89 research outputs found
Labor analgesia: An update on the effect of epidural analgesia on labor outcome
No full textFollowing the introduction of epidural for labor analgesia, debate has centered on the issue of its effect on outcome of labor; in terms of length of labor and increase in the rate of instrumental vaginal delivery and cesarean section (CS). There is no ideal study on the effect of epidural analgesia (EA) on the outcome of labor due to logistic problems in randomization, blinding and getting a control group; as a result these queries are partly answered. Despite these problems, it has been established that labor epidural has minimal effect on progress of established labor and maternal request should be a sufficient indication to start an epidural. Although instrumental vaginal delivery is probably increased with epidural but obstetrician practice, pain free patient and teaching opportunity are likely factors increasing the incidence. Maternal-fetal factors and obstetric management and not the use of EA are the most important determinants of the CS rate. The purpose of this review is to summarize data from controlled trials addressing the question of whether neuraxial labor analgesia causes an increased risk of CS or rate of instrumental delivery. In addition, the review discusses whether the timing of initiation of analgesia infl uences the mode of delivery
Multimodal analgesia for cesarean section: Evolving role of transversus abdominis plane block
No full textManagement of parturient with triplet pregnancy and placenta percreta: Importance of multi-disciplinary approach
No full textObstetric conditions like placenta percreta and multiple pregnancies can be extremely challenging as they pose a high risk for both the mother and infants. In placenta percreta, placental villi penetrate through the wall of uterus into the surrounding organs including the bladder and carry a risk of massive maternal bleeding. Multiple pregnancies have greater complication rate than that in singleton pregnancy. Successful management of such challenges are best done by a multidisciplinary teamwork, where all members of a perinatal team are involved in decision making and management. We report the successful management of a triplet gestation associated with placenta percreta
Perfect recipes for obstetric anesthesia: Need of caution in the resource constraint environment
No full textEnhanced recovery after cesarean delivery & role of anesthesiologists: A narrative review
No full textEnhanced recovery after cesarean delivery (ERAC) is an evidence-based interdisciplinary protocol with an aim to improve quality of care and patient satisfaction while lowering health care cost by reducing length of hospital stay. It is an approach that combines several evidence-based perioperative care components to hasten patient recovery. ERAC uses multidisciplinary approach with inclusion of all stakeholders including anesthesiologists, obstetricians, pediatricians, nurses, pharmacists, patients, and hospital administration. Therefore, institutional support, local infrastructure, and compliance of all supporting systems are necessary for the successful implementation of ERAC. The role of anesthesiologists in implementation of standardized care cannot be disregarded as they are involved in the provision of perioperative services to improve maternal outcomes and healthcare quality. The purpose of this narrative review is to explore the components and guidelines from the enhanced recovery after surgery for caesarean delivery, highlight the responsibility of anesthesiologists in the existing and emerging ERAC programs and the difficulties associated with implementing the ERAC in resource-constrained environments
Medical errors related to look-alike and sound-alike drugs
No full textDespite recent developments in the inventory management, introduction of electronic drug trolleys and cabinets, color coding of the filled syringes and many more interventions, medication errors could not be eliminated. The most common of these are syringe swap and human errors regarding wrong drug administration due to look-alike drug containers or sound-alike names of the drugs belonging to diverse groups. Many of the fatalities, that occur in third world countries due to these causes, go unnoticed and unregistered. This special article complements two special editorials on the same topic by Professor Joseph D. Tobias et al and Professor Robert Stoelting, a case report, a patient’s perspective and a ‘Cliniquiz’ being published in the current issue of the journal. It discusses salient features of this issue as well as preventive measures and recommendations. Key words: Medications; Medications errors; Adverse drug events; Look-alike drugs; Sound-alike drugs Tall man lettering; Medication Errors Reporting Program; Anesthesia Patient Safety Foundation Citation: Ismail S and Taqi A. Medical errors related to look-alike and sound-alike drug
