The Gerard W. Ostheimer Lecture: What’s New in Obstetric ... LectureSOAP2004.pdf · Pharmacology...

SOAP 36th Annual MeetingMay 12-16, 2004

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Sanibel Harbour Resort and Spa, Ft. Myers, Florida

The Gerard W. Ostheimer Lecture:What’s New in Obstetric Anesthesia?

Lawrence C. Tsen, MDAssistant Professor in Anaesthesia

Harvard Medical School Department of Anesthesiology, Perioperative and Pain Medicine

Brigham & Women's Hospital, Boston MA


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"The great tragedy of Science - the slaying of a beautiful hypothesis by an ugly fact." Thomas H. Huxley (1825 - 1895)

This index was produced through a combination of search techniques. Foremost, a hand search of the table of contents of each 2003issue of the following journals was performed.

Anesthesia JournalsActa Anaesthesiologica Belgica, Acta Anaesthesiologica Scandanavica, Anaesthesia, Anaesthesia & Intensive Care, Anesthesia &Analgesia, Anesthesiology, Anesthesiology Clinics of North America, ASA Newsletter, British J Anaesthesia, Canadian J Anaesthesia,International J Obstetric Anesthesia, J Clinical Anesthesia, Obstetric Anesthesia Digest, Regional Anesthesia & Pain Medicine.

Obstetrics & Gynecology JournalsAmerican J Obstetrics & Gynecology, British J Obstetrics & Gynaecology, Clinical Obstetrics & Gynecology, Fertility & Sterility,Obstetrics & Gynecology, Obstetrical & Gynecologic Survey.

General Medical JournalsJAMA, New England J Medicine, Lancet, Science

In addition, Pub Med, All Science Citation Index, and Lexis/Nexis web searches were performed for various keywords related toobstetric anesthesiology.

Almost all contributions in this index (even letters) are accompanied by a short synopsis. If I misinterpreted or missed a tasty piece ofliterature (especially yours), for this I claim ignorance or inexperience and extend my apologies! Thanks to all authors for yourcontributions to our collective learning and to my own mentors who, despite working with limited substrate, have engendered anenthusiasm for reading the literature. I hope this index assists your own research and/or clinical efforts and contributes to improvedoutcomes for the special patients that we serve.

ARTICLESThe Pregnant Patient, the Fetus, and the NewbornAssisted Reproductive TechnologiesCoexisting Disease

AgingAutonomic DysfunctionCardiacConnective TissueEndocrineGastointestinalHematologicHepaticHypertensionImmunologicInfectionLocal Anesthetic AllergyLymphaticMusculoskeletalNeoplasmNeurologicOrthopedicPainPsychiatricRenalRespiratorySubstance Abuse


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TraumaVascular

Complementary and Alternative MedicineFetus

Fetal MonitoringFetal Surgery

Maternal Fever and Neonatal Sepsis WorkupNewborn

BehaviorBreast FeedingCerebral PalsyLow Birth WeightMacrosomiaMeconium AspirationMorbidityMortalityPharmacologyRespiratory DistressResuscitation/EvaluationUmbilical Cord Issues

Non-Obstetric Surgery during PregnancyPharmacologic Alterations in Women/PregnancyPhysiologic Alterations in Women/PregnancyPlacental Issues

Obstetric Issues and ImplicationsComplications-Obstetric

Abdominal PregnancyAmniotic Fluid EmbolismHemorrhageHyperemesis GravidarumMaternal MortalityMultiple GestationNeurologic InjuryOvarian Hyperstimulation SyndromePainPIH/PreeclampsiaPerineal Trauma/LacerationsPreterm LaborPulmonary EmbolismRetained PlacentaSurprise Delivery of InfantUmbilical Cord IssuesUterine Rupture

Critical Care for Obstetric PatientsObstetric Management Issues

Birth CentersBreechCerclage PlacementCesarean DeliveryFeeding during LaborInduction of Labor


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Instrumental DeliveryIntrapartum CareMalpresentationMultiple GestationPostpartum CareTermination of PregnancyVBAC

OB Anesthetic Issues and ImplicationsAnalgesia for Labor and Delivery

Alternative TechniquesAmbulationAnatomyBenefit of AnesthesiaBreech DeliveryBreastfeedingCSE TechniqueEquipmentEpidural TechniquesFetal EffectsFluid PreloadingForceps DeliveryMaternal EducationMaternal PositionMaternal SatisfactionObstetric ManagementPCEAPharmacologyPhysiologyProgress of LaborRetained PlacentaSpinal TechniqueTermination of PregnancyTest DoseTiming of PlacementVolative Agents

Anesthesia for Cerclage PlacementAnesthesia for Cesarean Delivery

General AnesthesiaLateral TiltOxygenationPruritis Postoperative Nausea and VomitingPostoperative (Cesarean) Pain ManagementPostoperative Shivering/HypothermiaRegional AnesthesiaTiming of DeliveryVasopressors

Anesthesia for Tubal LigationComplications-Anesthesia

AirwayAllergy


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Aspiration ProphylaxisCardiac ArrestDrug ErrorDrug ExposureEquipmentHearing ImpairmentHigh SpinalHypoglycemiaHypotensionInadequate AnesthesiaInfectionIntravenous ToxicityNausea/VomitingNeurologic InjuryOther InjuryProlonged Spinal AnesthesiaPruritisRecurrent AnesthesiaRespiratory DepressionSeizuresSpinal HeadacheUrinary Incontinence/Retention

ConsentEconomics and StaffingPharmacologyPostoperative Pain Management

PharmacologyPhysiology

MiscellaneousAbstractsEducation/Residency/Registrar TrainingEthicsHistoryLabor SupportMedicolegal IssuesNursingResearchWebsites/Books/Leaflets/Journal Announcements


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ARTICLES

THE PREGNANT PATIENT, THE FETUS, AND THE NEWBORN

Assisted Reproductive Technologies

1. McManis S. Midlife Mommy. San Francisco Chronicle. San Francisco, CA, 2003:E1. Ethical and physiologic issues roil when 56 year old decides on having another child.

2. Andrews M, Gibbons W, Oehninger S, et al. Optimizing use of assisted reproduction. Am J Obstet Gynecol 2003; 189:327-32. Details of one ART center.

3. Nassar AH, Usta IM, Rechdan JB, Harb TS, Adra AM, Abu-Musa AA. Pregnancy outcome in spontaneous twins versus twins who were conceived through in vitro fertilization. Am J Obstet Gynecol 2003; 189:513-8. IVF twins are more likely to be delivered by cesarean and have a higher incidence of preterm birth and have longer nursery stays.

4. Schieve LA, Tatham L, Peterson HB, Toner J, Jeng G. Spontaneous abortion among pregnancies conceived using assisted reproductive technology in the United States. Obstet Gynecol 2003; 101:959-67. 62,228 clinical pregnancies from 1996-1998 US clinic data noted that the risk of spontaneous abortion does not appear higher; however older women using their own eggs still need to consider than their risk is quite high.

5. Klein J, Pena JE, Thornton MH, Sauer MV. Understanding the motivations, concerns, and desires of human immunodeficiency virus 1-serodiscordant couples wishing to have children through assisted reproduction. Obstet Gynecol 2003; 101:987-94. Couples were aware of risks and understood that their child might contact HIV.

6. de La Rochebrochard E, Thonneau P. Paternal age >or=40 years: an important risk factor for infertility. Am J Obstet Gynecol 2003; 189:901-5. Retrospective, multinational study of 6188 European women selected randomly; paternal age is a factor!

7. Jones HW. Multiple births: how are we doing? Fertil Steril 2003; 79:17-21. Editorial suggests that the issue of multiple births needs to be addressed by the medical societies, and perhaps the legislative process.

8. Wood S, Thomas K, Sephton V, Troup S, Kingsland C, Lewis-Jones I. Postoperative pain, complications, and satisfaction rates in patients who undergo surgical sperm retrieval. Fertil Steril 2003; 79:56-62. Questionnaire based survey noted that this procedure is well tolerated with only minor complications.

9. Gleicher N. Modern obstetrical and infertility care may increase the prevalence of disease: an evolutionary concept. Fertil Steril2003; 79:249-52. Selective review of literature suggesting that evolutionary barriers to reproduction had lead to an increased prevalence in diseases.

10. Nichols JE, Crane MM, Higdon HL, Miller PB, Boone WR. Extremes of body mass index reduce in vitro fertilization pregnancy rates. Fertil Steril 2003; 79:645-7. Retrospective analysis noted underweight and obese females have reduced IVF success.

11. Kovalevsky G, Rinaudo P, Coutifaris C. Do assisted reproductive technologies cause adverse fetal outcomes? Fertil Steril 2003; 79:1270-2. An association, but not necessarily causal relationships, with ART and low birth weight/birth defects was observed in this editorial.

12. Smithers PR, Halliday J, Hale L, Talbot JM, Breheny S, Healy D. High frequency of cesarean section, antepartum hemorrhage, placenta previa, and preterm delivery in in-vitro fertilization twin pregnancies. Fertil Steril 2003; 80:666-8. Registry analysis ofIVF mixed sex twins from 1991-9, notes increased incidence of placenta previa and antepartum hemorrhage even after adjustment for maternal age and parity.


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Coexisting Disease

Aging

13. Salihu HM, Shumpert MN, Slay M, Kirby RS, Alexander GR. Childbearing beyond maternal age 50 and fetal outcomes in the United States. Obstet Gynecol 2003; 102:1006-14. Retrospective stud of all deliveries in the US from 1997-1999. 539 deliveries in mothers 50 or greater noted increased risks for the fetus.

14. Kuczkowski KM. Advanced maternal age parturient: is there reason for concern? Acta Obstet Gynecol Scand 2003; 82:681. Letter notes increasing co-morbidities in the aging parturient.

Autonomic Dysfunction

15. Kuczkowski KM. Peripartum anaesthetic management of a parturient with spinal cord injury and autonomic hyperreflexia. Anaesthesia 2003; 58:823-4. Letter detailing case of a parturient with uterine contractions inducing autonomic hyperreflexia.

Cardiac

16. Campbell N, Rosaeg OP, Chan KL. Anaesthetic management of a parturient with pulmonary stenosis and aortic incompetence for Caesarean section. Br J Anaesth 2003; 90:241-3.

17. Levy DM. Anaesthesia for Caesarean section in women with heart disease. Br J Anaesth 2003; 90:401-2; author reply 401-2.Letter author debates management of a woman with complex arrhythmias and an implantable cardioverter defibrillator.

18. Shade GH, Jr., Ross G, Bever FN, Uddin Z, Devireddy L, Gardin JM. Troponin I in the diagnosis of acute myocardial infarction in pregnancy, labor, and post partum. Am J Obstet Gynecol 2002; 187:1719-20. Case report suggests that troponinI should be a marker of choice in the diagnosis of AMI during peripartum period.

19. Ishiyama T, Oguchi T, Iijima T, Matsukawa T, Kashimoto S, Kumazawa T. Combined spinal and epidural anesthesia for cesarean section in a patient with hypertrophic obstructive cardiomyopathy. Anesth Analg 2003; 96:629-30. Letter describinga case of a parturient with HOCM successfully managed with a small dose spinal combined with epidural anesthesia.

20. Reimold SC, Rutherford JD. Clinical practice. Valvular heart disease in pregnancy. N Engl J Med 2003; 349:52-9. Excellent review of the physiology and consequences of these specific disorders during pregnancy.

21. Mulder BJ, Bleker OP. Valvular heart disease in pregnancy. N Engl J Med 2003; 349:1387. Letter following Reimold article noting that the review did not include the critical need to observe these parturients in the early (<72hr) puerperium.

22. Horstkotte D, Fassbender D, Piper C. [Congenital heart disease and acquired valvular lesions in pregnancy]. Herz 2003; 28:227-39. Review, in German, of the implications of congenital heart disease during pregnancy.

23. Gowda RM, Khan IA, Mehta NJ, Vasavada BC, Sacchi TJ. Cardiac arrhythmias in pregnancy: clinical and therapeutic considerations. Int J Cardiol 2003; 88:129-33. Wonderful review noting that pregnancy can precipitate arrhythmias, with the risk increasing during labor and delivery.

24. Malhotra M, Sharma JB, Arora P, Batra S, Sharma S, Arora R. Mitral valve surgery and maternal and fetal outcome in valvular heart disease. Int J Gynaecol Obstet 2003; 81:151-6. Retrospective analysis of 308 women with mitral valve disorder indicated that mitral valve surgery before or during pregnancy did not significantly improve maternal and fetal outcomes but decreased adverse events such as congestive heart failure and cardiac arrhythmias.


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25. Lewis NL, Dob DP, Yentis SM. UK registry of high-risk obstetric anaesthesia: arrhythmias, cardiomyopathy, aortic stenosis, transposition of the great arteries and Marfan's syndrome. International Journal of Obstetric Anesthesia 2003; 12:28-34. Voluntary registry yields ideas for monitoring, management, and outcomes.

26. Van de Velde M, Budts W, Vandermeersch E, Spitz B. Continuous spinal analgesia for labor pain in a parturient with aortic stenosis. International Journal of Obstetric Anesthesia. 2003; 12:51-54. Case report in patient with mod/severe AS utilizing acontinuous spinal catheter for labor analgesia.

27. Camci E, Sungur Z, Tugrul M. Simultaneous cesarean section and aortic dissection repair [3]. [Journal: Letter]. International Journal of Obstetric Anesthesia 2003; 12:58-59. Letter reporting case of acute aortic dissection in primip at 32 wks gestation.

28. Boyle RK. Anaesthesia in parturients with heart disease: a five year review in an Australian tertiary hospital. International Journal of Obstetric Anesthesia 2003; 12:173-177. Retrospective analysis of 1993-1997 of 68 parturients with cardiac disease.

29. Coven G, Arpesella R, Ciceri M, Preseglio I, Cardani A. Accelerated idioventricular rhythm during spinal anesthesia for cesarean section. International Journal of Obstetric Anesthesia 2003; 12:121-125. Case report of aberrant rhythm; better treated with atropine than ephedrine.

30. Okamoto T, Minami K, Shiraishi M, Ogata J, Shigematsu A. Repeated supraventricular tachycardia in an asymptomatic patient with Wolff-Parkinson-White syndrome during Cesarean delivery. Can J Anaesth 2003; 50:752-3. Letter describing case of WPW reactivation during cesarean.

31. Webster JA, Self DD. Anesthesia for pericardial window in a pregnant patient with cardiac tamponade and mediastinal mass. Can J Anaesth 2003; 50:815-8. G2P1 parturient at 29 wks with acute cardiac tamponade and an anterior mediastinal mass in late pregnancy underwent a GA for creation of the window, then underwent regional at a later date for a vaginal delivery!

32. Kaufman I, Bondy R, Benjamin A. Peripartum cardiomyopathy and thromboembolism; anesthetic management and clinical course of an obese, diabetic patient. Can J Anaesth 2003; 50:161-5. 38 yo diabetic, obese parturient with EF 40-45% had a cesarean delivery under GA with monitors; postop cerebral infarct.

33. Tsen LC. Anesthetic management of the parturient with cardiac and diabetic diseases. Clin Obstet Gynecol 2003; 46:700-10.Review of predominantly congenital cardiac diseases and all types of diabetic disease manifesting at time of pregnancy.

34. Whitehead SJ, Berg CJ, Chang J. Pregnancy-related mortality due to cardiomyopathy: United States, 1991-1997. Obstet Gynecol 2003; 102:1326-31. CDC data from 1991-7 observed 245 cardiomyopathy deaths, 171 of which were peripartum cardiomyopathy. Further studies necessary for a prevalence and racial disparity noted.

35. Thaman R, Varnava A, Hamid MS, et al. Pregnancy related complications in women with hypertrophic cardiomyopathy. Heart 2003; 89:752-6. Report of 127 consecutively referred women with this entity; suggest most tolerate pregnancy well, however, planned delivery and monitoring necessary. Moreover, states epidural analgesia should continued to be used cautiously.

36. Brown O. Direct current cardioversion during pregnancy. Bjog 2003; 110:713-4. Letter raising awareness of biphasic waveform and internal cardioversion as options associated with greater effectiveness and less energy requirements.

37. Dubois L, Belkacem H, Berl M, Dailland P, Carli P. [Single ventricle and obstetric anaesthesia: two cases report]. Ann Fr Anesth Reanim 2003; 22:50-3. Case report of two cases of single ventricle parturients managed by regional anesthesia for both caesarean and vaginal delivery.


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Connective Tissue

38. Douglas M, Gunka V, Von Dadelszen P. Anesthesia for the parturient with pseudoxanthoma elasticum. International Journal of Obstetric Anesthesia. 2003; 12:45-47. Case report of 2 parturients with this rare inherited connective tissue disorder.

39. Youngs P, Sice P, Harvey P. Labour analgesia and pseudoxanthoma elasticum (PXE). International Journal of Obstetric Anesthesia 2003; 12:48-50. Case report as above.

Endocrine

40. McAnulty GR, Hall GM. Anaesthesia for the diabetic patient. Br J Anaesth 2003; 90:428-9. Editorial which notes drugs used in general anesthesia may affect metabolism in diabetic patients.

41. Cermakova A, Knibb AA, Hoskins C, Menon G. Post partum phaeochromocytoma. International Journal of Obstetric Anesthesia 2003; 12:300-4. Case report of parturient who had uneventful pregnancy and delivery but expired postpartum. Very good discussion.

42. Brody SC, Harris R, Lohr K. Screening for gestational diabetes: a summary of the evidence for the U.S. Preventive Services Task Force. Obstet Gynecol 2003; 101:380-95. Lack of high-quality evidence noted to be an issue of this systematic review of evidence for screening for GDM.

43. Nachum Z, Rakover Y, Weiner E, Shalev E. Graves' disease in pregnancy: prospective evaluation of a selective invasive treatment protocol. Am J Obstet Gynecol 2003; 189:159-65. Case series and discussion of parturients with Graves' disease who underwent umbilical blood sampling to improve the control of fetal thyroid function.

44. Gabbe SG, Graves CR. Management of diabetes mellitus complicating pregnancy. Obstet Gynecol 2003; 102:857-68. Expert series covers the implications and management of this disease during pregnancy.

Gastrointestinal

45. Alstead EM, Nelson-Piercy C. Inflammatory bowel disease in pregnancy. Gut 2003; 52:159-61. IBD may lead to SGAbabies; more research needed.

46. Henriksen MG, Hessov I, Dela F, Vind Hansen H, Haraldsted V, Rodt SA. Effects of preoperative oral carbohydrates and peptides on postoperative endocrine response, mobilization, nutrition and muscle function in abdominal surgery. Acta Anaesthesiol Scand 2003; 47:191-9. Greater preservation of glycogen synthase in muscle biopsies and quadriceps strength ingroups given carbohydrate rich drinks the night and morning prior to surgery. (Average age 64, mostly male for GI surgery).No differences in ambulation time, nutritional intake or wellbeing.

47. Richter JE. Gastroesophageal reflux disease during pregnancy. Gastroenterology Clinics of North America. 2003; 32:235-.

48. Wong CA, Cariaso D, Johnson EC, Leu D, McCarthy RJ. Body habitus does not influence spread of sensory blockade after the intrathecal injection of a hypobaric solution in term parturients. Can J Anaesth 2003; 50:689-93. Prospective observational study of 245 term parturients receiving intrathecal 2.5 mg bupiv + 25 µg fent in sitting position. Lack of clinically significant increase in cephalic spread observed with weight; height did not influence sensory analgesia. Suggest dose adjustments based on body habitus not necessary.

49. Jensen DM, Damm P, Sorensen B, et al. Pregnancy outcome and prepregnancy body mass index in 2459 glucose-tolerant Danish women. Am J Obstet Gynecol 2003; 189:239-44. Prepregnancy overweight and obesity is associated with adverse pregnancy outcome in glucose tolerant women (2459 pregnant women).


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50. Andrews M, Gibbons W, Oehninger S, et al. Optimizing use of assisted reproduction. Am J Obstet Gynecol 2003; 189:327-32. Historical cohort analysis of 122 women with a BMI >40. VBAC trials in obese women are 3x more likely to be complicated by infection and do not result in reduced costs.

Hematologic

51. Khare M, Nelson-Piercy C. Acquired thrombophilias and pregnancy. Best Pract Res Clin Obstet Gynaecol 2003; 17:491-507. Acquired thrombophilias are hypercoagulable states secondary to various etiologies. Current management strategies, using low-molecular-weight heparin and aspirin, result in a greater than 70% live birth rate.

52. Dhar P, Abramovitz S, DiMichele D, Gibb CB, Gadalla F. Management of pregnancy in a patient with severe haemophilia A. Br J Anaesth 2003; 91:432-5. Case report of parturient with severe hemophilia A; indicates importance of recombinant factorVIII concentrate prior to epidural.

53. Shapiro SS. Treating thrombosis in the 21st century. N Engl J Med 2003; 349:1762-4. Editorial which nicely reviews the mechanism and current treatment of this disorder.

54. Akkad A, Oppenheimer C, Mushambi M, Pavord S. Intrapartum care for women on full anticoagulation. International Journalof Obstetric Anesthesia 2003; 12:188-192. Case report underscores the need for multidisciplinary management.

55. Kuczkowski KM. Labour-induced sickle cell crisis in a previously asymptomatic parturient with sickle cell disease. Anaesthesia 2003; 58:1044-5. Letter reporting case of a parturient with sickle cell disease with first vaso-occlusive crisis during labor.

56. Waters JH, Lukauskiene E, Anderson ME. Intraoperative blood salvage during cesarean delivery in a patient with beta thalassemia intermedia. Anesth Analg 2003; 97:1808-9. Case report suggests that cell salvage can be performed safely for cesarean delivery.

57. Samama CM. Should a normal thromboelastogram allow us to perform a neuraxial block? A strong word of warning. Can J Anaesth 2003; 50:761-3. Editorial to letter below suggesting that TEG for clinical decision making regarding neuraxial blockade should be discouraged at this time.

58. Frolich MA, Gibby G, Mahla ME. Thromboelastography to assess coagulation in the thrombocytopenic parturient. Can J Anaesth 2003; 50:853. Letter describing two cases of TEG being used to decide whether neuraxial blockade was appropriate.

59. Gupta B, Prakash S, Gujral K. Anaesthetic management of the parturient with protein S deficiency and lumboperitoneal shunt. Anaes Intens Care 2003; 31:573-5. Case report of protein S parturient for cesarean delivery under GA.

60. McCowan LM, Craigie S, Taylor RS, Ward C, McLintock C, North RA. Inherited thrombophilias are not increased in "idiopathic" small-for-gestational-age pregnancies. Am J Obstet Gynecol 2003; 188:981-5. Case controlled study of normotensive women who delivered a singleton SGA baby notes no increased relationship with inherited thrombophilias.

61. Bergqvist D, Wu CL, Neal JM. Anticoagulation and neuraxial regional anesthesia: perspectives. Reg Anesth Pain Med 2003; 28:163-6. Editorial on 2002 update by ASRA on this topic.

62. Horlocker TT, Wedel DJ, Benzon H, et al. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation). Reg Anesth Pain Med 2003; 28:172-97. Excellent resource; a must read.

63. Horlocker TT. Thromboprophylaxis and neuraxial anesthesia. Orthopedics 2003; 26:s243-9. Topic explained for orthopedic colleagues.


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64. McLure HA, Trenfield S, Quereshi A, Williams J. Post-splenectomy thrombocytopenia: implications for regional analgesia. Anaesthesia 2003; 58:1106-10. Immediate post-splenectomy patients, however, good review of leukemic and low plt count patients.

65. Benhamou D. Coagulopathy and obstetric anesthesia. Acta Anaesthesiol Belg 2003; 54:151-5. Short review of issues in the obstetric population.

67. Hohlagschwandtner M, Unfried G, Heinze G, Huber JC, Nagele F, Tempfer C. Combined thrombophilic polymorphisms in women with idiopathic recurrent miscarriage. Fertil Steril 2003; 79:1141-8. Prospective analysis of does not find an association between recurrent miscarriage and single or combined thrombophilic polymorphisms.

68. Pauer HU, Burfeind P, Kostering H, Emons G, Hinney B. Factor XII deficiency is strongly associated with primary recurrent abortions. Fertil Steril 2003; 80:590-4. Factor XII deficiency is strongly and somewhat associated with primary and secondary recurrent abortion, respectively.

69. Deering SH, Landy HJ, Tchabo N, Kessler C. Hypodysfibrinogenemia during pregnancy, labor, and delivery. Obstet Gynecol 2003; 101:1092-4. Case report of this rare disorder, that results in qualitatively and quantitatively abnormal fibrinogen, during pregnancy.

70. Pravinkumar E, Webster NR. HIT/HITT and alternative anticoagulation: current concepts. Br J Anaesth 2003; 90:676-85. Wonderful review of HIT/HITT. Remember, don't give platelets!

71. Fattorutto M. Evaluation of platelet aggregation in flow and platelet aggregometry during pregnancy. Br J Anaesth 2003; 90:252; author reply 252. The PFA-100 needs to be validated in comparison with aggregation tests.

72. Abramovitz S, Beilin Y. Thrombocytopenia, low molecular weight heparin, and obstetric anesthesia. Anesthesiol Clin North America 2003; 21:99-109. Parturients with these defects should be considered on a case-by-case basis; guidelines discussed.

73. Nuttall GA, Stehling LC, Beighley CM, Faust RJ. Current transfusion practices of members of the American Society of Anesthesiologists: a survey. Anesthesiology 2003; 99:1433-43. Survey study indicates considerable practice changes (more conservative in giving blood products) since 1981.

74. Dawood F, Farquharson R, Quenby S, Toh CH. Acquired activated protein C resistance may be a risk factor for recurrent fetal loss. Fertil Steril 2003; 80:649-50. Letter notes relationship between APCR and recurrent pregnancy loss and suggests that antithrombotic modalities need to be tested for potential benefit.

75. Dawood F, Farquharson R, Quenby S. Activated protein C resistance and pregnancy loss. Hosp Med 2003; 64:24-7. Review analyzes recent literature to evaluate this association and address the gestation and type of pregnancy loss.

76. Pauer HU, Voigt-Tschirschwitz T, Hinney B, et al. Analyzes of three common thrombophilic gene mutations in German women with recurrent abortions. Acta Obstet Gynecol Scand 2003; 82:942-7. The study found no association between the prevalence of factor V Leiden, factor II prothrombin, and methylenetetrahydrofolate reductase (MTHFR) mutations in women with recurrent abortions (> or =2 abortions) in the German population.

77. Prochazka M, Happach C, Marsal K, Dahlback B, Lindqvist PG. Factor V Leiden in pregnancies complicated by placental abruption. Bjog 2003; 110:462-6. FVL was not associated with placental abruption in this retrospective case control study of102 women vs. 2371 prospectively collected controls; however, venous thrombosis was increased in women with placental abruption, indicating thrombophilias.


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78. Pegoraro RJ, Hira B, Rom L, Moodley J. Plasminogen activator inhibitor type 1 (PAI1) and platelet glycoprotein IIIa (PGIIIa) polymorphisms in Black South Africans with pre-eclampsia. Acta Obstet Gynecol Scand 2003; 82:313-7. Neither the 4G allele of the plasminogen activator inhibitor Type 1 nor the PlA2 allele of the platelet glycoprotein IIIa have any significant role as risk factors in the patho-etiology of pre-eclampsia in Black South Africans,

79. Hira B, Pegoraro RJ, Rom L, Moodley J. Absence of Factor V Leiden, thrombomodulin and prothrombin gene variants in Black South African women with pre-eclampsia and eclampsia. Bjog 2003; 110:327-8. Genotyping was performed in 100 patients with pre-eclampsia and 100 normotensive pregnant controls to detect the G or A allele at residue 506 of the Factor Vgene, and the C or T allele at residue 455 of the thrombomodulin gene. No relationship was found.

80. Baudo F, de Cataldo F. Acquired factor VIII inhibitors in pregnancy: data from the Italian Haemophilia Register relevant to clinical practice. Bjog 2003; 110:311-4. Retrospective analysis of registry of clinical problems in pregnancy related to factor VIII; correction of aPTT is underscored.

81. Novoa L, Navarro Egea M, Vieito Amor M, Hernandez Iniesta J, Arxer A, Villalonga A. [Obstetric analgesia and anesthesia with remifentanyl in a patient with von Willebrand disease]. Rev Esp Anestesiol Reanim 2003; 50:242-4. Case report of parturient managed with PCA remifentanyl for labor; cesarean with general.

82. Guasch Arevalo E, Suarez Cobian A. [Platelet count and hematic punction with epidural block in obstetrics]. Rev Esp Anestesiol Reanim 2003; 50:130-4. Retrospective review of 1,168 obstetric patients given regional blocks for labor. Seventy-two bloody punctures were observed, for an incidence of 6.16%, and the incidence was significantly higher in the group of patients with over 350,000 platelets/mm3 (p < 0.05).

83. Al-Kouatly HB, Chasen ST, Kalish RB, Chervenak FA. Causes of thrombocytopenia in triplet gestations. Am J Obstet Gynecol 2003; 189:177-80. Review of 126 triplet pregnancies from 1993-2001 observed that thrombocytopenia was most likely to be related to preeclampsia than gestational changes.

84. Webert KE, Mittal R, Sigouin C, Heddle NM, Kelton JG. A retrospective 11-year analysis of obstetric patients with idiopathic thrombocytopenic purpura. Blood 2003; 102:4306-11. Retrospective study of 119 pregnancies noted. During delivery, 44 women (37.3%) received epidural analgesia without complications, with most having a platelet count between 50and 149 x 109/L.

85. Lecompte T, Lasne D. [Delivery, epidural analgesia and essential thrombocythaemia: evaluation of platelet function and haemorrhagic risk]. Ann Fr Anesth Reanim 2003; 22:396-8. Editorial.

Hepatic

86. Lentschener C, Ozier Y. What anaesthetists need to know about viral hepatitis. Acta Anaesthesiol Scand 2003; 47:794-803. Not specific to pregnancy, but important review article.

Hypertension

87. Polley LS. Anesthetic management of hypertension in pregnancy. Clin Obstet Gynecol 2003; 46:688-99. Good review of definitions, pathogenesis and anesthetic implications.

Immunologic

88. Grewal K, Samsoon G. Combined spinal-epidural anaesthesia for caesarean section in a patient with Takayasu's disease. International Journal of Obstetric Anesthesia 2003; 12:234-235. Letter reporting case of Takayasu's disease successfully managed with a CSE.


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89. Balestrieri PJ, Ferguson JE, 2nd. Management of a parturient with a history of local anesthetic allergy. Anesth Analg 2003; 96:1489-90. Case report noting the timing and testing issue in a parturient with a local anesthetic allergy.

90. Hepner DL, Castells MC, Tsen LC. Should local anesthetic allergy testing be routinely performed during pregnancy? Anesth Analg 2003; 97:1853-4; author reply 1854. Letter provides reasons for caution to applied to local anesthetic testing during pregnancy.

91. Rawat RS, Dehran M. Anaesthetic management of a pregnant patient with antiphospholipid antibody syndrome for emergency caesarean section. International Journal of Obstetric Anesthesia 2003; 12:311. Letter describes case of pregnant patient with stated syndrome on heparin and aspirin; BT, Clot time, PTT normal; spinal performed without complications.

92. Franklin RD, Kutteh WH. Effects of unfractionated and low molecular weight heparin on antiphospholipid antibody binding in vitro. Obstet Gynecol 2003; 101:455-62. LMWH and Heparin reduce the in-vitro binding of antiphospholipid antibodies on a per unit basis.

93. Branch DW, Khamashta MA. Antiphospholipid syndrome: obstetric diagnosis, management, and controversies. Obstet Gynecol 2003; 101:1333-44. Expert view of this syndrome. Very good review.

94. Jacobsen AF, Qvigstad E, Sandset PM. Low molecular weight heparin (dalteparin) for the treatment of venous thromboembolism in pregnancy. Bjog 2003; 110:139-44. Observational study in 20 pregnant women with acute venous thromobembolism notes that dalteparin may be used for the treatment (with a 10-20% higher dose than non-pregnant) of acute venous thromboembolism in pregnancy.

Infection

95. From the Center of Disease Control and Prevention. Pregnancy in perinatally HIV-infected adolescents and young adults--Puerto Rico, 2002. Jama 2003; 289:1496-7.

96. Brown ZA, Wald A, Morrow RA, Selke S, Zeh J, Corey L. Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant. Jama 2003; 289:203-9. Neonatal HSV infection rates can be reduced by preventing maternal acquisition of genital HSV-1 and HSV-2 infection near term. It can also be reduced by cesarean delivery and limiting the use of invasive monitors among women shedding HSV at the time of labor.

