Racial Disparities in Preterm Birth among Pregnant Women with Obesity.

OBJECTIVES: We assessed the impact of obesity and racial disparities on preterm birth (PTB) in the United States and sought to determine whether obesity widens the racial-ethnic disparity gap in preterm birth with a focus on non-Hispanic Black and White women. METHODS: Using birth data for the years 2014-2019 made publicly available by the Centers for Disease Control and Prevention and obtained from the National Vital Statistics System, we conducted a cross-sectional cohort study analyzing a total of 14,864,844 births from 2014 to 2019. RESULTS: We observed dose-dependent changes in obesity and PTB by defining obesity in subgroups and PTB in a stratified method. PTB occurred more among non-Hispanic Black women than their non-Hispanic White and Hispanic counterparts. We observed a consistent trend of increased PTB among women with high body mass index. Racial disparity existed in PTB among pregnant obese women, with non-Hispanic Black women exhibiting the greatest risk for PTB. CONCLUSIONS: Our work further contributes to the growing knowledge of the existence of health disparity among the Black population.

Use of the laryngeal mask airway as an alternative to the tracheal tube during ambulatory anesthesia.

UNLABELLED: We designed a prospective, randomized, multicenter study to compare anesthetic requirements, recovery times, and postoperative side effects when a laryngeal mask airway (LMA) was used as an alternative to the tracheal tube (TT) during ambulatory anesthesia. After induction of anesthesia with midazolam 2 mg, fentanyl 1 microg/kg, and propofol 2 mg/kg, 381 patients were randomly assigned to receive either an LMA (n = 207) or TT (n = 174) for airway management. In patients assigned to the TT group, succinylcholine 1 mg/kg or a nondepolarizing muscle relaxant was administered to facilitate tracheal intubation. Anesthesia was maintained with volatile anesthetics in combination with nitrous oxide 60% and oxygen. The average time to placement of the two airway devices (5 min) and the failure rates (1%) were similar in the two groups. Although there was a significant decrease in the intraoperative fentanyl requirement in the LMA group, the difference was of little clinical significance. Furthermore, there were no differences in the volatile anesthetic requirements. The time from end of surgery to removal of the airway device (5 min) was also similar in the two study groups. Although duration of the postanesthesia care unit stay and time to ambulation were significantly shorter in the LMA group, there were no differences in the times to "home readiness." The incidence of nausea and vomiting and the need for rescue antiemetic treatments in the postoperative period were similar in the two airway management groups. However, the incidence of postoperative sore throat was significantly greater in patients receiving the TT (versus the LMA). In conclusion, this study suggests that the LMA is a useful alternative to the TT for airway management during ambulatory anesthesia. IMPLICATIONS: Use of the laryngeal mask airway can obviate the need for insertion of a tracheal tube for many ambulatory surgery procedures, and thereby decrease the incidence of postoperative sore throats.