Purpose Of Review: Simulation training in obstetric anesthesia has become widespread in recent years. Simulations are used to train staff and trainees, assess and improve team performance, and evaluate the work environment. This review summarizes current research in these categories.
Recent Findings: Simulation to improve individual technical skills has focused on induction of general anesthesia for emergent cesarean delivery, an infrequently encountered scenario by anesthesia trainees. Low- and high-fidelity simulation devices for the learning and practicing neuraxial and non-neuraxial procedures have been described, and both are equally effective. The use of checklists in obstetric emergencies has become common as and post-scenario debriefing techniques have improved. Although participant task performance improves, whether participants retain learned skills or whether simulation improves patient outcomes has not yet been established. Tools to assess teamwork during simulation have been developed, but none have been rigorously validated. In-situ vs. offsite simulations do not differ in effectiveness.
Summary: Simulation allows for practice of tasks and teamwork in a controlled manner. There is little data whether simulation improves patient outcomes and metrics to predict the long-term retention of skills by simulation participants have not been developed.
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http://dx.doi.org/10.1097/ACO.0000000000000522 | DOI Listing |
Int J Obstet Anesth
December 2024
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, United States.
Arachnoid cysts are fluid-filled cavities that are usually asymptomatic and do not require surgical intervention. However, there are concerns and limited literature on the safety of neuraxial procedure in obstetric patients with cranial arachnoid cysts. We describe the anesthetic management of a pregnant patient with a large arachnoid cyst with mass effect on the cerebellum who presented in labor.
View Article and Find Full Text PDFBest Pract Res Clin Anaesthesiol
September 2024
Department of Anaesthesiology, University Hospitals Leuven (BE), Department of Cardiovascular Sciences, KU Leuven (BE), Herestraat 49, B-3000, Leuven, Belgium.
Critical illness during pregnancy poses significant challenges driven by complex interactions between physiological changes, pre-existing conditions, and healthcare disparities. In high-income countries, increasing maternal age and comorbidities complicate obstetric care by triggering an unprecedented rise in cardiac disease during pregnancy, while infections like influenza and COVID-19 are important causes of maternal adult respiratory distress syndrome. Extracorporeal membrane oxygenation (ECMO) gained prominence as a vital intervention, providing respiratory and/or cardiac support, for varying indications between antenatal and postpartum periods.
View Article and Find Full Text PDFBest Pract Res Clin Anaesthesiol
September 2024
Joan Kirner Women's and Children's Sunshine Hospital, Western Health, St Albans, Australia. Electronic address:
Cardiovascular disease is a leading cause of morbidity and mortality for pregnant patients. A significant portion of cardiac morbidity and mortality is preventable and related to poor or delayed recognition of clinical warning signs and oversights in management. The establishment of pregnancy heart teams facilitates multidisciplinary planning to improve management of people with cardiovascular disease.
View Article and Find Full Text PDFBest Pract Res Clin Anaesthesiol
September 2024
Department of Anesthesiology, University Hospital Basel, Basel, Switzerland.
The issue of obesity continues to reach new levels globally, affecting individuals across the age continuum. Obesity in pregnancy is associated with myriad comorbidities which may negatively impact the fetus, particularly dysfunctional labor and failure to progress ending in unplanned cesarean delivery. Neuraxial anesthesia represents the gold standard for cesarean delivery anesthesia and is increasingly beneficial for obese patients due to the risk of difficult airway.
View Article and Find Full Text PDFBest Pract Res Clin Anaesthesiol
September 2024
Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, L1, Boston, MA, 02115, USA. Electronic address:
Preeclampsia is a life-threatening complication that develops in 2-8% of pregnancies. It is characterized by elevated blood pressure after 20 weeks of gestation and may progress to multiorgan dysfunction, leading to severe maternal and fetal morbidity and mortality. The only definitive treatment is delivery, and efforts are focused on early risk prediction, surveillance, and severity mitigation.
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