache, Managed with Epidural Blood Patch, Is Associated with Subsequent Chronic Low Back Pain in Patients: a Pilot Study.

Purpose Of Review: Post dural puncture headache (PDPH) is a relatively common complication which may occur in the setting of inadvertent dural puncture (DP) during labor epidural analgesia and during intentional DP during spinal anesthetic placement or diagnostic lumbar puncture. Few publications have established the long-term safety of an epidural blood patch (EBP) for the treatment of a PDPH.

Recent Findings: The aim of this pilot study was to examine the association of chronic low back pain (LBP) in patients who experienced a PDPH following labor analgesia and were treated with an EBP.

Cerebrospinal Fluid Protein Changes in Preeclampsia.

The molecular mechanisms underlying seizure susceptibility in preeclampsia are unknown. We hypothesized that altered expression of distinct proteins in the cerebrospinal fluid (CSF) may reflect pathophysiological changes in the central nervous system that contribute to the neurological manifestations of severe preeclampsia. We obtained CSF samples from 13 patients with preeclampsia and 14 control patients during spinal anesthesia before delivery and analyzed them by SOMAscan, an aptamer-based proteomics platform for alterations in 1310 protein levels.

Epidural Analgesia During the Second Stage of Labor: A Randomized Controlled Trial.

Objective: To evaluate whether maintaining a motor-sparing epidural analgesia infusion affects the duration of the second stage of labor in nulliparous parturients compared with a placebo control.

Methods: We conducted a double-blind, randomized, placebo-controlled trial involving nulliparous women with term cephalic singleton pregnancies who requested epidural analgesia. All women received epidural analgesia for the first stage of labor using 0.

What's New in Obstetric Anesthesia: The 2016 Gerard W. Ostheimer Lecture.

This special article presents potentially important trends and issues affecting the field of obstetric anesthesia drawn from publications in 2015. Both maternal mortality and morbidity in the United States have increased in recent years because, in part, of the changing demographics of the childbearing population. Pregnant women are older and have more pre-existing conditions and complex medical histories.

Assessment of Perioperative Ultrasound Workflow Understanding: A Consensus.

Objectives: Understanding of the workflow of perioperative ultrasound (US) examination is an integral component of proficiency. Workflow consists of the practical steps prior to executing an US examination (eg, equipment operation). Whereas other proficiency components (ie, cognitive knowledge and manual dexterity) can be tested, workflow understanding is difficult to define and assess due to its contextual and institution-specific nature.

Imaging skills for transthoracic echocardiography in cardiology fellows: The value of motion metrics.

Background: Proficiency in transthoracic echocardiography (TTE) requires an integration of cognitive knowledge and psychomotor skills. Whereas cognitive knowledge can be quantified, psychomotor skills are implied after repetitive task performance. We applied motion analyses to evaluate psychomotor skill acquisition during simulator-based TTE training.

Impact of gender and body surface area on outcome after abdominal aortic aneurysm repair.

Background: A gender-neutral threshold aneurysm diameter (AD) of more than 5.5 cm for surgical intervention in abdominal aortic aneurysms (AAA) ignores the fact that women have a smaller baseline AD. We hypothesized that women have a greater AD relative to body surface area (BSA) at the time of surgery and that this worsens outcome.

Teaching concepts of transesophageal echocardiography via Web-based modules.

Objectives: Teaching transesophageal echocardiography (TEE) remains challenging. The authors hypothesized that using online modules with live teaching in an echo training course would be feasible and result in superior knowledge acquisition to live teaching only.

Design: In this prospective cohort study, the authors implemented a TEE course with online modules and live teaching and compared it to a live-teaching-only version.

Novel, multimodal approach for basic transesophageal echocardiographic teaching.

Objectives: Web and simulation technology may help in creating a transesophageal echocardiography (TEE) curriculum. The authors discuss the educational principles applied to developing and implementing a multimodal TEE curriculum.

Design And Setting: The authors modified a pilot course based on principles for effective simulation-based education.