97. From the Centers for Disease Control and Prevention. Intrauterine West Nile virus infection--New York, 2002. Jama 2003; 289:295-6. Naturally acquired immunity results in a 69% reduction in the risk of congenital CMV infection in future pregnancies.

98. Fowler KB, Stagno S, Pass RF. Maternal immunity and prevention of congenital cytomegalovirus infection. Jama 2003; 289:1008-11. Naturally acquired immunity results in a 69% reduction in the risk of congenital CMV infection in future pregnancies.

99. Cohan D. Cesarean delivery and risk of herpes simplex virus infection. Jama 2003; 289:2208; author reply 2208-9.

100. Birnbach DJ, Meadows W, Stein DJ, Murray O, Thys DM, Sordillo EM. Comparison of povidone iodine and DuraPrep, an iodophor-in-isopropyl alcohol solution, for skin disinfection prior to epidural catheter insertion in parturients. Anesthesiology 2003; 98:164-9. Cultures obtained in 60 parturients prior to, immediately following antisepsis and just prior to removal of the catheter, suggest that DuraPrep is better than providone iodine in the number of positive skin cultures immediately after disinfection and in combating bacterial regrowth and colonization.

101. Hughes SC. Of plague and "pestilence". J Clin Anesth 2003; 15:166-9. Editorial citing the world impact of AIDS. Previews article below.


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102. Kuczkowski KM. Human immunodeficiency virus in the parturient. J Clin Anesth 2003; 15:224-33. Nice review article summarizing the prevalence and implications of this disease.

103. Eldor J. Local anaesthetic antibacterial activity. Anaesthesia 2003; 58:926-8; discussion 928. Letter suggests that manufacturers should declare the limited antibacterial activity of their drugs. Response by Astra Zeneca suggests clinical setting is different.

104. Kruger AM, Bhagwanjee S. HIV/AIDS: Impact on maternal mortality at the Johannesburg Hospital, South Africa, 1995-2001. International Journal of Obstetric Anesthesia 2003; 12:164-168. Significant increase in maternal mortality due to HIV/AIDS noted.

105. Minkoff H. Human immunodeficiency virus infection in pregnancy. Obstet Gynecol 2003; 101:797-810. Expert view of HIVin pregnancy. Good review.

106. Brown NW, Parsons AP, Kam PC. Anaesthetic considerations in a parturient with varicella presenting for Caesarean section. Anaesthesia 2003; 58:1092-5. Case of parturient with chickenpox offers good review of anesthetic implications.

107. Sheffield JS, Hollier LM, Hill JB, Stuart GS, Wendel GD. Acyclovir prophylaxis to prevent herpes simplex virus recurrence at delivery: a systematic review. Obstet Gynecol 2003; 102:1396-403. Meta analysis indicates prophylactic acyclovir startingat 36 wks gestation reduces the risk of HSV detection at delivery, cesarean for recurrent genital herpes, and risk of HSV viralshedding during pregnancy.

Local Anesthetic Allergy

108. Brown S, Jenkins JR. A primigravida allegedly allergic to local anaesthetics. International Journal of Obstetric Anesthesia 2003; 12:113-115. Case report noting evaluation and use of local anesthetics for labor in "allergic" parturient.

109. Lee JS. Local anesthetic allergy in a parturient. Anesth Analg 2003; 97:1204; author reply 1204. Letter querying clinical planfor parturient with local anesthetic allergy (Anesth Analg 2003;96:1489-90).

110. Finucane BT. Allergies to local anesthetics - the real truth. Can J Anaesth 2003; 50:869-74. Editorial reviews the history and allergic reactions to local anesthetics. Well written.

Lymphatic

111. Nishio I, Mandell GL, Ramanathan S, Sumkin JH. Epidural labor analgesia for a patient with disseminated lymphangiomatosis. Anesth Analg 2003; 96:1805-8. Case report of parturient noting the multisystem involvement of this disease process.

112. McLoughlin L, Thomas G, Hasan K. Pregnancy and lymphangioleiomyomatosis: anaesthetic management. International Journal of Obstetric Anesthesia 2003; 12:40-44. Case report with internet survey of 30 pregnancies of this rare, progressive cystic pulmonary disease.

Musculoskeletal

113. Habib AS, Millar S, Deballi P, 3rd, Muir HA. Anesthetic management of a ventilator-dependent parturient with the King-Denborough syndrome. Can J Anaesth 2003; 50:589-92. Case report of KDS a rare disorder of facial and skeletal deformities and slowly progressive myopathy and susceptibility to MH. Managed with an epidural and outlet forceps delivery.


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114. Abel DE, Grotegut CA. King syndrome in pregnancy. Obstet Gynecol 2003; 101:1146-9. Case report of syndrome causing craniofacial and skeletal anomalies, myopathies, and a predisposition to malignant hyperthermia in a parturient. Managed with an epidural technique.

Neoplasm

115. Fernandez CL, Kuczkowski KM. Images in Anesthesia: intrathoracic leiomyosarcoma in a parturient presenting for Cesarean delivery. Can J Anaesth 2003; 50:1051. MRI and CXR images from a 21 yo parturient who expired 3 wks postpartum despite chemotherapy.

Neurologic

116. Yap SH. Spinal muscular atrophy. International Journal of Obstetric Anesthesia 2003; 12:237. Letter reports case of parturients with disorder of anterior horn cells managed by spinal anesthesia for cesarean.

117. Landau R, Giraud R, Delrue V, Kern C. Spinal anesthesia for cesarean delivery in a woman with a surgically corrected type I Arnold Chiari malformation. Anesth Analg 2003; 97:253-5. Case report of a successful spinal anesthetic for cesarean delivery this cerebellar disorder.

118. Buettner A. Anaesthesia for caesarean section in a patient with spinal muscular atrophy. Anaes Intens Care 2003; 31:92-4. Case report of primigravid woman with spinal muscular atrophy Type III (Kugelberg-Welander syndrome). Elective caesarean section was performed at 38 weeks gestation under spinal anaesthesia.

119. Ehrenberg HM, Mercer BM, Catalano P, Fisgus JR. Pregnancy in a spinal cord-injured bilateral total leg amputee: management and considerations. Am J Obstet Gynecol 2003; 188:1096-9. Case report of parturient with a T10 spinal cord transection; cesarean delivery via GA.

120. Sunko BM, Hat J, Kelecic M, Gopcevic A. Tocolysis with ritodrine worsens cerebral oedema in a patient with brain injury. International Journal of Obstetric Anesthesia 2003; 12:293-6. Case report of 33 wk pregnant patient with head injury; neurologic status severely deteriorated with tocolytic use.

121. Rawlinson SC, Webster VJ. Spinal anaesthesia for caesarean section in a patient with Cockayne syndrome. International Journal of Obstetric Anesthesia 2003; 12:297-9. Case report of syndrome characterized by photosensitivity, dysmorphism, short stature, and neurologic deficits. Elective cesarean under spinal noted.

122. Dalmas AF, Texier C, Ducloy-Bouthors AS, Krivosic-Horber R. [Obstetrical analgesia and anaesthesia in multiple sclerosis]. Ann Fr Anesth Reanim 2003; 22:861-4. Consecutive series of 19 patients with MS; 10 had epidurals; author suggests epidural analgesia/anesthesia not associated with adverse sequelae.

123. Pereira L. Obstetric management of the patient with spinal cord injury. Obstet Gynecol Surv 2003; 58:678-87. Epidural anesthesia important to prevent autonomic dysreflexia.

124. Berl M, Dubois L, Belkacem H, Dailland P, Carli P. [Von Hippel-Lindau disease and obstetric anaesthesia: 3 cases report]. Ann Fr Anesth Reanim 2003; 22:359-62. Case report of 3 patients with this rare autosomal dominant genetic disorder with retinal and nervous system haemangioblastomas, phaeochromocytomia, kidney, pancreas and endolymphatic tumors. Successful management with epidural analgesia/anesthesia.

125. Kuczkowski KM. The eye of a pregnant woman and obstetric anaesthesia. Anaesthesia 2003; 58:1142-3. Letter describing case of pregnancy related contact lens intolerance in parturient with ocular symptoms following a cesarean under general.

126. Dinn RB, Harris A, Marcus PS. Ocular changes in pregnancy. Obstet Gynecol Surv 2003; 58:137-44. Review notes the various ocular changes in pregnancy including those that occur with preeclampsia and diabetes.


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127. Rezig K, Diar N, Benabidallah D, Khodja A, Saint-Leger S. [Paraplegia and pregnancy: anaesthetic management]. Ann Fr Anesth Reanim 2003; 22:238-41. Vaginal delivery with an epidural.

Orthopedic

128. Smith PS, Wilson RC, Robinson APC, Lyons GR. Regional blockade for delivery in women with scoliosis or previous spinal surgery. International Journal of Obstetric Anesthesia. 2003; 12:17-22. Prospective observational study, 41 cases for analysis.Noted epidural, spinal and continuous spinal techniques all performed well for both labor and operative deliveries.

129. Russell R, Comara S. Regional blocks for delivery in women with scoliosis or previous spinal surgery. International Journal of Obstetric Anesthesia 2003; 12:308-10. Letter reviews case series of 57 deliveries in 45 women with scoliosis or prior spinal surgery where very few cases of epidural or spinal difficulty were noted.

130. Villevieille T, Mercier FJ, Benhamou D. [Is obstetric epidural anaesthesia technically possible after spinal surgery and does itwork?]. Ann Fr Anesth Reanim 2003; 22:91-5. Retrospective analysis of 31 parturients with previous spine surgery notes technical and analgesic failures in 18%; authors conclude, not surprisingly, that epidural techniques appear to be less reliable in this patient group.

Pain

131. Shah RV. The management of nonobstetric pains in pregnancy. Reg Anesth Pain Med 2003; 28:362-3. Iliohypogastric neuralgia and transient bone marrow edema syndrome discussed.

Psychiatric

132. Johnson RC, Slade P. Obstetric complications and anxiety during pregnancy: is there a relationship? J Psychosom Obstet Gynaecol 2003; 24:1-14. Review of recent work in the field; on balance the evidence reviewed suggests that a general association between anxiety and obstetric complications per se does not exist, but specific types of anxiety, such as psychosocial stress, family functioning, or fear of childbirth may have associations with specific complications, such as prolonged labor or Cesarean section

133. Pinto N, Koren G. Research on maternal and fetal safety after exposure to antidepressants in utero. Am J Obstet Gynecol 2003; 189:1810-1; author reply 1811. Letter suggests that these studies are difficult and should include findings of registries.

Renal

134. Gyenge CC, Bowen BD, Reed RK, Bert JL. Mathematical model of renal elimination of fluid and small ions during hyper- and hypovolemic conditions. Acta Anaesthesiol Scand 2003; 47:122-37. Renal response to the provision of fluids and blood loss modeled in a 70kg man. For the very interested reader only!

Respiratory

135. Kee WDN, Leung TN. Severe acute respiratory syndrome (SARS). International Journal of Obstetric Anesthesia 2003; 12:151-152. Editorial commenting on the unclear maternal, neonatal, and anesthetic implications of SARS.

136. Williams M, Appelboam R, McQuillan P. Presentation of diaphragmatic herniae during pregnancy and labour. International Journal of Obstetric Anesthesia 2003; 12:130-134. Two cases, one traumatic, the other congenital, of diaphragmatic hernia during pregnancy.

137. Duggan AB, Katz SG. Combined spinal and epidural anaesthesia for caesarean section in a parturient with severe primary pulmonary hypertension. Anaes Intens Care 2003; 31:565-9. Case report of PPH with nitric oxide use.


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138. Kuczkowski K, Benumof JL. Subglottic tracheal stenosis in pregnancy: Anaesthetic implications. Anaes Intens Care 2003; 31:576-7. Case report of parturient undergoing elective surgical tracheostomy prior to labor analgesia.

139. Sciscione AC, Ivester T, Largoza M, Manley J, Shlossman P, Colmorgen GH. Acute pulmonary edema in pregnancy. Obstet Gynecol 2003; 101:511-5. Review of approximately 63K pregnancies; 51 women had acute pulmonary edema. Basic etiologies noted.

140. Blaise G, Langleben D, Hubert B. Pulmonary arterial hypertension: pathophysiology and anesthetic approach. Anesthesiology2003; 99:1415-32. Excellent review including obstetric patients.

141. Bracken MB, Triche EW, Belanger K, Saftlas A, Beckett WS, Leaderer BP. Asthma symptoms, severity, and drug therapy: a prospective study of effects on 2205 pregnancies. Obstet Gynecol 2003; 102:739-52. Cohort study of 873 pregnant women with asthma vs 1333 without asthma; No effect of asthma symptoms or severity was found on preterm delivery; however, useof oral steroids and theophyliine reduced gestational length.

142. Bromilow J, McCormick A. A novel role for magnesium? Anaesthesia 2003; 58:1246-7. Letter highlights case of asthmatic parturient for c/s under CSE who was treated with magnesium only to assist asthma.

Substance Abuse

143. Birnbach DJ. Anesthetic management of the drug-abusing parturient: are you ready? J Clin Anesth 2003; 15:325-7. Editorial to article below noting that practitioners should be vigilant to the diagnosis of drug abuse, even in parturients, whenever an unexpected response to anesthesia occurs.

144. Kuczkowski KM. Anesthetic implications of drug abuse in pregnancy. J Clin Anesth 2003; 15:382-94. Review article covering specific abuse agents in regards to the pathophysiology of effect and interactions with pregnancy and anesthesia.

145. Kuczkowski KM. Social drug use in the parturient: implications for the management of obstetrical anaesthesia. Med J Malaysia 2003; 58:147-54; quiz 155. Similar to above.

146. Kuczkowski KM. Social drug use in the parturient: implications for the management of obstetrical anaesthesia. Med J Malaysia 2003; 58:147-54; quiz 155. Similar to above.

147. Kuczkowski KM, Benumof JL. Amphetamine abuse in pregnancy: anesthetic implications. Acta Anaesthesiol Belg 2003; 54:161-3. Case report detailing issues with this drug.

148. Kuczkowski KM. Caesarean section in a cocaine-intoxicated parturient: regional vs. general anaesthesia? Anaesthesia 2003; 58:1042-3. Letter notes case of parturient where regional anesthesia was used following acute crack cocaine use.

149. Kuczkowski KM. Solvents in pregnancy: an emerging problem in obstetrics and obstetric anaesthesia. Anaesthesia 2003; 58:1036-7. Letter reporting case of parturient abusing household solvents as an illicit use substance.

150. Sun LS, Takuma S, Lui R, Homma S. The effect of maternal cocaine exposure on neonatal rat cardiac function. Anesth Analg2003; 97:878-82. Perinatal cocaine exposure in neonatal rats does not modify resting contractile function, but attenuates response to beta stimulation.

151. Ross VH, Moore CH, Pan PH, Fragneto RY, James RL, Justis GB. Reduced duration of intrathecal sufentanil analgesia in laboring cocaine users. Anesth Analg 2003; 97:1504-8. Shorter duration (87 vs. 139 min) analgesia from 10 µg sufenta via CSE in 31 parturients in labor if urine positive for cocaine.


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152. Ebrahim SH, Gfroerer J. Pregnancy-related substance use in the United States during 1996-1998. Obstet Gynecol 2003; 101:374-9. Data analysis of National Household Survey on Drug Abuse. 6.4% of nonpregnant women o childbearing age, and 2.8% of pregnant women reported use of illicit drugs.

153. England LJ, Levine RJ, Mills JL, Klebanoff MA, Yu KF, Cnattingius S. Adverse pregnancy outcomes in snuff users. Am J Obstet Gynecol 2003; 189:939-43. Oral tobacco use in women is associated with increased risk of preterm delivery and preeclampsia in 789 users (compared to randomly selected 11,240 smokers and 11,495 nonusers).

154. Kuczkowski KM. Inhalation induction of anesthesia with sevoflurane for emergency Cesarean section in an amphetamine-intoxicated parturient without an intravenous access. Acta Anaesthesiol Scand 2003; 47:1181-2. Case report of parturient requiring cesarean due to amphetamine induced ploacental abruption and severe fetal bradycardia; lost iv enroute; sevo induction and intubation.

155. Kuczkowski KM. Diagnostic tattoo in a parturient with 'ecstasy' use. Anaesthesia 2003; 58:1251-2. Letter describes case of parturient with a tattoo which alerted health care providers to elicit drug use.

156. Kuczkowski KM, Benumof JL. Amphetamine abuse in pregnancy: anesthetic implications. Acta Anaesthesiol Belg 2003; 54:161-3. Case report of parturient with recent amphetamine use.

Trauma

157. Kuczkowski KM, Fouhy SA, Greenberg M, Benumof JL. Trauma in pregnancy: anaesthetic management of the pregnant trauma victim with unstable cervical spine. Anaesthesia 2003; 58:822. Letter discussing case of parturient undergoing an awake fiberoptic tracheal intubation.

158. Kuczkowski K, Fernandez CL. Thermal injury in pregnancy: anaesthetic considerations. Anaesthesia 2003; 58:931-2. Letter reporting case of parturient with significant burns to torso, upper and lower body.

Vascular

159. Popham P, Buettner A. Arterial aneurysms of the lienorenal axis during pregnancy. International Journal of Obstetric Anesthesia 2003; 12:117-119. Two cases of splenic artery rupture in parturients discussed.

Complementary and Alternative Medicine

160. Glover DD, Amonkar M, Rybeck BF, Tracy TS. Prescription, over-the-counter, and herbal medicine use in a rural, obstetric population. Am J Obstet Gynecol 2003; 188:1039-45. Medication use substantial throughout pregnancy, including contraindicated medications.

161. Edmonds SE, Montgomery JC. Reversible ovarian failure induced by a Chinese herbal medicine: lei gong teng. Bjog 2003; 110:77-8. Case report noting clear but reversible effect of herbal medicine on ovarian failure.

162. Seibel MM. A guest editorial: complementary and alternative medicine and women's health--time to catch up! Obstet Gynecol Surv 2003; 58:149-51. Editorial notes need to be familiar, ask patients and establish referral patterns for CAM practitioners.


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Fetus

Fetal Monitoring

163. Noren H, Amer-Wahlin I, Hagberg H, et al. Fetal electrocardiography in labor and neonatal outcome: data from the Swedish randomized controlled trial on intrapartum fetal monitoring. Am J Obstet Gynecol 2003; 188:183-92. Cardiotocography in 4966 term fetuses notes more accurate identification of intrapartum hypoxia with the addition of ST analysis.

164. DeBattista C, Cochran M, Barry JJ, Brock-Utne JG. Fetal heart rate decelerations during ECT-induced seizures: is it important? Acta Anaesthesiol Scand 2003; 47:101-3. Case report of a parturient at 17 wks gestation. FHR decelerations are transient.

165. Esen UI. Fetal distress and the 30-minute rule. Anaesthesia 2003; 58:1249. Letter suggests that the 30 min rule is based on arbitrary and unscientific data.

166. Losch A, Kainz C, Kohlberger P, et al. Influence on fetal blood pH when adding amniotic fluid: an in vitro model. Bjog 2003; 110:453-6. In-vitro model demonstrates significant rise in blood pH with the addition of amniotic fluid; suggests possible masking of fetal distress may occur when doing fetal blood pH sampling if amniotic fluid contaminates sample.

167. Elimian A, Lawlor P, Figueroa R, Wiencek V, Garry D, Quirk JG. Intrapartum assessment of fetal well-being: any role for a fetal admission test? J Matern Fetal Neonatal Med 2003; 13:408-13. Irrespective of the definition of reactivity, women with anon-reactive fetal admission test were more likely to be delivered by Cesarean section, to have fetal distress resulting in Cesarean section and to have a longer neonatal hospital stay.

168. Gorenberg DM, Pattillo C, Hendi P, Rumney PJ, Garite TJ. Fetal pulse oximetry: correlation between oxygen desaturation, duration, and frequency and neonatal outcomes. Am J Obstet Gynecol 2003; 189:136-8. Fetal oxygen saturation of <30% is associated with declining fetal arterial pH.

169. Kitlinski ML, Kallen K, Marsal K, Olofsson P. Gestational age-dependent reference values for pH in umbilical cord arterial blood at term. Obstet Gynecol 2003; 102:338-45. A physiologic linear decline of umbilical artery pH with gestational age at term was found in an evaluation of 24,390 term singleton vaginal deliveries with an Apgar score of 9 or greater. Authors suggest a gestational age adjusted umbilical artery pH reference should be used, and will result in fewer diagnoses of cord academia than a stationary cutoff of pH of less than 7.10.

Fetal Surgery

170. Rosen MA, Andreae MH, Cameron AG. Nitroglycerin for fetal surgery: fetoscopy and ex utero intrapartum treatment procedure with malignant hyperthermia precautions. Anesth Analg 2003; 96:698-700. Case report of parturient with MH riskundergoing an EXIT procedure under epidural anesthesia + IV nitroglycerin for tocolysis.

171. Wenstrom KD. Fetal Surgery for Congenital Diaphragmatic Hernia. N Engl J Med 2003; 349:1887-1888. Perspective on article below.

172. Harrison MR, Keller RL, Hawgood SB, et al. A Randomized Trial of Fetal Endoscopic Tracheal Occlusion for Severe Fetal Congenital Diaphragmatic Hernia. N Engl J Med 2003; 349:1916-1924. Randomized trial of 24 patients which was stopped early due to the unexpectedly high survival rate (90 days of age) of fetuses in the non-surgical group.

173. Strumper D, Durieux ME, Gogarten W, Van Aken H, Hartleb K, Marcus MA. Fetal plasma concentrations after intraamniotic sufentanil in chronically instrumented pregnant sheep. Anesthesiology 2003; 98:1400-6; discussion 5A-6A. Fetal lamb absorbs intraamniotic sufentanil and achieves significantly greater plasma concentrations than the ewe; suggests may be a potential approach for fetal analgesia following in-utero fetal surgery.


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174. Moise KJ, Jr. Maternal-fetal surgery for spina bifida: on the brink of a new era? Am J Obstet Gynecol 2003; 189:311. Editorial (see article below) noting unique concerns of in-utero repair surgeries.

175. ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 44, July 2003. (Replaces Committee Opinion Number 252, March 2001). Obstet Gynecol 2003; 102:203-13. Covers possibility of in-utero surgery.

Maternal Infection, Fever and Neonatal Sepsis Workup

176. De Jongh RF, Vissers KC, Booij LH, De Jongh KL, Vincken P, Meert TF. Interleukin-6 and perioperative thermoregulation and HPA-axis activation. Cytokine 2003; 21:248-56.

177. De Jongh RF, Vissers KC, Meert TF, Booij LH, De Deyne CS, Heylen RJ. The role of interleukin-6 in nociception and pain. Anesth Analg 2003; 96:1096-103. Increasing evidence suggests that cytokines are important in acute and chronic pain, influencing the transduction, conduction, and transmission of nociceptive signals.

178. Smulian JC, Bhandari V, Vintzileos AM, et al. Intrapartum fever at term: serum and histologic markers of inflammation. Am J Obstet Gynecol 2003; 188:269-74. Term intrapartum fever has a stronger association with maternal serum interleukin-6 levels than either histologic chorioamnionitis or umbilical vein interleukin-6 levels in 47 case controlled pairs.

179. Tomimatsu T, Fukuda H, Kanagawa T, Mu J, Kanzaki T, Murata Y. Effects of hyperthermia on hypoxic-ischemic brain damage in the immature rat: its influence on caspase-3-like protease. Am J Obstet Gynecol 2003; 188:768-73. Hyperthermia during hypoxia-ischemia markedly sensitizes the immature brain to insult; may be mediated by an escalation of the apoptotic cell death pathway.

180. Banerjee S, Steer PJ. The rise in maternal temperature associated with regional analgesia in labour is harmful and should be treated. International Journal of Obstetric Anesthesia 2003; 12:280-4. Proposer of debate (see below) suggests the need for better studies, and potentially treatments to avoid temperature increases.

181. Irestedtz L. The rise in maternal temperature associated with regional analgesia in labour is harmful and should be treated. International Journal of Obstetric Anesthesia 2003; 12:284-6. Opposer of debate (see above) suggests causal relationship hasnot been established.

182. Finster M. Fever and infection during parturition: a preanesthetic or a postanesthetic problem? J Clin Anesth 2003; 15:409-10. Editorial for article below suggests an area where large well controlled studies are needed.

183. Kuczkowski KM, Reisner LS. Anesthetic management of the parturient with fever and infection. J Clin Anesth 2003; 15:478-88. Good review of issues associated with pre and post anesthetic temperature elevation in the parturient.

184. Goetzl L, Cohen A, Frigoletto F, Jr., Lang JM, Lieberman E. Maternal epidural analgesia and rates of maternal antibiotic treatment in a low-risk nulliparous population. J Perinatol 2003; 23:457-61. Retrospective analysis of 1235 nulliparous women with singleton term pregnancies presenting in labor with a temperature of < 99.5 degrees F. Antibiotic use during labor was categorized by indication. Authors conclude that an increased risk of epidural related fever results in increased maternal antibiotic treatment for presumed chorioamnionitis.

Newborn

Behavior

185. Casper RC, Fleisher BE, Lee-Ancajas JC, et al. Follow-up of children of depressed mothers exposed or not exposed to antidepressant drugs during pregnancy. J Pediatr 2003; 142:402-8. Six and 40 mo follow-up of standardized pediatric and dysmorphology examinations. SSRIs during fetal development may have subtle effects on motor development and control.


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186. Salisbury A, Law K, LaGasse L, Lester B. MSJAMA. Maternal-fetal attachment. Jama 2003; 289:1701.

187. van Dis J. MSJAMA. The maternal-fetal relationship. Jama 2003; 289:1696.

188. Stormer N. MSJAMA. Seeing the fetus: the role of technology and image in the maternal-fetal relationship. Jama 2003; 289:1700.

Breast Feeding

189. Henderson JJ, Dickinson JE, Evans SF, McDonald SJ, Paech MJ. Impact of intrapartum epidural analgesia on breast-feeding duration. Aust N Z J Obstet Gynaecol 2003; 43:372-7. Self-report by nulliparous women at 2 and 6 months post-partum observed a high use of epidural analgesia in labour; of those who utilized epidural analgesia, a shorter duration of breast-feeding was noted.

190. Radzyminski S. The effect of ultra low dose epidural analgesia on newborn breastfeeding behaviors. J Obstet Gynecol Neonatal Nurs 2003; 32:322-31. Two groups of neonates in this study. One group was born to mothers who received epiduralanalgesia, and one group was born to mothers who received no pain medication for labor. Both groups were observed for initial breastfeeding behaviors using the Premature Infant Breastfeeding Behavior Scale following birth and at 24 hours. No differences were observed.

Cerebral Palsy

191. Nelson KB. Can we prevent cerebral palsy? N Engl J Med 2003; 349:1765-9. Article concludes that at the present time, cerebral palsy is not preventable in the vast majority of cases.

192. Willoughby RE, Jr., Nelson KB. Chorioamnionitis and brain injury. Clin Perinatol 2002; 29:603-21. Retrospective case-control study noting that exposure to intrauterine infection was not an independent risk factor for CP in very premature infants when gestational age and other confounders were tightly controlled.

193. Qiu H, Paneth N, Lorenz JM, Collins M. Labor and delivery factors in brain damage, disabling cerebral palsy, and neonatal death in low-birth-weight infants. Am J Obstet Gynecol 2003; 189:1143-9. Active labor (but not vaginal delivery) was an independent risk factor for major brain injury in preterm infants; however, elective cesarean unlikely to prove a viable clinical strategy for prevention of neonatal brain injury.

194. Hankins GD, Speer M. Defining the pathogenesis and pathophysiology of neonatal encephalopathy and cerebral palsy. ObstetGynecol 2003; 102:628-36. Expert opinion notes the criteria that must exist for the diagnosis.

Low Birth Weight

195. Strathearn L. Long-term cognitive function in very low-birth-weight infants. Jama 2003; 289:2209. Letter.

196. Schmidt B, Asztalos EV, Roberts RS, Robertson CM, Sauve RS, Whitfield MF. Impact of bronchopulmonary dysplasia, braininjury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months: results from the trial of indomethacin prophylaxis in preterms. Jama 2003; 289:1124-9. In ELBW infants who survive to a postmenstrual age of 36 weeks, a simple count of 3 common neonatal morbidities strongly predicts the risk of later death or neurosensory impairment.

197. Aylward GP. Cognitive function in preterm infants: no simple answers. Jama 2003; 289:752-3. Editorial.

198. Ment LR, Vohr B, Allan W, et al. Change in cognitive function over time in very low-birth-weight infants. Jama 2003; 289:705-11. The majority of VLBW children had improvement in verbal and IQ test scores over time. Only children with early-onset IVH followed by significant central nervous system injury had low PPVT-R scores that declined over time.


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Macrosomia

199. Bergmann RL, Richter R, Bergmann KE, Plagemann A, Brauer M, Dudenhausen JW. Secular trends in neonatal macrosomia in Berlin: influences of potential determinants. Paediatr Perinat Epidemiol 2003; 17:244-9. Neonatal macrosomia is correlated with multiparous, older, non-smoking, BMI > 26, and affluence.

200. Boulet SL, Alexander GR, Salihu HM, Pass M. Macrosomic births in the united states: determinants, outcomes, and proposedgrades of risk. Am J Obstet Gynecol 2003; 188:1372-8. As analyzed in linked live birth and infant death cohort files from 1995-7 in the US after 37 wks gestation, macrosomia >4000 g is useful for increased risks of labor and newborn complications, >4500 g is more predictive of neonatal morbidity, and >5000 g may be a better indicator of infant mortality risk.

Meconium Aspiration

201. Tashiro K, Cui XG, Kobayashi T, Curstedt T, Robertson B. Modified protocols for surfactant therapy in experimental meconium aspiration syndrome. Biol Neonate 2003; 83:49-56. Promising new protocols.

202. Ramon y Cajal CL, Martinez RO. Defecation in utero: a physiologic fetal function. Am J Obstet Gynecol 2003; 188:153-6. 240 fetuses studied sonographically notes defecation in utero is a normal function and highest between wk 28 and 34.

Morbidity

203. Gherman RB, Ouzounian JG, Satin AJ, Goodwin TM, Phelan JP. A comparison of shoulder dystocia-associated transient and permanent brachial plexus palsies. Obstet Gynecol 2003; 102:544-8. Retrospective case-control analysis from a national registry noted that there is no significant difference in antepartum and intrapartum characteristics which ultimately resulted ineither a transient or a permanent injury.

Mortality

204. Gould JB, Qin C, Marks AR, Chavez G. Neonatal Mortality in Weekend vs Weekday Births. Jama 2003; 289:2958-62. California linked data from infant birth and death certificates. Neonatal mortality increased from 2.8/1000 births to 3.12/1000 births on weekends, but after adjusting for birth weight, the increase was not statistically significant.

205. Herman-Giddens ME, Smith JB, Mittal M, Carlson M, Butts JD. Newborns killed or left to die by a parent: a population-based study. Jama 2003; 289:1425-9.

206. Ananth CV, Smulian JC, Vintzileos AM. The effect of placenta previa on neonatal mortality: a population-based study in the United States, 1989 through 1997. Am J Obstet Gynecol 2003; 188:1299-304. Placenta previa is associated with an increased risk of neonatal death.

207. Salihu HM, Li Q, Rouse DJ, Alexander GR. Placenta previa: neonatal death after live births in the United States. Am J ObstetGynecol 2003; 188:1305-9. Placenta previa triples the rate of neonatal mortality, mediated mainly through preterm birth in this population-based retrospective cohort study of 1997 US singleton live births.

208. Holdcroft A, Konje JC, May A. Small babies and substandard anaesthesia: the Confidential Enquiries into Stillbirths and Deaths in Infancy 27/28 report. International Journal of Obstetric Anesthesia 2003; 12:271-4. Comparison of maternal demographics, and anesthesia where infancy deaths did and did not occur. Suggested areas for improvement noted.


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Pharmacology

209. Kearns GL, Abdel-Rahman SM, Alander SW, Blowey DL, Leeder JS, Kauffman RE. Developmental pharmacology--drug disposition, action, and therapy in infants and children. N Engl J Med 2003; 349:1157-67. Primarily covers pharmacology ofinfants, however, offers a great review of the timeframe in the fetus of development of various enzymes.

210. Mattingly JE, D'Alessio J, Ramanathan J. Effects of obstetric analgesics and anesthetics on the neonate : a review. Paediatr Drugs 2003; 5:615-27. Good review noting safety of regional techniques on maternal and fetal/neonatal outcomes.

