Mode of anesthesia for cesarean delivery with pernicious placenta previa — a retrospective study

Objectives: Anesthesia for cesarean delivery in parturients diagnosed with pernicious placenta previa remains controversial. This study aimed to review pernicious placenta previa cases to evaluate anesthetic management strategies. Material and methods: This retrospective analysis included patients who underwent cesarean delivery (CD) for pernicious placenta previa at the Affiliated Hospital of Zunyi Medical University between December 1, 2012 and November 31, 2017. Patient demographic data, obstetric characteristics, anesthetic management, and maternal outcomes were extracted from the hospital’s computerized database. Results: In all, 61 consecutive cases of pernicious placenta previa were identified among 9512 cesarean deliveries. General anesthesia was performed on 27 of the 61 patients (44.3%). Among GA group, 16 (59.3%) had placenta accreta, 8 of whom required cesarean hysterectomy. Also, 13 of the 27 (48.1%) GA patients required transfer to the intensive care unit. The other 34 patients (55.7%) were given regional anesthesia, 9 of whom were converted to general anesthesia due to excessive bleeding and prolonged operation times. Statistical results indicated that regional anesthesia was associated with a significantly shorter operation time, less perioperative blood loss, fewer intraoperative red blood cell transfusions, and a lower incidence of complications. Conclusions: Anesthetic management is important for parturients with pernicious placenta previa. Although regional anesthesia was our preferred method for these patients, general anesthesia is safe for patients with pernicious placenta previa who experience massive blood loss and prolonged operation times

The effect of epidural analgesia on maternal-neonatal outcomes: a retrospective study

Objectives: Epidural analgesia is commonly used for relieving labor pain in contemporary clinical practice. The rate of pregnant women who request epidural analgesia during labor has been increasing annually, leading to a debate on the effect of epidural analgesia on maternal or neonatal outcomes.Material and methods: The medical records of nulliparous women with a term singleton pregnancy from January to December 2019 at the Affiliated Hospital of Zunyi Medical University were retrospectively reviewed. The women were divided into those who received epidural analgesia during delivery and those who did not receive it. Maternal and neonatal outcomes were assessed.Results: A total of 528 women met the inclusion criteria. The overall labor analgesia rate was 43.0% (227). Women with epidural analgesia had a significantly longer second stage [34.5 (22.8–65.3) vs 27.0 (18.0–41.3) min, p < 0.001] and total duration of labor [698.5 (493.5–875.0) vs 489.5 (344.0-676.3) min, p < 0.001] compared with those without epidural. There were no significant relationships between epidural analgesia and the normal vaginal delivery rate, the incidence of episiotomy, and other adverse maternal or neonatal outcomes (p > 0.05).Conclusions: Epidural analgesia can prolong the second stage of labor, but this is no increased risk for both mother and neonate

Comparison of the Efficacy and Safety of Adamgammadex with Sugammadex for Reversal of Rocuronium-Induced Neuromuscular Block: Results of a Phase II Clinical Trial

This current phase II clinical trial was to compare the effect and safety of adamgammadex, a new cyclodextrin-based selective relaxant binding agent, with sugammadex to reverse rocuronium-induced neuromuscular block. Patients were randomised to receive adamgammadex (4 or 6 mg kg−1) or sugammadex (2 mg kg−1, as a positive control group) at the reappearance of the second twitch (T2) in response to TOF stimulation. The standard safety data were collected. The 4 mg kg−1 (n = 16) and 6 mg kg−1 (n = 20) adamgammadex- and 2 mg kg−1 (n = 20) sugammadex-induced recovery time of TOF ratio to 0.9 were 2.3, 1.6, and 1.5 min, respectively (p = 0.49). The 4 mg kg −1 adamgammadex-induced median recovery time was longer than that of 2 mg kg−1 sugammadex (p = 0.01), and there was no difference between the 6 mg kg −1 adamgammadex group and 2 mg kg−1 sugammadex group (p = 0.32). Then, the number of patients who experienced adverse events (AEs) was 6, 11, and 14 for adamgammadex at 4, 6 mg kg−1 and sugammadex at 2 mg kg−1, respectively. The treatment emergent AEs that occurred more than twice were detailed as follows: incision site pain, hypotension, emesis, fever, throat pain, blood bilirubin increase, abnormal T-wave of ECG, dizziness, incision site swelling, postoperative fever, expectoration, and nausea. For drug-related AEs, the increased urine acetone bodies and first-degree atrioventricular block were observed in two patients from sugammadex group. Then, the previously reported AEs were not observed in this study, including anaphylaxis, haemorrhage, recurarization, abnormal basic vital signs, or lengthened QRS intervals and QT intervals. Adamgammadex was found to be effective for reversal of rocuronium-induced neuromuscular block as sugammadex