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1 What s NEW in Obstetric Anesthesia? Yusuke MAZDA Division of Obstetric Anesthesia, Saitama Medical Center!
2 No financial COI to disclose Yusuke MAZDA Division of Obstetric Anesthesia, Saitama Medical Center!
3 What s New in Obstetric Anesthesia The 2014 Gerand W. Ostheimer Lecture Leffert L. A&A 2015; 120(5):
4 6% Hydroxyethyl Starch (130/0.4) vs Ringer s! Lactate Preloading before Spinal Anaesthesia! for Caesarean Delivery Mercier FJ, et al. BJA 2014; 113(3):
5 60% Crystalloid 50% ml % 40% 37% p= % Mercier FJ, et al. BJA 2014; 113(3):
6 500 ml Crystalloid 100! [x1,000/µl] Day 0 Day ± ± ± ± 57 p=0.84 p=0.67! [mg/dl] Day 0 Day ± ± ± ± 0.13 p=0.35 p=0.82 Mercier FJ, et al. BJA 2014; 113(3):
7 This company-sponsored study was fully funded by Fresenius Kabi Deutschland GmbH. Mercier FJ, et al. BJA 2014; 113(3):
8 Comparison between Colloid Preload and! Crystalloid Co-load in Cesarean Section! Under Spinal Anesthesia Tawfik MM, et al. IJOA 2014; 23(4):
9 60% 500 ml % Crystalloid Crystalloid 40% 52.4% 42.2% p= % Tawfik MM, et al. IJOA 2014; 23(4):
10 Prevention of Hypotension during Spinal! Anesthesia for Elective Caesarean Section Coloading with HAE 130/0.4 vs Normal Saline Solution! Bennasr L, et al. Ann Fr Anesth Reanim. 2014; 33(12):
11 75% Crystalloid 60% 500 ml % % 40.0% p= % Bennasr L, et al. Ann Fr Anesth Reanim. 2014; 33(12):
12 Prophylactic Phenylephrine for Caesarean! Section under Spinal Anaesthesia Heesen M, et al. Anaesthesia 2014; 69(2):
13 !! Heesen M, et al. Anaesthesia 2014; 69(2):
14 ! RR 0.36 [95%CI 0.18, 0.73]! RR 2.00 [95%CI 0.36, 11.17] Heesen M, et al. Anaesthesia 2014; 69(2):
15 6 Randomized Double-blinded Comparison of! Norepinephrine and Phenylephrine for! Maintenance of Blood Pressure during Spinal! Anesthesia for Cesarean Delivery 二重盲検ランダム化比較試験 香港 高比重ブピバカイン 11mg, フェンタニル 15µg ノルアドレナリン持続静注 mg/hr n=49 フェニレフリン持続静注 0-6 mg/hr n=52 晶質液コロード MAX 2,000 ml A computer-controlled closed-loop feedback system Ngan Kee WD, et al. Anesthesiology 2015; 122(4):
16 ! 102.7% 93.8% p=0.004 Ngan Kee WD, et al. Anesthesiology 2015; 122(4):
17 7 Effect of Lateral Tilt Angle on the Volume of! the Abdominal Aorta and Inferior Vena Cava! in Pregnant and Nonpregnant Women! Determined by Magnetic Resonance Imaging 観察コホート研究 東京女子医大 妊婦10名 非妊婦10名 MRI 大動脈 下大静脈を測定 ベッドの角度 0, 15, 30, 45 胸郭インピーダンス法 心拍出量 平均動脈圧 心拍数 Higuchi H, et al. Anesthesiology 2015; 122(2):
18 Higuchi H, et al. Anesthesiology 2015; 122(2):
19 Choice of Anaesthetic Agents for Caesarean! Section A UK Survey of Current Practice Murdoch H, et al. IJOA 2013; 22(1): 31-5.
20 8 帝王切開の全身麻酔薬に関するアンケート調査 7% 第一選択は チオペンタール 昔から使用している 術中覚醒が少ない 37% 31% 新生児への影響 13% 93% Murdoch H, et al. IJOA 2013; 22(1): 31-5.
21 8 帝王切開の全身麻酔薬に関するアンケート調査 プロポフォール!! NO YES 40% 58% Murdoch H, et al. IJOA 2013; 22(1): 31-5.
