Yale Anesthesiology

In this episode, Dr. Yavor Metodiev delves into the anesthetic considerations that should be taken when caring for a patient with oncological disease during pregnancy. Dr. Metodiev and colleagues concisely summarize the complexities of treating patients with oncological disease, emphasizing the crucial balance between maternal and fetal safety. With the increasing incidence of oncological disease in pregnant women (1 in 2000), anesthetists are expected to encounter more of these cases, and we play a pivotal role in managing these patients during the peripartum period. https://pubmed.ncbi.nlm.nih.gov/39775436/

In this episode, Dr. Blake Mergler, Dr. Reid Mergler, and Dr. Caoimhe Duffy examine the crucial role of anesthesiologists in recognizing and addressing trauma during labor. Their thorough narrative review highlights the importance of trauma-informed care, which shifts the focus from “what is wrong with the patient” to “what has happened to the patient.” The trio discusses how anesthesiologists can embrace this mindset, promoting empathy and understanding without judgment. https://pubmed.ncbi.nlm.nih.gov/39231043/ https://pubmed.ncbi.nlm.nih.gov/39897428/

In this episode, we explore the concept of a highly functional team, its characteristics, and the importance of fostering interdisciplinary teamwork among healthcare professionals such as anesthesiologists, obstetricians, nurses, and others. Dr. Girnius emphasizes that such collaboration enhances communication and efficiency and improves patient outcomes. Additionally, we discuss the process of identifying and implementing what needs to change while addressing the challenges associated with introducing change within our healthcare system. Improving Obstetric Anesthesia Care Through Teaming and Improvement Science https://pubmed.ncbi.nlm.nih.gov/39325012/ Preoperative Multidisciplinary Team Huddle Improves Communication and Safety for Unscheduled Cesarean Deliveries: A System Redesign Using Improvement Science https://pubmed.ncbi.nlm.nih.gov/39269911/

In this episode, we discuss the importance of following intravenous access recommendations for cesarean deliveries with Dr. Scott Seki at his institution. How do Dr. Seki and his colleagues define adequate intravenous access? Which patients are more or less likely to receive the recommended IV access? What are the patient implications if we fail to provide the recommended IV access? These are some of the questions we explored during this podcast. By the end of the episode, I began reevaluating the significance and sometimes implicit implications of not adhering to the recommended IV access standards.

In this episode, Dr. Landau, a renowned expert and researcher in the topic of pain, delves into the evolution of our understanding of this topic. We explore how the research and its definition have changed over the past few decades. Additionally, we discuss her study titled “Pain during cesarean delivery: a patient-related prospective observational study assessing the incidence and risk factors for intraoperative pain and intravenous medication administration.”

In this episode, Dr. Mark I. Zakowski delves into the pressing issue of pain during cesarean delivery. During our interview, we explore how our societies (ASA and SOAP) are collaborating to provide practitioners with valuable insights into managing this problem that affects approximately 15-20% of cesarean delivery patients. The ASA approved the “Statement on Pain during Cesarean Delivery” from the Committee on Obstetric Anesthesia, which advises all practitioners on the pervasive problem of failure to achieve pain-free cesarean delivery. This is a testament of how our societies are collaborating to improve patient care. Pain during Cesarean Delivery: We Can and Must Do Better https://pubmed.ncbi.nlm.nih.gov/38597801/ American Society of Anesthesiologists: Statement on pain during cesarean delivery. Edited by Committee on Obstetric Anesthesia. American Society of Anesthesiologists. 2023. Available at: https://www.asahq.org/standards-and-practice-parameters/state-ment-on-pain-during-cesarean-delivery

Dr. Allana Munro and Dr. Ronald George are two obstetric anesthesia experts whose research is focused on labor analgesia. Two years ago, they demonstrated that “achieving desired pain relief” is of utmost importance to our patients. The question remains: How can we safely achieve this while minimizing workload and side effects? In this episode, they discuss their study titled “An Innovative Approach to Determine Programmed Intermittent Epidural Bolus Pump Settings for Labor Analgesia: A Randomized Controlled Trial.” Using the response surface methodology, they identified optimal settings for the programmed intermittent epidural bolus pump (PIEB) that maximize maternal satisfaction, minimize clinician-administered boluses, and balance PCEA boluses delivered to those requested. An Innovative Approach to Determine Programmed Intermittent Epidural Bolus Pump Settings for Labor Analgesia: A Randomized Controlled Trial. https://pubmed.ncbi.nlm.nih.gov/38905148/ Patient Preferences for Outcomes Associated With Labor Epidural Analgesia. https://pubmed.ncbi.nlm.nih.gov/35355544/

