scholarly journals Intravenous Dexmedetomidine as an Adjunct to Neuraxial Anesthesia in Cesarean Delivery: A Retrospective Chart Review

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Paul R. Davis ◽  
Hans P. Sviggum ◽  
Daniel J. Delaney ◽  
Katherine W. Arendt ◽  
Adam K. Jacob ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Cesarean Delivery ◽  
Retrospective Chart Review ◽  
Obstetric Anesthesia ◽  
Similar Rate ◽  
Neuraxial Anesthesia ◽  
Standard Group ◽  
Rescue Analgesia ◽  
The Mean

Background. Dexmedetomidine is a selective α-2 agonist commonly used for sedation that has been used in obstetric anesthesia for multimodal labor analgesia, postcesarean delivery analgesia, and perioperative shivering. This study evaluated the role of intravenous dexmedetomidine to provide rescue analgesia and/or sedation during cesarean delivery under neuraxial anesthesia. Methods. We conducted a single-center, retrospective cohort study of all parturients undergoing cesarean delivery under neuraxial anesthesia between December 1, 2018, and November 30, 2019, who required supplemental analgesia during the procedure. Patients were divided into two groups: patients who received intravenous dexmedetomidine (Dexmed group) and patients who received adjunct medications such as fentanyl, midazolam, ketamine, and nitrous oxide (Standard group). Primary outcome was incidence of conversion to general anesthesia. Results. During the study period, 107 patients received adjunct medications. There was no difference in conversion to general anesthesia between the Dexmed group and the Standard group (6% (4/62) vs. 9% (4/45); p = 0.718 ). In the Dexmed group, the mean dexmedetomidine dose received was 37 μg (range 10 to 140 μg). While the use of inotropic/vasopressor medications was common and similar in both groups, there was an increase in the incidence of bradycardia (Dexmed 15% vs. Standard 2%; p = 0.042 ) but not hypotension (Dexmed 24% vs. Standard 24%; p = 1.00 ) in the Dexmed group. Conclusion. In patients who required supplemental analgesia for cesarean delivery, those who received dexmedetomidine versus other medications had a similar rate of conversion to general anesthesia, a statistically significant increase in bradycardia, but no difference in the incidence of hypotension.

scholarly journals Anesthetic management in cesarean delivery of women with placenta previa: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dazhi Fan ◽  
Jiaming Rao ◽  
Dongxin Lin ◽  
Huishan Zhang ◽  
Zixing Zhou ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Transfusion ◽  
Blood Loss ◽  
General Anesthesia ◽  
Cesarean Delivery ◽  
Retrospective Cohort ◽  
Placenta Previa ◽  
Neuraxial Anesthesia ◽  
Estimated Blood Loss ◽  
Maternal And Neonatal Outcomes

Abstract Background The incidence of placenta preiva is rising. Cesarean delivery is identified as the only safe and appropriate mode of delivery for pregnancies with placenta previa. Anesthesia is important during the cesarean delivery. The aim of this study is to assess maternal and neonatal outcomes of patients with placenta previa managed with neuraxial anesthesia as compared to those who underwent general anesthesia during cesarean delivery. Methods A retrospective cohort study was performed of all patients with placenta preiva at our large academic institution from January 1, 2014 to June 30, 2019. Patients were managed neuraxial anesthesia and general anesthesia during cesarean delivery. Results We identified 1234 patients with placenta previa who underwent cesarean delivery at our institution. Neuraxial anesthesia was performed in 737 (59.7%), and general anesthesia was completed in 497 (40.3%) patients. The mean estimated blood loss at neuraxial anesthesia of 558.96 ± 42.77 ml were significantly lower than the estimated blood loss at general anesthesia of 1952.51 ± 180 ml (p < 0.001). One hundred and forty-six of 737 (19.8%) patients required blood transfusion at neuraxial anesthesia, whereas 381 out of 497 (76.7%) patients required blood transfusion at general anesthesia. The rate neonatal asphyxia and admission to NICU at neuraxial anesthesia was significantly lower than general anesthesia (2.7% vs. 19.5 and 18.2% vs. 44.1%, respectively). After adjusting confounding factors, blood loss was less, Apgar score at 1- and 5-min were higher, and the rate of blood transfusion, neonatal asphyxia, and admission to NICU were lower in the neuraxial group. Conclusions Our data demonstrated that neuraxial anesthesia is associated with better maternal and neonatal outcomes during cesarean delivery in women with placenta previa.

scholarly journals Anesthesiologist Specialization and Use of General Anesthesia for Cesarean Delivery