211. Thorp JA, O'Connor M, Belden B, Etzenhouser J, Hoffman EL, Jones PG. Effects of phenobarbital and multiple-dose corticosteroids on developmental outcome at age 7 years. Obstet Gynecol 2003; 101:363-73. Combined antenatal exposure to Phenobarbital and repetitive steroid therapy was not associated with adverse effects on intelligence, achievement, behavior,or head circumference at 7 yrs of age.

Respiratory Distress

212. Elimian A, Figueroa R, Spitzer AR, Ogburn PL, Wiencek V, Quirk JG. Antenatal corticosteroids: are incomplete courses beneficial? Obstet Gynecol 2003; 102:352-5. 125 neonates between 23-34 wks gestation noted that an incomplete course of antenatal corticosteroids is associated with a reduction in the need for vasopressors, rate of intraventricular hemorrhage, and neonatal death.

Resuscitation/Evaluation

213. Burlingame JM, Esfandiari N, Sharma RK, Mascha E, Falcone T. Total antioxidant capacity and reactive oxygen species in amniotic fluid. Obstet Gynecol 2003; 101:756-61. Interesting study suggests that antioxidants are present in the amniotic fluid at least as early as the second trimester and increase with gestational age. Reactive oxygen species are not necessarily present.

Umbilical Cord Issues

214. Jones J, Stevens CE, Rubinstein P, Robertazzi RR, Kerr A, Cabbad MF. Obstetric predictors of placental/umbilical cord bloodvolume for transplantation. Am J Obstet Gynecol 2003; 188:503-9. Several obstetric variables are related to the amount of cord blood collected for future transplantation.

215. Clapp JF, 3rd, Stepanchak W, Hashimoto K, Ehrenberg H, Lopez B. The natural history of antenatal nuchal cords. Am J Obstet Gynecol 2003; 189:488-93. Prospective study at 24, 30, 36 wks notes nuchal cords usually occur randomly, with increased frequency in late gestation, and appear to be a normal part of intrauterine life and are only rarely associated with perinatal M/M.

216. Lotgering FK, Bishai JM, Struijk PC, et al. Ten-minute umbilical cord occlusion markedly reduces cerebral blood flow and heat production in fetal sheep. Am J Obstet Gynecol 2003; 189:233-8. Autoregulation of cerebral blood flow was lost within 4 minutes of occlusion, probably as a result of hypoxia, combined with hypotension. A reduction in cerebral heat production preceded and exceeded the reduction in blood flow perhaps suggesting an active down-regulation of cerebral metabolism. Recovery of cerebral blood flow and heat production to control values was incomplete for more than 60 minutes after restoration of umbilical flow.


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Non-Obstetric Surgery during Pregnancy

217. ACOG Committee Opinion Number 284, August 2003: Nonobstetric surgery in pregnancy. Obstet Gynecol 2003; 102:431. This one paragraph opinion states that there are "no data to allow us to make specific recommendations", but states that a team approach (anesthesia, obstetrics, surgery) is necessary for the optimal safety of the woman and her baby.

218. Jenkins TM, Mackey SF, Benzoni EM, Tolosa JE, Sciscione AC. Non-obstetric surgery during gestation: risk factors for lower birthweight. Aust N Z J Obstet Gynaecol 2003; 43:27-31. Authors suggest in this retrospective study that the exposureto general anesthesia was associated with lower birth weight?!

219. Ong BY, Baron K, Stearns EL, Baron C, Paetkau D, Segstro R. Severe fetal bradycardia in a pregnant surgical patient despitenormal oxygenation and blood pressure. Can J Anaesth 2003; 50:922-5. Case of woman at 34 wks gestation for cholecytectomy complicated by fetal bradycardia resulting in a cesarean delivery.

220. Fanzago E. Anaesthesia for non-obstetric surgery in pregnant patients. Minerva Anestesiol 2003; 69:416-27. Basic review of issues including prevention of preterm labor.

Pharmacologic Alterations in Women/Pregnancy

221. Pleym H, Spigset O, Kharasch ED, Dale O. Gender differences in drug effects: implications for anesthesiologists. Acta Anaesthesiol Scand 2003; 47:241-59. Excellent review of pharmacokinetic and pharmacodynamic differences gender differences to major groups of anesthetic drugs.

222. Grewal S. To refuse or not to refuse, that is the question? Anaesthesia 2003; 58:715; author's reply 715. Letter with reply noted by S. Yentis discussing reduction of syntocinon dose.

223. Sato N, Tanaka KA, Szlam F, Tsuda A, Arias ME, Levy JH. The vasodilatory effects of hydralazine, nicardipine, nitroglycerin, and fenoldopam in the human umbilical artery. Anesth Analg 2003; 96:539-44. The noted agents used to treat acute hypertension have no adverse effects on umbilical artery tone; however, in larger concentrations (> 10-5 M), fenoldopam may produce contraction of the umbilical artery.

224. Lanni SM, Tillinghast J, Silver HM. Hemodynamic changes and baroreflex gain in the supine hypotensive syndrome. Am J Obstet Gynecol 2002; 187:1636-41. Authors concluded that a decrease in baroreflex gain is not a cause of supine hypotensive syndrome.

225. Bytautiene E, Vedernikov YP, Saade GR, Romero R, Garfield RE. Effect of histamine on phasic and tonic contractions of isolated uterine tissue from pregnant women. Am J Obstet Gynecol 2003; 188:774-8. H1 but not H2 (cimetidine) antagonistssignificantly attenuate phasic myometrial contractions to histamine.

226. Schellenberg JC, Stewart AW, Pliska V. Uterine contractile response to the graded infusion of oxytocin in guinea pigs near term. Am J Obstet Gynecol 2003; 189:201-7. Uterine contractile response to oxytocin increases during the 1-2 wks before term in guinea pigs, despite stable myometrial oxytocin receptor density.

227. Sephton V, Farquharson RG, Topping J, et al. A longitudinal study of maternal dose response to low molecular weight heparinin pregnancy. Obstet Gynecol 2003; 101:1307-11. A longitudinal, prospective, observational study in 24 women questions dose monitoring extrapolation of LMWH from nonpregnant women.

228. Vogelvang TE, van der Mooren MJ, Kamp O, Mijatovic V, Visser CA, Kenemans P. Effects of oral and transdermal low-doseestrogen therapy on echocardiographic parameters of cardiac function. Fertil Steril 2003; 80:546-53. 152 nonpregnant, postmenopausal, hysterectomized women; however, demonstrated potential beneficial influence by echocardiographic parameters of left ventricular function of estrogen + progestin but not estrogen alone.


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229. Nilsson L, Reinheimer T, Steinwall M, Akerlund M. FE 200 440: a selective oxytocin antagonist on the term-pregnant humanuterus. Bjog 2003; 110:1025-8. In an in-vitro study, the new analogue FE 200 440 is a selective oxytocin antagonist and, in contrast to atosiban and ANTAG III, has practically no effect on vasopressin-induced contractions of isolated term-pregnant human myometrium.

230. Monir-Bishty E, Pierce SJ, Kupittayanant S, Shmygol A, Wray S. The effects of metabolic inhibition on intracellular calcium and contractility of human myometrium. Bjog 2003; 110:1050-6. Impairment of oxidative phyosphorylation may explain dysfunctional labor.

231. Hausman N, Beharry KD, Nishihara KC, Akmal Y, Asrat T. Effect of the antenatal administration of celecoxib during the second and third trimesters of pregnancy on prostaglandin, cytokine, and nitric oxide levels in rabbits. Am J Obstet Gynecol 2003; 189:1737-43.

232. Hausman N, Beharry K, Nishihara K, Akmal Y, Stavitsky Y, Asrat T. Response of fetal prostanoids, nitric oxide, and ductus arteriosus to the short- and long-term antenatal administration of celecoxib, a selective cyclo-oxygenase-2 inhibitor, in the pregnant rabbit. Am J Obstet Gynecol 2003; 189:1744-50.

233. Hausman N, Beharry K, Nishihara K, Akmal Y, Asrat T. Antenatal administration of celecoxib, a selective cyclooxygenase (COX)-2 inhibitor, appears to improve placental perfusion in the pregnant rabbit. Prostaglandins Other Lipid Mediat 2003; 70:303-15.

Physiologic Alterations in Women/Pregnancy

234. Dschietzig T, Bartsch C, Richter C, Laule M, Baumann G, Stangl K. Relaxin, a pregnancy hormone, is a functional endothelin-1 antagonist: attenuation of endothelin-1-mediated vasoconstriction by stimulation of endothelin type-B receptor expression via ERK-1/2 and nuclear factor-kappaB. Circ Res 2003; 92:32-40.

235. Marnach ML, Ramin KD, Ramsey PS, Song SW, Stensland JJ, An KN. Characterization of the relationship between joint laxity and maternal hormones in pregnancy. Obstet Gynecol 2003; 101:331-5. Peripheral joint laxity increases during pregnancy, however, do not correlate well with maternal estradiol, progesterone, or relaxin levels.

236. Kametas NA, McAuliffe F, Krampl E, Chambers J, Nicolaides KH. Maternal cardiac function in twin pregnancy. Obstet Gynecol 2003; 102:806-15. Cross-sectional study of 119 pregnant women with twin pregnancies at 10-40 wks compared to 128 women with singleton pregnancies; notes greater hyperdynamic circulation with twin vs. singleton pregnancies, especially after 20 wks.

237. Zeeman GG, Hatab M, Twickler DM. Maternal cerebral blood flow changes in pregnancy. Am J Obstet Gynecol 2003; 189:968-72. 10 healthy pregnant volunteers underwent velocity encoded phase contrast MRI at 14-16, 28-32, 36-38 gestation, and 6-8 postpartum. A 20% reduction in large artery cerebral blood flow occurs during normal pregnancy.

238. Blanks AM, Thornton S. The role of oxytocin in parturition. Bjog 2003; 110 Suppl 20:46-51. Good review of the influence of oxytocin and the oxytocin receptor in labor.

239. Lopez Bernal A. Mechanisms of labour--biochemical aspects. Bjog 2003; 110 Suppl 20:39-45. Very good review of the endocrinology of parturition.

240. Blanks AM, Vatish M, Allen MJ, et al. Paracrine oxytocin and estradiol demonstrate a spatial increase in human intrauterine tissues with labor. J Clin Endocrinol Metab 2003; 88:3392-400. Interesting study using immunohistochemical analysis of amniotic epithelium, decidual stroma, and myometrium which demonstrates location and importance of oxytocin, oxytocin receptors, and estradiol in labor.


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241. Vaisanen-Tommiska M, Nuutila M, Aittomaki K, Hiilesmaa V, Ylikorkala O. Nitric oxide metabolites in cervical fluid during pregnancy: further evidence for the role of cervical nitric oxide in cervical ripening. Am J Obstet Gynecol 2003; 188:779-85.Cervical nitric oxide appears related to cervical ripening.

Placental Issues

242. Ananth CV, Demissie K, Smulian JC, Vintzileos AM. Placenta previa in singleton and twin births in the United States, 1989 through 1998: a comparison of risk factor profiles and associated conditions. Am J Obstet Gynecol 2003; 188:275-81. Cohort study of US natality data files of approximately 38 million and 1 million singleton and twin births. Suggests a 40% increased risk of placenta previa in twin gestation.

243. Faiz AS, Ananth CV. Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. J Matern Fetal Neonatal Med 2003; 13:175-90. Advancing maternal age, multiparity, previous Cesarean delivery and abortion, smoking and cocaine use during pregnancy, and male fetuses all conferred increased risk for placenta previa.

244. Konje JC, Howarth ES, Kaufmann P, Taylor DJ. Longitudinal quantification of uterine artery blood volume flow changes during gestation in pregnancies complicated by intrauterine growth restriction. Bjog 2003; 110:301-5. Serial longitudinal study observed early and marked changes in uterine artery diameter and flow in pregnancies complicated by IUGR.

245. Hausman N, Beharry K, Nishihara K, Akmal Y, Asrat T. Antenatal administration of celecoxib, a selective cyclooxygenase (COX)-2 inhibitor, appears to improve placental perfusion in the pregnant rabbit. Prostaglandins Other Lipid Mediat 2003; 70:303-15. Maternal administration of celecoxib appears to preferentially increase placental vasodilators and decrease placental TxA2, suggesting that the drug may increase uteroplacental perfusion without adverse fetal outcome.

OBSTETRIC ISSUES AND IMPLICATIONS

Complications-Obstetric

Abdominal Pregnancy

246. Wiesenfeld HC, Guido RS. Images in clinical medicine. Intraabdominal pregnancy after hysterectomy. N Engl J Med 2003; 349:1534. Case of 12 wk fetus implanted on the broad ligament.

Amniotic Fluid Embolism

247. Haines J, Wilkes RG. Non-fatal amniotic fluid embolism after cervical suture removal. Br J Anaesth 2003; 90:244-7. Case ofpulmonary edema at 37wks following attempted removal of a cervical suture under general anesthesia. The use of a SiteRite ultrasound machine was utilized to evaluate fluid status.

248. Stanten RD, Iverson LI, Daugharty TM, Lovett SM, Terry C, Blumenstock E. Amniotic fluid embolism causing catastrophic pulmonary vasoconstriction: diagnosis by transesophageal echocardiogram and treatment by cardiopulmonary bypass. Obstet Gynecol 2003; 102:496-8. Case report noting the use of TEE, CP bypass, and high dose steroids resulted in a successful outcome.

249. Goldszmidt E, Davies S. Two cases of hemorrhage secondary to amniotic fluid embolus managed with uterine artery embolization. Can J Anaesth 2003; 50:917-21. Case report of 2 cases of successful management of AFE with severe hemorrhage with uterine artery embolization.

250. Kent KJ, Cooper BC, Thomas KW, Zlatnik FJ. Presumed antepartum amniotic fluid embolism. Obstet Gynecol 2003; 102:493-5. Case report notes difficulty in diagnosing the disorder; suggests that anticoagulation may be a therapeutic option.


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Hemorrhage

251. Friedman Z, Berkenstadt H, Preisman S, Perel A. A comparison of lactated ringer's solution to hydroxyethyl starch 6% in a model of severe hemorrhagic shock and continuous bleeding in dogs. Anesth Analg 2003; 96:39-45, Non-pregnant animal model observed that fluid resuscitation to a target mean arterial blood pressure of 60 mmHg during uncontrolled bleeding resulted in larger oxygen delivery and smaller systemic lactate concentrations when hydroxyethyl starch 6% was used in comparison to LR.

252. Crochetiere C. Obstetric Emergencies. Anesthesiol Clin North America 2003; 21:111-25. Review concentrating on the management of obstetric hemorrhage.

253. Chulu A, Kuczkowski KM. Anaesthetic management of the parturient with massive peripartum haemorrhage and fetal demise. Anaesthesia 2003; 58:933-4. Letter describes case of massive hemorrhage in a parturient with placenta previa in the developing world rural heath care facility in Zambia.

254. Esler MD, Douglas MJ. Planning for hemorrhage. Steps an anesthesiologist can take to limit and treat hemorrhage in the obstetric patient. Anesthesiol Clin North America 2003; 21:127-44, vii. Techniques reviewed to limit and treat obstetric hemorrhage.

255. Sharma S, Varshney S, Davies M. Management of obstetric emergencies in the accident and emergency department: a national survey of UK guidelines. International Journal of Obstetric Anesthesia; 12:306-7. Letter reports a questionnaire-based survey to accident and emergency departments noting that few had guidelines to deal with obstetric emergencies.

256. Condous GS, Arulkumaran S. Medical and conservative surgical management of postpartum hemorrhage. J Obstet Gynaecol Can 2003; 25:931-6. Review of managements for this entity including test suggested below.

257. Condous GS, Arulkumaran S, Symonds I, Chapman R, Sinha A, Razvi K. The "tamponade test" in the management of massive postpartum hemorrhage. Obstet Gynecol 2003; 101:767-72. Describes use of an inflated Sengstaken-Blakemore balloon catheter to tamponade postpartum hemorrhage; may also allow time to correct coagulopathies.

258. Caliskan E, Dilbaz B, Meydanli MM, Ozturk N, Narin MA, Haberal A. Oral misoprostol for the third stage of labor: a randomized controlled trial. Obstet Gynecol 2003; 101:921-8. In a trial of 1474 women, oral misoprosol alone was as effective as oxytocin but less effective than oxytocin + methylergonovine or misoprosol.

259. Branch DW, Rodgers GM. Recombinant activated factor VII: a new weapon in the fight against hemorrhage. Obstet Gynecol 2003; 101:1155-6. Editorial notes that two case reports (below) dramatically suggest the value of this factor in treating obstetric/gynecologic hemorrhage.

260. Danilos J, Goral A, Paluszkiewicz P, Przesmycki K, Kotarski J. Successful treatment with recombinant factor VIIa for intractable bleeding at pelvic surgery. Obstet Gynecol 2003; 101:1172-3. Apt title for case of severe hemorrhage from multiple sites with resection of pelvic sarcomas. Nonpregnant.

261. Bouwmeester FW, Jonkhoff AR, Verheijen RH, van Geijn HP. Successful treatment of life-threatening postpartum hemorrhage with recombinant activated factor VII. Obstet Gynecol 2003; 101:1174-6. Case report of 30 yo nullipara with major postpartum hemorrhage due to uterine atony and vaginal lacerations; hemorrhageic shock and multiple failed therapies.Resolved with activated factor VII.

262. Wang H, Garmel S. Successful term pregnancy after bilateral uterine artery embolization for postpartum hemorrhage. Obstet Gynecol 2003; 102:603-4. Case noting that pregnancy after embolization is possible.


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263. de Souza A, Permezel M, Anderson M, Ross A, McMillan J, Walker S. Antenatal erythropoietin and intra-operative cell salvage in a Jehovah's Witness with placenta praevia. Bjog 2003; 110:524-6. Case noting value of epo and cell salvage for high risk situations where blood transfusion is not an option.

264. Mousa HA, Alfirevic Z. Treatment for primary postpartum haemorrhage. Cochrane Database Syst Rev 2003:CD003249. Rectal misoprostol in a dose of 800 micrograms could be a useful 'first line' drug for the treatment of primary postpartum haemorrhage. Further randomized controlled trials are required to identify the best drug combinations, route, and dose for thetreatment of postpartum haemorrhage.

Hyperemesis Gravidarum

265. Lagiou P, Tamimi R, Mucci LA, Trichopoulos D, Adami HO, Hsieh CC. Nausea and vomiting in pregnancy in relation to prolactin, estrogens, and progesterone: a prospective study. Obstet Gynecol 2003; 101:639-44. Lower levels of prolactin and a trend for high levels of estradiol were correlated with n/v at any time during pregnancy until the 27th wk.

266. Rosen T, de Veciana M, Miller HS, Stewart L, Rebarber A, Slotnick RN. A randomized controlled trial of nerve stimulation for relief of nausea and vomiting in pregnancy. Obstet Gynecol 2003; 102:129-35. 21 day trial during first trimester notes in 187 that nerve stimulation therapy is effective in reducing nausea/vomiting and promoting weight gain in symptomatic women.

267. Yost NP, McIntire DD, Wians FH, Jr., Ramin SM, Balko JA, Leveno KJ. A randomized, placebo-controlled trial of corticosteroids for hyperemesis due to pregnancy. Obstet Gynecol 2003; 102:1250-4. Randomized, controlled trial of IVmethylpred + oral pred taper vs. saline did not reduce need for rehospitalization later in pregnancy.

Maternal Mortality

268. Wildsmith JA. Confidential enquiries into maternal deaths, 1997-1999. Br J Anaesth 2003; 90:257; author reply 257-8. Author of letter suggests that the anaesthetist left mother to resuscitate baby and this contributed to maternal death.

269. Berg CJ, Chang J, Callaghan WM, Whitehead SJ. Pregnancy-related mortality in the United States, 1991-1997. Obstet Gynecol 2003; 101:289-96. The mortality ratio increased from 10.3 in 1991 to 12.9 in 1997; black women continue to have an almost 4 fold increased risk of pregnancy related mortality.

Multiple Gestation

270. Redline RW. Nonidentical twins with a single placenta--disproving dogma in perinatal pathology. N Engl J Med 2003; 349:111-4. Perspective on report below, with great diagram.

271. Souter VL, Kapur RP, Nyholt DR, et al. A report of dizygous monochorionic twins. N Engl J Med 2003; 349:154-8. Interesting, previous thought impossible case of dizygous (two embryos) but monochorionic (single placenta) twins. The influence of IVF in this case merits further investigation.

Neurologic Injury

272. Christianson LM, Bovbjerg VE, McDavitt EC, Hullfish KL. Risk factors for perineal injury during delivery. Am J Obstet Gynecol 2003; 189:255-60. Retrospective review of 2078 deliveries; 4.4% incidence of anal sphincter injury. Forceps and nulliparity were risk factors.

273. Fitzpatrick M, O'Brien C, O'Connell P R, O'Herlihy C. Patterns of abnormal pudendal nerve function that are associated with postpartum fecal incontinence. Am J Obstet Gynecol 2003; 189:730-5. Four abnormal patterns observed in a cohort of 83 women being evaluated for fecal incontinence after vaginal delivery; pattern can influence treatment.


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274. DeLancey JO, Kearney R, Chou Q, Speights S, Binno S. The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol 2003; 101:46-53. Abnormalities of the levator ani muscle are present on MRI after vaginal delivery in primiparous but not nulliparous women.

275. Olsen AL, Ross M, Stansfield RB, Kreiter C. Pelvic floor nerve conduction studies: establishing clinically relevant normativedata. Am J Obstet Gynecol 2003; 189:1114-9. 42 continent women noted age and vaginal delivery associated with dysfunction.

276. Vercellini P, Chapron C, Fedele L, Frontino G, Zaina B, Crosignani PG. Evidence for asymmetric distribution of sciatic nerveendometriosis. Obstet Gynecol 2003; 102:383-7. Evaluation of reports notes sciatic nerve endometriosis is not uncommon.

277. Whiteside JL, Barber MD, Walters MD, Falcone T. Anatomy of ilioinguinal and iliohypogastric nerves in relation to trocar placement and low transverse incisions. Am J Obstet Gynecol 2003; 189:1574-8; discussion 1578. Courses of iliohypogastric and ilioinguinal nerves mapped from 11 adult female cadavers note that surgical sites below the level of the anterior superior iliac spine have potential for ilioinguinal or iliohypogattic injury.

Ovarian Hyperstimulation Syndrome

278. Smits G, Olatunbosun O, Delbaere A, Pierson R, Vassart G, Costagliola S. Ovarian hyperstimulation syndrome due to a mutation in the follicle-stimulating hormone receptor. N Engl J Med 2003; 349:760-6. Case report defining a reason for this iatrogenic complication of IVF.

279. Kaiser UB. The pathogenesis of the ovarian hyperstimulation syndrome. N Engl J Med 2003; 349:729-32. Editorial for the article above noting the pathophysiology of this disorder.

Pain

280. Pyke MR, Shutt LE. The management of nonobstetric pains in pregnancy. Reg Anesth Pain Med 2003; 28:54-7. Case report of 3 parturients with different somatic pain entities treated with local anesthetic and steroid injection.

PIH/Preeclampsia

281. Marfurt D, Lyrer P, Ruttimann U, Strebel S, Schneider MC. Recurrent post-partum seizures after epidural blood patch. Br J Anaesth 2003; 90:247-50. Case of late onset pre-eclampsia in association of epidural blood patch.

282. Sherman R, Armory P, Moody P, Hope T, Mahajan RP. Effects of magnesium sulphate on cerebral haemodynamics in healthyvolunteers: a transcranial Doppler study. Br J Anaesth 2003; 91:273-5. Normal healthy volunteer study demonstrates that magnesium (16 mmol loading dose + 2.7 mmol/hr x 45 min) does not affect cerebral artery blood flow velocity, cerebral autoregulation and cerebral vascular reactivity to carbon dioxide. It was associated with nausea and hypotension.

283. Ramanathan J, Bennett K. Pre-eclampsia: fluids, drugs, and anesthetic management. Anesthesiol Clin North America 2003; 21:145-63. The evaluation and anesthetic management; promotes neuraxial over general anesthesia.

284. Chiu CL, Mansor M, Ng KP, Chan YK. Retrospective review of spinal versus epidural anaesthesia for caesarean section in pre-eclamptic patients. International Journal of Obstetric Anesthesia. 2003; 12:23-27. 121 cases of non-laboring patients noted similar alterations in blood pressure, fluids, and outcome. Limited definition of severity of disease process.

285. Galloway S, Lyons G. Preeclampsia complicated by placental abruption, HELLP, coagulopathy and renal failure - Further lessons. International Journal of Obstetric Anesthesia. 2003; 12:35-39. Case report presented humbly; used DDAVP and renal dialysis.


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286. Lanzinger MJ, Moretti EW, Wilderman RF, El-Moalem HE, Toffaletti JG, Moon RE. The relationship between ionized and total serum magnesium concentrations during abdominal surgery. J Clin Anesth 2003; 15:245-9. Nonpregnant patients, however, notes that correlation between ionized and total serum magnesium exists, but decreases significantly during abdominal surgery without massive transfusion. May have relevance to PIH/preeclamptic patients.

287. Greene MF. Magnesium sulfate for preeclampsia. N Engl J Med 2003; 348:275-6. Perspective regarding editorial below.

288. Belfort MA, Anthony J, Saade GR, Allen JC, Jr. A comparison of magnesium sulfate and nimodipine for the prevention of eclampsia. N Engl J Med 2003; 348:304-11. Randomized, unblended, multicenter study notes magnesium to be 3X more effective than nimodipine in preventing seizures in women with severe preeclampsia.

289. Dyer RA, Els I, Farbas J, Torr GJ, Schoeman LK, James MF. Prospective, randomized trial comparing general with spinal anesthesia for cesarean delivery in preeclamptic patients with a nonreassuring fetal heart trace. Anesthesiology 2003; 99:561-9; discussion 5A-6A. 70 parturients with severe preeclampsia (160/110) randomized to spinal versus general for cesarean delivery. Maternal hemodynamics were similar, but spinal anesthesia required more ephedrine and was associated with lowerumbilical artery pH and base deficits.

290. Rice I, Hellewell SA. Driving after eclampsia: are we acting in our patient's best interests? International Journal of Obstetric Anesthesia 2003; 12:139-140. Letter noting that medical practitioners should improve advising their patients not to drive following eclamptic seizures.

291. Santos AC, Birnbach DJ. Spinal anesthesia in the parturient with severe preeclampsia: time for reconsideration. Anesth Analg2003; 97:621-2. Editorial for the following article suggests that spinal anesthesia may be an appropriate choice for women with severe preeclampsia having a cesarean delivery.

292. Aya AG, Mangin R, Vialles N, et al. Patients with severe preeclampsia experience less hypotension during spinal anesthesia for elective cesarean delivery than healthy parturients: a prospective cohort comparison. Anesth Analg 2003; 97:867-72. 30 severe preeclamptics compared to 30 normal parturients had a 6x less risk for hypotension and required less ephedrine.

293. Dube L, Granry JC. The therapeutic use of magnesium in anesthesiology, intensive care and emergency medicine: a review. Can J Anaesth 2003; 50:732-46. Nice review of all the uses for the 4th most common mineral salt in the human body.

294. Izci B, Riha RL, Martin SE, et al. The upper airway in pregnancy and pre-eclampsia. Am J Respir Crit Care Med 2003; 167:137-40. Parturients with pre-eclampsia, when compared to non-preeclamptics and non-pregnant individuals had upper airway narrowing in both upright and supine postures by acoustic reflection.

295. Newman MG, Robichaux AG, Stedman CM, et al. Perinatal outcomes in preeclampsia that is complicated by massive proteinuria. Am J Obstet Gynecol 2003; 188:264-8. In women with preeclampsia that is treated expectantly, maternal and perinatal outcomes are not affected by the degree of proteinuria.

296. McElrath TF. Association between use of antenatal magnesium sulfate in preterm labor and adverse health outcomes in infants. Am J Obstet Gynecol 2003; 188:294; author reply 294-5. Letter suggests that magnesium sulfate may not necessarilybe associated with poor perinatal outcomes.

297. Rouse DJ, Hirtz DG, Thom E. Association between use of antenatal magnesium sulfate in preterm labor and adverse health outcomes in infants. Am J Obstet Gynecol 2003; 188:295. Letter noting that whether magnesium jeopardizes or benefits preterm infants is a matter of serious concern and currently being studied. BEAM trial.

298. Nevo O, Thaler I, Shik V, Vortman T, Soustiel JF. The effect of isosorbide dinitrate, a donor of nitric oxide, on maternal cerebral blood flow in gestational hypertension and preeclampsia. Am J Obstet Gynecol 2003; 188:1360-5. Blood flow velocity in the middle cerebral artery was reduced after isosorbide dinitrate in 19 hypertensive pregnant patients; estimated cerebral perfusion pressure and pulsatility index remained unchanged.


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299. Seller C, Popham P. An anaesthetic dilemma: to block or not to block? International Journal of Obstetric Anesthesia 2003; 12:307-8. Letter describing case of pregnant patient having severe and sudden abdominal pain during placement of spinal; postpartum preeclampsia and HEELP developed.

300. Cotter AM, Molloy AM, Scott JM, Daly SF. Elevated plasma homocysteine in early pregnancy: a risk factor for the development of nonsevere preeclampsia. Am J Obstet Gynecol 2003; 189:391-4; discussion 394-6. 71 cases of nonsevere preeclampsia sampled at approx 15 wks noted an increased homocysteine level compared to normal controls.

301. Martin JN, Jr., Thigpen BD, Rose CH, Cushman J, Moore A, May WL. Maternal benefit of high-dose intravenous corticosteroid therapy for HELLP syndrome. Am J Obstet Gynecol 2003; 189:830-4. Retrospective analysis of almost 500 patients over two time periods notes that early initiation of high dose IV corticosteroids for HELLP syndrome significantly lessened maternal disease, reduced maternal morbidity and expedited recovery.

302. Isler CM, Bennett WA, Rinewalt AN, et al. Evaluation of a rat model of preeclampsia for HELLP syndrome characteristics. J Soc Gynecol Investig 2003; 10:151-3. The reduced uterine perfusion pressure (RUPP) rat model does not appear to express features of HELLP syndrome.

303. Isler CM, Magann EF, Rinehart BK, Terrone DA, Bass JD, Martin JN, Jr. Dexamethasone compared with betamethasone for glucocorticoid treatment of postpartum HELLP syndrome. Int J Gynaecol Obstet 2003; 80:291-7. Prospective with some randomized patients (n= 36) noted that dexamethasone was superior.

304. Isler CM, Rinehart BK, Terrone DA, May WL, Magann EF, Martin JN, Jr. The importance of parity to major maternal morbidity in the eclamptic mother with HELLP syndrome. Hypertens Pregnancy 2003; 22:287-94. Retrospective analysis of 603 nulliparous and 361 parous patients. Unless parous patients with severe preeclampsia with or without HELLP syndrome develop eclampsia, their disease acuity does not differ significantly from their nulliparous counterparts.

305. Isler CM, Barrilleaux PS, Rinehart BK, Magann EF, Martin JN, Jr. Postpartum seizure prophylaxis: using maternal clinical parameters to guide therapy. Obstet Gynecol 2003; 101:66-9. 503 patients prospectively followed; clinical criteria, when compared to arbitrary protocols, can shorten the duration of postpartum magnesium sulfate for seizure prophylaxis.

306. Chipchase J, Peebles D, Rodeck C. Severe preeclampsia and cerebral blood volume response to postural change. Obstet Gynecol 2003; 101:86-92. In normotensive (n = 13), and pregnancy induced hypertensive (n=9) a fall in median cerebral blood volume was noted; conversely in preeclamptic women a median rise in cerebral blood volume was noted.

307. Scott JR. Magnesium sulfate for mild preeclampsia. Obstet Gynecol 2003; 101:213. Editorial notes the inadequate power of article below, but suggests should be preserved for a future meta-analysis.

308. Livingston JC, Livingston LW, Ramsey R, Mabie BC, Sibai BM. Magnesium sulfate in women with mild preeclampsia: a randomized controlled trial. Obstet Gynecol 2003; 101:217-20. 222 women with mild preeclampsia to magnesium or placebo; no major impact on disease progression noted. However, as stated above, the study is under-powered.

309. Coomarasamy A, Honest H, Papaioannou S, Gee H, Khan KS. Aspirin for prevention of preeclampsia in women with historical risk factors: a systematic review. Obstet Gynecol 2003; 101:1319-32. Meta-analysis of 14 RCT trials suggests that aspirin reduces the risk of perinatal death and preeclampsia in women with historical risk factors.