Observational study to assess the effectiveness of postoperative pain of patients undergoing elective cesarean section
No full textBackground: The study was designed to assess the strategy, effectiveness, and safety of postoperative pain management inpatients undergoing elective cesarean section in the obstetric unit of our hospital.Materials and Methods: Patients having elective cesarean section from December 2008 to May 2009 were included in thisobservational study. We recorded patient’s demographics, postoperative pain orders, and analgesia regime on the day of surgery.Anesthesia team, which included one of the investigators, assessed the overall pain since the time of surgery by visual analoguescale (VAS) and also recorded any complications since the time of surgery and patients’ satisfaction with the pain management.Results: A total of 263 patients were reviewed during the study period. Postoperative analgesia regime was started by theobstetric team in 81% of patients and in rest by the anesthesia team. The common modality of pain management was intravenousopioid infusion (94%) and coanalgesia was used in 99% of patients. The analysis of pain at rest by VAS was between 1 and3 in 89.7%, 4 and 6 in 9.5%, and 7 and 10 in 0.8% of patients. The VAS on movement was 1–3 in 60.1%, 4–6 in 33.1%, and7–10 in 6.8% of patients. Patients’ opinion regarding postoperative pain management was satisfactory in 91.6% of patientsand unsatisfactory in 8.4% of patients. Overall, 9% of patients had minor complications, which responded well to treatment.Conclusion: The regime for postoperative pain management was mostly started and followed by the obstetric team at thehospital. Although the postoperative pain management was adequate in terms of patients’ safety, it was not effective accordingto the goal set by Joint Commission on Accreditation of uniformly low pain score of not more than 3 out of 10 both at rest andwith movement
Response to the letter for the article - Observational study to assess the effectiveness of postoperative pain management of patients undergoing elective caesarean section
No full textUse of transversus abdominis plane block as an anesthetic technique in a high risk patient for abdominal wall surgery
No full textTransversus abdominis plane (TAP) block produces a reversible blockade of peripheral nerves that provides sensation to the lower abdominal wall from T9 to L1. It has been successfully used as a part of postoperative multimodal analgesia in abdominal surgery since 2001, but its role as a sole anesthetic agent has not been define
Incidence of cesarean section and analysis of risk factors for failed conversion of labor epidural to surgical anesthesia: A prospective, observational study in a tertiary care center
No full textBackground and Aims: This study aimed to analyze the effect of labor epidural (LE) on the incidence of cesarean section (CS) and assess the risk factors involved in failed conversion of LE to surgical anesthesia for CS.
Material and Methods: A prospective observational study of 18 months from January 2012 to June 2013 was conducted on all patients who had delivered in the labor room suit of our hospital. The data collected for all 4694 patients included their demographics, parity and mode of delivery. In addition a predesigned proforma, with additional information was used for 629 parturient with LE.
Results: During the study period, total numbers of deliveries performed in our hospital were 4694, with an epidural rate of 13.4% (629/4694). No significant difference (P = 0.06) was observed in the rate of CS among women with or without LE (28 % [n = 176/629] vs. 31.7 % [n = 1289/4065]), however, a statistically significant difference (P < 0.01) was observed in the rate of assisted delivery in patients receiving LE as compared to those delivering without it (8.7% [n = 55/629] vs. n = 3.7% [154/4065]).
For 176 patients requiring CS, LE utilization for surgical anesthesia was 52.8% (93/176) and factors identified for not utilizing LE in 47% (83/176) were; failure to achieve surgical anesthesia in 6.8% (12/176), emergency CS in 28.4% (50/176), patient preference in 6.8% (12/176) and inadequate labor pain relief with LE in 5.1% (9/176) patients. Non-obstetric anesthesiologists were involved in 59% (49/83) of cases where LE was not used for CS.
Conclusion: LE had no effect on the rate of CS; however it significantly increased (P < 0.01) the rate of assisted delivery. Factors like inadequate LE, emergency situations and non-obstetric anesthesiologists can all be responsible for failed conversion of LE to surgical anesthesia for CS
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