Category: Yale Anesthesiology

This collection features interviews with anesthesiologists and other experts in which we discuss topics ranging from basic anesthesia to subspecialty-related topics.

Accuracy of ChatGPT

Accuracy of ChatGPT

In this episode, Dr. Allison Mootz, an obstetric anesthesiology fellow at Brigham and Women, discusses her thought-provoking article titled- The Accuracy of ChatGPT-Generated Responses in Answering Commonly Asked Patient Questions About Labor Epidurals: A Survey-Based Study.
https://pubmed.ncbi.nlm.nih.gov/38180897/
Comparing Physician and Artificial Intelligence Chatbot Responses to Patient Questions Posted to a Public Social Media Forum
https://pubmed.ncbi.nlm.nih.gov/37115527/

Modern Labor Epidural Analgesia

Modern Labor Epidural Analgesia

In this episode, Dr. Ron George provides a tour de force of our past and present labor analgesia management. We discuss his recent publication, Modern Labor Epidural Analgesia: Implications for Labor Outcomes and Maternal-Fetal Health.
https://pubmed.ncbi.nlm.nih.gov/37164496/
The Most Influential Publications in Obstetric Anesthesiology, 1998–2017: Utilizing the Delphi Method for Expert Consensus
https://pubmed.ncbi.nlm.nih.gov/32282388/
Effect of low-dose mobile versus traditional epidural techniques on mode of delivery: a randomised controlled trial
https://pubmed.ncbi.nlm.nih.gov/11454372/
A comparison of a basal infusion with automated mandatory boluses in parturient-controlled epidural analgesia during labor
https://pubmed.ncbi.nlm.nih.gov/17312228/
The risk of cesarean delivery with neuraxial analgesia given early versus late in labor
https://pubmed.ncbi.nlm.nih.gov/15716559/

Tranexamic Acid: Drug error deaths

Tranexamic Acid: Drug error deaths

In this episode, Dr. David Bishop, a Specialist Anesthesiologist and Head of the Clinical Unit of Anaesthesia at Edendale Hospital in Pietermaritzburg talks about a vital topic and his recent publication, Tranexamic acid at cesarean delivery: drug-error deaths.

Tranexamic acid at cesarean delivery: drug-error deaths

https://pubmed.ncbi.nlm.nih.gov/36300729/

Spinal tranexamic acid – a new killer in town

https://pubmed.ncbi.nlm.nih.gov/30985919/

YouTube publication (Tranexamic acid during CS: Drug error warning (https://www.youtube.com/watch?v=jeFtFWeMwkw&t=184s)

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

https://pubmed.ncbi.nlm.nih.gov/28456509/

Electronic Maternal Alerting System

Electronic Maternal Alerting System

In this episode, Dr. Thomas Klumpner, whose research interests involve using technology to detect childbirth complications before they become life-threatening, discusses with us his research titled: Use of a Novel Electronic Maternal Surveillance System and the Maternal Early Warning Criteria to Detect Severe Postpartum Hemorrhage

Use of a Novel Electronic Maternal Surveillance System and the Maternal Early Warning Criteria to Detect Severe Postpartum Hemorrhage https://pubmed.ncbi.nlm.nih.gov/32022745/

Singh et al., A validation study of the CEMACH recommended modified early obstetric warning system (MEOWS) https://pubmed.ncbi.nlm.nih.gov/22066604/

Klumpner, T, stal. User Perceptions of an Electronic Maternal Alerting System. A A Pract. 2020;14(11):e01308 – https://pubmed.ncbi.nlm.nih.gov/32935951/

Use of a novel electronic maternal surveillance system to generate automated alerts on the labor and delivery unit https://pubmed.ncbi.nlm.nih.gov/29945569/

Consensus Guidelines: Postdural Puncture Headache

Consensus Guidelines: Postdural Puncture Headache

In this episode, Dr. Vishal Uppal, whose primary research interests are improving the safety and efficacy of regional anesthesia techniques in high-risk patient populations, discussed his article Consensus Practice Guidelines on Postdural Puncture Headache From a Multisociety, International Working Group: A Summary Report.

