Charge and adsorption height dependence of the self-metalation of porphyrins on ultrathin MgO(001) films.

We have experimentally determined the adsorption structure, charge state, and metalation state of porphin, the fundamental building block of porphyrins, on ultrathin Ag(001)-supported MgO(001) films by scanning tunneling microscopy and photoemission spectroscopy, supported by calculations based on density functional theory. By tuning the substrate work function to values below and above the critical work function for charging, we succeeded in the preparation of 2H-P monolayers which contain negatively charged and uncharged molecules. It is shown that the porphin molecules self-metalate at room temperature, forming the corresponding Mg-porphin, irrespective of their charge state. This is in contrast to self-metalation of tetraphenyl porphyrin (TPP), which occurs on planar MgO(001) only if the molecules are negatively charged. The different reactivity is explained by the reduced molecule-substrate distance of the planar porphin molecule compared to the bulkier TPP. The results of this study shed light on the mechanism of porphyrin self-metalation on oxides and highlight the role of the adsorption geometry on the chemical reactivity.

A one-dimensional high-order commensurate phase of tilted molecules.

We report on the formation of a high-order commensurate (HOC) structure of 5,14-dihydro-5,7,12,14-tetraazapentacene (DHTAP) molecules on the highly corrugated Cu(110)-(2 × 1)O surface. Scanning tunnelling microscopy shows that the DHTAP molecules form a periodic uniaxial arrangement in which groups of seven molecules are distributed over exactly nine substrate lattice spacings along the [1̄10] direction. DFT-calculations reveal that this peculiar arrangement is associated with different tilting of the seven DHTAP molecules within the quasi one-dimensional HOC unit cell. The orientational degree of freedom thus adds a new parameter, which can efficiently stabilize complex molecular structures on corrugated surfaces.

Dexamethasone for the treatment of established postoperative nausea and vomiting: A randomised dose finding trial.

BACKGROUND: Dexamethasone is widely used for the prevention of postoperative nausea and vomiting (PONV) but little is known about its efficacy for the treatment of established PONV. OBJECTIVE: To test the antiemetic efficacy of intravenous dexamethasone for the treatment of established PONV in adults undergoing surgery under general anaesthesia and to determine whether there is dose-responsiveness. DESIGN: The DexPonv trial is a multicentre, placebo-controlled, randomised, double-blind, dose-finding study. Inclusion of patients was between September 2012 and November 2017. Follow-up for PONV symptoms was for 24 h. Thirty days postoperatively, patients were contacted by study nurses for any information on postoperative bleeding and infection. SETTING: Four public hospitals in Switzerland. PATIENTS: A total of 803 adults scheduled for elective surgery without any antiemetic prophylaxis signed the consent form; 714 were included. Among those, 319 had PONV and 281 patients were eventually randomised (intention to treat population and safety set). The per protocol set consisted of 260 patients. INTERVENTIONS: Patients with PONV symptoms (including retching) were randomised to a single intravenous dose of dexamethasone 3, 6 or 12 mg or matching placebo. MAIN OUTCOME MEASURES: The primary endpoint was the absence of further nausea or vomiting (including retching), within 24 h after administration of the study drug. RESULTS: Dexamethasone was ineffective during the first 24 h, whatever the dosage, compared to placebo, even when the model was adjusted for known risk factors (P = 0.170). There were no differences in the time to treatment failure or the quality of sleep during the first night. There was a positive correlation between the dose of dexamethasone and blood glucose concentrations (P < 0.001), but not with bleeding risk, wound infections or other adverse effects. CONCLUSION: This randomised trial failed to show anti-emetic efficacy of any of the tested intravenous regimens of dexamethasone for the treatment of established PONV in adults undergoing surgery under general anaesthesia. TRIAL REGISTRATION: clinicaltrials.gov (NCT01975727).

Rapid Sequence Induction With a Standard Intubation Dose of Rocuronium After Magnesium Pretreatment Compared With Succinylcholine: A Randomized Clinical Trial.

BACKGROUND: Succinylcholine remains the muscle relaxant of choice for rapid sequence induction (RSI) but has many adverse effects. High-dose rocuronium bromide may be an alternative to succinylcholine for RSI but recovery times are nearly doubled compared with a standard intubating dose of rocuronium. Magnesium sulfate significantly shortens the onset time of a standard intubating dose of rocuronium. We set out to investigate whether intravenous (IV) pretreatment with MgSO4 followed by a standard intubating dose of rocuronium achieved superior intubation conditions compared with succinylcholine. METHODS: Adults were randomized to receive a 15-minute IV infusion of MgSO4 (60 mg·kg-1) immediately before RSI with propofol 2 mg·kg-1, sufentanil 0.2 µg·kg-1 and rocuronium 0.6 mg·kg-1, or a matching 15-minute IV infusion of saline immediately before an identical RSI, but with succinylcholine 1 mg·kg-1. Primary end point was the rate of excellent intubating conditions 60 seconds after administration of the neuromuscular blocking agent and compared between groups using multivariable log-binomial regression model. Secondary end points were blood pressure and heart rate before induction, before and after intubation, and adverse events up to 24 hours postoperatively. RESULTS: Among 280 randomized patients, intubating conditions could be analyzed in 259 (133 MgSO4-rocuronium and 126 saline-succinylcholine). The rate of excellent intubating conditions was 46% with MgSO4-rocuronium and 45% with saline-succinylcholine. The analysis adjusted for gender and center showed no superiority of MgSO4-rocuronium compared with saline-succinylcholine (relative risk [RR] 1.06, 95% confidence interval [CI], 0.81-1.39, P = .659). The rate of excellent intubating conditions was higher in women (54% [70 of 130]) compared with men (37% [48 of 129]; adjusted RR 1.42, 95% CI, 1.07-1.91, P = .017). No significant difference between groups was observed for systolic and diastolic blood pressures. Mean heart rate was significantly higher in the MgSO4-rocuronium group. The percentage of patients with at least 1 adverse event was lower with MgSO4-rocuronium (11%) compared with saline-succinylcholine (28%) (RR 0.38, 95% CI, 0.22-0.66, P < .001). With saline-succinylcholine, adverse events consisted mainly of postoperative muscle pain (n = 26 [19%]) and signs of histamine release (n = 13 [9%]). With MgSO4-rocuronium, few patients had pain on injection, nausea and vomiting, or skin rash during the MgSO4-infusion (n = 5 [4%]). CONCLUSIONS: IV pretreatment with MgSO4 followed by a standard intubating dose of rocuronium did not provide superior intubation conditions to succinylcholine but had fewer adverse effects.

