Caesarean delivery is the most performed inpatient surgery worldwide, with rates expected to rise. Optimising maternal recovery benefits not only the mother, but also the newborn and society. Enhanced Recovery After Caesarean delivery (ERAC) protocols standardize the approach to perioperative management of patients in order to accelerate early postoperative maternal rehabilitation.
View Article and Find Full Text PDFBest Pract Res Clin Anaesthesiol
September 2024
Labour analgesia is a crucial aspect of obstetric anaesthesia, aiming to alleviate pain during childbirth while ensuring maternal and foetal safety. Over the past decade, advancements in labour analgesia techniques have evolved, impacting initiation, maintenance, and outcomes. We emphasize the longstanding importance of epidural analgesia while recognizing the growing significance of combined spinal-epidural and dural puncture epidural techniques for labour initiation.
View Article and Find Full Text PDFBest Pract Res Clin Anaesthesiol
September 2024
Background: Labour epidural analgesia reportedly fails in up to 10 to 25% of cases. A joint taskforce of European Society of Anaesthesiology and Intensive Care (ESAIC) experts was created to develop this focused guideline on the management of failing epidural analgesia in a previously well functioning epidural catheter.
Design: Six clinical questions were defined using a PICO (Population/Intervention/Comparison/Outcome) strategy to conduct a systematic literature search.
Background: General anesthesia during pregnancy is not uncommon, for example, for trauma surgery, cerclage, or cesarean delivery. Current recommendations are to maintain maternal partial pressure of carbon dioxide in arterial blood (paCO2) at 30 mm Hg, which is based solely on the average maternal paCO2 in awake pregnant women. However, there is no evidence that this target, compared to other targets, would enable optimal conditions for the fetus during general anesthesia.
View Article and Find Full Text PDFOptimal postoperative pain management is a prerequisite for enhancing functional recovery after surgery. However, many studies assessing analgesic interventions have limitations. Consequently, further improvements in study design are urgently needed.
View Article and Find Full Text PDFThe aim of this pragmatic approach to retrospective observational study was to identify the end-tidal concentration of sevoflurane which was associated with optimal surgical conditions (i.e., absence of any movement, coughing and straining) in 127 pregnant sheep.
View Article and Find Full Text PDFBackground: Older adults account for a large proportion of hospital admissions. In this study we aim to bridge a gap between medical and psychosocial factors in predicting hospitalisation.
Methods: Demographic and social characteristics of community-dwelling pre-frail and frail older people were collected by questionnaires every six months during a two year follow-up.
Contemporary crop production in Europe relies on nitrogen (N) fertilization. Fertilizer prices soared in 2021-2022, and remained at historical high levels in 2023. These high prices invoked an immediate concern on the possible consequences for Europe's food production.
View Article and Find Full Text PDFBackground: Anaesthetists of all grades who work on a labour ward are likely to be involved in the insertion or management of an intrathecal catheter after inadvertent dural puncture at some point in their careers. Although the use of intrathecal catheters after inadvertent dural puncture in labour has increased in popularity over recent decades, robust evidence on best practice has been lacking.
Methods: The Obstetric Anaesthetists' Association set up an expert working party to review the literature.
In the last two decades, an exponentially growing number of meta-analyses (MAs) synthesize thousands of peer-reviewed studies on the environmental impacts of farming practices (FPs). This paper describes the iMAP-FP evidence library, a comprehensive dataset on the effects of 34 categories of FPs (such as agronomic practices, cropping and livestock systems, land management options and mitigation techniques) on 34 impacts including climate mitigation, soil health, environmental pollution, water use, nutrients cycling, biodiversity, and agricultural productivity. Through systematic screening, 570 MAs published since 2000 were selected and categorized according to the type of FP.
View Article and Find Full Text PDFBackground: In recent years, the effectiveness and cost-effectiveness of digital health services for people with musculoskeletal conditions have increasingly been studied and show potential. Despite the potential of digital health services, their use in primary care is lagging. A thorough implementation is needed, including the development of implementation strategies that potentially improve the use of digital health services in primary care.
View Article and Find Full Text PDFLaparoscopic cholecystectomy can be associated with significant postoperative pain that is difficult to treat. We aimed to evaluate the available literature and develop updated recommendations for optimal pain management after laparoscopic cholecystectomy. A systematic review was performed using the procedure-specific postoperative pain management (PROSPECT) methodology.
View Article and Find Full Text PDFBackground: The dural puncture epidural (DPE) technique has been associated with better sacral analgesia compared with a traditional epidural (EPL) technique in laboring parturients. The aim of this study was to investigate whether DPE with a 27-gauge pencil-point needle compared with a traditional EPL technique produces more rapid bilateral sacral blockade in nulliparous parturients.
Methods: Patients were randomized to a DPE or EPL technique.
The low incidence of vincristine-induced peripheral neuropathy (VIPN) in Kenyan children may result from low vincristine exposure. We studied vincristine exposure in Kenyan children and dose-escalated in case of low vincristine exposure (NCT05844670). Average vincristine exposure was high.
View Article and Find Full Text PDFObjective: To quantify the association between prophylactic radiologic interventions and perioperative blood loss during cesarean delivery in women with placenta accreta spectrum disorder through a systematic review and network meta-analysis.
Data Sources: On January 3, 2023, a literature search was conducted in PubMed, EMBASE, Cochrane Library, and Web of Science. We also checked ClinicalTrials.
Several regional anesthesia (RA) techniques have been described for distal upper limb surgery. However, the best approach in terms of RA block success rate and safety is not well recognized. To assess and compare the surgical anesthesia and efficacy of axillary brachial plexus block with other RA techniques for hand and wrist surgery.
View Article and Find Full Text PDFBackground: Digital interventions are a promising avenue to promote physical activity in healthy adults. Current practices recommend to include end-users early on in the development process. This study focuses on the wishes and needs of users regarding an a mobile health (mHealth) application that promotes physical activity in healthy adults, and on the differences between participants who do or do not meet the World Health Organization's recommendation of an equivalent of 150 minutes of moderate intensity physical activity.
View Article and Find Full Text PDF