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Recent Advances in Obstetric Anesthesiology
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Recent Advances in Obstetric Anesthesiology

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Anesthesiology".

Deadline for manuscript submissions: closed (30 November 2022) | Viewed by 13780

Special Issue Editor

Prof. Dr. Kassiani Theodoraki

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Guest Editor
Department of Anesthesiology, Aretaieion University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
Interests: anesthesiology; obstetric anesthesia; regional anesthesia; labor analgesia; perioperative care; postoperative pain; opioid-sparing techniques; opioid-free techniques quality of recovery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The Journal of Clinical Medicine (JCM) is supporting the publication of a Special Issue on “Recent Advances in Obstetric Anesthesiology”, for which I will be serving as Guest Editor.

Obstetric anesthesiologists play a vital role in safeguarding maternal safety and ensuring an optimal outcome for both the mother and the fetus. In recent years, we have witnessed significant advances in obstetric anesthesiology encompassing the whole field of perinatal care of obstetric patients. Innovations have emerged which have made labor analgesia safer and more effective, while advances exist today in spinal and epidural techniques for operative deliveries, new treatments for hypotension associated with neuraxial blockade have been introduced, and algorithms and guidelines have improved the safety of general anesthesia in obstetrics. The aforementioned facts, along with tailored strategies and a systematic approach in postpartum hemorrhage management, as well as improved education and the use of simulation, have led to a considerable reduction in anesthesia-related morbidity and mortality.

The Special Issue aims to provide up-to-date data by presenting research on the subspecialty of obstetric anesthesiology and to be a comprehensive aggregation of work performed by experts in the field, thus providing a valuable resource of knowledge for obstetric anesthesiologists worldwide. By providing the opportunity to publish a significant number of articles on this important issue in modern anesthesia practice, we hope we will be able to enhance readers’ ability to appreciate recent advances in obstetric anesthesiology and augment their potential gain of knowledge. Therefore, this Special Issue encourages submissions on the current state of the art but also on ongoing controversies related to the practice of obstetric anesthesiology.


I would therefore kindly invite healthcare professionals and researchers involved in the care of obstetric patients to address relevant topics and submit original research articles, reviews, meta-analyses, or observational studies to JCM in order to get published in this Special Issue after a thorough peer review by experts in the field.
I am very much looking forward to receiving your submissions.

Sincerely,

Dr. Kassiani Theodoraki
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • obstetric anesthesia
  • cesarean section
  • labor pain
  • labor analgesia
  • epidural analgesia
  • neuraxial block
  • regional anesthesia
  • spinal anesthesia
  • combined spinal–epidural anesthesia
  • hypotension

Related Special Issue

Published Papers (6 papers)