22 Murdoch H, et al. IJOA 2013; 22(1): 31-5.
23 Murdoch H, et al. IJOA 2013; 22(1): 31-5.
24 Survey on the Adequacy of Depth of! Anaesthesia with Bispectral Index and! Isolated Forearm Technique in Elective! Caesarean Section under General Anaesthesia with Sevoflurane Zand F, et al. BJA 2014; 112(5):
25 Zand F, et al. BJA 2014; 112(5):
26 Zand F, et al. BJA 2014; 112(5):
27 Video Laryngoscopes and the Obstetric Airway Tunstall 1976 DAS 2004 Scott-Brown S, et al. IJOA 2015; 24(2):
28 !!! Scott-Brown S, et al. IJOA 2015; 24(2):
29 OAA/DAS Working Party Scott-Brown S, et al. IJOA 2015; 24(2):
30 Risk of Autism Associated with General! Anesthesia during Cesarean Delivery A Population-Based Birth-Cohort Analysis Chien LN, et al. J Autism Dev Disord. 2015; 45(4):
31 ! RR 1.07 [95%CI 0.96, 1.19]! RR 1.52 [95%CI 1.18, 1.94] Chien LN, et al. J Autism Dev Disord. 2015; 45(4):
32 Transversus Abdominis Plane Block does! not Improve Early or Late Pain Outcomes! after Cesarean Delivery McKeen DM, et al. Can J Anaesth. 2014; 61(7):
33 McKeen DM, et al. Can J Anaesth. 2014; 61(7):
34 McKeen DM, et al. Can J Anaesth. 2014; 61(7):
35 The Relationship between Serum Progesterone! Concentration and Anesthetic and Analgesic! Requirements A Prospective Observational Study of Parturients Undergoing Cesarean! Delivery Lee J, et al. BJA 2014; 112(5):
36 A Randomized Comparative Trial of Early! Initiation of Oral Maternal Feeding versus! Conventional Oral Feeding after Cesaran! Delivery Masood SN DM, et al. Int J Gynaecol Obstet. 2014; 126(2):
37 60% 50% 40% 30% 20% 15 Masood SN DM, et al. Int J Gynaecol Obstet. 2014; 126(2):
38 10% 7.5% 5% 2.5% 0% Masood SN DM, et al. Int J Gynaecol Obstet. 2014; 126(2):
39 Effects of Gum Chewing on Postoperative! Bowel Motility after Caesarean Section A Meta-analysis of Randomised Controlled Trials Zhu YP, et al. BJOG 2014; 121(7):
40 !! Zhu YP, et al. BJOG 2014; 121(7):
41 MD (hours) 95%CI , , , , Zhu YP, et al. BJOG 2014; 121(7):
42 The Effects of Oral Fluid Intake an Hour before! Cesarean Section on Regurgitation Incidence Ghorashi Z, et al. Iran J Nurs Midwifery Res. 2014; 19(4):
43 Ghorashi Z, et al. Iran J Nurs Midwifery Res. 2014; 19(4):
44 Interrater Reliability of Qualitative Ultrasound! Assessment of Gastric Content in the Third! Trimester of Pregnancy Arzola C, et al. BJA 2014; 113(6):
45 bull s eye starry night frosted glass Arzola C, et al. BJA 2014; 113(6):
46 Arzola C, et al. BJA 2014; 113(6):
47 Ultrasound Imaging for Lumbar Punctures and! Epidural Catheterisations Shaikh F, et al. BMJ 2013; 346: f1720.
48 ! RR 0.21 [95%CI 0.10, 0.43]! RR 0.27 [95%CI 0.11, 0.67] Shaikh F, et al. BMJ 2013; 346: f1720.
49 18 超音波検査補助による脊椎 刺 硬膜外カテーテル留置 刺回数 血管損傷 MD -1.01回 [95% CI -1.56, -0.45] RR 0.28 [95% CI 0.09, 0.92] Shaikh F, et al. BMJ 2013; 346: f1720.