310. Douglas J. Best evidence in anesthetic practice: prevention: magnesium sulfate reduces the risk of eclampsia in women with pre-eclampsia. Can J Anaesth 2003; 50:1035-7. Commentary reviews 2 major studies (Magpie, Nimodipine) noting that magnesium is the best agent to prevent eclampsia.

311. Macarthur A. Best evidence in anesthetic practice: prevention: magnesium sulfate reduces the risk of eclampsia in women with pre-eclampsia. Can J Anaesth 2003; 50:1035-8. Commentary reviews the 2 major studies (as above); notes that abnormal cerebral perfusion caused by these agents may be important in future investigations and clinical considerations.


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312. Sibai BM. Diagnosis and management of gestational hypertension and preeclampsia. Obstet Gynecol 2003; 102:181-92. High risk pregnancy expert series nicely reviews the topic; appropriate support of anesthetic neuraxial techniques.

313. Subtil D, Goeusse P, Puech F, et al. Aspirin (100 mg) used for prevention of pre-eclampsia in nulliparous women: the Essai Regional Aspirine Mere-Enfant study (Part 1). Bjog 2003; 110:475-84. 3294 nulliparous women between 14 and 20 wks randomized to 100 mg aspirin vs. placebo; found aspirin does not reduce incidence of pre-eclampsia, however, it did result inan increase in bleeding complications.

314. Subtil D, Goeusse P, Houfflin-Debarge V, et al. Randomized comparison of uterine artery Doppler and aspirin (100 mg) with placebo in nulliparous women: the Essai Regional Aspirine Mere-Enfant study (Part 2). Bjog 2003; 110:485-91. 1853 nulliparous women between 14 and 20 wks gestation randomized to a uterine Doppler examination between 22 and 24 wks or take a placebo. Women with abnormal Doppler waveforms received 100 mg of aspirin daily through 36 wks. Despite an observed sensitivity in screening for pre-eclampsia, routine uterine Doppler analysis could not be recommended, as aspirin was ineffective.

315. Audibert F, Salomon LJ, Castaigne-Meary V, Alves K, Frydman R. Selective termination of a twin pregnancy as a treatment of severe pre-eclampsia. Bjog 2003; 110:68-9. Case report of termination of growth restricted twin resulted in disappearanceof pre-eclampsia.

316. Coomarasamy A, Braunholtz D, Song F, Taylor R, Khan KS. Individualising use of aspirin to prevent pre-eclampsia: a framework for clinical decision making. Bjog 2003; 110:882-8. Clinical review notes that substantial variation in preeclampsia risk exist, thereby causing systematic reviews of aspirin effects to possibly result in inappropriate treatment guidelines.

317. Hazra S, Waugh J, Bosio P. 'Pure' pre-eclampsia before 20 weeks of gestation: a unique entity. Bjog 2003; 110:1034-5. Just when you believed that the pre-20 wk timeframe was safe….this case report describes the first case of pre-eclampsia at 18 wks gestation not associated with triploidy, trophoblastic disease or antiphospholipid syndrome.

318. Wilson ML, Goodwin TM, Pan VL, Ingles SA. Molecular epidemiology of preeclampsia. Obstet Gynecol Surv 2003; 58:39-66. Excellent review of the molecular basis of preeclampsia.

319. Wilson BJ, Watson MS, Prescott GJ, et al. Hypertensive diseases of pregnancy and risk of hypertension and stroke in later life: results from cohort study. Bmj 2003; 326:845. Cohort analysis of women in Scotland from national database suggest that hypertensive diseases of pregnancy seem to be associated in later life with diseases related to hypertension.

320. Williams KP, Wilson S. The impact of parity on the incidence of HELLP syndrome and small for gestational age infants in hypertensive pregnant women. J Obstet Gynaecol Can 2002; 24:485-9. Retrospective analysis noting that preeclamptic primigravid primiparous and multigravid primiparous groups behaved similarly in their clinical expression of hypertensive complications but differed from the multiparous group by having a higher incidence of HELLP syndrome. The incidence of complications in hypertensive pregnant women varied by parity but not by gravidity.

Perineal Trauma/Lacerations

321. Williams A. Third-degree perineal tears: risk factors and outcome after primary repair. J Obstet Gynaecol 2003; 23:611-4. Authors made no comments on epidural techniques as cause (for once!), but noted that regional and general techniques are often required (76%) for their repair.

322. Gupta N, Kiran TU, Mulik V, Bethel J, Bhal K. The incidence, risk factors and obstetric outcome in primigravid women sustaining anal sphincter tears. Acta Obstet Gynecol Scand 2003; 82:736-43. Retrospective database analysis noted fetal macrosomia and doctor conducted deliveries were independent risk factors for anal sphincter tears; also suggested that "spinal analgesia at delivery' was associated (as were use of forceps, being postdates, etc. etc.).


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Preterm Labor

323. Kuczkowski KM, Benumof JL. Rebound hyperkalemia after cessation of intravenous tocolytic therapy with terbutaline in thetreatment of preterm labor: anesthetic implications. J Clin Anesth 2003; 15:357-8. Case report detailing increase in potassium with peaked Twaves on ECG with cessation of terbutaline, but no treatment required.

324. Greene MF. Progesterone and preterm delivery--deja vu all over again. N Engl J Med 2003; 348:2453-5. Editorial on article below.

325. Meis PJ, Klebanoff M, Thom E, et al. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. N Engl J Med 2003; 348:2379-85. In 310 women (vs. 153 controls) with prior preterm delivery, treatment with 17Pprogesterone significantly reduced the risk of delivery at less than 37 wks gestation.

326. Low JA, Killen H, Derrick EJ. Antepartum fetal asphyxia in the preterm pregnancy. Am J Obstet Gynecol 2003; 188:461-5. Fetal asphyxia in pregnancies that are delivered preterm is present frequently before labor, as noted by nonstress tests, fetal heart rate monitoring and biophysical profiles.

327. Sawdy RJ, Lye S, Fisk NM, Bennett PR. A double-blind randomized study of fetal side effects during and after the short-termmaternal administration of indomethacin, sulindac, and nimesulide for the treatment of preterm labor. Am J Obstet Gynecol 2003; 188:1046-51. Nimesulide, a Cox-2 preferential inhibitor, caused similar reductions in fetal observations as indomethacin and sulindac.

328. Plaut MM, Smith W, Kennedy K. Fetal fibronectin: the impact of a rapid test on the treatment of women with preterm labor symptoms. Am J Obstet Gynecol 2003; 188:1588-93; discussion 1593-5.

329. Berkman ND, Thorp JM, Jr., Lohr KN, et al. Tocolytic treatment for the management of preterm labor: a review of the evidence. Am J Obstet Gynecol 2003; 188:1648-59. AJOG review of 256 articles. Tocolytic therapy can prolong gestation; betamimetics appear no better than other drugs and may pose a maternal risk. Continued maintenance tocolytic therapy has little or no value.

330. Siega-Riz AM, Promislow JH, Savitz DA, Thorp JM, Jr., McDonald T. Vitamin C intake and the risk of preterm delivery. AmJ Obstet Gynecol 2003; 189:519-25. Prospective cohort study of 2064 women noted women who had total vitamin C intake <10th percentile had 2x risk of preterm delivery.

331. Sakai M, Sasaki Y, Yamagishi N, Tanebe K, Yoneda S, Saito S. The preterm labor index and fetal fibronectin for prediction ofpreterm delivery with intact membranes. Obstet Gynecol 2003; 101:123-8. The preterm labor index was similar to the fetal fibronectin assay in its ability to predict preterm delivery in 185 women with preterm labor and intact membranes.

332. Mercer BM. Preterm premature rupture of the membranes. Obstet Gynecol 2003; 101:178-93. Expert's view; Good review ofpreterm PROM.

333. Iams JD. Prediction and early detection of preterm labor. Obstet Gynecol 2003; 101:402-12. Expert's view; good review of preterm labor.

334. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologist. Number 43, May 2003. Managementof preterm labor. Obstet Gynecol 2003; 101:1039-47. The purpose of this document is to present the various methods proposed to manage preterm labor and the evidence for their roles in clinical practice. Despite the numerous management methods proposed the incidence of preterm birth has changed little over the past 40 years. Uncertainty persists about the best strategies for managing preterm labor.


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335. Spong CY. Recent developments in preventing recurrent preterm birth. Obstet Gynecol 2003; 101:1153-4. Editorial suggests that recent trials support the use of progesterone therapy to prevent subsequent preterm delivery.

336. ACOG Committee Opinion. Use of progesterone to reduce preterm birth. Obstet Gynecol 2003; 102:1115-6. Opinion notes that limited data exists, but appears to support the use in women with a documented history of previous spontaneous birth at less than 37 wks gestation.

337. Winkler M. Role of cytokines and other inflammatory mediators. Bjog 2003; 110 Suppl 20:118-23. Nice review of these mediators on cervical softening and dilation during chorioamniotic infection.

338. Lumley J. Method of delivery for the preterm infant. Bjog 2003; 110 Suppl 20:88-92. Good review on the issues of elective cesarean delivery versus expectant management for preterm infants.

339. Friese K. The role of infection in preterm labour. Bjog 2003; 110 Suppl 20:52-4. Good review suggesting that bacterial vaginosis and intrauterine infection are believed to be important risk factors for preterm delivery.

340. Coomarasamy A, Knox EM, Gee H, Song F, Khan KS. Effectiveness of nifedipine versus atosiban for tocolysis in preterm labour: a meta-analysis with an indirect comparison of randomized trials. Bjog 2003; 110:1045-9. Systematic review of RCTwith meta-analysis suggests that nifedipine is more effective than atosiban for tocolysis in preterm labor.

Pulmonary Embolism

341. Fedullo PF, Tapson VF. Clinical practice. The evaluation of suspected pulmonary embolism. N Engl J Med 2003; 349:1247-56. Non-pregnant patient, however reviews the evidence for diagnosis, testing, and gives algorithms, conclusions and recommendations.

342. Gei AF, Vadhera RB, Hankins GD. Embolism during pregnancy: thrombus, air, and amniotic fluid. Anesthesiol Clin North America 2003; 21:165-82. Review of clinical characteristics to allow distinction and treatment of these entities.

343. Stratmann G, Gregory GA. Neurogenic and humoral vasoconstriction in acute pulmonary thromboembolism. Anesth Analg 2003; 97:341-54. Very good review of animal and some human data on the factors associated with acute PE.

Retained Placenta

344. Delefosse D, Samain E, Helias A, et al. Late onset of cortical blindness in a patient with severe preeclampsia related to retained placental fragments. Anesthesiology 2003; 98:261-3. Case report of preeclamptic parturients who suffered transient cortical blindness 26 days after cesarean delivery, related to undiagnosed retained placental fragments.

345. Jha S, Chiu JW, Yeo IS. Intravenous nitro-glycerine versus general anaesthesia for placental extraction--a sequential comparison. Med Sci Monit 2003; 9:CS63-6. Case report of a 34-year-old gravida 4, para 3 parturient with retained placenta and postpartum haemorrhage on two consecutive deliveries who had the placenta successfully removed manually by the samesurgeon under general anaesthesia versus fentanyl and nitro-glycerine on the first and second deliveries, respectively.

346. Krasznai I, Rigo J, Jr., Boze T, Papp Z. Uncommon type of placentation after previous cesarean deliveries. Obstet Gynecol 2003; 102:549-51. Case report of cervical placentation in a prior scar; gravid hysterectomy occurred.

Surprise Delivery of Infant

347. Kuehn B, Saxena HN, Menon G. Anaesthetised for evacuation of retained products of conception; delivered a baby instead. Anaesthesia 2003; 58:725-6. Parturient thought to have 12 wk loss delivered a 30-32 wk infant instead. Highlights need for experienced gynaecologist to examine patient.


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348. Morris C. A response to 'Anaesthetised for evacuation of retained products of conception; delivered a baby instead', Kuehn B,Saxenta HN, Menon G, Anaesthesia 2003; 58: 725-6. Anaesthesia 2003; 58:1147-8. Letter response to above.

Umbilical Cord Issues

349. Camann W, Marquardt J. Images in clinical medicine. Complex umbilical-cord knot. N Engl J Med 2003; 349:159. Photograph of a double knotted umbilical cord.

350. Spencer NA. Complex umbilical-cord knot. N Engl J Med 2003; 349:1389-90. Letter explaining the genesis for the complexknot captured in the Camann photograph above.

351. Bythell V. Cord prolapse demands general anaesthesia. International Journal of Obstetric Anesthesia 2003; 12:287-9. Proposer of debate (see below) notes that although improved fetal outcome with speedier delivery of these infants is insufficient, we should continue to facilitate delivery as promptly as possible.

352. Scrutton M. Cord prolapse demands general anaesthesia. International Journal of Obstetric Anesthesia 2003; 12:290-2. Opposer of debate (see above) notes that general anesthesia remains a significant cause of maternal morbidity and mortality.

Uterine Rupture

353. Kuczkowski KM. Uterine rupture: signs and symptoms and the effect of labor analgesia on diagnostic accuracy. J Clin Anesth 2003; 15:243. Letter noting that pain is not a classical symptom of uterine rupture regardless of analgesia.

354. Chauhan SP, Martin JN, Jr., Henrichs CE, Morrison JC, Magann EF. Maternal and perinatal complications with uterine rupture in 142,075 patients who attempted vaginal birth after cesarean delivery: A review of the literature. Am J Obstet Gynecol 2003; 189:408-17. Review of 361 articles notes several adverse outcomes with uterine rupture associated with VBAC.

355. Litwin AA. Uterine rupture in a primigravid patient and anesthetic implications: a case report. Aana J 2003; 71:353-6. Case report of epidural vaginal delivery, D/C, laparotomy, noting uterine rupture. DIC then hysterectomy.

356. Ofir K, Sheiner E, Levy A, Katz M, Mazor M. Uterine rupture: risk factors and pregnancy outcome. Am J Obstet Gynecol 2003; 189:1042-6. Population based study of 117,685 singleton deliveries at one institution 1988-99; occurred in 0.035%, most associated with prior c/s, malpresentation, and second stage dystocia.

Critical Care for the Obstetric Patient

357. Zeeman GG, Wendel GD, Jr., Cunningham FG. A blueprint for obstetric critical care. Am J Obstet Gynecol 2003; 188:532-6.Prospective study evaluating admissions to an obstetric intermediate care unit and obstetric admissions to a medical/surgical ICU. Suggests that an intermediate care unit decreases admissions to a med/surg ICU, and should be a considered option for tertiary care centers.

358. Cheng C, Raman S. Intensive care use by critically ill obstetric patients: a five-year review. International Journal of ObstetricAnesthesia 2003; 12:89-92. Retrospective analysis of 43 obstetric admissions to ICU. Median stay duration of 3 days, majority had a good outcome.

359. Jenkins TM, Troiano NH, Graves CR, Baird SM, Boehm FH. Mechanical ventilation in an obstetric population: characteristics and delivery rates. Am J Obstet Gynecol 2003; 188:549-52. Most obstetric patients who receive mechanical ventilation will require delivery because of their condition. Retrospective review of 51 cases.


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360. Demirkiran O, Dikmen Y, Utku T, Urkmez S. Critically ill obstetric patients in the intensive care unit. International Journal ofObstetric Anesthesia 2003; 12:266-70. Retrospective analysis of 125 obstetric admissions to the ICU over a 5 yr period. Overall mortality 10.4%; preeclampsia/eclampsia and postpartum hemorrhage most common reasons for admission.

361. Gilbert TT, Smulian JC, Martin AA, Ananth CV, Scorza W, Scardella AT. Obstetric admissions to the intensive care unit: outcomes and severity of illness. Obstet Gynecol 2003; 102:897-903. The simplified acute physiologic score (SAPS II) did not accurately predict mortality in obstetric patients admitted for indications related to pregnancy and delivery.

Obstetric Management Issues

Birth Centers

362. Jackson DJ, Lang JM, Swartz WH, et al. Outcomes, safety, and resource utilization in a collaborative care birth center program compared with traditional physician-based perinatal care. Am J Public Health 2003; 93:999-1006. Outcomes, safety, and resource utilization in a collaborative management birth center model of perinatal care versus traditional physician-based care demonstrated similar outcomes in 2957 low-risk, low-income women: 1808 receiving collaborative care and 1149 receiving traditional care.

Breech

363. Bujold E, Marquette GP, Ferreira E, Gauthier RJ, Boucher M. Sublingual nitroglycerin versus intravenous ritodrine as tocolytic for external cephalic version: a double-blinded randomized trial. Am J Obstet Gynecol 2003; 188:1454-7; discussion 1457-9. 74 randomized parturients noted ECV success higher with ritodine (45% vs. 24%); headache and lower blood pressure more common with nitroglycerine.

364. Bujold E, Sergerie M, Masse A, Verschelden G, Bedard MJ, Dube J. Sublingual nitroglycerine as a tocolytic in external cephalic version: a comparative study. J Obstet Gynaecol Can 2003; 25:203-7. Retrospective review; noted nitroglycerine not associated with higher success rate than ritodine.

365. Bujold E, Boucher M, Rinfret D, Berman S, Ferreira E, Marquette GP. Sublingual nitroglycerin versus placebo as a tocolytic for external cephalic version: a randomized controlled trial in parous women. Am J Obstet Gynecol 2003; 189:1070-3. 99 patients randomized to nitro vs. placebo shows success rate of 48% vs. 63%.

366. External cephalic version: When should it be done?: Hutton EK, Kaufman K, Hodnett E, Amankwah K, Hewson SA, McKayD, et al. External cephalic version beginning at 34 weeks' gestation versus 37 weeks' gestation: A randomized multicenter trial. Am J Obstet Gynecol 2003;189:245-54. J Midwifery Womens Health 2003; 48:478.

367. Hutton EK, Kaufman K, Hodnett E, et al. External cephalic version beginning at 34 weeks' gestation versus 37 weeks' gestation: a randomized multicenter trial. Am J Obstet Gynecol 2003; 189:245-54. Early ECV at 34-36 wks may reduce risk of noncephalic presentation at delivery when compared to 37-38 wks. (116 women in each group).

368. Boucher M, Bujold E, Marquette GP, Vezina Y. The relationship between amniotic fluid index and successful external cephalic version: a 14-year experience. Am J Obstet Gynecol 2003; 189:751-4. Prospective observational study of 1361 women notes that AFI is associated with success of ECV.

369. Krebs L, Langhoff-Roos J. Elective cesarean delivery for term breech. Obstet Gynecol 2003; 101:690-6. Retrospective cohort of 15,441 primiparas who delivered a singleton breech at term in Denmark. Elective cesarean delivery for a term breech carries a low risk of severe maternal complications.


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370. Bujold E, Boucher M, Rinfret D, Berman S, Ferreira E, Marquette GP. Sublingual nitroglycerin versus placebo as a tocolytic for external cephalic version: a randomized controlled trial in parous women. Am J Obstet Gynecol 2003; 189:1070-3. 99 patients randomized to 2 sublingual sprays of 400 µg nitroglycerin or placebo; nitroglycerin was less successful (48%vs 63%).

371. Gilbert WM, Hicks SM, Boe NM, Danielsen B. Vaginal versus cesarean delivery for breech presentation in California: a population-based study. Obstet Gynecol 2003; 102:911-7. Retrospective, population based cohort of all term, normal birth weight, nonanomalous newborns in California 91-99. Neonatal mortality and morbidity increased significantly when breech fetus was delivered vaginally versus by cesarean.

372. Rietberg CC, Elferink-Stinkens PM, Brand R, van Loon AJ, Van Hemel OJ, Visser GH. Term breech presentation in The Netherlands from 1995 to 1999: mortality and morbidity in relation to the mode of delivery of 33824 infants. Bjog 2003; 110:604-9. Retrospective observational study noting early neonatal morbidity and mortality with a trial of labor in term breech presentations (33,824 infants).

Cerclage Placement

373. Drakeley AJ, Roberts D, Alfirevic Z. Cervical cerclage for prevention of preterm delivery: meta-analysis of randomized trials. Obstet Gynecol 2003; 102:621-7. Meta-analysis noted that the effectiveness of cerclage in preventing preterm deliveryin women at low or medium risk for second trimester pregnancy loss has not been proven.

374. Belej-Rak T, Okun N, Windrim R, Ross S, Hannah ME. Effectiveness of cervical cerclage for a sonographically shortened cervix: a systematic review and meta-analysis. Am J Obstet Gynecol 2003; 189:1679-87. Meta analysis does not support cerclage for a sonographically detected short cervix.

375. Odibo AO, Elkousy M, Ural SH, Macones GA. Prevention of preterm birth by cervical cerclage compared with expectant management: a systematic review. Obstet Gynecol Surv 2003; 58:130-6. Meta-analysis notes trend towards cervical cerclagereducing preterm births before 34 weeks in use, however, no improvement in neonatal mortality and an increase in postpartum fever were observed.

Cesarean Delivery

376. Smith KA. Unnecessary Caesareans. Tampa Tribune. Tampa, FL, 2003:10. Letter to editor by CNM stating complications of cesarean deliveries.

377. Staff H. "Too Posh to Push" celeb moms opt for designer C-sections. Boston Herald. Boston, MA, 2003. Celebrity mums-to-be more worried about their bikini lines than their babies.

378. Bost BW. Cesarean delivery on demand: what will it cost? Am J Obstet Gynecol 2003; 188:1418-21; discussion 1421-3. 1 year cost data from not-for-profit community hospital suggest cesarean on demand should have little impact on overall costs; discussion following this by other individuals detail other implications.

379. Luthy DA, Malmgren JA, Zingheim RW, Leininger CJ. Physician contribution to a cesarean delivery risk model. Am J ObstetGynecol 2003; 188:1579-85; discussion 1585-7. Prospective cohort study of all live births weighing >500 g for a 2 year period at a large metropolitan hospital. Concluded that physician management adds a significant independent effect to cesarean delivery risk.

380. Women's Health Care Professionals Issue Warning About Cesarean Section on Demand. PR Newswire Association, Inc. Washington, 2003. Women's health care organizations believe ACOG downplays risk of C/S.

381. Minkoff H, Chervenak FA. Elective primary cesarean delivery. N Engl J Med 2003; 348:946-50. Commentary suggests an obligation to provide qualitative and quantitative assessment of risks and benefits to elective cesarean section to women.


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382. Li T, Rhoads GG, Smulian J, Demissie K, Wartenberg D, Kruse L. Physician cesarean delivery rates and risk-adjusted perinatal outcomes. Obstet Gynecol 2003; 101:1204-12. A small increase in infant intracranial hemorrhage was noted in physicians who perform relatively few cesarean deliveries in this population-based study of 171,295 singleton births in New Jersey.

383. Nygaard I, Cruikshank DP. Should all women be offered elective cesarean delivery? Obstet Gynecol 2003; 102:217-9. Editorial suggests that it is "ill advised to routinely give all prenatal patients the choice of their desired mode of delivery".

384. Heffner LJ, Elkin E, Fretts RC. Impact of labor induction, gestational age, and maternal age on cesarean delivery rates. Obstet Gynecol 2003; 102:287-93. Retrospective cohort on 14,409 women; notes that induction of labor, older maternal age,and gestational age over 40 wks each independently increase the risk for cesarean delivery in both nulliparous and multiparous women.

385. Joseph KS, Young DC, Dodds L, et al. Changes in maternal characteristics and obstetric practice and recent increases in primary cesarean delivery. Obstet Gynecol 2003; 102:791-800. Recent increases in primary cesarean delivery rates are a consequence of increasing maternal age (>35) weight (>70kg), and weight gain during pregnancy (>20kg).

386. Wilkes PT, Wolf DM, Kronbach DW, Kunze M, Gibbs RS. Risk factors for cesarean delivery at presentation of nulliparous patients in labor. Obstet Gynecol 2003; 102:1352-7. Case control, chart review study of 325 nulliparous patients presenting in labor at term with singleton vertex fetus with cesarean (study subjects) or vaginal (controls) delivery. Suggests within 2 hrs of admission, slow cervical dilation change, fetal station, as well as maternal weight, gestational age, and preeclampsia, are independent variables that increase cesarean delivery.

387. Matthews TG, Crowley P, Chong A, McKenna P, McGarvey C, O'Regan M. Rising caesarean section rates: a cause for concern? Bjog 2003; 110:346-9. Commentary finds a correlation in three Dublin hospitals between increasing cesarean section rate and a falling birthweight specific infant mortality rate; suggests that this outcome needs to be evaluated when commenting on cesarean section rates.

388. Allen VM, O'Connell CM, Liston RM, Baskett TF. Maternal morbidity associated with cesarean delivery without labor compared with spontaneous onset of labor at term. Obstet Gynecol 2003; 102:477-82. Population bsed study of Nova Scotia hospitals from 1988-2001 (18,435 women) concludes that an increased maternal morbidity in elective cesarean delivery compared with spontaneous onset of labor is limited to puerperal febrile morbidity. Maternal morbidity is increased after assisted vaginal delivery and cesarean delivery in labor compared with cesarean delivery without labor.

389. Danielian P, Nikolaou D. The unfacts of "request" caesarean section. Bjog 2003; 110:784; author reply 784-5. Letter suggests that the available evidence suggests that any claim of knowing whether vaginal versus elective cesarean delivery is safer is not justified.

390. Aslam MF, Gilmour K, Fawdry RD. Who wants a caesarean section? A study of women's personal experience of vaginal and caesarean delivery. J Obstet Gynaecol 2003; 23:364-6. Article relates the views of 50 women who had at least one vaginal and one caesarean section.

Feeding during Labor

391. Parsons M. Midwifery dilemma: to fast or feed the labouring woman. Part I: The case for restricting oral intake in labour. Aust J Midwifery 2003; 16:7-13. Explores the entity of gastric aspiration.

392. O'Sullivan G, Scrutton M. NPO during labor. Is there any scientific validation? Anesthesiol Clin North America 2003; 21:87-98. Author concludes that current evidence suggests that solids and semi-solids should be avoided once a woman is in active labor or requests analgesia but allow a carefully audited introduction of isotonic drinks.


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Induction of Labor

393. Robinson C, Schumann R, Zhang P, Young RC. Oxytocin-induced desensitization of the oxytocin receptor. Am J Obstet Gynecol 2003; 188:497-502. Cultured human uterine myocytes are desensitized to oxytocin stimulation by a 3-6 hr preincubation with oxytocin.

394. Johnson DP, Davis NR, Brown AJ. Risk of cesarean delivery after induction at term in nulliparous women with an unfavorable cervix. Am J Obstet Gynecol 2003; 188:1565-9; discussion 1569-72. Retrospective study of 2647 nulliparous women undergoing induction noted that a significantly increased risk of cesarean delivery, especially when the Bishop score is less than or greater/equal to 5 (31.5% vs. 18.1%).

395. Sanchez-Ramos L, Olivier F, Delke I, Kaunitz AM. Labor induction versus expectant management for postterm pregnancies: a systematic review with meta-analysis. Obstet Gynecol 2003; 101:1312-8. Meta analysis of RCTs suggests that labor induction at 41 wks reduces cesarean deliveries without compromising perinatal outcomes.

396. van Gemund N, Hardeman A, Scherjon SA, Kanhai HH. Intervention rates after elective induction of labor compared to laborwith a spontaneous onset. A matched cohort study. Gynecol Obstet Invest 2003; 56:133-8. Matched cohort study (122 induction, 122 spontaneous) notes elective induction of labor leads to increased intervention rates during labor. The rate of cesarean delivery is high, particular in nulliparous women and multiparous women without a previous vaginal birth.

Instrumental Delivery

397. Sadan O, Ginath S, Gomel A, et al. Vacuum application through a nonfully dilated cervix: a viable option. Arch Gynecol Obstet 2003; 268:281-3. Case control cohort study of 39 women with vacuum deliveries through a nonfully dilated cervix larger than 9 cm and station of the head at S or more +2 cm. Based on predefined criteria, vacuum extraction through a nonfully dilated cervix is a viable alternative to emergency cesarean section and is apparently not associated with higher maternal or infant morbidity.

Intrapartum Care

398. From the Center of Disease Control and Prevention. State-specific trends in US live births to women born outside the 50 states and the District of Columbia--United States, 1990 and 2000. Jama 2003; 289:1503-5.

399. Nahum GG, Stanislaw H. Ultrasonographic prediction of term birth weight: how accurate is it? Am J Obstet Gynecol 2003; 188:566-74. Most sonographic fetal biometric algorithms used to predict term birth weight are no more accurate than equations based solely on maternal characteristics.

400. Owen J, Iams JD, Hauth JC. Vaginal sonography and cervical incompetence. Am J Obstet Gynecol 2003; 188:586-96. AJOGreview article suggests cerclage for sonographically suspected cervical incompetence should remain investigational. Good review.

401. Olesen AW, Westergaard JG, Olsen J. Perinatal and maternal complications related to postterm delivery: a national register-based study, 1978-1993. Am J Obstet Gynecol 2003; 189:222-7. Postterm delivery significantly increases risks of perinatal and maternal complications in Denmark. Approx 78K singleton deliveries.

402. ACOG practice bulletin number 47, October 2003: Prophylactic Antibiotics in Labor and Delivery. Obstet Gynecol 2003; 102:875-82. Good review of scenarios and evidence where antibiotics during labor and delivery are helpful.

403. ACOG committee opinion number 286, October 2003: patient safety in obstetrics and gynecology. Obstet Gynecol 2003; 102:883-5. Elements of safety for patients are discussed; communication and system error identification are discussed.


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404. ACOG Practice Bulletin Number 49, December 2003: Dystocia and augmentation of labor. Obstet Gynecol 2003; 102:1445-54. Reviews definition, risk factors, criteria that require delivery and management of labor.

Malpresentation

405. Buhimschi CS, Buhimschi IA, Malinow AM, Weiner CP. Uterine contractility in women whose fetus is delivered in the occipitoposterior position. Am J Obstet Gynecol 2003; 188:734-9. Laboring women generate normal intrauterine pressure despite an occipitoposterior fetal position. Also comments that malpresentation is not the result of epidural use.

406. Ponkey SE, Cohen AP, Heffner LJ, Lieberman E. Persistent fetal occiput posterior position: obstetric outcomes. Obstet Gynecol 2003; 101:915-20. Cohort study of 6434 consecutive, term, vertex, laboring nulliparous and multiparous patients comparing occiput posterior and anterior positions. Noted spontaneous vaginal delivery occurred in only 26% for nulliparas, and 57% for multiparas. Balanced view of epidurals-suggest association but not causation!

Multiple Gestation

407. Hogle KL, Hutton EK, McBrien KA, Barrett JF, Hannah ME. Cesarean delivery for twins: a systematic review and meta-analysis. Am J Obstet Gynecol 2003; 188:220-7. In four studies of 1932 infants, planned cesarean delivery may decrease riskof low 5 min Apgar, particularly if twin A is breech; other, no evidence to support planned cesarean for twins.

408. Russell RB, Petrini JR, Damus K, Mattison DR, Schwarz RH. The changing epidemiology of multiple births in the United States. Obstet Gynecol 2003; 101:129-35. Between 1980 and 1999, this retrospective analysis of National Center for Health Statistics data notes an increase of multiple births by 59%.

409. Williams KP, Galerneau F. Intrapartum influences on cesarean delivery in multiple gestation. Acta Obstet Gynecol Scand 2003; 82:241-5. Retrospective analysis of 10 yr, 967 consecutive twin pregnancies with a gestational age >/=32 weeks with twin A presenting as a vertex and eligible for vaginal delivery were reviewed. A number of influences discussed, however, authors concluded that the presence of an epidural technique reduced the likelihood of a cesarean section.

410. Ramsey PS, Repke JT. Intrapartum management of multifetal pregnancies. Semin Perinatol 2003; 27:54-72. Review includesimportance of anesthetic consultation.

Postpartum Care

411. Webb DA, Robbins JM. Mode of delivery and risk of postpartum re-hospitalization. Jama 2003; 289:46-7. letter.

Termination of Pregnancy

412. Keder LM. Best practices in surgical abortion. Am J Obstet Gynecol 2003; 189:418-22. Review noted that the majority of first trimester surgical abortions are done under paracervical block; suggests that addition of sedation improves patient satisfaction but "does not significantly affect pain ratings".

413. Barnett EH. Witnesses testify on first of five abortion bills. The Oregonian. Salem, OR, 2003:B04. Testimony on bills including the two cited below.

414. Gouras M. House Approves Fetal Pain Bill. Associated Press, 2003. (Oregon) House approved Fetus Pain Prevention Act requiring physicians to tell women considering an abortion after 16 wks that the fetus may have pain.