2019 ◽  
Vol 130 (2) ◽  
pp. 237-246 ◽  
Author(s):  
Benjamin T. Cobb ◽  
Meghan B. Lane-Fall ◽  
Richard C. Month ◽  
Onyi C. Onuoha ◽  
Sindhu K. Srinivas ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Cesarean Delivery ◽  
Subgroup Analysis ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Medical Center ◽  
Academic Medical Center ◽  
Obstetric Anesthesia ◽  
Epidural Block ◽  
Cesarean Deliveries

AbstractEditor’s PerspectiveWhat We Already Know about This TopicWhat This Manuscript Tells Us That Is NewBackgroundGuidelines for obstetric anesthesia recommend neuraxial anesthesia (i.e., spinal or epidural block) for cesarean delivery in most patients. Little is known about the association of anesthesiologist specialization in obstetric anesthesia with a patient’s likelihood of receiving general anesthesia. The authors conducted a retrospective cohort study to compare utilization of general anesthesia for cesarean delivery among patients treated by generalist versus obstetric-specialized anesthesiologists.MethodsThe authors studied patients undergoing cesarean delivery for live singleton pregnancies from 2013 through 2017 at one academic medical center. Data were extracted from the electronic medical record. The authors estimated the association of anesthesiologist specialization in obstetric anesthesia with the odds of receiving general anesthesia for cesarean delivery.ResultsOf the cesarean deliveries in our sample, 2,649 of 4,052 (65.4%) were performed by obstetric-specialized anesthesiologists, and 1,403 of 4,052 (34.6%) by generalists. Use of general anesthesia differed for patients treated by specialists and generalists (7.3% vs. 12.1%; P &lt; 0.001). After adjustment, the odds of receiving general anesthesia were lower among patients treated by obstetric-specialized anesthesiologists among all patients (adjusted odds ratio, 0.71; 95% CI, 0.55 to 0.92; P = 0.011), and in a subgroup analysis restricted to urgent or emergent cesarean deliveries (adjusted odds ratio, 0.75; 95% CI, 0.56 to 0.99; P = 0.049). There was no association between provider specialization and the odds of receiving general anesthesia in a subgroup analysis restricted to evening or weekend deliveries (adjusted odds ratio, 0.76; 95% CI, 0.56 to 1.03; P = 0.085).ConclusionsTreatment by an obstetric anesthesiologist was associated with lower odds of receiving general anesthesia for cesarean delivery; however, this finding did not persist in a subgroup analysis restricted to evening and weekend deliveries.

scholarly journals The Role of Antioxidants in the Treatment of Congenital CMV-Related Hearing: A Case-Control Study

OTO Open ◽  
2019 ◽  
Vol 3 (2) ◽  
pp. 2473974X1984185 ◽  
Author(s):  
Hilary McCrary ◽  
Veronica del Calvo ◽  
Jeremy Purser ◽  
Geoff Casazza ◽  
Albert Park
Keyword(s):  
Hearing Loss ◽  
Case Control Study ◽  
Retrospective Chart Review ◽  
Case Control ◽  
Antioxidant Therapy ◽  
Hearing Thresholds ◽  
The Mean ◽  
The Right ◽  
Control Study

Objective Antioxidants have been used as a therapeutic measure for several causes of hearing loss, and this study aims to examine the use of antioxidants in children with congenital cytomegalovirus (cCMV)–related hearing loss. Study Design Case-control study. Setting Academic pediatric hospital. Subjects and Methods A retrospective chart review of pediatric patients with cCMV-related hearing loss treated with and without antioxidants (vitamins A, C, and E and magnesium, known as ACE-Mg) was completed. The primary end point was the mean change in hearing thresholds for the right and left ears after therapy. An evaluation of the mean change in thresholds was evaluated at the following frequencies: 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz. A 2-sample t test and multiple linear regression were used to evaluate the data. Results A total of 78 children with cCMV-related hearing loss were included in the study, of whom 10 were treated with antioxidants. The average amount of time in which antioxidants were taken was 387 days. When comparing cases and controls, there was no differences in the mean change of hearing thresholds at each frequency for both the right and left ears ( P > .05). Length of antioxidant therapy and age at which therapy was initiated had no effect on hearing scores ( P > .05). Conclusions Oxidative stress plays a role in the pathogenesis of cCMV-related hearing loss. ACE-Mg is a safe adjuvant therapy for the treatment of hearing loss in children; however, this study demonstrates no hearing-related benefit from ACE-Mg antioxidant therapy.