Consensus guidelines
https://pubmed.ncbi.nlm.nih.gov/37581893/
Atypical headache following dural puncture in obstetric
https://pubmed.ncbi.nlm.nih.gov/24934311/
A prospective controlled study of continuous spinal analgesia versus repeat epidural analgesia after accidental dural puncture in labour
https://pubmed.ncbi.nlm.nih.gov/22153280/
One patch or more? Defining success in treatment of post-dural puncture headache
https://pubmed.ncbi.nlm.nih.gov/28089183/
Sphenopalatine ganglion block for postdural puncture headache
https://pubmed.ncbi.nlm.nih.gov/19413836/
Major Neurologic Complications Associated With Postdural Puncture Headache in Obstetrics: A Retrospective Cohort Study
https://pubmed.ncbi.nlm.nih.gov/31335402/
The volume of blood for epidural blood patch in obstetrics: a randomized, blinded clinical trial
https://pubmed.ncbi.nlm.nih.gov/21596867/

Trauma Informed Care

Trauma Informed Care

In this episode, Dr. Tracey Vogel, an obstetric anesthesiologist who is very well-versed in a topic we should all know about, discusses trauma-informed care. What is trauma-informed care, and how can we become a trauma-informed care unit? These and many more questions are addressed during this Podcast. “A service that is not trauma-informed is trauma denied.”

Trauma-Informed Care on Labor and Delivery
https://pubmed.ncbi.nlm.nih.gov/34776109/
Antepartum and intrapartum risk factors and the impact of PTSD on mother and child
https://pubmed.ncbi.nlm.nih.gov/33456935/
Nocebo-induced hyperalgesia during local anesthetic injection
https://pubmed.ncbi.nlm.nih.gov/20042440/
The relationship between women’s intention to request labor epidural analgesia, actually delivering with labor epidural analgesia, and Postpartum depression at six weeks
https://pubmed.ncbi.nlm.nih.gov/28930940/
Impact of patient choice
https://pubmed.ncbi.nlm.nih.gov/30867278/
Patient choice compared to no choice (“Deception study”)
https://pubmed.ncbi.nlm.nih.gov/28486595/
Trauma-Informed Care During Pregnancy and Birth
Pain during cesarean delivery: A patient-related prospective observational study assessing the incidence and risk factors for intraoperative pain and intravenous medication administration
https://pubmed.ncbi.nlm.nih.gov/37865217/

Maternal – Fetal Interventions

Maternal – Fetal Interventions

In this episode, Dr. Mark Rollins and Dr. Chatterjee, two leading experts in anesthesia for maternal-fetal intervention, share their knowledge with us. Specifically, we discussed fetal benefits and preoperative, intraoperative, and postoperative management for this delicate procedure in which two patients are undergoing surgical intervention under our care. Should we provide analgesia directly or indirectly to the fetus? How can we achieve the tenet goal of excellent uterine relaxation without compromising placental perfusion? Is the use of Sugammadex warranted for midgestation fetal interventions? These and much more were discussed during this Podcast.

Anesthesia for Maternal-Fetal Interventions: A Consensus Statement
https://pubmed.ncbi.nlm.nih.gov/33048913/

Survey of Fetal Therapy Centers in the North American Fetal Therapy Network.

https://pubmed.ncbi.nlm.nih.gov/33827094/

Sugammadex Administration in Pregnant Women and Women of Reproductive Potential: A Narrative Review

https://pubmed.ncbi.nlm.nih.gov/31283616/

Society for Obstetric Anesthesia and Perinatology
Statement on Sugammadex during pregnancy and lactation
https://www.soap.org/assets/docs/SOAP_Statement_Sugammadex_During_Pregnancy_Lactation_APPROVED.pdf

Sugammadex Use for Reversal in Nonobstetric
Surgery During Pregnancy: A Reexamination of the
Evidence

https://pubmed.ncbi.nlm.nih.gov/37205805/

A Randomized Trial of Prenatal versus Postnatal Repair of Myelomeningocele (MOMs trial)

https://pubmed.ncbi.nlm.nih.gov/21306277/

The Dural Puncture Epidural

The Dural Puncture Epidural

In this episode, Dr. B Amnon Berger shared the results of his study – Epidural catheter replacement rates with dural puncture epidural labor analgesia compared with epidural analgesia without dural puncture: a retrospective cohort study. Besides, we discussed the benefits of a dural puncture epidural technique and how it differs from the combined spinal-epidural technique.