415. Gouras M. House changes mind on fetal pain bill. Associated Press, 2003. (Oregon) House reverses the decision on bill requiring physicians tell women getting abortions that the procedure may cause pain to the fetus.


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416. Thorp JM, Jr., Hartmann KE, Shadigian E. Long-term physical and psychological health consequences of induced abortion: review of the evidence. Obstet Gynecol Surv 2003; 58:67-79. Review of findings and epidemiologic problems in studying the long-term consequences of abortion.

VBAC

417. Elkousy MA, Sammel M, Stevens E, Peipert JF, Macones G. The effect of birth weight on vaginal birth after cesarean delivery success rates. Am J Obstet Gynecol 2003; 188:824-30. VBAC data of 9960 women (from 16 centers over 5 yrs) note that vaginal success rate is less than 50% when neonatal birth weight exceeds 4000 g.

418. Mankuta DD, Leshno MM, Menasche MM, Brezis MM. Vaginal birth after cesarean section: trial of labor or repeat cesarean section? A decision analysis. Am J Obstet Gynecol 2003; 189:714-9. A model that suggests if additional pregnancies after cesarean were wished for, a trial of labor had a 50% or greater chance of success.

419. Bucklin BA. Vaginal birth after cesarean delivery. Anesthesiology 2003; 99:1444-8. Excellent review of topic including anesthetic implications.

420. Delaney T, Young DC. Spontaneous versus induced labor after a previous cesarean delivery. Obstet Gynecol 2003; 102:39-44. Retrospective review of 3746 patients with one prior cesarean notes that induced labor is associated with higher rate of early postpartum hemorrhage, cesarean delivery, and neonatal ICU admission.

OB ANESTHETIC ISSUES AND IMPLICATIONS

Analgeisa for Labor and Delivery

Alternative Techniques

421. Paech M. Newer techniques of labor analgesia. Anesthesiol Clin North America 2003; 21:1-17. Reviews continuous spinal analgesia, lumbar sympathetic block, patient controlled intravenous remifentanil, and subanesthetic volatile agents.

422. Campbell DC. Parenteral opioids for labor analgesia. Clin Obstet Gynecol 2003; 46:616-22. Brief review of intravenous labor analgesia.

423. Cyna AM. Hypno-analgesia for a labouring parturient with contra-indications to central neuraxial block. Anaesthesia 2003; 58:101-2. Letter suggests that hypnotherapy works, however, the patient utilized Entonox during labor!

424. Leeman L, Fontaine P, King V, Klein MC, Ratcliffe S. Management of labor pain: promoting patient choice. Am Fam Physician 2003; 68:1023, 1026, 1033 passim. Editorial to the two articles below (interesting that editorialist is also the author of the two articles!) which suggests that parturients, family practitioners and hospitals are actively dissuaded from using alternative pain relief modalities.

425. Leeman L, Fontaine P, King V, Klein MC, Ratcliffe S. The nature and management of labor pain: part I. Nonpharmacologic pain relief. Am Fam Physician 2003; 68:1109-12. Brief review with limited references of nonpharmacologic pain relief; introduced with pretext that pain relief is NOT an important determinant for maternal satisfaction.

426. Leeman L, Fontaine P, King V, Klein MC, Ratcliffe S. The nature and management of labor pain: part II. Pharmacologic painrelief. Am Fam Physician 2003; 68:1115-20. Brief review part II, again with limited references. Suggests that the high use of epidural analgesia may be the result of limited labor pain options offered.

427. Toscano A, Pancaro C. Obstetric analgesia: back to the future? J Matern Fetal Neonatal Med 2003; 14:6-7. Editorial comments on the use of inhaled volatiles for labor.


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428. Waters BL, Raisler J. Ice massage for the reduction of labor pain. J Midwifery Womens Health 2003; 48:317-21. A one-group, pretest, posttest use of ice massage of the acupressure energy meridian point large intestine 4 (LI4) to reduce labor pain during contractions; an effect was suggested.

429. Wickham S. Alternidurals. Pract Midwife 2003; 6:47.

430. Chung UL, Hung LC, Kuo SC, Huang CL. Effects of LI4 and BL 67 acupressure on labor pain and uterine contractions in the first stage of labor. J Nurs Res 2003; 11:251-60. The study suggests in 127 randomized paturtients that LI4 and BL67 acupressure may lessen labor pain during the active phase of the first stage of labor. There were no verified effects on uterinecontractions.

431. Nesheim BI, Kinge R, Berg B, et al. Acupuncture during labor can reduce the use of meperidine: a controlled clinical study. Clin J Pain 2003; 19:187-91. randomized, unblinded, controlled study. One group received acupuncture (N = 106); another did not (N = 92). A second control group (N = 92), drawn from the labor ward protocol, consisted of patients who met the eligibility criteria for the study and were matched to the "no acupuncture" group by parity, but who had not been offered the opportunity to take part. Meperidine was given to 11% of the acupuncture group, 37% of the no acupuncture group (P < 0.0001), and 29% of the control group.

432. Bodner K, Bodner-Adler B, Wierrani F, et al. Effects of water birth on maternal and neonatal outcomes. Wien Klin Wochenschr 2002; 114:391-5. Case control of 140 women who wanted a water birth. A statistically significant decrease in the use of medical analgesia (p = 0.0001) and oxytocin (p = 0.002) was observed in women who had water births. No difference in neonatal parameters.

433. Spellerberg E, Smidt-Jensen SL. [A retrospective analysis of the results of obstetric acupuncture at Frederiksberg Hospital]. Ugeskr Laeger 2003; 165:1023-7. Retrospective study notes acupuncture to be effective during labor by parturients and midwives.

434. Robertson A. TENS--a marketing triumph. Pract Midwife 2003; 6:20-1. Review of use in Labor.

435. Geissbuhler V, Eberhard J. [Alternative obstetrics: bed, chair or tub? Have alternative birthing methods become established?].Ther Umsch 2002; 59:689-95. Article suggests that nonpharmacologic alternatives are common to obstetrics.

Ambulation

436. Karraz M. [Difficult start in France for early ambulation with epidural analgesia in obstetrics]. Ann Fr Anesth Reanim 2003; 22:832-3. Letter.

437. Karraz MA. Ambulatory epidural anesthesia and the duration of labor. Int J Gynaecol Obstet 2003; 80:117-22. 221 women with uncomplicated pregnancies in spontaneous labor between 36-42 weeks of gestation or scheduled for induced labor randomized to ambulatory and non-ambulatory. All were given intermittent epidural injections of 0.1% ropivacaine with 0.6 microg/ml sufentanil for analgesia during labor. No significant differences in mode of delivery, consumption of local anesthetic, or oxytocin requirement, but shorter duration (173.4+/-109.9 min vs. 236.4+/-130.6 min; P=0.001) in ambulating parturients.

Anatomy

438. 1.Kim J T, Bahk JH, Sung J. Influence of age and sex on the position of the conus medullaris and Tuffier's line in adults. Anesthesiology 2003; 99:1359-63. Nonpregnant, mixed ages and gender; 690 patients evaluated by MRI. A safety margin of2-4 vertebral bodies and intervertebral spaces between conus medullaris and tuffier's line exists regardless of gender or presence of transitional vertebra. However, closer with age and palpation of subcutaneous fat must be considered.


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439. Shiroyama K, Izumi H, Kubo T, Nakamura R. Distance from the skin to the epidural space at the first lumbar interspace in a Japanese obstetric population. Hiroshima J Med Sci 2003; 52:27-9. Prospective examination of 95 parturient women found acorrelation of body weight with epidural space distance was the highest of the physical factors (r2 = 0.800, p = 0.0001), and asimple regression equation was formulated to aid in predicting SE distance: "SE distance (cm) = 0.05 x body weight (kg) + 0.36".

Benefit of Anesthesia

440. Lyons G. Can anesthesia improve the outcome in high risk obstetric patients? Middle East J Anesthesiol 2003; 17:71-81. Benefit of referral and assessment of high risk patients by an anesthesiologist are discussed.

Breastfeeding

441. Baumgarder DJ, Muehl P, Fischer M, Pribbenow B. Effect of labor epidural anesthesia on breast-feeding of healthy full-term newborns delivered vaginally. J Am Board Fam Pract 2003; 16:7-13. Cohort study comparing 115 consecutive healthy full term breast-feeding newborns delivered vaginally of mothers who had epidural analgesia with 116 newborns not exposed to maternal epidural analgesia. Concludes negative association with early breast feeding success despite not inhibiting early breast feeding attempts. Did not analyze or report epidural medication type or dosage, length of labor, socioeconomic status, use of local anesthesia, or use of postpartum analgesics.

Breech Delivery

442. Pratt SD. Anesthesia for breech presentation and multiple gestation. Clin Obstet Gynecol 2003; 46:711-29. Good review, includes neuraxial techniques for external cephalic version.

CSE Technique

443. DeBalli P, Breen TW. Intrathecal opioids for combined spinal-epidural analgesia during labour. CNS Drugs 2003; 17:889-904. Good review of agents and implications of their selection for the CSE technique.

Equipment

444. Lechner TJ, van Wijk MG, Maas AJ, et al. Clinical results with the acoustic puncture assist device, a new acoustic device to identify the epidural space. Anesth Analg 2003; 96:1183-7. A prototype acoustic puncture assist device was reliable, safe andsimple and allowed better needle control and teaching.

445. Goebel A, Ovenden K, Glynn C. Incorrect distance markings on an epidural catheter. Br J Anaesth 2003; 91:610. Letter withphotograph and description noting that catheter markings can be incorrect.

446. Beilin Y, Hossain S, Bodian CA. The numeric rating scale and labor epidural analgesia. Anesth Analg 2003; 96:1794-8. In a post hoc analysis of three previous studies with mixed parity women noted that the use of a verbal numeric rating scale correlated with desire for additional analgesic medication.

447. Angle PJ, Kronberg JE, Thompson DE, et al. Dural tissue trauma and cerebrospinal fluid leak after epidural needle puncture: effect of needle design, angle, and bevel orientation. Anesthesiology 2003; 99:1376-82. CSF leak is most influenced by epidural needle gauge.

448. Armstrong J. Managing accidentally cut epidural catheters. Anaesthesia 2003; 58:1139-40. Letter review literature and comments on solution to maintain sterility.


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449. Eckmann DM. Variations in epidural catheter manufacture: implications for bending and stiffness. Reg Anesth Pain Med 2003; 28:37-42. 6 different catheters evaluated; authors conclude that cross-sectional shape and material properties influencebending stiffness.

450. Grau T, Bartusseck E, Conradi R, Martin E, Motsch J. Ultrasound imaging improves learning curves in obstetric epidural anesthesia: a preliminary study. Can J Anaesth 2003; 50:1047-50. Higher rate of success noted with ultrasonographic prepuncture approach to epidural space in two groups of residents, with their first 60 total epidurals.

451. Martin R, Pirlet M, Parent M, Gingras F. Evaluation of epidural catheter tip position. Can J Anaesth 2003; 50:963; author reply 963-4. Letter describes Arrow flex tip and Portex catheters evaluated by x-ray go in all directions.

Epidural Techniques

452. Eltzschig HK, Lieberman ES, Camann WR. Regional anesthesia and analgesia for labor and delivery. N Engl J Med 2003; 348:319-32. Wonderful review of contemporary topics on our practice.

453. Jakobi P, Solt I, Zimmer EZ. Regional anesthesia and analgesia for labor and delivery. N Engl J Med 2003; 348:1818-20; author reply 1818-20. Letter to Eltzschig article suggesting that oral, nonnarcotic analgesia after cesarean delivery should be promoted.

454. Van de Velde M, Teunkens A, Vandermeersch E. Regional anesthesia and analgesia for labor and delivery. N Engl J Med 2003; 348:1818-20; author reply 1818-20. Letter to Eltzschig article stressing the importance of the effects of fetal heart rate as a result of CSE, and that regional analgesia is not a generic procedure.

455. Zwissler B. Regional anesthesia and analgesia for labor and delivery. N Engl J Med 2003; 348:1818-20; author reply 1818-20. Letter to Eltzschig article emphasizing that epidural analgesia is very unlikely to have any clinically relevant effect on cesarean delivery.

456. Lang SA, Tsui B, Grau T. New avenues of epidural research. Anesth Analg 2003; 97:292-3. Letter noting alternatives (mostly directed to heavily sedated or anesthetized pts) in finding the epidural space: electrostimulation and ultrasound.

457. Shenouda PE, Cunningham BJ. Assessing the superiority of saline versus air for use in the epidural loss of resistance technique: a literature review. Reg Anesth Pain Med 2003; 28:48-53. Authors conclude that saline is a superior technique.

458. Gadalla F, Lee SH, Choi KC, Fong J, Gomillion MC, Leighton BL. Injecting saline through the epidural needle decreases theiv epidural catheter placement rate during combined spinal-epidural labour analgesia. Can J Anaesth 2003; 50:382-5. Injecting saline 10 mL through the epidural needle prior to epidural catheter placement in 100 women requesting CSE with intrathecal opioid, noted to decrease venous catheter placements.

459. Kuczkowski KM. Saline through the epidural needle: what volume? Can J Anaesth 2003; 50:1077; author reply 1077. Letter challenging investigators to study saline vs. air, follows and agreed by author of article above.

460. Lang SA. Identification of the epidural space: air or saline? Can J Anaesth 2003; 50:860-1; author reply 861-2. Letter suggests air is a good technique but technique and judgment required.

461. Errando CL. Identification of the epidural space: air or saline? Can J Anaesth 2003; 50:861; author reply 861-2. Letter suggests that volume of air is important to sequelae.

462. Sobue K, Tsuda T, Yumoto M, Nakagawa T, Nakano M, Katsuya H. Skin analgesia with lidocaine tape prior to epidural blockade. Can J Anaesth 2003; 50:95-6. Use of lidocaine tape (18 mg lidocaine 60% in a 30.5x50 mm film) prior to epiduralblockade is effective in decreasing pain of insertion.


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463. D'Angelo R. New techniques for labor analgesia: PCEA and CSE. Clin Obstet Gynecol 2003; 46:623-32. Good review of these techniques including advantages, disadvantages and recommendations.

464. May A. Obstetric anaesthesia and analgesia. Anaesthesia 2003; 58:1186-9. "State of the Art" series focusing on advances in the field.

465. Wildsmith JA. Regional anaesthesia. Anaesthesia 2003; 58:1200-3. "State of the Art" series focusing on advances in the field. Non-obstetric topics.

466. Belgian guidelines and recommendations for safe practice in obstetric anesthesia. Acta Anaesthesiol Belg 2003; 54:119-25. Guidelines to enhance quality, safety and patient satisfaction with obstetric anesthesia.

467. Lee BB, Chen PP, Ngan Kee WD. Status of obstetric epidural analgesia services in Hong Kong public hospitals: postal questionnaire survey. Hong Kong Med J 2003; 9:407-14. Compared to 1995, the availability has increased but still not 24/7 at all hospitals; overall epidural analgesia rate 15% (8-20% range).

468. Crass D, Friedrich J. [Epidural analgesia during childbirth]. Anaesthesist 2003; 52:727-44; quiz 745-6. Review of practical issues relating to this technique.

469. Zuokumor P, Columb M. Epidural anaesthesia for pain relief in labour. Eur J Anaesthesiol 2003; 20:674-5; author reply 675-6. Letter.

470. Farragher R, Datta S. Recent advances in obstetric anesthesia. J Anesth 2003; 17:30-41. Review focuses on low dose CSE, spinal anesthesia for preeclampsia patients, and cell savers and blood conservation.

471. Villevieille T, Mercier F, Shannon PE, Auroy Y, Benhamou D. Efficacy of epidural analgesia during labour and delivery: a comparison between singleton vertex presentation, singleton breech presentation and twin pregnancies. Eur J Anaesthesiol 2003; 20:164-5. Letter.

472. Boon JM, Prinsloo E, Raath RP. A paramedian approach for epidural block: an anatomic and radiologic description. Reg Anesth Pain Med 2003; 28:221-7. Cadaver study of new epidural technique approach. May be helpful for difficult placements, but work is preliminary.

Fetal Effects

473. Holdcroft A, Dob D. Regional analgesia for labour and fetal distress: culprit or innocent bystander? International Journal of Obstetric Anesthesia 2003; 12:153-155. Editorial evaluating the possible causes of fetal bradycardia following regional anesthesia.

474. Hill JB, Alexander JM, Sharma SK, McIntire DD, Leveno KJ. A comparison of the effects of epidural and meperidine analgesia during labor on fetal heart rate. Obstet Gynecol 2003; 102:333-7. Cohort study of 200 women with epidural compared to 156 women with meperidine PCA; Incidence and type of FHR deceleration were not significantly different between methods within 40 minutes of initiation (41% meperidine, 34% epidural exhibited decelerations).

475. Soncini E, Grignaffini A, Anfuso S, Cavicchioni O. [Epidural analgesia during labour: maternal, fetal and neonatal aspects]. Minerva Ginecol 2003; 55:263-9. Prospective comparative study of epiduralized versus control parturients suggests with the use of intermittent bolus of ropivacaine (0.2%) + Fent, no differences in delivery modalities or neonatal outcomes were noted.


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476. Bodner-Adler B, Bodner K, Kimberger O, et al. The effect of epidural analgesia on obstetric lacerations and neonatal outcome during spontaneous vaginal delivery. Arch Gynecol Obstet 2003; 267:130-3. Multicenter study of databases notes epidural analgesia does not have a detrimental effect on the integrity of the birth-canal and on neonatal outcome during spontaneous vaginal delivery.

Fluid Preloading

477. Kubli M, Shennan AH, Seed PT, O'Sullivan G. A randomized controlled trial of fluid pre-loading before low dose epidural analgesia for labour. International Journal of Obstetric Anesthesia 2003; 12:256-60. 168 parturients randomized to 7mL/kg Hartmann's solution vs. no-preload prior to low dose epidural (0.1%B 15 mL + fentanyl 2 µg/mL). No differences noted in decrease in MAP, proportion dropping >20%, or FHR changes. ; 350 participants in each group needed to exclude type 2 error.

Forceps Delivery

478. Aubard Y, Fourgeaud V, Collet D, Grandchamp P, Vincelot A. Forceps delivery and the use of synthetic opioid analgesia during epidural anaesthesia. Eur J Obstet Gynecol Reprod Biol 2003; 106:130-3. Retrospective study of two 3-year periods suggesting that the addition of sufentanil via an epidural did not affect forceps rate, however, implying that epidural analgesiaincreases the forceps rate.

479. Carroll TG, Engelken M, Mosier MC, Nazir N. Epidural analgesia and severe perineal laceration in a community-based obstetric practice. J Am Board Fam Pract 2003; 16:1-6. Retrospective cohort study of 2,759 patients noted 65 of 634 had an epidural placement and severe perineal lacerations. Concluded that epidural analgesia was associated with an increase in severe perineal trauma, but as a result of an associated threefold increased risk of instrument use. Instrument use in vaginal delivery more than tripled the risk of severe perineal laceration.

Maternal Education

480. White LA, Gorton P, Wee MYK, Mandal N. Written information about epidural analgesia for women in labour: did it improve knowledge? International Journal of Obstetric Anesthesia 2003; 12:93-97. Audit of 200 women noted that those receiving a laminated epidural card for a verbal discussion significantly improved knowledge level regarding epidural analgesia.

481. Stewart A, Sodhi V, Harper N, Yentis SM. Assessment of the effect upon maternal knowledge of an information leaflet about pain relief in labour. Anaesthesia 2003; 58:1015-9. Parturients receiving the OAA leaflet (n=37) improved their knowledge over those receiving the standard booking information (n = 39).

482. Wadland LP, Sveigaard AL, Jensen AG. [A study of labor pain experiences, knowledge of epidural pain relief and satisfactionwith pain relief]. Ugeskr Laeger 2003; 165:4527-30.

483. Olayemi O, Aimakhu CO, Udoh ES. Attitudes of patients to obstetric analgesia at the University College Hospital, Ibadan, Nigeria. J Obstet Gynaecol 2003; 23:38-40. A Structured questionnaire administered to 1,000 antenatal patients notes awareness of obstetric analgesia is relatively low (only 10% were aware of epidural analgesia); however, a high proportion ofpatients would accept analgesia in labour if offered.

Maternal Position

484. Soetens FM, Meeuwis HC, Van der Donck AG, De Vel MA, Schijven MP, Van Zundert AA. Influence of maternal position during epidural labor analgesia. International Journal of Obstetric Anesthesia 2003; 12:98-101. Dosing of catheter with 0.125% bupivacaine 10mL with 1:800,000 epi + sufenta 7.5 µg in 77 women randomized to the left lateral or 15 degree left tilt positions. The 15 degree lateral tilt resulted in better bilateral sensory blockade at 20 and 30 min; however, supine hypotensive syndrome occurred in 3 patients (vs. none in other group) in this position.


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485. Kodali BS, Mang A, Camann W. A new role for labor "support" personnel. International Journal of Obstetric Anesthesia 2003; 12:305. Letter and photo of husband sitting on bed with parturient wrapped around him for epidural placement.

486. Bodner-Adler B, Bodner K, Kimberger O, Lozanov P, Husslein P, Mayerhofer K. Women's position during labour: influence on maternal and neonatal outcome. Wien Klin Wochenschr 2003; 115:720-3. Case control analysis of 307 women in "free squatting"position suggests a decrease in use of analgesia, oxytocin, and episiotomies.

Maternal Satisfaction

487. Elkadry E, Kenton K, White P, Creech S, Brubaker L. Do mothers remember key events during labor? Am J Obstet Gynecol 2003; 189:195-200. 60% of mothers (277 women with median of 10 wks since delivery, mean age 26yrs) could not recall accurately at least one major labor management event. Studies that rely on recall are likely to have high error rates. (NB. Noanesthetic variables).

Obstetric Management

488. Roberts CL, Raynes-Greenow CH, Upton A, Douglas ID, Peat B. Management of labour among women with epidural analgesia. Aust N Z J Obstet Gynaecol 2003; 43:78-81. Survey of delivery suites in New South Wales (NSW) that annually provide at least 100 epidurals to 'standard primipara'. Epidural rates among 'standard primipara' at these hospitals ranged from 14 to 85% (median 46%). Continuous epidural infusion was the most commonly used technique (63%). For 'standard primipara' with an epidural 62% of units usually augmented labour with oxytocin, 89% discontinued the epidural in second stage and 67% had policies of delayed pushing.

PCEA

489. Boselli E, Debon R, Duflo F, Bryssine B, Allaouchiche B, Chassard D. Ropivacaine 0.15% plus sufentanil 0.5 microg/mLand ropivacaine 0.10% plus sufentanil 0.5 microg/mL are equivalent for patient-controlled epidural analgesia during labor. Anesth Analg 2003; 96:1173-7. Ropivacaine 0.10% + sufentanil 0.5 µg/mL via PCEA for labor analgesia is equally effectiveas ropivacaine 0.15% + 0.5 µg/mL. A 30% local anesthetic sparing effect and a 40% reduction in cost was also observed, however, no change in motor block or side effects were observed.

490. Ledin Eriksson S, Gentele C, Olofsson CH. PCEA compared to continuous epidural infusion in an ultra-low-dose regimen forlabor pain relief: a randomized study. Acta Anaesthesiol Scand 2003; 47:1085-90. 80 parturients randomized to CEI with ropiv 1 mg/ml + sufent 0.5 µg/ml at 6 ml/h or PCEA with 4 mL demand doses with a 20 min lockout. PCEA consumed 33%less study solution with no differences in pain relief, efficacy, side effects or obstetric outcome.

Pharmacology

491. Arakawa M. Intrathecal magnesium prolongs fentanyl analgesia. Anesth Analg 2003; 96:1533; author reply 1533. Letter queries author's finding of magnesium potentiation of fentanyl.

492. de Beer DA, Thomas ML. Caudal additives in children--solutions or problems? Br J Anaesth 2003; 90:487-98. Interesting review article of additives used in caudal anesthesia for pediatrics. May offer ideas for research in the obstetric population.

493. Eichenberger U, Giani C, Petersen-Felix S, Graven-Nielsen T, Arendt-Nielsen L, Curatolo M. Lumbar epidural fentanyl: segmental spread and effect on temporal summation and muscle pain. Br J Anaesth 2003; 90:467-73. Fentanyl 100 µg, but not 50 µg, diluted with saline to 15 mL and injected epidurally at L2-3 produced analgesia to heat stimulation at only a singledermatome. Challenges popular belief of greater spread.

494. Rane K, Sollevi A, Segerdahl M. A randomized double-blind evaluation of adenosine as adjunct to sufentanil in spinal labouranalgesia. Acta Anaesthesiol Scand 2003; 47:601-3. The addition of 500 µg of adenosine to 10 µg sufentanil did not provide differences in quality or duration of labor analgesia.


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495. Arakawa M, Aoyama Y, Ohe Y. Block of the sacral segments in lumbar epidural anaesthesia. Br J Anaesth 2003; 90:173-8. 27 Nonpregnant patients given L4-5/L5-S1 blocks with 17 mL of agent suggests the addition of epinephrine and bicarbonate increases pain thresholds at S1 and S3 segments and decreases onset time.

496. Sanchez del Aguila MJ, Jones MF, Vohra A. Premixed solutions of diamorphine in ropivacaine for epidural anaesthesia: a study on their long-term stability. Br J Anaesth 2003; 90:179-82. Solutions of ropivacaine and diamorphine indicate that diamorphine, but not ropivacaine, degrades over time. A 10% degradation this occurs over 6-30 days depending on temperature and storage bag.

497. Ueta K, Takeda K, Ohsumi H, Haruna J, Shibuya H, Mashimo T. A small preoperative test dose of intravenous fentanyl can predict subsequent analgesic efficacy and incidence of side effects in patients due to receive epidural fentanyl. Anesth Analg 2003; 96:1079-82. Nonpregnant patients: Response to 50 µg of fentanyl IV can predict response to bupiv/fentanyl epidural infusion postoperatively.

498. Sites BD, Beach M, Biggs R, et al. Intrathecal clonidine added to a bupivacaine-morphine spinal anesthetic improves postoperative analgesia for total knee arthroplasty. Anesth Analg 2003; 96:1083-8. Nonpregnant patients: Intrathecal clonidine 25 µg + morphine 250 µg decreased 24 hr IV morphine consumption and improved VAS scores when compared to morphine alone following total knee arthroplasty.

499. Roelants F, Rizzo M, Lavand'homme P. The effect of epidural neostigmine combined with ropivacaine and sufentanil on neuraxial analgesia during labor. Anesth Analg 2003; 96:1161-6. Neostigmine (4 µg/kg) + ropivacaine 10 mg provided equivalent initial labor epidural analgesia to ropivacaine 20 mg; however was less effective than sufentanil 10 µg + ropivacaine 10 mg in terms of potency and duration.

500. Kampe S, Pietruck C, Diefenbach C. Density determination of bupivacaine and bupivacaine-opioid mixtures for spinal anesthesia. Anesth Analg 2003; 96:1234; author reply 1234-5. Letter questions whether opioids affect solution density and spread.

501. Rhee K, Kang K, Kim J, Jeon Y. Intravenous clonidine prolongs bupivacaine spinal anesthesia. Acta Anaesthesiol Scand 2003; 47:1001-5. Nonpregnant, ortho pts; 3 µg/kg within 1h following spinal bupivacaine block prolonged anesthesia by 1hr.

502. Connelly NR, Parker RK, Pedersen T, et al. Diluent volume for epidural fentanyl and its effect on analgesia in early labor. Anesth Analg 2003; 96:1799-804. 60 laboring primigravid women receiving 3 mL epidural test dose of 1.5% lidocaine + 1:200K epi with 100 µg fentanyl in 2 mL, 10 mL, or 20 mL volume. When placed approx at 5cm, volume in which fentanyl given does not affect onset or duration of block or ability to ambulate.

503. Panni M, Segal S. New local anesthetics. Are they worth the cost? Anesthesiol Clin North America 2003; 21:19-38. Authors conclude that the large difference in cost cannot currently justify the use of these new agents in the obstetric setting.

504. Hart EM, Ahmed N, Buggy DJ. Impact study of the introduction of low-dose epidural (bupivacaine 0.1%/fentanyl 2É g.mL-1]) compared with bupivacaine 0.25% for labour analgesia. International Journal of Obstetric Anesthesia. 2003; 12:4-8. Retrospective analysis of 300 parturients all receiving intermittent boluses, half receiving 0.25% bupiv versus 0.1% bupiv + fent 2 µg/mL 10mL. Concluded low dose reduces incidence of instrumental deliveries and bladder catheterization, but increases anesthetic interventions.

505. Kiran TSU, Thakur MB, Bethel JA, Bhal PS. Comparison of continuous infusion versus midwife administered top-ups of epidural bupivacaine for labour analgesia: Effect on second stage of labour and mode of delivery. International Journal of Obstetric Anesthesia. 2003; 12:9-11. Retrospective study of 410 primigravid parturients receiving 0.1% bupiv + fent 2 µg/mL continuous versus intermittent boluses. Concluded no differences in prolonged second stage or cesarean. Reduction of motor blockade in intermittent group.


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506. Polley LS, Columb MO. Ropivacaine and bupivacaine: concentrating on dosing! Anesth Analg 2003; 96:1251-3. Editorial onarticle below noting the difficulties in meta-analyses noting the importance of attention to relative potencies of local anesthetics.

507. Halpern SH, Walsh V. Epidural ropivacaine versus bupivacaine for labor: a meta-analysis. Anesth Analg 2003; 96:1473-9.

508. Hess PE, Vasudevan A, Snowman C, Pratt SD. Small dose bupivacaine-fentanyl spinal analgesia combined with morphine forlabor. Anesth Analg 2003; 97:247-52. 60 parturients receiving CSE with bupiv 2 mg, fent 12.5 µg ± morphine 125 µg. Morphine did not prolong analgesia, but improved control of pain and postpartum pain meds.

509. Shin SW, Sandner-Kiesling A, Eisenach JC. Systemic, but not intrathecal ketorolac is antinociceptive to uterine cervical distension in rats. Pain 2003; 105:109-14. Unlike morphine, which reduces response to UCD by spinal and supraspinal mechanisms and whose action is blocked by estrogen, the cyclooxygenase inhibitor, ketorolac acts at an estrogen-independent, non spinal site.

510. Shin SW, Eisenach JC. Intrathecal morphine reduces the visceromotor response to acute uterine cervical distension in an estrogen-independent manner. Anesthesiology 2003; 98:1467-71; discussion 6A. Intrathecal morphine reduced the visceromotor reflex response to UCD in a dose-dependent manner that was unaffected by estrogen treatment.

511. Halpern SH, Breen TW, Campbell DC, et al. A multicenter, randomized, controlled trial comparing bupivacaine with ropivacaine for labor analgesia. Anesthesiology 2003; 98:1431-5. No difference in incidence of the primary outcome, operative delivery, or neonatal outcome in nulliparous patients receiving low concentrations of the agents.

512. Eisenach JC, Hood DD, Curry R, Shafer SL. Cephalad movement of morphine and fentanyl in humans after intrathecal injection. Anesthesiology 2003; 99:166-73. Volunteer nonpregnant study evaluates pharmacokinetics within CSF of morphine and fentanyl.

513. Teoh WH, Sia AT. Hyperbaric bupivacaine 2.5 mg prolongs analgesia compared with plain bupivacaine when added to intrathecal fentanyl 25 microg in advanced labor. Anesth Analg 2003; 97:873-7. 37 nulliparous parturients noted hyperbaric formulation had longer median duration (122 min; 80-120 min) vs. (95 min;75-125 min).

514. Mather LE, Cousins MJ. The site of action of epidural fentanyl: what can be learned by studying the difference between infusion and bolus administration? The importance of history, one hopes. Anesth Analg 2003; 97:1211-3. Editorial queries whether the question is truly dichotomous, ie. Spinal or supraspinal only.

515. Ginosar Y, Riley ET, Angst MS. The site of action of epidural fentanyl in humans: the difference between infusion and bolus administration. Anesth Analg 2003; 97:1428-38. 10 nonpregnant volunteers in randomized crossover design to receive epidural bolus or infusion; authors conclude that for the dose range evaluated, epidural fentanyl acts predominantly at the spinal sites when given as a bolus, and supraspinal sites when administered as an infusion.

516. Ginosar Y, Columb MO, Cohen SE, et al. The site of action of epidural fentanyl infusions in the presence of local anesthetics:a minimum local analgesic concentration infusion study in nulliparous labor. Anesth Analg 2003; 97:1439-45. 48 women received epidural bupiv 0.125% 20-30mL then randomized to IV or epidural fentanyl 30 µg/h. MLAC then performed. Authors conclude that a marked increase in potency for epidural route.