scholarly journals 2786. The Role of Respiratory Panel PCR in Decreasing Antibiotic Exposure in Patients Diagnosed With a Respiratory Viral Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S984-S984
Author(s):  
Alexander Vostal ◽  
Michael Antonio Gonzalez ◽  
Nellie Darling ◽  
Christine Papastamelos ◽  
Madhuri Natarajan ◽  
...  
Keyword(s):  
Viral Infections ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Antibiotic Exposure ◽  
Duration Of Treatment ◽  
Bacterial Cultures ◽  
Antibiotic Duration ◽  
The Mean ◽  
Student’S T

Abstract Background Respiratory viral infections (RVI) are becoming increasingly recognized as an important cause of pneumonia. There is limited data regarding the role of rapid PCR testing for RVI and its effect on antibiotic duration and length of stay (LOS). Methods We performed a single-center, retrospective chart review in adult patients who were admitted and underwent evaluation with the FilmArray Multiplex Respiratory Panel (RP) (Biomerieux™) using a random sample from July 1, 2016 through April 1, 2018. Patient clinical and virologic characteristics, LOS, antibiotic use, and duration of treatment were collected. A Student’s t-test was performed for all comparisons. Results We identified 540 patients who were admitted and underwent RP testing. The mean age was 57.1 years (range 19–99), 50.2% were immunocompromised, 23.8% were transplant recipients, 70.4% had respiratory symptoms, and 35.7% had an admitting diagnosis of pneumonia. 55.6% required supplemental O2 and 24.6% had an ICU admission that required either noninvasive or mechanical ventilation. 22.6% (N = 122) of these patients were diagnosed with an RVI, of which 15 were co-infected with two or more respiratory viruses. There were 41 (34%) rhinovirus/enterovirus, 41 (34%) influenza (Types A/H1, A/H3, A/H1-2209, and B), 16 (13%) RSV, 15 (12%) coronavirus (Types NL63, OC43, 229E, and HKU1), 13 (11%) metapneumovirus, and 7 (5%) parainfluenza (Types 2, 3, and 4). 85.2% (104/122) of patients with an RVI received antibiotics. The mean LOS and antibiotic duration were 9.07 days and 7.31 days for patients with an RVI when compared with 11.5 days and 10.4 days for patients without an RVI (P = 0.098; P = 0.032), respectively. In patients with an RVI and negative bacterial cultures, the mean LOS was 8.4 days and mean antibiotic duration was 5.9 days when compared with 16.4 days and 15.5 days for all patients with positive bacterial cultures (P = 0.003; P < 0.0001), respectively. The mean time from available results of + RP to antibiotic discontinuation was 5.1 days in the setting of negative bacterial cultures. Conclusion Although antibiotic exposure and time to discontinuation still remained significant in patients diagnosed with an RVI, there was a marked reduction in LOS and antibiotic duration in the subset of patients with an RVI and negative bacterial cultures. Disclosures All authors: No reported disclosures.

Adverse Events and Factors Associated with Potentially Avoidable Use of General Anesthesia in Cesarean Deliveries

2019 ◽  
Vol 130 (6) ◽  
pp. 912-922 ◽  
Author(s):  
Jean Guglielminotti ◽  
Ruth Landau ◽  
Guohua Li
Keyword(s):  
Adverse Events ◽  
General Anesthesia ◽  
Cesarean Delivery ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Neuraxial Anesthesia ◽  
General Anesthetics ◽  
Factors Associated ◽  
Increased Risk ◽  
Anesthesia Complications

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Compared with neuraxial anesthesia, general anesthesia for cesarean delivery is associated with increased risk of maternal adverse events. Reducing avoidable general anesthetics for cesarean delivery may improve safety of obstetric anesthesia care. This study examined adverse events, trends, and factors associated with potentially avoidable general anesthetics for cesarean delivery. Methods This retrospective study analyzed cesarean delivery cases without a recorded indication for general anesthesia or contraindication to neuraxial anesthesia in New York State hospitals, 2003 to 2014. Adverse events included anesthesia complications (systemic, neuraxial-related, and drug-related), surgical site infection, venous thromboembolism, and the composite of death or cardiac arrest. Anesthesia complications were defined as severe if associated with death, organ failure, or prolonged hospital stay. Results During the study period, 466,014 cesarean deliveries without a recorded indication for general anesthesia or contraindication to neuraxial anesthesia were analyzed; 26,431 were completed with general anesthesia (5.7%). The proportion of avoidable general anesthetics decreased from 5.6% in 2003 to 2004 to 4.8% in 2013 to 2014 (14% reduction; P &lt; 0.001). Avoidable general anesthetics were associated with significantly increased risk of anesthesia complications (adjusted odds ratio, 1.6; 95% CI, 1.4 to 1.9), severe complications (adjusted odds ratio, 2.9; 95% CI, 1.6 to 5.2), surgical site infection (adjusted odds ratio, 1.7; 95% CI, 1.5 to 2.1), and venous thromboembolism (adjusted odds ratio, 1.9; 95% CI, 1.3 to 3.0), but not of death or cardiac arrest. Labor neuraxial analgesia rate was one of the most actionable hospital-level factors associated with avoidable general anesthetics. Relative to hospitals with a rate greater than or equal to 75%, the adjusted odds ratio of avoidable general anesthetics increased to 1.3 (95% CI, 1.2 to 1.4), 1.6 (95% CI, 1.5 to 1.7), and 3.2 (95% CI, 3.0 to 3.5) as the rate decreased to 50 to 74.9%, 25 to 49.9%, and less than 25%, respectively. Conclusions Compared with neuraxial anesthesia, avoidable general anesthetics are associated with increased risk of adverse maternal outcomes.

