Obstetric Anesthesiologists as Perioperative Physicians: Improving Peripartum Care and Patient Safety

Moaveni, Daria M.; Cohn, Jennifer; Zahid, Zahira; Ranasinghe, J. Sudharma

doi:10.1007/s40140-014-0094-1

Cited by 5 publications

(4 citation statements)

References 99 publications

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“…For marginalized populations, that have often experienced systemic stigmatization to varying degrees, this demands avoidance of further structural traumatization. 10,41 The obstetric anesthesiologist, as a peripartum physician, 42 can have a profound impact on a patient's birth experience. We have a responsibility to advocate for inclusive forms and policies, as well as to actively discourage heteronormativity in a realm that is all too easily centred on just that.…”

Section: Discussionmentioning

confidence: 99%

Sexual and gender minorities educational content within obstetric anesthesia fellowship programs: a survey

MacCormick

George

2020

Can J Anesth/J Can Anesth

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Section: Discussionmentioning

confidence: 99%

Sexual and gender minorities educational content within obstetric anesthesia fellowship programs: a survey

MacCormick

George

2020

Can J Anesth/J Can Anesth

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“…Timing of these medications can impact the available options. Thus, concurrent comorbidities and disease severity require a flexible approach to optimal individualized labor analgesia [ 6 ].…”

Section: Pre-admission Obstetric Anesthesiologist Consultationmentioning

confidence: 99%

Update on Non-neuraxial Labor Analgesia

Karol

Weiniger

2021

Curr Anesthesiol Rep

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Purpose of Review This review will present recent updates for the use of non-neuraxial analgesia for laboring women. Recent Findings Non-neuraxial labor analgesia by nitrous oxide and intravenous opioids are described, and safety concerns with regard to remifentanil administration have been a major focus of recent studies. Fentanyl and nitrous oxide offer some efficacy, albeit less than remifentanil, however with a greater safety margin. Summary Women may request or require alternatives to neuraxial labor analgesia, in some cases due to concurrent comorbidities. Remifentanil offers the most efficacious alternative analgesia option; however, safety concerns may preclude widespread use.

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“…Nine years later, in 2019, there is again an urgent need to advocate for the inclusion of pregnant women and sex equity in peri‐operative medicine research and clinical practice . As a collaborative team with obstetricians, midwives and physicians, anaesthetists need to change our thinking from the antenatal period being one of passive bystanding, to it being a crucial peri‐operative period in which we are active participants in the peri‐operative management of pregnant women . As a collaborative group we also need to change our approach to childbirth in the light of caesarean section surgery being an essential surgical operation.…”

Section: The Parrcel Approach To Maternal Peri‐operative Medicinementioning

confidence: 99%

Sex, suffering and silence – why peri‐operative medicine must prioritise pregnant women

Dennis

Sheridan

2019

Anaesthesia

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Peri-operative medicine, defined as the medical care of patients from the time of contemplation of surgery through the operative period to full recovery, is being formally integrated into the care of surgical patients internationally, with large collaborative groups developing clinical and research agendas focusing on peri-operative outcomes [1, 2]. This integration follows recognition by the Lancet Commission on Global Surgery that five billion people globally do not have access to safe anaesthesia and surgery, which are essential to reducing the global burden of disease [3-5]. An acknowledgement of this problem, which was neglected in health systems for over 50 years, was made in 2015 when the World Health Organization's Sixty-Eighth World Health Assembly passed a resolution to make safe surgery and anaesthesia an essential requirement of universal health coverage. This means that emergency and essential surgical care and anaesthesia are now embedded into the post-2015 global agenda and the sustainable development goals (SDG) [6]. Recognising the multidisciplinary, collaborative approach of peri-operative medicine and matching this with global agendas and goals will assist in enabling access to safe surgery to all. Caesarean section surgery is an essential surgical operation This procedure makes up approximately 30% of all operations in low middle-income countries each year [7-9]. Despite this, the 131 million pregnant women who might require this major abdominal surgery each year are rarely specifically highlighted in discourse on peri-operative medicine [7]. This is of concern as caesarean section surgery often occurs in an emergency setting, always involves bleeding and often a high risk of significant haemorrhage (> 500 ml), and is associated with the well-recognised postoperative complications of bleeding, infection, deep vein thrombosis and pulmonary embolism. These perioperative problems often occur on the background of comorbid conditions of hypertension (10% of pregnant women), obesity, diabetes and anaemia. Caesarean section surgery has been identified as a Bellwether procedure by Global Surgery 2030 [4] meaning that it is an essential surgical procedure and one that should be able to be offered in all hospitals. Raising the profile of caesarean section surgery in pregnant women is necessary to enable the provision of safe peri-operative care to this often-forgotten group of surgical patients. Pregnant women are an integral peri-operative medicine population The antenatal and postnatal period is also the peri-operative period for 23 million young women globally who have caesarean section surgery each year (18.6% of pregnant women globally) [9]. The global maternal mortality ratio (MMR) in 2015 was 385 deaths per 100,000 women giving birth [10]. Given the number of women who undergo caesarean section surgery, the global problem of maternal mortality is intimately linked with a solution offered by the framework of peri-operative medicine. In the African 1504

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Obstetric Anesthesiologists as Perioperative Physicians: Improving Peripartum Care and Patient Safety

Cited by 5 publications

References 99 publications

Sexual and gender minorities educational content within obstetric anesthesia fellowship programs: a survey

Sexual and gender minorities educational content within obstetric anesthesia fellowship programs: a survey

Update on Non-neuraxial Labor Analgesia

Sex, suffering and silence – why peri‐operative medicine must prioritise pregnant women

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