517. Lacassie HJ, Columb MO. The relative motor blocking potencies of bupivacaine and levobupivacaine in labor. Anesth Analg 2003; 97:1509-13. 60 parturients in labor randomized to MLAC with epidural bupiv or levobupiv demonstrates levo provides less potent motor block.

518. Bernard JM, Le Roux D, Frouin J. Ropivacaine and fentanyl concentrations in patient-controlled epidural analgesia during labor: a volume-range study. Anesth Analg 2003; 97:1800-7. PCEA study evaluated 6 different regimens of ropiv + fent notes that drug mass is more important than volume or concentration.


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519. Okutomi T, Mochizuki J, Amano K, Datta S. The effect of intrathecal epinephrine on epidural infused analgesics during labor. Reg Anesth Pain Med 2003; 28:108-12. Mixed parity parturients randomized to bupiv 2.5mg, fent 25 µg +/- epi 100 µg notes longer sensory and motor blockade with epi.

520. Neal JM. Effects of epinephrine in local anesthetics on the central and peripheral nervous systems: Neurotoxicity and neural blood flow. Reg Anesth Pain Med 2003; 28:124-34. Nice review of pharmacology and physiologic implications of epi.

521. Polley LS, Columb MO, Naughton NN, Wagner DS, van de Ven CJ, Goralski KH. Relative analgesic potencies of levobupivacaine and ropivacaine for epidural analgesia in labor. Anesthesiology 2003; 99:1354-8. 105 parturients at = 7cm dilated randomized to epidural with levo or ropiv in a MLAC study. Ropiv:levobupiv potency ratio 0.98; no difference in motor effects.

522. Benhamou D, Ghosh C, Mercier FJ. A randomized sequential allocation study to determine the minimum effective analgesic concentration of levobupivacaine and ropivacaine in patients receiving epidural analgesia for labor. Anesthesiology 2003; 99:1383-6. 94 parturients = 5cm dilated randomized to epidural with levo or ropiv in a MLAC study. Levo found to be 19%more potent than ropiv but similar sensory, motor and safety.

523. Castro C, Tharmaratnam U, Brockhurst N, Tureanu L, Tam K, Windrim R. Patient-controlled analgesia with fentanyl provides effective analgesia for second trimester labour: a randomized controlled study. Can J Anaesth 2003; 50:1039-46. 3 fentanyl PCA regimens compared with morphine PCA; no difference with respect to pain, however, morphine had highest side effects. Fent 50 µg q 6 min lockout had satisfactory analgesia.

524. Blaise G. Should we use naloxone epidurally? Can J Anaesth 2003; 50:875-8. Editorial suggesting that we should evaluate naloxone should be further evaluated. Mentions letter below.

525. Okutomi T, Saito M, Mochizuki J, Amano K. Prophylactic epidural naloxone reduces the incidence and severity of neuraxial fentanyl-induced pruritus during labour analgesia in primiparous parturients. Can J Anaesth 2003; 50:961-2. Letter reporting the use of bupiv, fent, epi +/- 0.0004% naloxone infusions epidurally in 69 parturients. Notes a reduction in pruritis (71% without vs. 26% with naloxone).

526. Stienstra R. The place of ropivacaine in anesthesia. Acta Anaesthesiol Belg 2003; 54:141-8. Basic review of this new local anesthetic in labor, postoperative analgesia and surgery.

527. Fernandez C, Sala X, Plaza A, Lopez A, Celemin M, Gomar C. [Epidural anesthesia with ropivacaine vs. bupivacaine in continuous perfusion for the treatment of labor pains]. Rev Esp Anestesiol Reanim 2003; 50:70-6. The analgesic efficacy andextent of motor block of 0.125% ropivacaine or 0.125% bupivacaine by continuous epidural perfusion in 60 ASA I-II women, each carrying a single fetus at full term and in spontaneous labor. Ropiv group required more boluses (NS), and motor block was greater in the Bupiv group (p < 0.05).

528. Nikkola E. [Intravenous fentanyl in obstetrical analgesia]. Duodecim 2003; 119:2063-8.

529. Werrbach K, Wroblewski M. Self-administered pain medications. A practical approach in an OB/GYN setting. AWHONN Lifelines 2003; 7:132-8. Patient controlled analgesia.

Physiology

530. Tong C, Ma W, Shin SW, James RL, Eisenach JC. Uterine cervical distension induces cFos expression in deep dorsal horn neurons of the rat spinal cord. Anesthesiology 2003; 99:205-11. Innovative study which gets closer to the mechanism of labor pain. (Read my review).


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531. Antognini JF, Jinks SL, Atherley R, Clayton C, Carstens E. Spinal anaesthesia indirectly depresses cortical activity associatedwith electrical stimulation of the reticular formation. Br J Anaesth 2003; 91:233-8. Nonpregnant goat model demonstrates that lidocaine spinal anesthesia blocks ascending somatosenory transmission, resulting in the depression of reticulo-thalamo-cortical arousal mechanisms. Consistent with spinal anesthesia decreasing sedation and anesthetic requirements.

532. Reynolds F. Fetal and maternal lactate increase during active second stage of labour (what about the effect of maternal analgesia?). Bjog 2003; 110:86. Letter suggesting the benefit of epiduralized labor having less severe metabolic acidosis andlower lactate levels at birth, and poses the question: Shouldn't the possible benefits to the baby of a maternal epidural be disclosed?

533. Buyukkocak U, Caglayan O, Oral H, Basar H, Daphan C. The effects of anesthetic techniques on acute phase response at delivery (anesthesia and acute phase response). Clin Biochem 2003; 36:67-70. 40 parturients in 4 groups (vaginal vs. cesarean; spinal vs. epidural). No influence of anesthetic techniques on acute phase response (c-reactive protein, albumin) except hemodilution effect. In the view of delivery types, vaginal delivery caused less stress response than section.

Progress of Labor

534. Halpern SH, Leighton BL. Misconceptions about neuraxial analgesia. Anesthesiol Clin North America 2003; 21:59-70. Restates that evidence is limited to categorically state a causal relationship of labor epidural analgesia and use of forceps and prolonged labor.

535. Reynolds F, Russell R, Porter J, Smeeton M. Does the use of low dose bupivacaine/opioid epidural infusion increase the normal delivery rate? International Journal of Obstetric Anesthesia 2003; 12:156-163. Almost 600 parturients of mixed parity randomized to 0.0625% bupiv+fent 2.5 µg/mL or sufenta 0.25 µg/mL versus 0.125% bupiv. No increase in normal delivery rate with low dose infusion.

536. Sharma SK, Leveno KJ. Regional analgesia and progress of labor. Clin Obstet Gynecol 2003; 46:633-45. Good review of retrospective, population based, and randomized studies including a special section on the trials at Parkland.

537. Plunkett BA, Lin A, Wong CA, Grobman WA, Peaceman AM. Management of the second stage of labor in nulliparas with continuous epidural analgesia. Obstet Gynecol 2003; 102:109-14. Randomizing approximately 200 nulliparous parturients with low dose bupivacaine 0.0625% with fentanyl 2 µg/ml to push immediately on full cervical dilation or to wait until a "strong urge" to push, the investigators found no difference in the time spent pushing (approximately 60 min), mode of delivery, or neonatal or maternal morbidity. However, "delayed" group only waited an average of 10 minutes longer.

538. Kuczkowski KM. Combined spinal-epidural analgesia and cervical dilation: Is there an association? Acta Anaesthesiol Scand 2003; 47:1305. Letter describes 2 multiparous women with rapid cervical dilation after CSE; queries if this can be a physiologic effect of the technique as previously reported in nulliparous patients.

539. Lewis NL, Plaat F, Qureshi AM. Syntocinon and 'epidurals' in labour--which comes first? Anaesthesia 2003; 58:1249-50. Nice letter reviews 500 consecutive mixed parity parturients. Notes that in 302 women who received regional analgesia and syntocinon augmentation of labor, 62% had the syntocinon already planned or in progress. Authors conclude epidural analgesia is not solely responsible for high rates of augmentation.

540. O'Connell MP, Hussain J, Maclennan FA, Lindow SW. Factors associated with a prolonged second state of labour--a case-controlled study of 364 nulliparous labours. J Obstet Gynaecol 2003; 23:255-7. Retrospective case control study of nulliparous women with a second stage less and more than 2 hours' duration. Shorter second stage of labour noted in patientssignificantly younger (mean age 23.2 vs. 24.9 years) with significantly smaller babies (mean weight 3315 g vs. 3463 g); longer labors were not surprisingly significantly associated with oxytocin and epidural use. The intervention rate did not rise above 50% until the second stage exceeded 5 hours duration. The fetal outcome was good in both groups of patients.


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541. Wadland LP, Sveigaard AL, Jensen AG. [A study of labor pain experiences, knowledge of epidural pain relief and satisfactionwith pain relief]. Ugeskr Laeger 2003; 165:4527-30. Retrospective study with epiduralized parturients (339) versus controls (6868) suggesting epidural has an effect on instrumental deliveries.

Retained Placenta

542. Jha S, Chiu JW, Yeo IS. Intravenous nitro-glycerine versus general anaesthesia for placental extraction--a sequential comparison. Med Sci Monit 2003; 9:CS63-6. Case report of parturient who on two consecutive deliveries and had the placenta removed manually by the same surgeon under two different anaesthetic techniques.

Spinal Technique

543. Eriksson SL, Blomberg I, Olofsson C. Single-shot intrathecal sufentanil with bupivacaine in late labour--analgesic quality and obstetric outcome. Eur J Obstet Gynecol Reprod Biol 2003; 110:131-5. Forty multiparous women in advanced labour were given a spinal injection of sufentanil 7.5 microg and bmg.upivacaine 2 mg. Noted to be effective but of limited duration; high pruritis observed.

Termination of Pregnancy

544. Viviand X, Fabre G, Ortega D, Dayan A, Boubli L, Martin C. Target-controlled sedation-analgesia using propofol and remifentanil in women undergoing late termination of pregnancy. International Journal of Obstetric Anesthesia 2003; 12:83-88. 21 women underwent termination of pregnancy for severe fetal abnormality used target controlled infusion system; median duration of analgesia was 150 min. Significant analgesia and satisfaction with this technique reported.

Test Dose

545. Calimaran AL, Strauss-Hoder TP, Wang WY, McCarthy RJ, Wong CA. The effect of epidural test dose on motor function after a combined spinal-epidural technique for labor analgesia. Anesth Analg 2003; 96:1167-72. A test dose with 3 mLlidocaine 1.5% with epi 1:200,000 should be avoided immediately after initiation of CSE analgesia when early ambulation is desired.

546. Dalal P, Reynolds F, Gertenbach C, Harker H, O'Sullivan G. Assessing bupivacaine 10 mg/fentanyl 20 µg as an intrathecal test dose. International Journal of Obstetric Anesthesia 2003; 12:250-5. 42 patients: 20 scheduled for elective cesarean section via spinal and 22 for labor via epidural. Both groups received B 10 mg + F 20 µg either spinally or epidurally. At 4 minutes, the presence of warm toes and motor or sensory block were seen only in the spinal groups.

547. Gaiser RR. The epidural test dose in obstetric anesthesia: it is not obsolete. J Clin Anesth 2003; 15:474-7. Author in an opinion piece, supports continued use of lido 1.5% + epi 1:200,000 test dose for labor epidural.

548. Khan RM, Chabra J, Alam MT, Ashraf M, Jain D. Whoosh test 2 and confirmation of lumbar epidural space. Anaesthesia 2003; 58:1251. Authors describe their "Whoosh test 2" which uses saline + air via epidural when placement unclear and an assistant auscultates two dermatomes above. Unclear description of result.

Timing of Placement

549. Carvalho B, Coghill J. Vaginal examination: a requirement before calling the anaesthetist? Br J Anaesth 2003; 90:402. Letterauthors suggest that vaginal examination should be done immediately before placement to assist selection of labor analgesia.

Volatile Agents

550. Rosen M. Another choice for Queen Victoria? International Journal of Obstetric Anesthesia 2003; 12:71-73. Editorial reviewing the history of inhaled agents for labor. Introduced the following article.


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551. Toscano A, Pancaro C, Giovannoni S, et al. Sevoflurane analgesia in obstetrics: a pilot study. International Journal of Obstetric Anesthesia 2003; 12:79-82. 50 parturients breathed a mixture of 2-3% sevoflurane, oxygen and air with satisfactory VAS, maternal outcomes and APGAR scores.

Anesthesia for Cerclage Placement

552. Handi F, Terui K. Non-pharmacological sedation during spinal anesthesia for transvaginal cervical cerclage. International Journal of Obstetric Anesthesia 2003; 12:234. Letter suggests the use of intra-operative music in addition to spinal anesthesia.

553. Beilin Y, Zahn J, Abramovitz S, Bernstein HH, Hossain S, Bodian C. Subarachnoid small-dose bupivacaine versus lidocaine for cervical cerclage. Anesth Analg 2003; 97:56-61. Intrathecal Lido 30 mg vs. Bupiv 5.25 mg, both with fent 20 µg, found to be satisfactory for cervical cerclage.

554. Schumann R, Rafique MB. Low-dose epidural anesthesia for cervical cerclage. Can J Anaesth 2003; 50:424-5. Letter notes use of 0.125% bupiv + Epi + fent for cerclage placement.

Anesthesia for Cesarean Delivery

General Anesthesia

555. Geisser W, Schreiber M, Hofbauer H, et al. Sevoflurane versus isoflurane - anaesthesia for lower abdominal surgery. Effects on perioperative glucose metabolism. Acta Anaesthesiol Scand 2003; 47:174-80. Sevoflurane is comparable to isoflurane in not preventing the metabolic and endocrine responses to surgical stress in 20 patients undergoing abdominal hysterectomy (nonpreg).

556. Hong J-Y, Jee Y-S, Yoon H-J, Kim SM. Comparison of general and epidural anesthesia in elective cesarean section for placenta previa totalis: Maternal hemodynamics, blood loss and neonatal outcome. International Journal of Obstetric Anesthesia. 2003; 12:12-16. 25 paturients randomized to general versus epidural noted that epidural anesthesia resulted in better hemodynamics and less blood loss. No difference observed in neonatal outcome.

557. Bolton TJ, Randall K, Yentis SM. Effect of the Confidential Enquiries into Maternal Deaths on the use of Syntocinon at Caesarean section in the UK. Anaesthesia 2003; 58:277-9. UK survey in 2002 compared to 2001 following Confidential Enquiries report on the use of Syntocinon at CS. Survey of OB anaesthetist use of syntocinon notes reduction in dose and slower injection. Motivation for change in part the CE report of maternal deaths with rapid administration of the drug. Confidential Enquiries cited as method to improve practice.

558. Hayward I, Duff O, Stacey R. Towards improving spinal anaesthesia [Journal: Letter]. International Journal of Obstetric Anesthesia 2003; 12:59-60. Letter suggests that increasing the dose of local anesthetic and the use of a lipid soluble opioid isof importance during a cesarean to reduce the conversion to general anesthesia.

559. Adams HA, Meyer P, Stoppa A, Muller-Goch A, Bayer P, Hecker H. [Anaesthesia for caesarean section. Comparison of two general anaesthetic regimens and spinal anaesthesia]. Anaesthesist 2003; 52:23-32. Study of TIVA versus Sevo general vs. spinal anesthesia; Apgar, pH, stress hormones in all neonates comparable.

560. Brown J, McAtamney D. Remifentanil infusion for high-risk caesarean section. International Journal of Obstetric Anesthesia 2003; 12. Letter describing a case of a parturient with a subaortic valve membrane undergoing a remifent/sevo technique.

561. Purdie NL, Kenny GNC, McGrady EM. Patient controlled administration of intravenous alfentanil during elective caesarean section under subarachnoid anaesthesia. International Journal of Obstetric Anesthesia 2003; 12:169-172. Observational studynotes that PCA with alfentanil is an effective adjuvant during cesarean delivery under spinal anesthesia.


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562. Duggal K. Propofol should be the induction agent of choice for caesarean section under general anaesthesia. International Journal of Obstetric Anesthesia 2003; 12:275-6. Proposer of debate (see below) notes propofol is a good choice.

563. Russell R. Propofol should be the induction agent of choice for caesarean section under general anaesthesia. International Journal of Obstetric Anesthesia 2003; 12:276-9. Opposer of debate (see above) notes concern for neonatal depression with propofol.

564. Jenkins JG, Khan MM. Anaesthesia for Caesarean section: a survey in a UK region from 1992 to 2002. Anaesthesia 2003; 58:1114-8. Use of regional anesthesia has increased dramatically for cesarean over the time period; authors site concern regarding limited trainee exposure to GA.

Lateral Tilt

565. Mendonca C, Griffiths J, Ateleanu B, Collis RE. Hypotension following combined spinal-epidural anaesthesia for Caesarean section. Left lateral position vs. tilted supine position. Anaesthesia 2003; 58:428-31. 87 parturients randomized to full or 12 degree left lateral after CSE in seated position; less early hypotension in full lateral group, however, when turned supine, developed hypotension; overall 80 vs. 90% hypotension respectively. Ephed requirements overall similar. 3 in full lateral position needed activation of epidural catheter.

566. Jones SJ, Kinsella SM, Donald FA. Comparison of measured and estimated angles of table tilt at Caesarean section. Br J Anaesth 2003; 90:86-7. Estimation of table tile angle is unreliable.

567. Kinsella SM. Lateral tilt for pregnant women: why 15 degrees? Anaesthesia 2003; 58:835-6. Editorial reviews the degree of lateral tilt, noting that 15 degrees is the amount needed to reliably reduce IVC compression.

568. Bamber JH, Dresner M. Aortocaval compression in pregnancy: the effect of changing the degree and direction of lateral tilt on maternal cardiac output. Anesth Analg 2003; 97:256-8. Brief report on 33 third trimester parturients placed in 7 positions with bioimpedence cardiography measurements. Full left lateral recumbent position has the optimal cardiac output; movement from left 5 to 12.5 degree had little advantage.

569. Siegmueller C. A simple device as a guide to 15 degrees tilt during Caesarean section. Anaesthesia 2003; 58:934. Letter described a weight suspended from the left edge of the OR table which just reaches the group with at 15 degrees tilt. Photo.

570. Law AC, Lam KK, Irwin MG. The effect of right versus left lateral decubitus positions on induction of spinal anesthesia for cesarean delivery. Anesth Analg 2003; 97:1795-9. 60 parturients placed in decubitus positions for placement of hyperbaric bupiv (2.2 mL 0.5%) + 15 µg fent, then immediately placed in 20 degree left lateral position, shows no difference in levels, vasopressor use, or complications.

Oxygenation

571. Edmark L, Kostova-Aherdan K, Enlund M, Hedenstierna G. Optimal oxygen concentration during induction of general anesthesia. Anesthesiology 2003; 98:28-33. Routine induction of general anesthesia in 36 non-pregnant women using 80% oxygen instead of 100% caused minimal atelectasis (recorded by computed tomography), but the time margin (303 ± 59 vs. 411 ± 84 s) before <90% oxygen saturation was significantly shortened.

572. Levy DM. F1O2 at emergency caesarean section. International Journal of Obstetric Anesthesia 2003; 12:140. Letter notes disagreement with authors (below); states insufficient evident to recommend optimal Fi02 for cesarean delivery under GA.

573. Kinsella SM, Thurlow JA. F1O2 at emergency caesarean section - Reply. International Journal of Obstetric Anesthesia 2003; 12:140-141. Response to above, notes that evidence suggests neonatal benefit with maternal 100% oxygen, but agrees more studies needed.


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Pruritis

574. Charuluxananan S, Kyokong O, Somboonviboon W, Narasethakamol A, Promlok P. Nalbuphine versus ondansetron for prevention of intrathecal morphine-induced pruritus after cesarean delivery. Anesth Analg 2003; 96:1789-93. Prophylactic success rate for pruritis for 240 randomly assigned parturients undergoing c/s with IV nalbuphine 4mg, ondansetron 4mg, ondansetron 8 mg, and normal saline was 20%, 13%, 12%, and 6%, respectively. No differences in nausea/vomiting, pain, sedation or shivering.

575. Szarvas S, Harmon D, Murphy D. Neuraxial opioid-induced pruritus: a review. J Clin Anesth 2003; 15:234-9. Review articleof postulated mechanisms and treatments.

576. Kuczkowski KM. Scabies: a differential diagnosis of pruritus following subarachnoid opioid administration. Anaesthesia 2003; 58:1140-1. Letter reporting case of pruritis from scabies that appeared to be activated by neuraxial opioids for cesarean delivery.

Postoperative Nausea and Vomiting

577. Nortcliffe SA, Shah J, Buggy DJ. Prevention of postoperative nausea and vomiting after spinal morphine for Caesarean section: comparison of cyclizine, dexamethasone and placebo. Br J Anaesth 2003; 90:665-70. 50 mg of cyclizine, an antiemetic, lessened the incidence and severity of n/v after bupiv 0.5% 2mL + fent 10 µg + 0.2 mg MSO4 better than dexamethasone 8mg or placebo.

578. Grenier Y, Drolet P. Asystolic cardiac arrest: an unusual reaction following iv metoclopramide. Can J Anaesth 2003; 50:333-5. Case report in 66 yr old (nonpregnant!) diabetic female with no cardiac history or medications. Raises awareness to past dysrhythmias with this commonly used drug.

579. Numazaki M, Fujii Y. Reduction of emetic symptoms during cesarean delivery with antiemetics: propofol at subhypnotic dose versus traditional antiemetics. J Clin Anesth 2003; 15:423-7. 100 parturients randomized to placebo, propofol 1mg/kg/hr, droperidol 1.25 mg or metoclopromide 10 mg. All non-proprofol groups received intralipid placebo. Propofol, droperidol, and metoclopromide were equally effective (20% incidence nausea, retching, or vomiting) vs. 60% in placebo group.

Postoperative (Cesarean) Pain Management

580. Wong P, Chadwick FD, Karovits J. Intranasal fentanyl for postoperative analgesia after elective Caesarean section. Anaesthesia 2003; 58:818-9. Letter. Use of patient controlled intranasal analgesia (PCINA) with fentanyl compared to intramuscular morphine with favorable results. Suggest further evaluation.

581. Coghill RC, Eisenach J. Individual differences in pain sensitivity: implications for treatment decisions. Anesthesiology 2003; 98:1312-4. Editorial to article below highlighting the possibility if preoperative tests can predict individual differences in postoperative pain.

582. Granot M, Lowenstein L, Yarnitsky D, Tamir A, Zimmer EZ. Postcesarean section pain prediction by preoperative experimental pain assessment. Anesthesiology 2003; 98:1422-6. Heat pain thresholds tested 1-2 days before elective cesarean delivery is useful in identifying women who will experience greater pain postoperatively.

583. Wilder-Smith CH, Hill L, Dyer RA, Torr G, Coetzee E. Postoperative sensitization and pain after cesarean delivery and the effects of single im doses of tramadol and diclofenac alone and in combination. Anesth Analg 2003; 97:526-33. Combinationof agents more effective for postoperative analgesia and prevention of sensitization then the two drugs given individually.


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584. Lowder JL, Shackelford DP, Holbert D, Beste TM. A randomized, controlled trial to compare ketorolac tromethamine versus placebo after cesarean section to reduce pain and narcotic usage. Am J Obstet Gynecol 2003; 189:1559-62; discussion 1562. 44 parturients randomized to PCA (morphine, hydromorphone, or meperidine!) with 2 q 6hr doses of ketorolac vs. placebo notes ketorolac effective for reduction of postoperative cesarean pain.

585. Duale C, Frey C, Bolandard F, Barriere A, Schoeffler P. Epidural versus intrathecal morphine for postoperative analgesia after Caesarean section. Br J Anaesth 2003; 91:690-4. CSE with 6mg hyper bupiv + sufenta 5 µg with additional epidural lido. 2mg epid vs. 0.075 mg spinal morphine noted VAS pain scores and additional morphine consumption over 24 hrs was higher in spinal group.

Postoperative Shivering/Hypothermia

586. Sessler DI. Treatment: meperidine, clonidine, doxapram, ketanserin, or alfentanil abolishes short-term postoperative shivering. Can J Anaesth 2003; 50:635-7. Commentary on nonpregnant review of trials (Anesth Analg 2002;94:453-60) on shivering. Good quick summary of issues and difficulty in studying postoperative shivering.

587. Sayyid SS, Jabbour DG, Baraka AS. Hypothermia and excessive sweating following intrathecal morphine in a parturient undergoing cesarean delivery. Reg Anesth Pain Med 2003; 28:140-3. Case report noting hypothermia and sweating may be related to morphine's disruption of thermoregulation.

588. Kasai T, Nakajima Y, Matsukawa T, Ueno H, Sunaguchi M, Mizobe T. Effect of preoperative amino acid infusion on thermoregulatory response during spinal anaesthesia. Br J Anaesth 2003; 90:58-61. Infusion of amino acids effectively prevents spinal anesthesia induced hypothermia by maintaining a higher metabolic rate and increasing the threshold core temperature for thermal vasoconstriction. Nonpregnant patients.

Regional Anesthesia

589. Choi DM, Kliffer AP, Douglas MJ. Dextromethorphan and intrathecal morphine for analgesia after Caesarean section under spinal anaesthesia. Br J Anaesth 2003; 90:653-8. The addition of 60 mg oral dextromethorphan did not augment bupiv 0.75% 1.2-1.6 ML + fent 10 µg + 0.05, 0.1, or 0.2 mg MSO4. Decreased N/V with dextromethorphan groups.

590. Ogun CO, Kirgiz EN, Duman A, Okesli S, Akyurek C. Comparison of intrathecal isobaric bupivacaine-morphine and ropivacaine-morphine for Caesarean delivery. Br J Anaesth 2003; 90:659-64. Bupivacaine vs. Ropivacaine (0.5%) 15 mg + 150 µg MSO4. Slower onset, faster recovery (20 min), less ephedrine used with Ropivacaine.

591. Cooper DW. Intrathecal diamorphine or intrathecal fentanyl to supplement spinal anaesthesia for cesarean section? Br J Anaesth 2003; 90:107. Letter suggests fentanyl is superior due to lower risk of dosing error and contamination. Authors disagree.

592. Ngan Kee WD, Lee A. Multivariate analysis of factors associated with umbilical arterial pH and standard base excess after Caesarean section under spinal anaesthesia. Anaesthesia 2003; 58:125-30. Concludes that ephedrine should not be used before delivery, uterine incision-to-delivery times should be minimized, and alpha-agonists should be used to minimize the magnitude and duration of hypotension.

593. Loughrey JP, Eappen S, Tsen LC. Spinal anesthesia for cesarean delivery shortly after an epidural blood patch. Anesth Analg 2003; 96:545-7, Case reporting the successful outcome of a parturient undergoing a usual dose spinal anesthetic 6hr following an EBP.

594. Ranasinghe JS, Steadman J, Toyama T, Lai M. Combined spinal epidural anaesthesia is better than spinal or epidural alone for Caesarean delivery. Br J Anaesth 2003; 91:299-300. Letter reports a retrospective analysis of 525 cases of CSE for cesarean; suggests low complication rate and low conversion rate to general.


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595. Saravanan S, Robinson AP, Qayoum Dar A, Columb MO, Lyons GR. Minimum dose of intrathecal diamorphine required to prevent intraoperative supplementation of spinal anaesthesia for Caesarean section. Br J Anaesth 2003; 91:368-72. The ED95 in 200 parturients note that 0.4 mg of intrathecal diamorphine is required to prevent intraoperative supplementation during spinal (hyperbaric 0.5% 12.5mg) anesthesia for C/S. Time to first request for analgesia, N, V, pruritis increase with dose.

596. Tortosa JC, Parry NS, Mercier FJ, Mazoit JX, Benhamou D. Efficacy of augmentation of epidural analgesia for Caesarean section. Br J Anaesth 2003; 91:532-5. Retrospective analysis of 194 parturients using lido 2% + epi for extension of an existing epidural noted general anesthesia and sedation required in 2.6% and 13.9%, respectively. Concludes augmentation of existing epidural for cesarean is reliable and effective.

597. Gautier P, De Kock M, Huberty L, Demir T, Izydorczic M, Vanderick B. Comparison of the effects of intrathecal ropivacaine,levobupivacaine, and bupivacaine for Caesarean section. Br J Anaesth 2003; 91:684-9. 90 parturients randomized to bupiv 8mg, L-bupiv 8mg, and Ropiv 12 mg (all with 2.5 µg sufenta) noted effective anesthesia in 97%, 80% and 87%, respectively.Concludes spinal racemic bupiv + sufenta remains an appropriate choice for C/S.

598. Portnoy D, Vadhera RB. Mechanisms and management of an incomplete epidural block for cesarean section. Anesthesiol Clin North America 2003; 21:39-57. Review of options available prior to and during a cesarean delivery.

599. Plaat F, Qureshi A, Bedson R. Failure of regional blockade for caesarean section: How often? International Journal of Obstetric Anesthesia 2003; 12:60-62. Letter notes successful use of CSE for cesarean and need to regularly review all regional labor blocks and identify high risk patients to avoid emergency general anesthesia.

600. Garry M, Davie S. Towards improving spinal anesthesia-reply. international Journal of Obstetric Anesthesia 2003; 12:61-62. Letter reply to above, reviewing anesthetic options.

601. Barry JJ, Sartain J. Assessing regional anaesthesia for casarean section. International Journal of Obstetric Anesthesia 2003; 12:62-63. Humorous device concocted from a coconut and a quill to test regional anesthesia.

602. Meininger D, Byhahn C, Kessler P, et al. Intrathecal fentanyl, sufentanil, or placebo combined with hyperbaric mepivacaine 2% for parturients undergoing elective cesarean delivery. Anesth Analg 2003; 96:852-8, table of contents. 100 parturients randomized to 5 intrathecal groups: 60 mg mepivacaine (2%) + fentanyl (5 or 10 µg) or sufentail (2.5 or 5 µg). Mepiv is appropriate for elective cesarean delivery; the addition of narcotics markedly improved postoperative analgesia.

603. Cooper DW, Mowbray P. Can choice of vasopressor therapy affect rostral spread of spinal anaesthetic? Anesthesiology 2003; 98:1524. Observation and retrospective analysis suggesting that cervical level from CSE for cesarean delivery was lowest when hypotension was prevented with intravenous infusions of phenylephrine and highest with ephedrine.

604. McAndrew CR, Harms P. Paraesthesiae during needle-through-needle combined spinal epidural versus single-shot spinal for elective caesarean section. Anaes Intens Care 2003; 31:514-17. Seventeen of forty-six (37%) women in the needle-through-needle CSE group and four of forty-three (9%) in the SSS group had paraesthesiae upon spinal needle insertion (P < 0.05, Chi-squared test). No patient had persistent neurological symptoms at postoperative day one.

605. Arakawa M, Aoyama Y, Ohe Y. Efficacy of 1% ropivacaine at sacral segments in lumbar epidural anesthesia. Reg Anesth Pain Med 2003; 28:208-14. Nonpregnant patients randomized to lido 2%, lido 2% + epi + bicarb, and Ropiv 1% via lumbar epidural. Lido + epi + bicarb had significantly faster and higher pain thresholds at S1 and S3. 1% Ropiv may be inadequate at sacral levels at 20 min.

606. Ogun CO, Duman A, Kirgiz EN, Okesli S. Lowest dose of spinal ropivacaine and adjuvant should be used in cesarean delivery. Reg Anesth Pain Med 2003; 28:253. Letter notes that dose of ropivacaine still unknown.


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607. Faccenda KA, Simpson AM, Henderson DJ, Smith D, McGrady EM, Morrison LM. A comparison of levobupivacaine 0.5% and racemic bupivacaine 0.5% for extradural anesthesia for caesarean section. Reg Anesth Pain Med 2003; 28:394-400. 62 parturients undergoing cesarean randomized to epidural 25 mL levobupiv 5% vs. bupiv 5%. Similar block characteristics noted.

608. Gaiser RR. Changes in the provision of anesthesia for the parturient undergoing cesarean section. Clin Obstet Gynecol 2003; 46:646-56. Good review of alterations in personnel, technique, concepts, disease states, and medications.

609. Bariskaner H, Tuncer S, Taner A, Dogan N. Effects of bupivacaine and ropivacaine on the isolated human umbilical artery. International Journal of Obstetric Anesthesia 2003; 12:261-5. Bupiv produced relaxation and ropiv produced contractions of isolated human umbilical arteries; nitric oxide, prostaglandins and adrenergic receptors appear to have no role on these responses. The mechanism of these responses remains unclear.