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Research

18 pages, 965 KiB  
Article
Colloid Preload versus Crystalloid Co-Load in the Setting of Norepinephrine Infusion during Cesarean Section: Time and Type of Administered Fluids Do Not Matter
by Kassiani Theodoraki, Sofia Hadzilia, Dimitrios Valsamidis, Konstantina Kalopita and Emmanouil Stamatakis
J. Clin. Med. 2023, 12(4), 1333; https://doi.org/10.3390/jcm12041333 - 07 Feb 2023
Cited by 5 | Viewed by 1748
Abstract
Background and Goal of Study: Spinal anesthesia for cesarean section is frequently associated with a high incidence of hypotension, which may bring about untoward effects for both the mother and fetus. Recently, norepinephrine has emerged as a promising alternative in maintaining blood [...] Read more.
Background and Goal of Study: Spinal anesthesia for cesarean section is frequently associated with a high incidence of hypotension, which may bring about untoward effects for both the mother and fetus. Recently, norepinephrine has emerged as a promising alternative in maintaining blood pressure in the obstetric setting. Fluid administration is another technique still widely used to prevent maternal hypotension. The optimal fluid strategy to prevent maternal hypotension has not been elucidated yet. It has been recently suggested that the main strategy in the prevention and management of hypotension should be the combination of vasoconstrictive medications and fluid administration. The aim of this randomized study was to compare the incidence of maternal hypotension in parturients receiving either colloid preload or crystalloid co-load in the setting of prophylactic norepinephrine infusion during elective cesarean section under combined spinal–epidural anesthesia. Materials and Methods: After ethics committee approval, 102 parturients with full-term singleton pregnancies were randomly allocated to either 6% hydroxyethyl starch 130/0.4 5 mL/kg before the onset of spinal anesthesia (colloid preload group) or Ringer’s lactate solution 10 mL/kg concurrent with the subarachnoid injection (crystalloid co-load group). In both groups, norepinephrine 4 μg/min starting simultaneously with the administration of the subarachnoid solution was also administered. The primary outcome of the study was the incidence of maternal hypotension, defined as systolic arterial pressure (SAP) <80% of baseline. The incidence of severe hypotension (SAP < 80 mmHg), total dose of vasoconstrictive agents administered, as well as the acid–base status and Apgar score of the neonate and any incidence of maternal side effects were also recorded. Results: Data analysis was performed on 100 parturients: 51 in the colloid preload group and 49 in the crystalloid co-load group. No significant differences were demonstrated between the colloid preload group and the crystalloid co-load group in the incidence of hypotension (13.7% vs. 16.3%, p = 0.933) or the incidence of severe hypotension (0% vs. 4%, p = 0.238). The median (range) ephedrine dose was 0 (0–15) mg in the colloid preload group and 0 (0–10) mg in the crystalloid co-load group (p = 0.807). The incidence of bradycardia, reactive hypertension, requirement for modification of vasopressor infusion, time to the first occurrence of hypotension, and maternal hemodynamics did not differ between the two groups. There were no significant differences in other maternal side effects or neonatal outcomes between groups. Conclusions: The incidence of hypotension with a norepinephrine preventive infusion is low and comparable with both colloid preload and crystalloid co-load. Both fluid-loading techniques are appropriate in women undergoing cesarean delivery. It appears that the optimal regimen for prevention of maternal hypotension is a combined strategy of a prophylactic vasopressor such as norepinephrine and fluids. Full article
(This article belongs to the Special Issue Recent Advances in Obstetric Anesthesiology)
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10 pages, 254 KiB  
Article
Sufentanil vs. Dexmedetomidine as Neuraxial Adjuvants in Cesarean Section: A Mono-Centric Retrospective Comparative Study
by Antonio Coviello, Carmine Iacovazzo, Anella D’Abrunzo, Marilena Ianniello, Maria Grazia Frigo, Annachiara Marra, Pasquale Buonanno, Maria Silvia Barone, Giuseppe Servillo and Maria Vargas
J. Clin. Med. 2022, 11(22), 6868; https://doi.org/10.3390/jcm11226868 - 21 Nov 2022
Cited by 2 | Viewed by 2306
Abstract
Spinal anesthesia is the best choice for caesarean delivery. This technique is characterized by a complete and predictable nerve block with a fast onset and few complications. Several intrathecal adjuvants are used in order to improve the quality and duration of anesthesia and [...] Read more.