In this episode, Dr. de Carvalho discusses his article, Efficacy and safety of ultrasound-guided versus landmark-guided neuraxial puncture: a systematic review, network meta-analysis and trial sequential analysis of randomized clinical trials. Dr. de Carvalho’s work reiterates that using ultrasound-guided neuraxial anesthesia results in a more efficient neuraxial placement. Ultrasound-guided neuraxial use results in fewer needle attempts and redirections and may improve patient satisfaction. Besides, his works demonstrate that ultrasound benefits both patients with normal and abnormal anatomy. Efficacy and safety of ultrasound-guided versus landmark-guided neuraxial puncture: a systematic review, network meta-analysis and trial sequential analysis of randomized clinical trials https://pubmed.ncbi.nlm.nih.gov/38876801/ Comparison of ultrasound-guided and traditional localisation in intraspinal anesthesia: a systematic review and network meta-analysis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10626869/

In this episode, Dr. Lawrence Tsen discusses the findings of his paper on Labor Analgesia Initiation with Dural Puncture Epidural (DPE) Versus Conventional Epidural Techniques. The paper presents a randomized biased-coin sequential allocation trial to determine the effective dose for 90% of patients of Bupivacaine. We explore the benefits of using the DPE technique, if any, along with criticisms from some experts. Additionally, we delve into whether DPE techniques can improve analgesia and the mechanisms behind it. These are just a few of the topics covered in this podcast. Labor Analgesia Initiation With Dural Puncture Epidural Versus Conventional Epidural Techniques: A Randomized Biased-Coin Sequential Allocation Trial to Determine the Effective Dose for 90% of Patients of Bupivacaine https://pubmed.ncbi.nlm.nih.gov/37824436/ Effect of Dural-Puncture Epidural vs Standard Epidural for Epidural Extension on Onset Time of Surgical Anesthesia in Elective Cesarean Delivery: A Randomized Clinical Trial https://pubmed.ncbi.nlm.nih.gov/37526934/ Epidural catheter replacement rates with dural puncture epidural labor analgesia compared with epidural analgesia without dural puncture: a retrospective cohort study https://pubmed.ncbi.nlm.nih.gov/36030558/ Quality of Labor Analgesia with Dural Puncture Epidural versus Standard Epidural Technique in Obese Parturients: A Double-blind Randomized Controlled Study https://pubmed.ncbi.nlm.nih.gov/35157756/ Sacral sensory blockade from 27-gauge pencil-point dural puncture epidural analgesia or epidural analgesia in laboring nulliparous parturients: a randomized controlled trial https://pubmed.ncbi.nlm.nih.gov/39024984/ Determination of the Optimal Volume of Programmed Intermittent Epidural Bolus When Combined With the Dural Puncture Epidural Technique for Labor Analgesia: A Random-Allocation Graded Dose-Response Study https://pubmed.ncbi.nlm.nih.gov/37010955/ Dural Puncture Epidural for Labor Analgesia: Is It Really an Improvement over Conventional Labor Epidural Analgesia? https://pubmed.ncbi.nlm.nih.gov/35320341/

In this episode, Dr. Holly Ende discusses her article, Implementation of an Epidural Rounding Reminder in the Electronic Medical Record Improves Performance of Standardized Patient Assessments during Labor. Dr. Ende’s work underscores the necessity of regular assessments of the effectiveness of neuraxial labor analgesia. This proactive approach is crucial for the timely identification of malfunction, ensuring the best possible outcomes for patients. Implementation of an Epidural Rounding Reminder in the Electronic Medical Record Improves Performance of Standardized Patient Assessments during Labor https://pubmed.ncbi.nlm.nih.gov/36634697/ Centers of Excellence for Anesthesia Care of Obstetric Patients https://pubmed.ncbi.nlm.nih.gov/30994544/