Timing of Delivery

610. O'Regan M. Delivery times for caesarean section at Queen Elizabeth Central Hospital, Blantyre, Malawi: is a 30-minute 'informed to start of operative delivery time' achievable? Anaesthesia 2003; 58:756-9. In a "developing world" urban teaching hospital, the 30 min decision to delivery time was reached in 69% of the time where an immediate threat to the lie of the mother or fetus was noted.

611. Yentis SM. Whose distress is it anyway? 'Fetal distress' and the 30-minute rule. Anaesthesia 2003; 58:732-3. Editorial observes that the indications for emergent cesarean should be continuously scrutinized; these indications lead to "chronological nit-picking".

612. McCahon RN, Catling S. Time required for surgical readiness in emergency caesarean section: spinal compared with general anaesthesia. International Journal of Obstetric Anesthesia 2003; 12:178-182. Observational retrospective study indicates that the average time for readiness was 15.4 min (range 2-44) versus 27.6 min (range 13-55 min) for general versus regional, respectively.

613. Russell IF. Labour ward clocks. Anaesthesia 2003; 58:930-1. Letter notes discrepancies in clocks on the labour unit.

Vasopressors

614. Bythell VE, Mowbray P, Cooper DW. Phenylephrine in obstetric regional anaesthesia. Anaesthesia 2003; 58:288-9. Letter. Advocates caution in preparing phenylephrine in anesthetists unfamiliar with this agent and the different formulations. Aprotocol for phenylephrine infusion was provided.

615. Adsumelli RS, Steinberg ES, Schabel JE, Saunders TA, Poppers PJ. Sequential compression device with thigh-high sleeves supports mean arterial pressure during Caesarean section under spinal anaesthesia. Br J Anaesth 2003; 91:695-8. 50 parturients randomized to SCD 50 mmHg versus without had a 20% decrease in MAP 52% vs. 92% following 12 mg bupiv, 0.2 MS04, 10 µg fent.

616. Ngan Kee W, McKinlay J, Lyons G. Obstetric neuraxial anaesthesia: Which vasopressor should we be using? (multiple letters). [Journal: Letter] . International Journal of Obstetric Anesthesia 2003; 12:55-57. Good discussion and response of theneosynephrine (Ngan Kee) versus ephedrine as the drug of choice.

617. Davies P, Howells H. Hypotension following combined spinal epidural anaesthesia. Anaesthesia 2003; 58:932; author reply 932-3. Letter suggests that placing parturients in full lateral position following CSE for cesarean delivery is a pointless to prevent hypotension; author Collis replies disagreement.


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618. Kobayashi S, Endou M, Sakuraya F, et al. The sympathomimetic actions of l-ephedrine and d-pseudoephedrine: direct receptor activation or norepinephrine release? Anesth Analg 2003; 97:1239-45. Study performed in-vivo in rats and in-vitro with human umbilical artery and vein notes that that neither ephedrine stereoisomer generated umbilical artery or vein contractions at concentrations to cause norepi release in atrial or anococcygeal muscles.

619. Yuen MK, Key LK. Prophylactic i.v. metaraminol during spinal anesthesia for elective Cesarean delivery. Can J Anaesth 2003; 50:858-9. Letter reporting 33 parturients randomized to metaraminol vs. saline; found reduced hypotension, less ephedrine, and better UV acid base status with metaraminol.

620. Vallejo MC, Ramanathan S. Should alpha-agonists be used as first line management of spinal hypotension? International Journal of Obstetric Anesthesia 2003; 12:243-5. Editorial states there is no need for debate regarding ephedrine vs. phenylephrine; choice should depend on blood pressure and heart rate.

Anesthesia for Tubal Ligation

621. Bucklin BA. Postpartum tubal ligation: timing and other anesthetic considerations. Clin Obstet Gynecol 2003; 46:657-66. Title summarizes it all.

Complications-Anesthesia

Airway

622. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2003; 98:1269-77. Definitions, Guidelines, and Recommendations for the evaluation of the airway, basic preparation, and strategies for management, extubation and follow-up of the difficult airway. Of note, the LMA has gained a more prominent position in the pathway.

623. Ovassapian A. Management of failed intubation in a septic parturient. Br J Anaesth 2003; 91:154; author reply 154-5. Letter suggests a number of intubations techniques that need to be learned and applied to the parturient, including the use of face mask ventilation during RSI. Response by authors of a 2002 case report agree.

624. Asai T, Murao K, Shingu K. Training method of applying pressure on the neck for laryngoscopy: use of a videolaryngoscope.Anaesthesia 2003; 58:602-3. Letter suggests that connecting a fiberoptic scope to a laryngoscope is an effective way of demonstrating the effect of cricoid pressure.

625. Kuczkowski KM, Benumof JL, Moeller-Bertram T, Kotzur A. An initially unnoticed piece of nasal jewelry in a parturient: implications for intraoperative airway management. J Clin Anesth 2003; 15:359-62. Case report detailing plain film and fiberoptic examinations due to a search for nasal jewelry; suggests nasal or oral jewelry in situ should be removed prior to surgery.

626. Bell D. Avoiding adverse outcomes when faced with 'difficulty with ventilation'. Anaesthesia 2003; 58:945-8. Editorial discussing triggering factors, preventive strategies, early detection, and management of the difficult airway (non pregnant). An algorithm enclosed. Useful to read.

627. Vaughan RS. Extubation--yesterday and today. Anaesthesia 2003; 58:949-50. Editorial querying what position (head down left lateral versus flat supine or head up positions) is best for extubation (non pregnant).

628. Szokol JW, Alspach D, Mehta MK, Parilla BV, Liptay MJ. Intermittent airway obstruction and superior vena cava syndrome in a patient with an undiagnosed mediastinal mass after cesarean delivery. Anesth Analg 2003; 97:883-4. Case report of parturient presenting with bloody emesis with case performed under GA.


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629. Ross BK. ASA closed claims in obstetrics: lessons learned. Anesthesiol Clin North America 2003; 21:183-97. ASA Closed Claims database notes a number of minor claims, reflecting a consumer's perspective. What can help? The authors submits: Careful personal conduct, Establish good rapport, Involvement in prenatal education, Early pre-anesthetic evaluation, Providerealistic expectation, Regularly review potential major and minor risks.

630. Gambling DR, Shay DC. The mother of all breathing problems. J Clin Anesth 2003; 15:491-494. Good editorial covering theissues related to the maternal airway; introduces article below.

631. Kuczkowski KM, Reisner LS, Benumof JL. Airway problems and new solutions for the obstetric patient. J Clin Anesth 2003;15:552-563. Comprehensive review article of techniques and concerns with maternal airway.

632. Popat M. The airway. Anaesthesia 2003; 58:1166-71. Part of the "State of the Art" series in anaesthesia; reviews recent guidelines, responses and concerns regarding the difficult airway.

633. Afzaal A, Kirk-Bayley J, Uncles DR. Something to chew over? Anaesthesia 2003; 58:1242. Letter detailing case of parturient s/p extuabation from GA for cesarean who had chewing gum obstructing the airway.

634. Gupta S, Pareek S, Dulara SC. Comparison of two methods for predicting difficult intubation in obstetric patients. Middle East J Anesthesiol 2003; 17:275-85. 372 obstetric patients undergoing elective or emergency cesarean under GA. When usedas a predictor of difficult laryngoscopy sensitivity, specificity and positive predictive value for modified Mallampati test were60%, 97.6% and 65% respectively and for Wilson risk sum they were 36%, 98.5% and 64% respectively, but when both testswere combined as predictors (with either of tests positive) sensitivity improved to 100% while specificity was marginally decreased to 96.2% and positive predictive value (64.8%) remained almost the same.

Allergy

635. Garvey LH, Roed-Petersen J, Husum B. Is there a risk of sensitization and allergy to chlorhexidine in health care workers? Acta Anaesthesiol Scand 2003; 47:720-4. No allergy was demonstrated in 104 volunteers.

636. Vercauteren MP, Coppejans HC, Sermeus L. Anaphylactoid reaction to hydroxyethylstarch during cesarean delivery in a patient with HELLP syndrome. Anesth Analg 2003; 96:859-61. Case report noting allergic reaction to pentastarch prior to initiating spinal anesthesia for cesarean delivery.

637. Hepner DL, Castells MC. Anaphylaxis during the perioperative period. Anesth Analg 2003; 97:1381-95. Wonderful review article covers many agents that anesthesiologists utilize.

638. Gei AF, Pacheco LD, Vanhook JW, Hankins GD. The use of a continuous infusion of epinephrine for anaphylactic shock during labor. Obstet Gynecol 2003; 102:1332-5. Case of anaphylaxis during labor due to ampicillin for group b strep; continuous infusion of epi required for persistent symptoms. Healthy fetus delivered.

Aspiration Prophylaxis

639. Hirota K, Kushikata T. Preanaesthetic H2 antagonists for acid aspiration pneumonia prophylaxis. Is there evidence of tolerance? Br J Anaesth 2003; 90:576-9. Wonderful review of the regulation of gastric acid secretion; H2 antgonists create tolerance on day 2-3. Proton pump inhibitors may be better for prophylaxis.

640. Cadamy AJ, Bong C. Awareness and traumatic recall of cricoid pressure. Anaesthesia 2003; 58:91. Letter commenting on need to instruct patient on technique.

641. Mearns C, Elliott J. Midwifes putting the pressure on...? Anaesthesia 2003; 58:297-8. Letter cites testing of members of theatre staff and concludes that no difference exists in the effectiveness of cricoid pressure applied by frequent vs. nonfrequent users, especially with inadequate training techniques.


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642. Cui XG, Tashiro K, Matsumoto H, Tsubokawa Y, Kobayashi T. Aerosolized surfactant and dextran for experimental acute respiratory distress syndrome caused by acidified milk in rats. Acta Anaesthesiol Scand 2003; 47:853-60. Inhaled dextran may assist in gastric aspiration.

643. Haslam N, Syndercombe A, Zimmer CR, Edmondson L, Duggan JE. Intragastric pressure and its relevance to protective cricoid force. Anaesthesia 2003; 58:1012-5. 100 consecutive patients studied with intragastic pressure manometry noted that 20N of force is sufficient to protect paralyzed patients from regurgitation.

644. Wilson NP. No pressure! Just feel the force. Anaesthesia 2003; 58:1135-6. Use of plunger of 20 mL syringe withdrawn to 20mL mark with end occluded with an obturator. Depressing to 10 mL requires 30 N of force.

Cardiac Arrest

645. Pollard JB. High doses of local anaesthetic during spinal anaesthesia may increase the risk of life-threatening vagal reactions.Br J Anaesth 2003; 90:525-6; author reply 526. Letter commenting on vagal predominance with high spinal levels; reply suggests can occur with even low or moderate doses of meds.

646. Azuma M, Yamane M, Tachibana K, Morimoto Y, Kemmotsu O. Effects of epinephrine and phosphodiesterase III inhibitors on bupivacaine-induced myocardial depression in guinea-pig papillary muscle. Br J Anaesth 2003; 90:66-71. Amrinone and milrinone effectively reversed the profound cardiovascular depression caused by bupivacaine.

647. Krishnam, Mallick A. Air in the epidural space leading to a neurological deficit. Anaesthesia 2003; 58:292-3. Letter noting ST segment depression during CS. Cardiac enzymes negative. Authors ask are we treating the patient or the ECG?

648. De La Coussaye JE, Aya AG, Eledjam JJ, Ladd LA, Copeland SE, Mather LE. Neurally-mediated Cardiotoxicity of Local Anesthetics: Direct Effect of Seizures or of Local Anesthetics? Anesthesiology 2003; 98:1295-7. Letter suggests that arrhythmias may be the result of pre- and convulsant effects of local anesthetic induced seizures and not necessarily direct cardiotoxicity.

649. Lefrant JY, Muller L, de La Coussaye JE, et al. Hemodynamic and cardiac electrophysiologic effects of lidocaine-bupivacaine mixture in anesthetized and ventilated piglets. Anesthesiology 2003; 98:96-103. The alterations of ventricular conduction parameters are greater with 4mg/kg bupivcaine than with a mixture of 16 mg/kg lidocaine + 4 mg/kg bupivicaine;hemodynamic parameters, however, were similarly altered.

650. Chilvers JP, Cooper G, Wilson M. Myocardial ischaemia complicating an elective Caesarean section. Anaesthesia 2003; 58:822-3. Letter detailing case of healthy parturient who suffered myocardial ischemia temporally related to oxytocin administration. Angiogram normal.

651. Hashiba M, Okutomi T, Saito K, Amano K, Okamoto H, Hoka S. [A case of cardiac arrest at induction of anesthesia for postpartum hysterectomy]. Masui 2002; 51:1355-8. Case of parturient treated with ritodrine for preterm labor and placenta previa, cesarean under epidural. Continued bleeding, induction of GA resulted in v tach, cardiac arrest.

652. Polley LS, Santos AC. Cardiac arrest following regional anesthesia with ropivacaine: here we go again! Anesthesiology 2003; 99:1253-4. Editorial commenting on first reports of cardiac arrest with ropivacaine for surgical regional anesthesia (lumbar plexus and lower extremity blocks in nonpregnant individuals- not included); Suggests the need for more reliable injection and monitoring techniques for these types of blocks.

653. Barel C, Belkhiria M, Bui-Xuan B, et al. Ropivacaine combined with various anti-arrhythmic drugs results in mild alterationsin myocardial contractility in pigs. Can J Anaesth 2003; 50:1031-4. The combination of anti-arrhythmic agents and ropivcaine in an anesthetized pig model noted decreased contractility, especially after amiodarone and nicardipine.


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Drug Error

654. Yentis SM, Randall K. Drug errors in obstetric anaesthesia: a national survey. International Journal of Obstetric Anesthesia 2003; 12:246-9. Postal survey in UK consultant led maternity units. 179/240 responded; 70 (39%) knew of at least one drugerror. Few units had policies or protocols for checking anesthetic drugs.

Drug Exposure

655. Gauger VT, Voepel-Lewis T, Rubin P, Kostrzewa A, Tait AR. A survey of obstetric complications and pregnancy outcomes in paediatric and nonpaediatric anaesthesiologists. Paediatr Anaesth 2003; 13:490-5. Questionnaire study of SPA members suggested a higher prevalence of spontaneous abortion in anaesthesiologists whose practice is >75% paediatrics.

Equipment

656. Pierre HL, Block BM, Wu CL. Difficult removal of a wire-reinforced epidural catheter. J Clin Anesth 2003; 15:140-1. Letter.Arrow flextip catheter removed in parturient on attempt at 3hrs after continuous gentle tension with tape.

657. Sturgess JE, Browne D. Complication of the combined spinal epidural technique 1. Anaesthesia 2003; 58:486; discussion 487. Letter. RapID extra-length pencil point spinal needle, 26G. Authors noted acute needle deformity during apparently atraumatic insertion.

658. Lok C, Kirk P. Complication of the combined spinal epidural technique 2. Anaesthesia 2003; 58:486-7; discussion 487. Letter. Nonpregnant patient with difficulty withdrawing spinal needle, resulting in epidural and spinal removal at same time; acute tip distortion of spinal needle noted in Sims/Portex spinal epidural set. Response by product manager given.

659. Lin CC. Air-locked epidural filter. Anesthesiology 2003; 99:515. Letter noting epidural filter responsible for pump occlusionin parturient; hypothesis tested.

660. Tsui BC, Finucane B. Tensile strength of 19- and 20-gauge arrow epidural catheters. Anesth Analg 2003; 97:1524-6. In-vitrotesting demonstrated no differences in tensile strength.

661. Parry G. What do we do with a disconnected epidural catheter? Can J Anaesth 2003; 50:523. Letter reports postal survey of practices after finding a disconnected catheter; multiple practices reported.

662. Sah N, Finegold H. Breakage of epidural catheters in two parturients. Can J Anaesth 2003; 50:619-20. Letter reporting two cases of Arrox Flextip Plus catheter breakage.

Hearing Impairment

663. Sprung J, Bourke DL, Contreras MG, Warner ME, Findlay J. Perioperative hearing impairment. Anesthesiology 2003; 98:241-57. Excellent review article on perioperative hearing loss. Includes a review of the pertinent anatomy and physiology.

664. Wong AY, Irwin MG. Postdural puncture tinnitus. Br J Anaesth 2003; 91:762-3.

665. Letter indicating a case in a parturient that tinnitus can occur with a dural puncture and deserves attention. Resolved with a blood patch more slowly than headache.

666. Hardy PA. Transient hearing loss with labour epidural block. Anaesthesia 2003; 58:1041. Letter notes that the mechanism is straightforward but not often reported.


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High Spinal

667. Cohen S, Fernandez N, Groysman R, Soremekun O. Loss of consciousness from epidural sufentanil for labour analgesia. Anaesthesia 2003; 58:487-8. Letter in which the authors suggest "unusual reactions to systemic absorption of epidural sufentanil and ropivacaine" for somnolence, aphasia, tremors. Parturient with known hypertension, diabetes, hypothyroid.

Hypoglycemia

668. Kuczkowski KM. Acute hypoglycaemia in a healthy parturient following induction of a combined spinal-epidural analgesia for labour. Anaesthesia 2003; 58:488-9. Letter noting case of hypoglycemia following CSE for labor.

Hypotension

669. Kannan S, Millns JP, Kilby A. Refractory hypotension during caesarean section following pre-operative administration of anti-hypertensive agents. International Journal of Obstetric Anesthesia 2003; 12:135-137. Case of parturient with concealed anteparturm hemorrhage and treatment for essential hypertension. Cesarean delivery under GA complicated by persistent hypotension.

670. Nobili C, Sofi G, Bisicchia C. [Prevention of hypotension in spinal anaesthesia carried out for caesarean section]. Minerva Anestesiol 2003; 69:392-401. Review article of the issue.

Inadequate Anesthesia

671. Wood M, Ismail F. Inadequate spinal anaesthesia with 0.5% Marcaine Heavy (Batch 1961). International Journal of ObstetricAnesthesia 2003; 12:310-1. Letter details 5 cases of spinal failure with same batch of bupiv; manufacturer assay shows no problems.

Infection

672. Hearn M. Epidural abscess complicating insertion of epidural catheters. Br J Anaesth 2003; 90:706-7; author reply 707. In high risk patients (immunosuppression, diabetes, cancer, underlying infection, in ICU), epidural sites should be evaluated even after catheter removal.

673. Soe-Jensen P. Catheter related epidural abscesses-don't wait for neurological deficits. Acta Anaesthesiol Scand 2003; 47:635. Letter suggesting importance of adequate antibiotic prophylaxis.

674. Kasai T, Yaegashi K, Hirose M, Fujita T, Tanaka Y. Aseptic meningitis during combined continuous spinal and epidural analgesia. Acta Anaesthesiol Scand 2003; 47:775-6. First report of aseptic meningitis with microcatheter CSA.

675. Pinder AJ, Dresner M. Meningococcal meningitis after combined spinal-epidural analgesia. International Journal of Obstetric Anesthesia 2003; 12:183-187. Case report suggests a relationship between CSE and meningitis.

676. Hernandez-Palazon J, Puertas-Garcia JP, Martinez-Lage JF, Tortosa JA. Lumbar spondylodiscitis caused by Propionibacterium acnes after epidural obstetric analgesia. Anesth Analg 2003; 96:1486-8. Disk infection following an epidural in a healthy parturient.

677. Cohen S, Uzum N, Alptekin B. Aseptic precautions for inserting an epidural catheter. Anaesthesia 2003; 58:930. Letter stating that a sterile gauze and transparent dressing is a appropriate aseptic precaution.

678. Scrutton M, Kinsella SM. The immediate caesarean section: rapid-sequence spinal and risk of infection. International Journalof Obstetric Anesthesia 2003; 12:143-144. Letter suggests that not touching the patient prior to cleansing, limited attempts, and simplifying meds should limit infectious risks.


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679. Collier C. Is a non-touch technique really necessary for spinal/epidural needle insertion? International Journal of Obstetric Anesthesia 2003; 12:144-145. Letter notes the difficulty in "not touching the metal part of the needle when performing a epidural and/or spinal anesthesia" as recommended in a prior article (IJOA 2002;11:265-269).

680. Kampe S, Poetter C, Buzello S, et al. Ropivacaine 0.1% with sufentanil 1 microg/mL inhibits in vitro growth of Pseudomonas aeruginosa and does not promote multiplication of Staphylococcus aureus. Anesth Analg 2003; 97:409-11. In-vitro study of bacteria transferred to R+S and spread on blood agar; authors speculate that sufentanil yields an additive effect.

681. Ide M, Saito S, Sasaki M, Goto F. Epidural abscess in a patient with dorsal hyperhidrosis. Can J Anaesth 2003; 50:450-3. Nonpregnant patient with hyperhidrosis in area of epidural catheterization yielded an abscess.

682. Hebl JR, Horlocker TT. You're not as clean as you think! The role of asepsis in reducing infectious complications related to regional anesthesia. Reg Anesth Pain Med 2003; 28:376-9. Editorial reiterates the concerns articulated with the article below; also mentions the convening of ASRA Consensus Conference on The Infectious Risks Associated with Regional Anesthesia (March 2004).

683. Yentur EA, Luleci N, Topcu I, Degerli K, Surucuoglu S. Is skin disinfection with 10% povidone iodine sufficient to prevent epidural needle and catheter contamination? Reg Anesth Pain Med 2003; 28:389-93. 67 nonpregnant patients underwent epidural placement following 10% povidone-iodine disinfection; a significant number of skin surface, epidural needles and catheters cultures were positive for colonization.

684. Smith N. Differences in spinal anaesthesia techniques. International Journal of Obstetric Anesthesia 2003; 12:308. Letter queries whether aspects of cleaning for spinal placement make a difference.

685. Kumar N, Sinha T, Grover VK. No touch technique for spinal needle insertion. International Journal of Obstetric Anesthesia 2003; 12:310. Letter describes a no touch technique for spinal needle insertion by touching the introducer and not the spinal shaft.

686. Edelstein S, Edoute Y. Bacterial sacroiliitis probably induced by lumbar epidural analgesia. Infect Dis Obstet Gynecol 2003; 11:105-8. Case report suggests a correlation.

687. Evans PR, Misra U. Poor outcome following epidural abscess complicating epidural analgesia for labour. Eur J Obstet Gynecol Reprod Biol 2003; 109:102-5. Case report, delayed diagnosis, incomplete recovery.

Intravenous Toxicity

688. Stewart J, Kellett N, Castro D. The central nervous system and cardiovascular effects of levobupivacaine and ropivacaine in healthy volunteers. Anesth Analg 2003; 97:412-6. Levo and ropiv found to produce similar CNS and CV effects when infused in volunteers at equal concentrations (0.5%), mg doses, and infusion rates.

689. Ohmura S, Sugano A, Kawada M, Yamamoto K. Pulmonary uptake of ropivacaine and levobupivacaine in rabbits. Anesth Analg 2003; 97:893-7. Advantages of ropiv over levobupiv in terms of less cardiovascular toxicity may be offset by smaller pulmonary uptake after inadvertent IV injection.

690. Kim JT, Rhee KY, Bahk JH, et al. Continuous mixed venous oxygen saturation, not mean blood pressure, is associated with early bupivacaine cardiotoxicity in dogs. Can J Anaesth 2003; 50:376-81. cSvO2 is superior to MBP for monitoring decreased cardiac output associated with bupivacaine infusions in dogs.

691. Funao T, Oda Y, Tanaka K, Asada A. The P-glycoprotein inhibitor quinidine decreases the threshold for bupivacaine-induced,but not lidocaine-induced, convulsions in rats. Can J Anaesth 2003; 50:805-11. The inhibition of P-glycoprotein results in increased brain/plasma concentration ratios and a lower threshold for bupivacaine, but not lidocaine, induced convulsions in arat model.


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692. Groban L. Central nervous system and cardiac effects from long-acting amide local anesthetic toxicity in the intact animal model. Reg Anesth Pain Med 2003; 28:3-11. Review of animal models of these local anesthetic toxicies and extrapolates to the clinical setting.

693. Groban L, Butterworth J. Lipid reversal of bupivacaine toxicity: has the silver bullet been identified? Reg Anesth Pain Med 2003; 28:167-9. Editorial notes significant findings of article below and clinical potential of lipids.

694. Weinberg G, Ripper R, Feinstein DL, Hoffman W. Lipid emulsion infusion rescues dogs from bupivacaine-induced cardiac toxicity. Reg Anesth Pain Med 2003; 28:198-202. Non-blinded dog model noted survival after bupiv 10 mg/kg IV over 10 sec successful only when lipid (vs. saline) infusion was given 10 min after internal cardiac massage.

695. Mahajan R. Avoiding the accidental iv injection of local anesthetics. Can J Anaesth 2003; 50:1077-8; author reply 1078. Letter suggests use of dedicated syringes and placement of epidural meds to avoid use in the IV.

Nausea/Vomiting

696. Gan TJ, Meyer T, Apfel CC, et al. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg 2003; 97:62-71. Nonpregnant individuals, however, good resource for management of these two entities.

697. Borgeat A, Ekatodramis G, Schenker CA. Postoperative nausea and vomiting in regional anesthesia: a review. Anesthesiology2003; 98:530-47. Nonpregnant individuals under a variety of blocks, however, includes good information on intrathecal and epidural medications and risk of PONV.

Neurologic Injury

698. Aldrete JA. Neurologic deficits and arachnoiditis following neuroaxial anesthesia. Acta Anaesthesiol Scand 2003; 47:3-12. Nice review article with recommendations.

699. Lee BB. Neuraxial complications after epidural and spinal anaesthesia. Acta Anaesthesiol Scand 2003; 47:371-3. Letter highlighting need to be vigilant prior to and after blockade. Elderly patient reported.

700. Eldor J. Whitacre spinal needle vs. Eldor spinal needle regarding the incidence of transient neurologic symptoms. Acta Anaesthesiol Scand 2003; 47:635-6. Letter suggesting that TNS symptoms should more carefully acknowledge needle type.

701. Krishnam, Mallick A. Air in the epidural space leading to a neurological deficit. Anaesthesia 2003; 58:292-3. Letter. Suggests air in the epidural space, confirmed by CT, resulted in sensory deficit in buttock, leg, and foot which resolved over 9 days.

702. Aldrete JA. Recurrent neurological symptoms in a patient after repeat combined spinal and epidural anaesthesia. Br J Anaesth2003; 90:402-4; author reply 403-4. Letter suggests TNS was the result of sequential full doses of local anesthetics.

703. de Medicis E. Paraplegia in association with spinal/epidural anaesthesia caused by unrecognized vertebral metastasis. Acta Anaesthesiol Scand 2003; 47:781; author reply 782. Letter questions association between paraplegia by vertebral metastasis and CSE.

704. Rose JB. Spinal cord injury in a child after single-shot epidural anesthesia. Anesth Analg 2003; 96:3-6. Editorial regarding a pediatric case that raises relevant issues of performing an epidural following a dural puncture.

705. Rodi Z, Straus I, Denic K, Deletis V, Vodusek DB. Transient paraplegia revealed by intraoperative neurophysiological monitoring: was it caused by the epidural anesthetic or an epidural hematoma? Anesth Analg 2003; 96:1785-8. Non-pregnantcase report revealing the value of intraoperative neurophysiologic monitoring in revealing an epidural hematoma.


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706. Robinson AP. Abducent nerve palsy in a parturient with a 25-gauge Sprotte needle - In reply. International Journal of Obstetric Anesthesia 2003; 12:236-237. Letter suggests that further prospective cohort studies to determine the risk of postpartum neurology is needed.

707. Kirihara Y, Saito Y, Sakura S, Hashimoto K, Kishimoto T, Yasui Y. Comparative neurotoxicity of intrathecal and epidural lidocaine in rats. Anesthesiology 2003; 99:961-8. Nonpregnant rat model calculates intrathecal:epidural potency ratio of lidocaine and observes histologic damage less severe with epidural administration.

708. Ho KM, Ismail H. Risks reconsidered. International Journal of Obstetric Anesthesia 2003; 12:141-142. Letter suggests data on neurologic symptoms (IJOA 2002;11:85-90) in need of reinterpretation.

709. Yamashita A, Matsumoto M, Matsumoto S, Itoh M, Kawai K, Sakabe T. A comparison of the neurotoxic effects on the spinal cord of tetracaine, lidocaine, bupivacaine, and ropivacaine administered intrathecally in rabbits. Anesth Analg 2003; 97:512-9. In animal model noted histopathologic changes with 10% lido = 2% tetra > 2% bupiv > 2% ropiv.

710. Panni MK, Camann W, Bhavani Shankar K. Hyperbaric therapy for a postpartum patient with prolonged epidural blockade and tomographic evidence of epidural air. Anesth Analg 2003; 97:1810-1. Hyperbaric therapy for epidural collection of air inpatient with delayed recovery from epidural labor analgesia.

711. Kinoshita H, Haba M, Yamazaki A, Hironaka Y, Iranami H, Hatano Y. Increased S-100 B protein levels in a patient undergoing Cesarean delivery in the presence of prolonged hemorrhagic shock. Can J Anaesth 2003; 50:618-9. Letter reportscase comparison of S-100 B protein, a marker of hypoxic brain damage, in a parturient who had hemorrhagic shock and then exhibited slight extrapyramidal symptoms.

712. Slowinski J, Szydlik W, Sanetra A, Kaminska I, Mrowka R. Bilateral chronic subdural hematomas with neurologic symptomscomplicating spinal anesthesia. Reg Anesth Pain Med 2003; 28:347-50. Nonpregnant woman s/p spinal with persistent headache treated with dexamethasone, reappeared and diagnosed as subdural hematomas, requiring decompression.

713. Kuczkowski KM, Benumof JL. Images in anesthesia: headache caused by pneumocephalus following inadvertent dural puncture during epidural space identification: is it time to abandon the loss of resistance to air technique? Can J Anaesth 2003; 50:159-60. CT Image of pneumocephalus.

714. Wong CA, Scavone BM, Dugan S, et al. Incidence of postpartum lumbosacral spine and lower extremity nerve injuries. Obstet Gynecol 2003; 101:279-88. 6048 women interviewed and 56 had a confirmed new injury as examined by a physiatrist. No direct relationship with regional anesthesia noted.

715. Kuczkowski KM, Benumof JL, Reisner LS, Alfery D, Myers R. Unilateral epidural nerve root hematoma in a parturient. ActaAnaesthesiol Belg 2003; 54:157-9. Case report of epidural nerve root hematoma with complete recovery following decompression.

716. Ros Mora J, Sarmiento Meneses LE, Corominas Barnadas JM, Conde Ospina P. [Postpartum paraparesis caused by probably polymyositis after obstetric epidural analgesia]. Rev Esp Anestesiol Reanim 2003; 50:430-1. Case report.

717. Monsma M, Gallego J, Lorente P, Estevez A, Villalain C, Bustos M. [Headache caused by cerebral angiopathy during labor with epidural analgesia]. Rev Esp Anestesiol Reanim 2003; 50:42-5. Case report of relatively unknown clinical entity, postpartum cerebral angiopathy, that developed during epidural analgesia for labor and that was initially believed to be a complication of the analgesic technique.

Other Injury

718. Murnaghan JM, Henderson SA, Allen RW. Burning issue: a danger of epidurals. Anaesthesia 2003; 58:613. Nonpregnant patient with an epidural infusion; high dermatomal level, resulting in thermal injury from holding a cup of coffee.


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719. Munnur U, Suresh MS. Backache, headache, and neurologic deficit after regional anesthesia. Anesthesiol Clin North America2003; 21:71-86. Review of common deficits during pregnancy and regional anesthesia.

720. Ross BK. ASA closed claims in obstetrics: lessons learned. Anesthesiol Clin North America 2003; 21:183-97. Of interest notes that a large proportion of claims were for "minor" injuries in the obstetric files (in comparison to nonob), suggestion patients unhappy with care or level of attention/treatment. Recommends establishment of good rapport, involvement in prenatal education, and provision of realistic risks/benefits/expectations.

721. Chandrasekhar S, Peterfreund RA. Horner's syndrome following very low concentration bupivacaine infusion for labor epidural analgesia. J Clin Anesth 2003; 15:217-9. Case report reviews possible mechanisms of this disorder.

722. Lang SA, Grau T. Spinal epidural hematoma and epidural analgesia. Can J Anaesth 2003; 50:422-3. Letter queries the possible causes and difficulties in studying epidural hematoma formation.