Distribution of blood flow in normal and arthritic joints. Role of arteriovenous shunting studied in growing dogs

1992 ◽  
Vol 262 (1) ◽  
pp. H38-H46 ◽  
Author(s):  
E. Stender Hansen ◽  
S. Z. He ◽  
V. E. Hjortdal ◽  
D. Kjolseth ◽  
K. Soballe
Keyword(s):  
Blood Flow ◽  
General Anesthesia ◽  
Relative Distribution ◽  
Arteriovenous Shunting ◽  
Growth Plates ◽  
Absolute Flow ◽  
The Mean ◽  
The Relationship ◽  
Arthritic Joints

Juvenile dog knee with chronic carrageenin-induced arthritis was studied under general anesthesia with 15-microns and 50-microns-sized microspheres (MS) to compare the distribution of absolute and weight-standardized blood flow in normal and arthritic limbs and to localize possible sites of arteriovenous (AV) shunting. Arthritic joints had severe synovial and capsular hyperemia. Absolute as well as standardized blood flow was increased in juxta-articular epiphyses and patella. Shafts were atrophic and had decreased absolute flow but normal standardized flow. However, redistribution of blood flow occurred among regions within the shafts, e.g., in metaphyses away from growth plates. The mean nonentrapment of 15-microns MS was 13.8% in arthritic limbs and 4.2% in control limbs. The uptake of 50-microns MS was lower than that of 15-microns MS in all bony flow compartments due to differences in their rheologic behavior in larger arteries. The relative distribution of 50-microns MS and 15-microns MS varied considerably among regions within bone. Arthritis caused a net shift in the uptake of 50-microns MS relative to that of 15-microns MS from central to subchondral epiphyseal bone, evidencing precapillary vasodilation, but the relationship was strictly unchanged when bones were examined in toto. This result militates against the hypothesis of AV shunting in arthritic bone.

scholarly journals The Role of Oncofertility Clinics in Facilitating Access to Reproductive Specialists

2016 ◽  
Vol 3 (4) ◽  
pp. 131-136 ◽  
Author(s):  
Eduardo Hariton ◽  
Pietro Bortoletto ◽  
Eden R Cardozo ◽  
Ephraim P Hochberg ◽  
Mary E Sabatini
Keyword(s):  
Massachusetts General Hospital ◽  
Retrospective Chart Review ◽  
Final Analysis ◽  
Cancer Center ◽  
The Mean ◽  
Reproductive Aged Women ◽  
The Impact ◽  
Patient Referrals ◽  
Mean Time

Purpose: To determine the impact of the establishment of a dedicated oncofertility clinic on the frequency of patient referrals for fertility preservation (FP) consultation and the time from patient referral to consultation. Methods: A retrospective chart review of all women aged 21 to 44 years with an active cancer diagnosis who were referred for FP consultation from 2011 to 2015. Results: A total of 6895 female patients eligible for FP were seen at the Massachusetts General Hospital (MGH) Cancer Center. Of those eligible, a total of 209 patients were referred for FP consultation with 150 included in the final analysis. Since the establishment of the oncofertility clinic, the mean time to nonemergent consultation with a reproductive endocrinologist decreased by 27%, from 10.4 to 7.6 days ( P = .03). Furthermore, the proportion of reproductive-aged females seen at the MGH Cancer Center referred for FP consultation increased from 1.7% to 3.0% ( P < .01). Conclusion: A dedicated oncofertility clinic increases physician referrals for FP and decreases the mean time to consultation, improving access to FP consultation for reproductive-aged women with cancer.

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