What's New in Obstetric Anesthesia? The 2018 Gerard W. Ostheimer Lecture.

The "What's New in Obstetric Anesthesia Lecture" is presented every year at the annual meeting of the Society for Obstetric Anesthesia and Perinatology. This lecture was established in 1975 to update the membership on the most relevant articles that were published in the preceding calendar year. In 1995, the lecture was renamed as the "Ostheimer Lecture" in honor of Gerard W. Ostheimer, an obstetric anesthesiologist from the Brigham and Women's Hospital with significant contributions in the field. This review summarizes key articles published in 2017 that were presented in the 2018 Ostheimer Lecture with a focus on opioid prescriptions, anesthesia for external cephalic version, labor analgesia, maternal morbidity, and global health. A proposed list of action items based on the 2017 literature is also presented.

Efectos de la analgesia epidural con Levobupicaina mas fentanyl, sobre estado materno fetal / Effect of epidural analgesia with levobucaine, bupicaine and fentanyl during labour

OBJETIVO: la administración de levobupivacaina en el espacio epidural para analgesia del trabajo de parto, en concentración de 0.185% es capaz de producir un efectivo control del dolor del trabajo de parto, sin bloqueo motor, ni efectos sistémicos y fetales indeseables. PACIENTES Y MÉTODOS: el estudio se realizó en las pacientes internadas en la sala de pre-partos del Hospital de La Mujer. Se tomó como muestra un total de 30 pacientes, divididas en dos grupos de estudio Grupo A (n = 15), a las cuales se administrará L-bupivacaina al 0.185% con adición de fentanyl, y un Grupo B (n = 15), al cual se administró bupivacaina al 0.125% más fentanyl. RESULTADOS: la calidad de la analgesia de 0 en todas las pacientes, manteniéndose en este nivel durante todo el trabajo de parto en el 80% de los casos. Ninguna paciente presentó bloqueo motor, ni efectos sistémicos indeseables producidos por la levobupivacaina. En ningún caso las calificaciones de Apgar fueron bajas. La frecuencia cardiaca fetal no presentó alteraciones (p<0.5). La actividad uterina se vio significativamente afectada en el grupo B (p < 0.06). El empleo de oxitocicos en el grupo B fue significativamente mayor (p<0.003). El bloqueo motor fue significativamente menor en el grupo A (p < 0.07).

OBJECTIVES: the administration of l-bupivacaine into the epidural space for getting an obstetric analgesia for labour at 0.185% concentration doesn't has systemic or foetal adverse effects. PATIENTS AND METHODS: the study has been done at the Hospital de la Mujer; on the patients interned to the labour room. A group of 30 women in active labour was divided in two study groups Group A (n=15) who ABSTRACT: received L-bupivacaine 0.185% plus fentanyl, Group B (n=15) who received bupivacaine 0.125% plus fentanyl. RESULTS: we found a quality of analgesia of 0 in all of the patients, maintaining this level during all of the labour time in 80% of the patient. Niether one presented motor blockage, adverse effects produced by the L-bupivacaine. In any case we have seen low Apgar scores. The foetus cardiac frequency has not been affected (p<0.5). The uterine activity has been affected in the B group (p<0.006). The use of oxytocin has been greater in the B group (p<0.003). The motor blockage has been minor in the A group (p<0.07)