Dr. Ammon study

https://pubmed.ncbi.nlm.nih.gov/36030558/

Importance of a working labor epidural

https://pubmed.ncbi.nlm.nih.gov/34106837/

CSE first described

https://pubmed.ncbi.nlm.nih.gov/7468971/

CSE/DPE techniques review
https://pubmed.ncbi.nlm.nih.gov/10594432/

Epidural vs CSE

https://pubmed.ncbi.nlm.nih.gov/9392696/

https://pubmed.ncbi.nlm.nih.gov/15321183/

https://pubmed.ncbi.nlm.nih.gov/15477051/

Epidural vs. DPE

https://pubmed.ncbi.nlm.nih.gov/28622178/

https://pubmed.ncbi.nlm.nih.gov/28067707/

https://pubmed.ncbi.nlm.nih.gov/35157756/

https://pubmed.ncbi.nlm.nih.gov/37526934/

DPE + CEI vs PIEB

https://pubmed.ncbi.nlm.nih.gov/32282386/

Pain management for Pregnant people with opioid use disorder

Pain management for Pregnant people with opioid use disorder

In this episode, Dr. Grace Lim, Associate professor and the Chief of the Obstetric Anesthesia division at the University of Pittsburgh, whose research is aimed at eliminating pain and suffering in special populations, optimizing perioperative medication use, and personalizing patient care, discussed with us two of her articles related to pain management of patients with and without opioid use disorder. Unfortunately, there is a big gap in knowledge and consensus when caring for patients with a history of opioid use disorder. In this episode, we discussed some of them.

References
CDC – About Opioid Use During Pregnancy
https://www.cdc.gov/pregnancy/opioids/basics.html
Associations between postpartum pain type, pain intensity and opioid use in patients with and without opioid use disorder: a cross-sectional study
https://pubmed.ncbi.nlm.nih.gov/36371258/

A Systematic Scoping Review of Peridelivery Pain Management for Pregnant People With Opioid Use Disorder: From the Society for Obstetric Anesthesia and Perinatology and Society for Maternal-Fetal Medicine
https://pubmed.ncbi.nlm.nih.gov/36135926/

Labor Pain, Analgesia, and Postpartum Depression:
Are We Asking the Right Questions?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7080613/

Other resources related to OUD
Buprenorphine versus Methadone for Opioid Use Disorder in Pregnancy
https://pubmed.ncbi.nlm.nih.gov/36449419/
Post-cesarean delivery pain. Management of the
opioid-dependent patient before, during and after
cesarean delivery
https://pubmed.ncbi.nlm.nih.gov/36449419/

Maternal Mental Health

Maternal Mental Health

In this episode, Dr. Katrina Furey, a board-certified adult psychiatrist who offers psychotherapy, medication management, and expert consultation for women with depression, anxiety, premenstrual dysphoric disorder (PMDD), perinatal mood and anxiety disorders (including OCD), birth trauma, and menopausal mood and anxiety disorders. Besides, she is part of Access Mental Health for Moms CT. This consultation service offers real-time psychiatric consultation to medical providers when patients present with mental health and substance use concerns.

Here are the links to the studies mentioned during our Podcast:
Access Mental Health for Moms CT
https://www.accessmhct.com
Newspaper link
https://www.cnn.com/2023/08/10/health/suicide-deaths-record-high-2022/index.html
The Collision of Mental Health, Substance Use Disorder, and Suicide
https://pubmed.ncbi.nlm.nih.gov/33957654/
Associations between postpartum pain type, pain intensity, and opioid use in patients with and without opioid use disorder: a cross-sectional study
https://www.bjanaesthesia.org/article/S0007-0912(22)00570-0/fulltext
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