Spinal anesthesia is the best choice for caesarean delivery. This technique is characterized by a complete and predictable nerve block with a fast onset and few complications. Several intrathecal adjuvants are used in order to improve the quality and duration of anesthesia and reduce its side effects. Sixty-two patients who underwent caesarean delivery under spinal anesthesia were included in this medical records review. In this retrospective study, after adopting exclusion criteria, we assessed 24 patients who received Hyperbaric Bupivacaine 0.5% 10 mg and dexmedetomidine 10 μg (G1), and 28 patients who received an institutional standard treatment with Hyperbaric Bupivacaine 0.5% 10 mg and sufentanil 5 μg (G2). We evaluated the difference in terms of motor and sensory block, postoperative pain, and adverse effects during the first 24 h following delivery and neonatal outcome. Our study found that the sufentanil group had a significantly lower requirement for analgesia than the dexmedetomidine group. Postoperative pain, assessed with the VAS scale, was stronger in G1 than in G2 (4 ± 2 vs. 2 ± 1, p-value < 0.01). Differences between the two groups regarding the intraoperative degree of motor and sensory block, motor recovery time, and neonatal Apgar scores were not noticed. Pruritus and shivering were observed only in G2. Itching and shivering did not occur in the dexmedetomidine group. Postoperative analgesia was superior in the sufentanil group, but the incidence of side effects was higher. Adjuvant dexmedetomidine prevented postoperative shivering. Full article
(This article belongs to the Special Issue Recent Advances in Obstetric Anesthesiology)
11 pages, 832 KiB  
Article
Current Epidemiology of the General Anesthesia Practice for Cesarean Delivery Using a Nationwide Claims Database in Japan: A Descriptive Study
by Hiroshi Yonekura, Yusuke Mazda, Shohei Noguchi, Hironaka Tsunobuchi and Motomu Shimaoka
J. Clin. Med. 2022, 11(16), 4808; https://doi.org/10.3390/jcm11164808 - 17 Aug 2022
Cited by 4 | Viewed by 2023
Abstract
The current status of general anesthesia practice for cesarean delivery in Japan remains unknown. Therefore, using a nationwide claims database, we aimed to investigate general anesthesia use for cesarean delivery over a period of 15 years, and to analyze the general anesthesia practice [...] Read more.
The current status of general anesthesia practice for cesarean delivery in Japan remains unknown. Therefore, using a nationwide claims database, we aimed to investigate general anesthesia use for cesarean delivery over a period of 15 years, and to analyze the general anesthesia practice in Japan. Patients who claimed the Japanese general anesthesia claim code (L008) for cesarean delivery between 1 January 2005, and 31 March 2020, were analyzed. Primary endpoint was the prevalence of general anesthesia use. We used two definitions of general anesthesia: L008 code only (insurance definition) and combination of the L008 code with muscle relaxant use (clinical definition). The general anesthesia claim cohort (L008) included 10,972 cesarean deliveries at 1111 institutions from 2005 to 2020. Muscle relaxants were used in 27.3% of L008 claims cases. The rate of general anesthesia use for cesarean delivery ranged from 3.9% in clinical definition to 14.4% in insurance definition of all cesarean deliveries. We observed a temporal trend of gradual decrease in general anesthesia use, regardless of its definition (p for trend < 0.001). We recommend the clinical definition of general anesthesia as the combination of L008 code and muscle relaxant use in a claims-based approach. Full article
(This article belongs to the Special Issue Recent Advances in Obstetric Anesthesiology)
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7 pages, 304 KiB  
Article
Obstetric Anesthesia Practice in the Tertiary Care Center: A 7-Year Retrospective Study and the Impact of the COVID-19 Pandemic on Obstetric Anesthesia Practice
by Paweł Krawczyk, Remigiusz Jaśkiewicz, Hubert Huras and Magdalena Kołak
J. Clin. Med. 2022, 11(11), 3183; https://doi.org/10.3390/jcm11113183 - 02 Jun 2022
Cited by 5 | Viewed by 1928
Abstract
There are many benefits of neuraxial anesthesia (NA) in the obstetric population. We performed a retrospective analysis of anesthesia provided to obstetric patients in the tertiary care center between 1 January 2014 and 31 December 2020 and the influence of the COVID-19 pandemic [...] Read more.
There are many benefits of neuraxial anesthesia (NA) in the obstetric population. We performed a retrospective analysis of anesthesia provided to obstetric patients in the tertiary care center between 1 January 2014 and 31 December 2020 and the influence of the COVID-19 pandemic on anesthetic practice. A total of 15,930 anesthesia procedures were performed. A total of 2182 (17.52%) cesarean sections (CS) required general anesthesia (GA), including 383 (3.07%) of emergency conversion from NA. NA for CS consisted of 9971 (80.04%) spinal anesthesia (SA) and 304 (2.44%) epidural anesthesia (EPI). We found a decrease in the GA rate for CS in 2020 (11.87% vs. 14.81%; p < 0.001). The conversion rate from NA to GA for CS was 2.39% for SA and 31.38% for EPI. The conversion rate from labor EPI to SA for CS increased in 2020 (3.10% vs. 1.24%; p < 0.001), as well as the SA rate for other obstetric procedures (61.32%; p < 0.001). We report 2670 NA for vaginal delivery, representing 31.13% of all vaginal deliveries. NA constituted the vast majority of obstetric anesthesia. However, we report a relatively high incidence of GA. There was a decrease in GA use in the obstetric population during the pandemic. Further reduction in GA use is possible, including an avoidable conversion from NA to GA. Full article