50 Elective Caesarean Section at 38 weeks versus! 39 weeks Neonatal and Maternal Outcomes in a Randomised Controlled Trial Glavind J, et al. BJOG 2013; 120(9):
51 48! NICU! RR 0.86 [95%CI 0.65, 1.15] 1!! RR 0.31 [95%CI 0.10, 0.94] Glavind J, et al. BJOG 2013; 120(9):
52 500mL!! RR 0.79 [95%CI 0.63, 0.99] Glavind J, et al. BJOG 2013; 120(9):
53 Early versus Late Initiation of Epidural! Analgesia for Labour Sng BL, et al. Cochrane Database Syst Rev. 2014; 10: CD007238
54 ! RR 1.02 [95%CI 0.96, 1.08]! RR 0.93 [95%CI 0.86, 1.01] Sng BL, et al. Cochrane Database Syst Rev. 2014; 10: CD007238
55 We conclude that for first time mothers in labour who request epidurals for pain relief, it would appear that the time to initiate epidural analgesia is dependent upon women s requests. Sng BL, et al. Cochrane Database Syst Rev. 2014; 10: CD007238
56 The Effect of Bupivacaine with Fentanyl! Temperature on Initiation and Maintenance! of Labor Epidural Analgesia Sviggum HP, et al. IJOA 2015; 24(1):
57 9.2 ± 4.7 min! vs! 16.0 ± 10.5 min p=0.005 Sviggum HP, et al. IJOA 2015; 24(1):
58 Intermittent Epidural Bolus Compared with! Continuous Epidural Infusions for Labor! Analgesia George RB, et al. A&A 2014; 116(1):
59 ! RR 0.87 [95%CI 0.56, 1.35]! RR 0.59 [95%CI 0.35, 1.00] George RB, et al. A&A 2014; 116(1):
60 ! MD 7.01/100mm [95%CI 6.19, 7.84] George RB, et al. A&A 2014; 116(1):
61 A Randomized Controlled Trail of the Efficacy! and Respiratory Effects of Patient-Controlled! Intravenous Remifentanil Analgesia and! Patient-Controlled Epidural Analgesia in! Laboring Women Stocki D, et al. A&A 2014; 118(3):
62 Stocki D, et al. A&A 2014; 118(3):
63 Impact of a Third Stage of Labor Oxytocin! Protocol on Cesarean Delivery Outcomes Lee AI, et al. IJOA 2014; 23(1):
64 p<0.001 Lee AI, et al. IJOA 2014; 23(1):
65 p=0.03 Lee AI, et al. IJOA 2014; 23(1):
66 The Use of Postpartum Hemorrhage Protocols! in United States Academic Obstetric! Anesthesia Units Kacmar RM, et al. A&A 2014; 119(4):
67 Kacmar RM, et al. A&A 2014; 119(4):
68 Kacmar RM, et al. A&A 2014; 119(4):
69 25 分 時出血対応プロトコールに関するアンケート調査 クリオプレシピテートの輸血基準 臨床的低フィブリノーゲン血症 フィブリノーゲン濃度 < 150mg/dL トロンボエラストグラム 1施設のみ Kacmar RM, et al. A&A 2014; 119(4):
70 Kacmar RM, et al. A&A 2014; 119(4):
71 Major Obstetric Haemorrhage: Monitoring with! Thromboelastography, Laboratory Analyses! or Both? Karlsson O, et al. IJOA 2014; 23(1): 10-7.
72 Karlsson O, et al. IJOA 2014; 23(1): 10-7.
73 The Relationship between Body Mass Index! and Port-Dural Puncture Headache! in Obstetric Patients Miu M, et al. IJOA 2014; 23(4):
74 p=0.827 Miu M, et al. IJOA 2014; 23(4):
75 Regional Anaesthesia and Patients with! Abnormalities of Coagulation The Association of Anaesthetists of Great Britain & Ireland! The Obstetric Anaesthetists Association! Regional Anaesthesia UK Harrop-Griffiths, et al. Anaesthesia 2013; 68 (9):
76 28 凝固障害における区域麻酔に関する英国ガイドライン this guidance is considerably more concise. 硬膜外血腫 10万人あたり 0.85人 an experienced anaesthetist should perform the procedure. Harrop-Griffiths, et al. Anaesthesia 2013; 68 (9):
77 Normal Increased High Very High (6 ) HELLP (24 ) / (6 ) () Harrop-Griffiths, et al. Anaesthesia 2013; 68 (9):
78 Serious Complications Related to! Obstetric Anesthesia The Serious Complication Repository Project of the Society for Obstetric Anesthesia and Perinatology D Angelo R. et al. Anesthesiology 2014; 120(6):
79 29 産科麻酔偶発症調査 307,495分 中 偶発症は157例 偶発症 ,000 D Angelo R. et al. Anesthesiology 2014; 120(6):
80 D Angelo R. et al. Anesthesiology 2014; 120(6):
81 D Angelo R. et al. Anesthesiology 2014; 120(6):
82 The Society for Obstetric Anesthesia and! Perinatology Consensus Statement on the! Management of Cardiac Arrest in Pregnancy Lipman S, et al. A&A 2014; 118(5):
83 Lipman S, et al. A&A 2014; 118(5):
84 Lipman S, et al. A&A 2014; 118(5):
85 ! THANKS! Non financial COI to disclose Yusuke MAZDA Division of Obstetric Anesthesia, Saitama Medical Center!
86 10!!!!
87 !!
88 !!
89
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