Platelet count and transfusion requirements during moderate or severe postpartum haemorrhage

Limited data exist on platelet transfusion during postpartum haemorrhage. We retrospectively analysed a consecutive cohort from a single centre of 347 women with moderate or severe postpartum haemorrhage, transfused according to national guidelines. Twelve (3%) women required a platelet transfusion. There were no differences between women who did and did not receive platelets with respect to age, mode of initiation of labour or mode of delivery. Women receiving a platelet transfusion had a lower median (IQR [range]) platelet count at study entry than women who did not receive platelets before haemorrhage (135 (97–175 [26–259])×109.l−1 vs 224 (186–274 [91–1006])×109.l−1), respectively), and at diagnosis of postpartum haemorrhage (median 114 (78–153 [58–238])×109.l−1 vs 193 (155–243 [78–762])×109.l−1 respectively). Six women were thrombocytopenic pre-delivery. The cause of haemorrhage that was associated with the highest rate of platelet transfusion was placental abruption, with three of 14 women being transfused. If antenatal thrombocytopenia or consumptive coagulopathy were not present, platelets were only required for haemorrhage > 5000 ml. Early formulaic platelet transfusion would have resulted in many women receiving platelets unnecessarily. Using current guidelines, the need for platelet transfusion is uncommon without antenatal thrombocytopenia, consumptive coagulopathy or haemorrhage > 5000 ml. We found no evidence to support early fixed-ratio platelet transfusion

Exploring the utility of assistive artificial intelligence for ultrasound scanning in regional anesthesia.

Introduction Ultrasound-guided regional anesthesia (UGRA) involves the acquisition and interpretation of ultrasound images to delineate sonoanatomy. This study explores the utility of a novel artificial intelligence (AI) device designed to assist in this task (ScanNav Anatomy Peripheral Nerve Block; ScanNav), which applies a color overlay on real-time ultrasound to highlight key anatomical structures. Methods Thirty anesthesiologists, 15 non-experts and 15 experts in UGRA, performed 240 ultrasound scans across nine peripheral nerve block regions. Half were performed with ScanNav. After scanning each block region, participants completed a questionnaire on the utility of the device in relation to training, teaching, and clinical practice in ultrasound scanning for UGRA. Ultrasound and color overlay output were recorded from scans performed with ScanNav. Experts present during the scans (real-time experts) were asked to assess potential for increased risk associated with use of the device (eg, needle trauma to safety structures). This was compared with experts who viewed the AI scans remotely. Results Non-experts were more likely to provide positive and less likely to provide negative feedback than experts (p=0.001). Positive feedback was provided most frequently by non-experts on the potential role for training (37/60, 61.7%); for experts, it was for its utility in teaching (30/60, 50%). Real-time and remote experts reported a potentially increased risk in 12/254 (4.7%) vs 8/254 (3.1%, p=0.362) scans, respectively. Discussion ScanNav shows potential to support non-experts in training and clinical practice, and experts in teaching UGRA. Such technology may aid the uptake and generalizability of UGRA. Trial registration number NCT04918693

Hydrometalation of PCBut and Activation of the P−C Bond by a Tetrairidium Carbonyl Cluster: Solution Characterization of [Ir4Pt(dppe)(CO)n{μ-PC(H)But}(μ-PPh2)] (n = 10 and 9) and Crystal and Molecular Structures of the Phosphinidine Complex [HIr4Pt(dppe)(μ-CO)(CO)7(μ-PCH2But)(μ-PPh2)] and of the Partially Encapsulated Phosphide Compound [Ir4Pt(dppe)(μ-CO)(CO)8(μ5-P)(μ-PPh2)]

Reaction of [HIr4(CO)10(μ-PPh2)], 1, with [Pt(dppe)(η2-PCBut)] yields four Ir4Pt clusters [Ir4Pt(dppe)(CO)n{μ-PC(H)But}(μ-PPh2)] (n = 10, 2, and 9, 3), [HIr4Pt(dppe)(μ-CO)(CO)7(μ-PCH2But)(μ-PPh2)], 4, and [Ir4Pt(dppe)(μ-CO)(CO)8(μ5-P)(μ-PPh2)], 5. These compounds contain fragments arising from hydrometalation and cleavage of the P−C triple bond of the phosphaalkyne. The structures of compounds 2 and 3, isolated as a mixture, were proposed on the basis of multinuclear NMR and mass spectrometry. To our knowledge these are the first examples of clusters containing a phosphido fragment {μ-PC(H)But} originating from hydrometalation of the phosphaalkyne. Compounds 4 and 5 were characterized in solution by multinuclear NMR spectroscopy, and their solid-state structures were determined by X-ray analyses. A remarkably low 1JP-Pt coupling constant in the Pt(dppe) fragment of the former square-based pyramidal compound is discussed

Standardizing nomenclature in regional anesthesia:an ASRA-ESRA Delphi consensus study of abdominal wall, paraspinal, and chest wall blocks

Item does not contain fulltextBACKGROUND: There is heterogeneity in the names and anatomical descriptions of regional anesthetic techniques. This may have adverse consequences on education, research, and implementation into clinical practice. We aimed to produce standardized nomenclature for abdominal wall, paraspinal, and chest wall regional anesthetic techniques. METHODS: We conducted an international consensus study involving experts using a three-round Delphi method to produce a list of names and corresponding descriptions of anatomical targets. After long-list formulation by a Steering Committee, the first and second rounds involved anonymous electronic voting and commenting, with the third round involving a virtual round table discussion aiming to achieve consensus on items that had yet to achieve it. Novel names were presented where required for anatomical clarity and harmonization. Strong consensus was defined as >/=75% agreement and weak consensus as 50% to 74% agreement. RESULTS: Sixty expert Collaborators participated in this study. After three rounds and clarification, harmonization, and introduction of novel nomenclature, strong consensus was achieved for the names of 16 block names and weak consensus for four names. For anatomical descriptions, strong consensus was achieved for 19 blocks and weak consensus was achieved for one approach. Several areas requiring further research were identified. CONCLUSIONS: Harmonization and standardization of nomenclature may improve education, research, and ultimately patient care. We present the first international consensus on nomenclature and anatomical descriptions of blocks of the abdominal wall, chest wall, and paraspinal blocks. We recommend using the consensus results in academic and clinical practice