(This article belongs to the Special Issue Recent Advances in Obstetric Anesthesiology)
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10 pages, 239 KiB  
Article
Epidural Catheterization in Obstetrics: A Checklist-Based Video Assessment of Free Available Video Material
by Armin N. Flinspach, Florian J. Raimann, Richard Schalk, Lena Bepler, Miriam Ruesseler, Mairen H. Flinspach, Kai Zacharowski and Jasmina Sterz
J. Clin. Med. 2022, 11(6), 1726; https://doi.org/10.3390/jcm11061726 - 20 Mar 2022
Cited by 3 | Viewed by 1918
Abstract
Epidural catheterization has become an indispensable part of modern pain therapy, for example, in obstetrics. Learning how to master this skill is an important competency. Videos are among the information sources with the highest information content for learning such skills. The present study [...] Read more.
Epidural catheterization has become an indispensable part of modern pain therapy, for example, in obstetrics. Learning how to master this skill is an important competency. Videos are among the information sources with the highest information content for learning such skills. The present study aims to analyze videos regarding epidural catheter placement provided on the YouTube platform based on a validated checklist. An expert workshop selected crucial items for learning epidural catheterization in obstetrics. Items were identified and optimized in a five-step testing process. Using this checklist, videos from YouTube were evaluated by eleven health care professionals. Sixteen videos were identified and analyzed. Concerning the catheterization-specific part of the checklist, only two videos showed satisfactory quality. In the didactic part, eleven out of 21 items reached a mean score >50% of the points. Regarding interrater reliability, the catheterization-specific checklist was shown to be substantial (Fleiss’ kappa = 0.610), and the didactic part was shown to be fair (Fleiss’ kappa = 0.401). Overall, standard monitoring and appropriate aseptic technique were followed in only 42% and 49% for the procedure. There was a significant correlation between the runtime and the content quality (p < 0.001). No correlation could be found in terms of platform rating parameters. The video quality varied highly in terms of the requirements of this practical skill. The majority appear unsuitable for self-study due to serious errors and deficiencies regarding patient safety. However, there is no quality control on free platforms. Accordingly, it is difficult to identify suitable videos for educational purposes. Full article
(This article belongs to the Special Issue Recent Advances in Obstetric Anesthesiology)
8 pages, 249 KiB  
Article
Sedation with Propofol plus Paracetamol in External Cephalic Version: An Observational Study
by Javier Sánchez-Romero, Jesús López-Pérez, Ana Belén Flores-Muñoz, María Josefa Méndez-Martínez, Fernando Araico-Rodríguez, Jaime Mendiola-Olivares, José Eliseo Blanco-Carnero, Luis Falcón-Araña, Aníbal Nieto-Díaz and María Luisa Sánchez-Ferrer
J. Clin. Med. 2022, 11(3), 489; https://doi.org/10.3390/jcm11030489 - 19 Jan 2022
Cited by 1 | Viewed by 1512
Abstract
Although the influence of neuraxial anesthesia or sedation with remifentanil in external cephalic version (ECV) is widely known, ECV results using propofol have not been previously analyzed. This study aimed to evaluate ECV outcomes when propofol was used. An observational analysis of ECV [...] Read more.
Although the influence of neuraxial anesthesia or sedation with remifentanil in external cephalic version (ECV) is widely known, ECV results using propofol have not been previously analyzed. This study aimed to evaluate ECV outcomes when propofol was used. An observational analysis of ECV was performed between 1 January 2018 and 31 December 2020. ECV was accomplished with tocolysis and propofol. One hundred and thirty-one pregnant women were recruited. The propofol mean dose was 156.1 mg (SD 6.1). A cephalic presentation was achieved in 61.1% (80/131) of the pregnant women. In total, 56.7% (38/67) of pregnant women with cephalic presentation at labor had a spontaneous delivery, 26.9% (18/67) had an operative delivery, and an intrapartum urgent cesarean section was performed in 16.4% (11/67). In total, 46 pregnant women (35.9%) were scheduled for an elective cesarean section due to non-cephalic presentation. The emergency cesarean section rate during the following 24 h was 10.7% (14/131). A major ECV complication arose in 15 cases (11.5%). ECV outcomes when propofol was used seems to be similar to those with other anesthetic adjunct, so sedation with propofol could be an adequate option for ECV. More studies are needed to compare its effectiveness with neuraxial techniques. Full article
(This article belongs to the Special Issue Recent Advances in Obstetric Anesthesiology)
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