723. Hawkins JL. Anesthesia-related maternal mortality. Clin Obstet Gynecol 2003; 46:679-87. Good review including airway and local anesthetic toxicity issues.

724. Wlody D. Complications of regional anesthesia in obstetrics. Clin Obstet Gynecol 2003; 46:667-78. Good review of infectious, neurologic and drug related complications of neuraxial blockade in the pregnant patient.

725. Kuczkowski KM, Goldsworthy M. Transient aphonia and aphagia in a parturient after induction of combined spinal-epidural labor analgesia with subarachnoid fentanyl and bupivacaine. Acta Anaesthesiol Belg 2003; 54:165-6. Inability to speak and swallow in parturient following CSE.

726. Hew CM, Cyna AM, Simmons SW. Avoiding inadvertent epidural injection of drugs intended for non-epidural use. Anaesth Intensive Care 2003; 31:44-9. Review of manuscripts note common mechanisms and preventative strategies.

Prolonged Spinal Anesthesia

727. Kuczkowski KM, Bellars R. Prolonged spinal anesthesia in a parturient after administration of a standard epidural test dose with lidocaine and epinephrine. Acta Anaesthesiol Scand 2003; 47:1050. 197 min duration of 3ml 1.5% lidocaine with epi 15 µg in parturient.

Pruritis

728. Mahajan R, Kumar Grover V. Neuraxial opioids and Koebner phenomenon: implications for anesthesiologists. Anesthesiology 2003; 99:229-30. Two case reports (nonpregnant) of a disease process where in persons with certain skin diseases, trauma is followed by new lesions identical to those in diseased skin; this may occur with pruritis following neuraxial opioids.

Recurrent Anesthesia

729. Kuczkowski KM, Benumof JL. Postoperative cough-induced recurrence of spinal anaesthesia in the parturient. Anaesthesia 2003; 58:101. Letter suggesting an example of valsalva maneuver-induced circulation of CSF.

730. Fawcett WJ, Stone JP. Recurarization in the recovery room following the use of magnesium sulphate. Br J Anaesth 2003; 91:435-8. Nonpregnant case report serves as a reminder that magnesium can result in muscle relaxation.


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Respiratory Depression

731. Anwari JS, Iqbal S. Antihistamines and potentiation of opioid induced sedation and respiratory depression. Anaesthesia 2003;58:494-5. Letter. Author suggests chlorpheniramine for treatment of pruritis was responsible for sedation/respiratory depression in parturient who received epidural local anesthetic + fentanyl for post c/s analgesia.

732. Ko S, Goldstein DH, VanDenKerkhof EG. Definitions of "respiratory depression" with intrathecal morphine postoperative analgesia: a review of the literature. Can J Anaesth 2003; 50:679-88. Respiratory depression has no clear definition in regards to intrathecal morphine.

Seizures

733. Srinivasa V, Eappen S, Schlossmacher MG, Gerner P. Seizures after epidural blood patch. Reg Anesth Pain Med 2003; 28:71;author reply 71-2. Letter refutes diagnosis of subdural hematoma as etiology for seizures in a parturient. Authors of initial case report reply (Kardash, Morrow).

Spinal Headache

734. Rice I, Radhakrishnan D, Nelson-Piercy C. Cerebral vasoconstrictors and postdural puncture headache: the big squeeze. Br J Anaesth 2003; 90:527; author reply 527-8. Letter suggests vasoconstrictors in patients with pre-existing vasoconstriction (PIH, etc) is unwise; author disagrees.

735. Mercieri M, Mercieri A, Paolini S, et al. Postpartum cerebral ischaemia after accidental dural puncture and epidural blood patch. Br J Anaesth 2003; 90:98-100. Speculates that cerebral vasospasm may result in significant cerebral deficits, and be caused by dural puncture or blood patching.

736. Clark MJ, Sellers WFS. Post dural puncture headache. Anaesthesia 2003; 58:101. Letter notes that neurologists don't yet know the value of non-quinke tip needles. "Today's lumbar puncture may be tomorrow's spinal or epidural anaesthetic on an unwilling patient".

737. Kuczkowski KM, Benumof JL. Decrease in the incidence of post-dural puncture headache: maintaining CSF volume. Acta Anaesthesiol Scand 2003; 47:98-100. Case report of 7 pts; suggest injecting CSF and preservative free saline and use of an intrathecal catheter reduces PDPH.

738. Kawamata T, Omote K, Matsumoto M, Toriyabe M, Ito T, Namiki A. Pneumocephalus following an epidural blood patch. Acta Anaesthesiol Scand 2003; 47:907-9. Nonpregnant case report, LORTA.

739. van den Berg AA, Nguyen L, von-Maszewski M, Hoefer H. Unexplained fitting in patients with post-dural puncture headache. Risk of iatrogenic pneumocephalus with air rationalizes use of loss of resistance to saline. Br J Anaesth 2003; 90:810-1; author reply 811-2. Letter suggests LORTA can cause iatrogenic morbidities; describes case; Response notes IVcaffeine may also cause seizures.

740. Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth 2003; 91:718-29. Excellent review of the entity.

741. Somri M, Teszler CB, Vaida SJ, et al. Postdural puncture headache: an imaging-guided management protocol. Anesth Analg 2003; 96:1809-12. Two cases of PDPH (including one pregnant) reported with use of CT which revealed intrathecal air.

742. Delecki A, Kathirgamanathan N, Rajakulendran Y. Injection of bacteraemic blood during epidural blood patching for PDPH -Should we consider alternatives?[Journal: Letter]. International Journal of Obstetric Anesthesia 2003; 12:57-58. Letter of a case with a suggestion that alternatives are safer.


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743. Chohan U, Khan M, Saeed-uz-zafar. Abducent nerve palsy in a parturient with a 25-gauge Sprotte needle. International Journal of Obstetric Anesthesia 2003; 12:235-236. Letter reporting case of PDPH with abducen nerve palsy.

744. Zimet A. Encourage the use of noncutting needles for diagnostic lumbar punctures. Anesth Analg 2003; 97:303. Letter noting the need for anesthesiologist to share their knowledge of needles with those practitioners doing lumbar punctures.

745. Obray JB, Long TR, Brown MJ, Wass CT. Lhermitte sign associated with postdural puncture headache in a parturient. Anesthesiology 2003; 98:786-8. Case report of a parturient with electric shock-like sensation to neck and upper thorax (Lhermitte sign) + PDPH.

746. Chan TML, Ahmed E, Yentis SM, Holdcroft A. Postpartum headaches: summary report of the National Obstetric Anaesthetic Database (NOAD) 1999. International Journal of Obstetric Anesthesia 2003; 12:107-112. Survey of database revealing expected associations of PDPH.

747. Rice I, Mountfield J, Radhakrishnan D, Nelson-Piercy C. Puerperal seizures associated with post dural puncture headache. International Journal of Obstetric Anesthesia 2003; 12:126-129. Case report in which authors speculate that early blood patch may decrease risk of seizures.

748. Davies RG, Laxton CJ, Donald FA. Unrecognized dural punctures. International Journal of Obstetric Anesthesia 2003; 12:142-143. Letter suggests a high incidence (16.3%) of unrecognized dural punctures in audit of hospital records 92-99.

749. Browne IM, Birnbach DJ. Neurocysticercosis: a new differential in the diagnosis of postdural puncture headache. Anesth Analg 2003; 97:580-2. Parasitic CNS infestation masquerading as a PDPH.

750. Castillo D, Tsen LC. Epidural blood patch placed in the presence of an unknown cervical epidural hematoma. Anesth Analg 2003; 97:885-7. Case report highlights use of spinal needle for epidural space confirmation, and use of blood patch in the setting of an epidural hematoma.

751. Lee JS. Does intrathecal mepivacaine cause post lumbar puncture headache? Anesth Analg 2003; 97:926; author reply 926-7.Letter queries whether report by Meininger (Anesth Analg 2003;96:853-8) indicates high PDPH incidence due to use of Mepivicaine; authors do not respond to this specific query.

752. Choi PT, Galinski SE, Takeuchi L, Lucas S, Tamayo C, Jadad AR. PDPH is a common complication of neuraxial blockade inparturients: a meta-analysis of obstetrical studies. Can J Anaesth 2003; 50:460-9. Review of multiple studies and case series notes PDPH being a common complication. Comments on needles as well.

753. Chiron B, Laffon M, Ferrandiere M, Pittet JF. Postdural puncture headache in a parturient with sickle cell disease: use of an epidural colloid patch. Can J Anaesth 2003; 50:812-4. Case report noting the use of a colloid because of no prior reports of blood patch in this condition.

754. Ayad S, Demian Y, Narouze SN, Tetzlaff JE. Subarachnoid catheter placement after wet tap for analgesia in labor: influence on the risk of headache in obstetric patients. Reg Anesth Pain Med 2003; 28:512-5. 115 parturients over 5 yrs divided by consecutive assignment after wet tap to epidural replacement, spinal cath removed at delivery, or spinal cath removed 24 hrs after delivery. PDPH most common in epid (81%), spinal removed (31%), or spinal X24 (3%).

755. Balestrieri PJ. The incidence of postdural puncture headache and combined spinal-epidural: some thoughts. International Journal of Obstetric Anesthesia 2003; 12:305-6. Letter suggests that the use of a spinal needle for confirmation is an important to prevent the dural puncture with the larger epidural needle.

756. Kuczkowski KM, Benumof JL. Once a post-dural puncture headache patient always post-dural puncture headache patient? Acta Anaesthesiol Belg 2003; 54:167-8. Parturient with PDPH x 2; authors suggest prior PDPH may place pt at high risk forfuture PDPH.


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757. Kuczkowski KM. Post-dural puncture headache, intracranial air and obstetric anesthesia. Anaesthesist 2003; 52:798-800. Case of pneumocephalus questions safety of LORA epidural technique.

Urinary Incontinence/Retention

758. Hershberger JM, Milad MP. A randomized clinical trial of lorazepam for the reduction of postoperative urinary retention. Obstet Gynecol 2003; 102:311-6. 90 nonpregnant women randomized to lorazepam vs. placebo noted no significant difference in postoperative urinary retention after ambulatory gynecologic surgeries (non-pregnant).

759. Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S. Vaginal delivery parameters and urinary incontinence: the Norwegian EPINCONT study. Am J Obstet Gynecol 2003; 189:1268-74. Although a statistically significant association was found between maternal stress incontinence in later life and birth weight >4000 g and epidural anaesthesia, the effects were too weak to suggest a real link.

760. Sartore A, Pregazzi R, Bortoli P, Grimaldi E, Ricci G, Guaschino S. Effects of epidural analgesia during labor on pelvic floor function after vaginal delivery. Acta Obstet Gynecol Scand 2003; 82:143-6. 70 matched pairs of primiparous women questioned about urogynecologic symptoms and examined by digital test, vaginal perineometry and uroflowmetric stop test score 3 months after vaginal delivery. No differences found. Use of epidural analgesia is not associated with symptoms related to perineal trauma and pelvic floor muscle weakness.

Consent

761. White SM, Baldwin TJ. Consent for anaesthesia. Anaesthesia 2003; 58:760-74. Special article noting issues with written consent. Small section regarding pregnancy.

762. Jenkins K, Baker AB. Consent and anaesthetic risk. Anaesthesia 2003; 58:962-84. Literature search on mortality and morbidity with suggestions on informing patient of relative risks.

763. Meyer JH, Jr. Informed consent, informed refusal, and informed choices. Am J Obstet Gynecol 2003; 189:319-26. Address to the 65th annual meeting of the South Atlantic Assoc of OB/GYN. Good review of issues of consent in OB.

764. Ranganathan M, Raghuraman G. Ethical considerations in obtaining consent under anaesthesia. Anaesthesia 2003; 58:1250-1; author reply 1251. Letter suggests errors in judgement in age (16 yo has capacity to decide in UK) and incorrect diagnosison consent.

765. Kuczkowski KM. Informed consent, the parturient, and obstetric anesthesia. J Clin Anesth 2003; 15:573-4. Editorial to article below.

766. Hoehner PJ. Ethical aspects of informed consent in obstetric anesthesia-new challenges and solutions. J Clin Anesth 2003; 15:587-600. Breaks the consent process into 7 elements that need to be satisfied to qualify as informed consent.

767. Meek T. A response to 'Consent issues in obstetric anaesthesia', Roberts J, Anaesthesia 2002; 57: 1232-3. Anaesthesia 2003; 58:405-6. Letter.

Economics and Staffing

768. Nyssen AS, Hansez I, Baele P, Lamy M, De Keyser V. Occupational stress and burnout in anaesthesia. Br J Anaesth 2003; 90:333-7. Questionnaire study of 318 Belgium anaesthetists. Anaesthetists have a mean stress level no higher than in other working populations; however, 40.4% of the group suffered from high emotional exhaustion (burnout). The highest rate was in young trainees under 30 years of age.


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769. Qureshi AM, Stevens M, Plaat F. Survey of anaesthetic support staff in obstetric units in England and Wales. Anaesthesia 2003; 58:578-82. Postal questionnaire of which 197 (76% response rate) obstetric units replied, indicating that 86% did not have a operating department practitioner/nurse (ODP/N) or resident exclusively for the maternity unit. Midwives in 76% of the units assisted the anaesthetist with the insertion of regional labor blocks.

770. Murray D, Dodds C. The effect of sleep disruption on performance of anaesthetists--a pilot study. Anaesthesia 2003; 58:520-5. Interesting article on sleep deprivation on driving simulator performance with novel vs. routine situations. Take the bus home post call!

Pharmacology

771. Salman MA, Sahin A, Onur MA, Oge K, Kassab A, Aypar U. Tramadol encapsulated into polyhydroxybutyrate microspheres:in vitro release and epidural analgesic effect in rats. Acta Anaesthesiol Scand 2003; 47:1006-1012. Centrally acting analgesicwith both opioid and non-opioid effects shows 21 h epidural analgesic effects with release from microspheres.

772. Eisenach JC, Yaksh TL. Epidural ketamine in healthy children--what's the point? Anesth Analg 2003; 96:626; author reply 626-7. Letter raises the issue of the need for preclinical toxicity studies prior to studying an agent within the epidural space.

773. Bernards CM, Shen DD, Sterling ES, et al. Epidural, cerebrospinal fluid, and plasma pharmacokinetics of epidural opioids (part 1): differences among opioids. Anesthesiology 2003; 99:455-65. Anesthetized, non-pregnant pig model notes pharmacokinetics of epidurally administered opioids; suggests complex pharmacokinetics with bioavailability is determined primarily by hydrophobicity.

774. Bernards CM, Shen DD, Sterling ES, et al. Epidural, cerebrospinal fluid, and plasma pharmacokinetics of epidural opioids (part 2): effect of epinephrine. Anesthesiology 2003; 99:466-75. Anesthetized, non-pregnant model noted above; indicates the pharmacokinetic effects of epinephrine varies with the opioid and compartment measured.

775. Flood P, Daniel D. Pronociceptive actions of isoflurane: a protective role for estrogen. Anesthesiology 2003; 99:476-9. Low doses of isoflurane increase pain sensitivity; high estrogen states reduce this increased sensitivity.

776. Clunie M, Crone LA, Klassen L, Yip R. Psychiatric side effects of indomethacin in parturients. Can J Anaesth 2003; 50:586-8. Retrospective review of adverse psychiatric drug reactions to indomethacin given for postpartum pain; proposed mechanism includes dopamine supersensitivity.

777. Wadhwa A, Durrani J, Sengupta P, Doufas AG, Sessler DI. Women have the same desflurane minimum alveolar concentrationas men: a prospective study. Anesthesiology 2003; 99:1062-5. The MAC of desflurane did not differ between young men and women undergoing surgery.

778. Dogru K, Yildiz K, Dalgic H, Sezer Z, Yaba G, Madenoglu H. Inhibitory effects of desflurane and sevoflurane on contractions of isolated gravid rat myometrium under oxytocin stimulation. Acta Anaesthesiol Scand 2003; 47:472-4. In-vitro application of desflurane and sevoflurane (0.5-2 MAC) similarly inhibit oxytocin induced myometrial contractions in the gravid rat in a dose dependent manner.

779. Fields AM, Richards TA, Ibrahim IN, Kaye AD. Ephedrine in the cat lung vasculature. Acta Anaesthesiol Scand 2003; 47:979-85. Ephedrine has significant vasoconstrictor activity in the pulmonary vascular bed of the cat.

780. Dogru K, Dalgic H, Yildiz K, Sezer Z, Madenoglu H. The direct depressant effects of desflurane and sevoflurane on spontaneous contractions of isolated gravid rat myometrium. International Journal of Obstetric Anesthesia 2003; 12:74-78. In vitro application of 0.5, 1.0, 2.0 MAC desflurane and sevoflurane in gravid rat myometrium. In a dose dependent manner,both agents had tocolytic activity, with such activity starting at 0.5 and 1.0 MAC with desflurane and sevoflurane respectively.


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781. Senat MV, Fischer C, Bernard JP, Ville Y. The use of lidocaine for fetocide in late termination of pregnancy. Bjog 2003; 110:296-300. Lidocaine 1% (7-20 mL) was effective via umbilical vein puncture to induce permanent fetal cardiac asystole for fetocide in late termination of pregnancy.

782. Hausman N, Beharry K, Nishihara K, Akmal Y, Stavitsky Y, Asrat T. Response of fetal prostanoids, nitric oxide, and ductus arteriosus to the short- and long-term antenatal administration of celecoxib, a selective cyclo-oxygenase-2 inhibitor, in the pregnant rabbit. Am J Obstet Gynecol 2003; 189:1744-50. This preliminary evaluation demonstrates that the maternal administration of celecoxib does not influence fetal ductus arteriosus patency adversely in rabbits.

783. Andaluz A, Tusell J, Trasserres O, et al. Transplacental transfer of propofol in pregnant ewes. Vet J 2003; 166:198-204. This study determines the pharmacokinetics of propofol in pregnant ewes in the last third of pregnancy, and placental transfer and pharmacokinetics in fetuses after the administration of a 6 mg/kg intravenous (i.v.) bolus (phase 1) or a 6 mg/kg i.v. bolus followed by continued infusion of 0.4 mg/kg/min. In ewes, the area under the blood concentration-time curve (AUC) and C(max) (8.6 mgh/mL and 9.5mg/mL, respectively) was higher than those of the fetus (1.6 mgh/mL and 1.19 mg/mL, respectively). The mean half-life was 0.5h in the dam and 1.1h in the fetus.

784. Karsli B, Kayacan N, Kucukyavuz Z, Mimaroglu C. Effects of local anesthetics on pregnant uterine muscles. Pol J Pharmacol 2003; 55:51-6. Exposure on myometrium isolated from pregnant rats to prilocaine, bupivacaine and ultracaine decreased amplitude, duration and integrated area under the contraction curve. In conclusion, the study drugs at higher concentrations decreased contractions of myometrium, but all drugs at higher concentrations elevated the frequency.

Postoperative Pain Management

Pharmacology

785. Talke P, Xu M, Paloheimo M, Kalso E. Effects of intrathecally administered dexmedetomidine, MPV-2426 and tizanidine on EMG in rats. Acta Anaesthesiol Scand 2003; 47:347-54. Intrathecally administered alpha 2 agonists have sedative and antinociceptive effects act supraspinally and may require dose escalation with discomfort.

786. Pertovaara A, Kalmari J. Comparison of the visceral antinociceptive effects of spinally administered MPV-2426 (fadolmidine) and clonidine in the rat. Anesthesiology 2003; 98:189-94. Spinal administration of MPV-2426 (fadolmidine), aselective alpha 2 adrenoceptor agonist, induced visceral antinociception equipotent to spinal clonidine. An intact sympatheticnervous system or intact brainstem-spinal pathway is not critical for this visceral antinociception.

787. Cepeda MS, Carr DB. Women experience more pain and require more morphine than men to achieve a similar degree of analgesia. Anesth Analg 2003; 97:1464-8. Prospective cohort study of surgical procedures under GA; post op treatment with morphine based on visual analog score. Found women exhibit higher pain intensity and greater weight adjusted morphine requirements to achieve similar degree of analgesia.

788. Berde CB, Brennan TJ, Raja SN. Opioids: more to learn, improvements to be made. Anesthesiology 2003; 98:1309-12. Editorial to article below.

789. Aubrun F, Langeron O, Quesnel C, Coriat P, Riou B. Relationships between measurement of pain using visual analog score and morphine requirements during postoperative intravenous morphine titration. Anesthesiology 2003; 98:1415-21. Nonpregnant study, suggests from data in 3,045 patients, that VAS >70 is indicative of severe pain. The relationship betweenthe initial VAS and morphine requirements is not linear.

790. Beilin B, Bessler H, Mayburd E, et al. Effects of preemptive analgesia on pain and cytokine production in the postoperative period. Anesthesiology 2003; 98:151-5. Preemptive epidural analgesia is associated with reduced postoperative pain and attenuated production of proinflammatory cytokines in 41 women undergoing transabdominal hysterectomy. Both groups received PCEA postoperatively.


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791. Schmitt TK, Mousa SA, Brack A, et al. Modulation of peripheral endogenous opioid analgesia by central afferent blockade. Anesthesiology 2003; 98:195-202. An effective central inhibition of pain (studied in rats undergoing continuous intrathecal morphine infusion) apparently signals a reduced need for recruitment of opioid-containing immune cells to an injured site.

Physiology

792. Dolan S, Kelly JG, Huan M, Nolan AM. Transient up-regulation of spinal cyclooxygenase-2 and neuronal nitric oxide synthase following surgical inflammation. Anesthesiology 2003; 98:170-80. Spinal cyclooxygenase and neuronal nitric oxidesynthase (NOS) in adult female sheep undergoing midline laparatomy for collection of ova are spinally induced. The findings also suggested a link with these enzymes and superovulatory treatment.

MISCELLANEOUS

Abstracts

793. 3 day course on Obstetric Anaesthesia and Analgesia - 17(th)-19(th) November 2003 - The Conference Centre at Church House, Westminster - London - Abstracts. International Journal of Obstetric Anesthesia 2003; 12:193-233.

794. Abstracts of the Society for Obstetric Anesthesia and Perinatology 35th Annual Meeting. May 14-17, 2003. Phoenix, Arizona, USA. Anesthesiology 2003; 98 Suppl 1:1-77.

Education/Residency/Registrar Training

795. Sutherland PD, Wee MYK, van HameL JCM, Campbell DNC. Obstetric anaesthesia training in the Wessex region before and after introduction of Calman training. International Journal of Obstetric Anesthesia 2003; 12:102-106.

796. Naik VN, Devito I, Halpern SH. Cusum analysis is a useful tool to assess resident proficiency at insertion of labour epidurals. Can J Anaesth 2003; 50:694-8. Cumulative sum analysis (Cusum) can be used to tract proficiency; suggests some residents require as many as 75 attempts.

797. Sutherland PD, Wee MYK, van HameL JCM, Campbell DNC. Obstetric anaesthesia training in the Wessex region before and after introduction of Calman training. International Journal of Obstetric Anesthesia 2003; 12:102-106. Questionnaire survey of trainees before and after institution of the Calman report (specialist training change to emphasize modular training).

798. Birnbach DJ. What's New In Obstetrical Anesthesia: Reaffirming our commitment to safety and comfort. ASA Newsletter 2003; 67:34. Commentary on the importance of our sub-specialty.

799. Camann W. Obstetrics-Never a dull moment! ASA Newsletter 2003; 67:13. Musings on the excitement within our sub-specialty.

800. Queenan JT. The future of obstetrics and gynecology. Obstet Gynecol 2003; 102:441-2. Editorial by deputy editor of journal laments the dissatisfaction in the field and the drop in medical students applying to OB/Gyn residencies. Precedes ACOG presidential address by Gibbons suggesting same thing.

Ethics

801. Chervenak FA, McCullough LB, Birnbach DJ. Ethics: an essential dimension of clinical obstetric anesthesia. Anesth Analg 2003; 96:1480-5. A framework for ethical issues in obstetric anesthesia.

802. Walton S. Birth plans and the falacy of the Ulysses directive. International Journal of Obstetric Anesthesia 2003; 12:138-139.Thoughtful letter presents philosophical arguments why going against the Ulysses directive (desire to be bound by original directive) is acceptable.


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803. ACOG Committee Opinion. Surgery and patient choice: the ethics of decision making. Obstet Gynecol 2003; 102:1101-6. Nice overview with different models of behavior. Elective cesarean delivery discussed.

804. ACOG Committee Opinion. Ethical considerations in research involving women. Obstet Gynecol 2003; 102:1107-13. Good review of issues including context and consent.

805. Gyamfi C, Gyamfi MM, Berkowitz RL. Ethical and medicolegal considerations in the obstetric care of a Jehovah's Witness. Obstet Gynecol 2003; 102:173-80. Ethical/Legal commentary on caring for individuals who are Jehovah's Witnesses. Includes a protocol for management.

History

806. Adams H. A tale of sorrow or travail? International Journal of Obstetric Anesthesia 2003; 12:64. Letter evaluating the Genesis 3:16 "in sorrow" statement suggests another translation of "travail" instead of "pain".

807. Clark RB. Rhesus, king of Thrace and erythroblastosis fetalis. International Journal of Obstetric Anesthesia 2003; 12:237-238. Letter touches on where the Rhesus monkey got its name.

808. Moore DC. Memories of the early years of regional anesthesia for childbirth. Reg Anesth Pain Med 2003; 28:466-9. Interesting report of the major changes in OB anesthesia since the 1920's.

809. Roy RP. A Darwinian view of obstructed labor. Obstet Gynecol 2003; 101:397-401. Essay on evolutionary biology of dystocia.

810. Lurie S, Glezerman M. The history of cesarean technique. Am J Obstet Gynecol 2003; 189:1803-6. Summary of developments in the technique; notes reports dating to 1480.

Labor Support

811. Continuous labor support offers big benefits to mothers and babies, has no known downsides; support from non-hospital caregivers reduced risk of cesarean birth by impressive 26%. PR Newswire Association, Inc., 2003. Article covering the "Continuous support for women during childbirth" study by the Cochrane Collaboration, citing the benefit of non-hospital caregivers (below).

812. Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database Syst Rev 2003:CD003766. Fifteen trials involving 12,791 women are included. In general, continuous intrapartum support was associated with greater benefits when the provider was not a member of the hospital staff, when it began early in labour, and in settings in which epidural analgesia was not routinely available.

813. Couvillion E. Dads in Delivery. Sunday Advocate. Baton Rouge, LA, 2003. Benefits of having fathers in delivery room.

814. Leavitt JW. What do men have to do with it? Fathers and mid-twentieth-century childbirth. Bull Hist Med 2003; 77:235-62. This article addresses the role of fathers during the births of their children, focusing on the United States in the mid-twentiethcentury when childbirth was a highly medicalized, in-hospital experience.

Medicolegal Issues

815. Harris LH, Paltrow L. MSJAMA. The status of pregnant women and fetuses in US criminal law. Jama 2003; 289:1697-9.

816. Ransom SB, Studdert DM, Dombrowski MP, Mello MM, Brennan TA. Reduced medicolegal risk by compliance with obstetric clinical pathways: a case--control study. Obstet Gynecol 2003; 101:751-5. Suggests compliance with clinical pathways appears to protect against malpractice litigation.


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Nursing

817. Kennell JH, Klaus MH. Continuous nursing support during labor. Jama 2003; 289:175-6; author reply 176.

818. Poole JH. Neuraxial analgesia for labor and birth: implications for mother and fetus. J Perinat Neonatal Nurs 2003; 17:252-67. Article notes difference in previous systemic analgesia + dense motor blockade regional technique versus contemporary regional techniques in terms of perinatal nursing support.

819. Poole JH. Analgesia and anesthesia during labor and birth: implications for mother and fetus. J Obstet Gynecol Neonatal Nurs 2003; 32:780-93. Article as above…two for the price of one?

820. Florence DJ, Palmer DG. Therapeutic choices for the discomforts of labor. J Perinat Neonatal Nurs 2003; 17:238-49; quiz 250-1. Article suggesting the options for nurse childbirth educators.

821. Mahlmeister L. Nursing responsibilities in preventing, preparing for, and managing epidural emergencies. J Perinat Neonatal Nurs 2003; 17:19-32; quiz 33-4. Review of the significant complications related to obstetric epidural with nurse recommendations in preparing for and managing epidural emergencies. Specific responsibilities of nurse managers and educators in competency training, evaluation, and guidance of nurses are also discussed.

Research

822. Nagele P. Misuse of standard error of the mean (SEM) when reporting variability of a sample. A critical evaluation of four anaesthesia journals. Br J Anaesth 2003; 90:514-6. One in four articles in Anesthesiology, Anesth Analg, Br J Anaesth, and Eur J Anaesth, incorrectly use SEM.

823. Breen T. Databases and obstetric anesthesia research: Opportunity and limitations. [Journal: Editorial]. International Journal of Obstetric Anesthesia. 2003; 12:1-3. Nice review of the potential for misleading with retrospective database searches; goodfocus on progress of labor controversy.

824. Duff P. Evaluation of a scientific manuscript: The perspective of the reviewer. Obstet Gynecol 2003; 101:623-4. Nice quick tips on how to evaluate a scientific manuscript.

825. Burmeister LF. Principles of successful sample surveys. Anesthesiology 2003; 99:1251-2. Quick tips on how to conduct a successful survey study.

826. Hawkins JL. SOAP-FAER Liaison: A win-win partnership for anesthesiology. ASA Newsletter 2003; 67:44. Review of research produced by this relationship.

Websites/Books/Leaflets/Journal Announcements

827. Barclay PM. Book Review: www.painfreebirthing.com. Br J Anaesth 2003; 91:816. Favorable review of the website noted.

828. Kuczkowski KM. New and challenging problems (and solutions) in obstetric anesthesia: introduction. J Clin Anesth 2003; 15:165. Editorial announcing a one per issue review article on obstetric anesthesia for this journal.

829. Tsen LC. Book Review: Handbook of Obstetric Anesthesia (Edited by Palmer, D'Angelo, Paech). International Journal of Obstetric Anesthesia 2003; 12:65-66. Favorable review of the new handbook.

830. Drury PME. Book Review: Cholera, Chloroform, and the Science of Medicine: A Life of John Snow. Br J Anaesth 2003; 91:768-9. Book on an impressive life of Queen Victoria's obstetric anaesthetist, written by 3 epidemiologist and 2 historians.Impressive bibliography.


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831. Yentis SM. Book Review: Clinical Research (Editor Smith F. G., Smith J. E. International Journal of Obstetric Anesthesia 2003; 2003:239. Mixed report on this text.

832. Muir H. Book Review: Obstetric Anesthesia: International Anesthesia Clinics, Vol 40, No 4. Anesth Analg 2003; 97:305-8. States book is good for the practicing OB anesthesiologist, but not recommended for those new to the field.

833. Bosjnak ZJ, Warltier DC, Eisenach JC, Arkoosh VA, Wissler RN, Todd MM. Journal related activities at the 2003 American Society of Anestheisologists Annual Meeting. Anesthesiology 2003; 99:526-9. Highlights the SOAP Journal Abstract Symposium.

834. Thomas J. Book Review: Shnider and Levinson's Anesthesia for Obstetrics, 4th ed (Ed: Hughes S.C., Levinson G., Rosen, M.A.). Anesthesiology 2003; 98:800-1. Favorable review of this updated edition.

835. Daniels A. Book Review: Chloroform: The Quest for Oblivion. Linda Stratmann Sutton. Sunday Telegraph (London). London, 2003:1. Favorable review by a physician (book written by a pharmacist).

836. Collins A. Book Review: Concise Anatomy for Anaesthesia. Erdman, A. International Journal of Obstetric Anesthesia 2003;12:146-7. Very favorable review.

837. Hawkins JL. Foreword. Clin Obstet Gynecol 2003; 46:614-5. Introduction by Guest Editor of Edition on Obstetric Anesthesia.

838. Quilligan EJ, Zuspan FP. Farewell address from Dr. Quilligan and Dr. Zuspan. Am J Obstet Gynecol 2003; 189:4. Address by our friend in the obstetric community, Dr. F Zuspan.

839. Riley ET, Cohen SE. Obstetric Anesthesia Pocket Reference. Paperback. Butterworth-Heinemann. 2003. 144pp. ISBN: 0750671661.

840. Winners of the SARB abstract competition: award 2002. Acta Anaesthesiol Belg 2003; 54:15. Of note, all three winners (clinical investigations, best resident abstract, experimental investigations) were relevant to anesthesia/analgesia during pregnancy!

841. Winner of the SARB grants. Acta Anaesthesiol Belg 2003; 54:17. M. Van de Velde "A new model of fetal pain in the chronically pregnant sheep preparation".

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