Complications in obstetric anaesthesia

Maronge, L.; Bogod, David

doi:10.1111/anae.14141

Cited by 54 publications

(44 citation statements)

References 26 publications

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“…Anaesthetic capacity is extremely limited in Uganda, with currently approximately 70 physician anaesthetists and 430 non‐physician anaesthetists serving a population of almost 40 million . The field of anaesthesia encompasses not simply the delivery of intra‐operative anaesthesia but also pain control, critical care and improvement of peri‐operative safety . The use of ultrasound‐guided regional anaesthesia may both stimulate professional development, and allow anaesthetists to engage with their surgical and nursing colleagues to promote analgesia beyond the operating room.…”

Section: Discussionmentioning

confidence: 99%

The analgesic effects of intrathecal morphine in comparison with ultrasound‐guided transversus abdominis plane block after caesarean section: a randomised controlled trial at a Ugandan regional referral hospital

et al. 2018

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Both transversus abdominis plane block and intrathecal morphine may produce prolonged postoperative analgesia, but the respective clinical outcomes of these anaesthetic techniques in resource-limited settings are not well described. We randomly assigned patients undergoing caesarean section to receive a hyperbaric bupivacaine (10 mg) spinal anaesthetic followed by an ultrasound-guided transversus abdominis plane block, or a hyperbaric bupivacaine (10 mg) spinal anaesthetic with 100 mcg intrathecal morphine, followed by a postoperative sham block. Supplemental postoperative analgesia included self-administered oral diclofenac 50 mg and paracetamol 1 g every 8 h. Numerical pain rating scores, the need for rescue medication, sideeffects and patient satisfaction were recorded at 8, 16 and 24 h. We enrolled a total of 130 patients, with 65 women in each group. The mean numerical rating score for intrathecal morphine vs. transversus abdominis plane blocks at 8 h were: at rest, 2.5 vs. 3.1 (p = 0.04); with coughing, 4.3 vs. 4.8 (p = 0.07); and with movement, 3.6 vs. 4.2 (p = 0.06). At 16 h, respective scores were: 2.9 vs. 3.1 (p = 0.40) at rest; 4.0 vs. 4.3 (p = 0.19) with coughing; and 4.8 vs. 5.0 (p = 0.33) with movement. At 24 h, the respective scores were: 2.9 vs. 2.3 (p = 0.01); 4.6 vs. 4.2 (p = 0.04) with coughing; and 3.9 vs. 3.4 (p = 0.02) with movement. The need for rescue medication and the incidence of pruritis, sedation and nausea and vomiting were similar in both groups. Patient satisfaction with pain control was similar in both groups, with the majority of patients reporting satisfaction as good or excellent. Intrathecal morphine and transversus abdominis plane block provided clinically similar outcomes for pain relief after caesarean section.

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Section: Discussionmentioning

confidence: 99%

The analgesic effects of intrathecal morphine in comparison with ultrasound‐guided transversus abdominis plane block after caesarean section: a randomised controlled trial at a Ugandan regional referral hospital

et al. 2018

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“…Neuraxial techniques remain the ‘gold standard’ for most obstetric anaesthetic indications yet, as our reports illustrate, rare and potentially serious complications can result from their use . Shields et al.…”

Section: Obstetric Anaesthesiamentioning

confidence: 86%

Reports in anaesthesia come of age!

Dalay

Guris

Shelton³

et al. 2019

Anaesthesia Reports

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In March 2019, Anaesthesia Reports, known previously as Anaesthesia Cases, launched with the publication of five new case reports. As a new online-only journal, we have implemented a continuous publication model where new reports appear online shortly following acceptance and are included in an issue. This allows rapid publication as soon as an article has been peer reviewed, revised, accepted, edited and typeset. We publish two issues each year, and our first issue includes 17 excellent new reports. Each report serves some novelty, educational value or interest to our readership. In this editorial we highlight the key clinical learning points from the first issue of the new Anaesthesia Reports format, which is the seventh issue since the inception of Anaesthesia Cases. Airway managementAwake nasal intubation with a flexible bronchoscope remains a safe procedure with a high success rate [1]. However, nasal tracheal tubes may not be the best option for mechanical ventilation in critical care and there may be several indications for a tracheal tube exchange procedure. Saunders et al. are the first to describe a novel approach to videolaryngoscope-assisted flexible intubation tracheal tube exchange, which, using a combination of several simple techniques, ensures the airway remains secure and visible throughout [2]. They provide an excellent recipe to navigate this challenging scenario which will be of use to all clinicians. Apnoeic oxygenation was first described in 1667, but only now are we beginning to understand its underlying physiology and clinical applications [3]. This has probably increased our familiarity with high-flow nasal oxygen, which is increasingly used for self-ventilating patients in several settings. Sodha and Fernandez are the first to describe its use in combination with deep intravenous sedation for a patient with obstructive sleep apnoea requiring surgery in the prone position [4]. As well as sparking significant debate among our readership, some commented that they have seen similar techniques used in past [5] which emphasises that case reports are worth writing. If your case is novel, educational and interesting, we will consider publishing it.Milne et al. provide a detailed description of their decision-making, as well as the relevant evidence, for how best to secure the airway of a patient with a laryngeal fracture and worsening laryngeal oedema following blunt neck trauma [6]. The associated discussion highlights how the principles of advanced airway management, such as awake tracheal intubation (ATI), are best taught and discussed when dissociated from general anaesthesia. Finally, the debate about the best technique for ATI continues, and the new Difficult Airway Society ATI guidelines are eagerly anticipated [7,8].

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“…Although post‐dural puncture headache after neuraxial anaesthesia may be one of the differential diagnoses, the report highlights ‘red flag’ headache symptoms that should alert the anaesthetist and other healthcare staff of the need for specialist review and imaging . These include sudden and severe onset, additional unusual symptoms (e.g.…”

Section: Other Lessonsmentioning

confidence: 99%