Development of the obstetric unanticipated difficult video-laryngoscopy algorithm through a quality improvement randomized open-label in situ simulation study.

Background: Video-laryngoscopy is increasingly used during general anesthesia for emergency cesarean deliveries. Given the heightened risk of difficult tracheal intubation in obstetrics, addressing challenges in airway management is crucial. In this simulation study, we hypothesized that using a flexible bronchoscope would lead to securing the airway faster than the Eschmann introducer when either device is used in addition to video-laryngoscopy.

Ethics and society review: Ethics reflection as a precondition to research funding.

Researchers in areas as diverse as computer science and political science must increasingly navigate the possible risks of their research to society. However, the history of medical experiments on vulnerable individuals influenced many research ethics reviews to focus exclusively on risks to human subjects rather than risks to human society. We describe an Ethics and Society Review board (ESR), which fills this moral gap by facilitating ethical and societal reflection as a requirement to access grant funding: Researchers cannot receive grant funding from participating programs until the researchers complete the ESR process for their proposal.

Difficulty in Advancing Flexible Epidural Catheters When Establishing Labor Analgesia: An Observational Open-Label Randomized Trial.

Background: While flexible epidural catheters reduce the risk of paresthesia and intravascular cannulation, they may be more challenging to advance beyond the tip of a Tuohy needle. This may increase placement time, number of attempts, and possibly complications when establishing labor analgesia. This study investigated the ability to advance flexible epidural catheters through different epidural needles from 2 commonly used, commercially available, epidural kits.

Sugammadex Administration in Pregnant Women: A Case Series of Maternal and Fetal Outcomes.

Sugammadex, given its high affinity for amino-steroid neuromuscular blockers, offers rapid and reliable neuromuscular blockade reversal, making it a popular reversal agent. This characteristic can be very useful in pregnant women, where incomplete reversal can have poor maternal and fetal outcomes. However, its use antenatally in pregnancy is controversial given concerns for progesterone binding, a hormone that is crucial for maintenance of pregnancy.

Sacral anatomical interspace landmark for lumbar puncture in pregnancy: A randomized trial.

Objective: To determine whether the sacral anatomical interspace landmark (SAIL) technique is more accurate than the classic intercristal line (ICL) technique in pregnant patients and to assess the percentage of clinical determinations above the third lumbar vertebra.

Methods: In this prospective, randomized, open-label trial, there were 110 singleton pregnant patients with gestational age greater than 37 weeks included. Selection procedure was a convenience sample of pregnant patients who presented for office visits or vaginal or cesarean delivery between March 15 and July 31, 2018, at a single-center obstetric tertiary care university hospital.

The Validity of Discharge Billing Codes Reflecting Severe Maternal Morbidity.

Background: Discharge diagnoses are used to track national trends and patterns of maternal morbidity. There are few data regarding the validity of the International Classification of Diseases (ICD) codes used for this purpose. The goal of our study was to try to better understand the validity of administrative data being used to monitor and assess trends in morbidity.

The rapid sequence spinal for category 1 caesarean section: anaesthetic trainee knowledge and practice.

Rapid sequence induction of general anaesthesia (GA) is the fastest anaesthetic technique in a category-1 caesarean section (C1CS) for foetal distress. Recently rapid sequence spinal anaesthesia (RSS) has been explored as a technique to avoid the potential risks of GA in such cases. Out of hours, trainee anaesthetists are often required to provide anaesthesia for these emergencies.

Fibromyalgia survey criteria are associated with increased postoperative opioid consumption in women undergoing hysterectomy.

Background: The current study was designed to test the hypothesis that the fibromyalgia survey criteria would be directly associated with increased opioid consumption after hysterectomy even when accounting for other factors previously described as being predictive for acute postoperative pain.

Methods: Two hundred eight adult patients undergoing hysterectomy between October 2011 and December 2013 were phenotyped preoperatively with the use of validated self-reported questionnaires including the 2011 fibromyalgia survey criteria, measures of pain severity and descriptors, psychological measures, preoperative opioid use, and health information. The primary outcome was the total postoperative opioid consumption converted to oral morphine equivalents.

Maternal physiologic parameters in relationship to systemic inflammatory response syndrome criteria: a systematic review and meta-analysis.

Objective: To establish the normal maternal range in healthy pregnant women for each component of the systemic inflammatory response syndrome (SIRS) criteria and compare these ranges with existing SIRS criteria.

Data Sources: PubMed, Embase, and ClinicalTrials.gov databases were searched to identify studies of healthy parturients from the first trimester through 12 weeks postpartum that reported maternal temperature, respiratory rate, PaCO2, heart rate, white blood cell count data, or a combination of these.

Acute pancreatitis and primary hyperparathyroidism in pregnancy: treatment of hypercalcemia with magnesium sulfate.

A patient is described in whom intravenous magnesium sulfate, administered for preeclampsia, successfully treated hypercalcemia associated with hyperparathyroidism. This single case suggests that magnesium sulfate might be an effective alternative to standard medical or surgical treatment of this condition.