Mobile snapshot hyperspectral imaging device for skin evaluation using diffractive optical elements.

OBJECTIVE: A mobile handheld snapshot hyperspectral imaging device was developed and tested for in vivo skin evaluation using a new spectral imaging technology. METHODS: The device is equipped with four different LED light sources (VIS, 810 nm, 850 nm, and 940 nm) for illumination. Based on a diffractive optical element (DOE) combined with a CMOS sensor chip, a snapshot hyperspectral imager is achieved for the application on human skin. The diffractive optical element (DOE) consists of a two-dimensional array of identically repeated diffractive microstructures. One hyperspectral image for all wavelength regions is taken within a few seconds. Complex recalculation of the VIS spectral distribution and image information from the received DOE image requires several minutes, depending on computing performance. A risk assessment on the irradiation sources shows no risk of harm due to the LED radiation. RESULTS: Skin tone color patches experiments reproducibly deliver images and spectra of different skin tones. First in vivo use of the device identified pigmentation changes within the field of view. CONCLUSION: We present a working mobile snapshot hyperspectral imaging tool based on diffractive optical elements. This device or future developments thereof can be used for broad skin evaluation in vivo.

Charge-Promoted Self-Metalation of Porphyrins on an Oxide Surface.

Metalation and self-metalation reactions of porphyrins on oxide surfaces have recently gained interest. The mechanism of porphyrin self-metalation on oxides is, however, far from being understood. Herein, we show by a combination of results obtained with scanning tunneling microscopy, photoemission spectroscopy, and DFT computations, that the self-metalation of 2H-tetraphenylporphyrin on the surface of ultrathin MgO(001) films is promoted by charge transfer. By tuning the work function of the MgO(001)/Ag(001) substrate, we are able to control the charge and the metalation state of the porphyrin molecules on the surface.

NOACs in Anesthesiology.

BACKGROUND: Due to increasing use of new oral anticoagulants (NOACs), clinicians are faced more and more frequently with clinical issues related to these drugs. OBJECTIVE: The objective of this publication is to make practical suggestions for the perioperative management of NOACs as well as for their handling in overdoses and bleedings. RECOMMENDATIONS: In elective surgery and creatinine clearance ≥ 50 ml/min, a NOAC should be discontinued 24-36 h before the intervention, and even earlier in case of reduced kidney function. In emergency interventions that cannot be delayed, the management is dependent on the NOAC plasma levels. With levels ≤ 30 ng/ml, surgery can be performed. With levels >30 ng/ml, reversal agents should be considered. In low bleeding risk surgery, NOACs can be re-started 24 h after the intervention, which is prolonged to 48-72 h after surgery with high bleeding risk. In case of NOAC overdose and minor bleedings, temporary discontinuation and supportive care are usually sufficient to control the situation. In severe or life-threatening bleedings, nonspecific and specific reversal agents should be considered.

On the limits of laminates in diffusive optics.

Laminate metamaterials lead to anisotropic material properties, which can be tailored by the contrast between the two ingredient materials within the laminate. Such tailored anisotropies are, for example, required to realize advanced invisibility cloaks, wormhole architectures, or analogues of negative refraction. The physics and mathematics of laminates is very well established in the context of the diffusion equation and mathematical equivalents thereof, such as the heat conduction equation, the electrical conduction equation, electrostatics, magnetostatics, and laminar fluid dynamics. However, the validity of the diffusion equation is often stressed for disordered optical media, because sufficiently large transmission of light is requested. As a result, the condition that all relevant transport mean free path lengths need to be small compared to all relevant geometrical dimensions, may not be fulfilled. Monte Carlo simulations can grasp the physics of this transition regime between diffusive and ballistic optics. Here, we present corresponding numerical simulations for laminates. On this basis, we discuss the resulting fundamental limitations and trade-offs for laminates.

Experimental Evidence for Sign Reversal of the Hall Coefficient in Three-Dimensional Metamaterials.

Effectively inverting the sign of material parameters is a striking possibility arising from the concept of metamaterials. Here, we show that the electrical properties of a p-type semiconductor can be mimicked by a metamaterial solely made of an n-type semiconductor. By fabricating and characterizing three-dimensional simple-cubic microlattices composed of interlocked hollow semiconducting tori, we demonstrate that sign and magnitude of the effective metamaterial Hall coefficient can be adjusted via a tori separation parameter-in agreement with previous theoretical and numerical predictions.

The Analgesic Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block in Adult Patients: A Meta-Analysis.

BACKGROUND: Previous meta-analyses of the transversus abdominis plane (TAP) block have examined a maximum of 12 articles, including fewer than 650 participants, and have not examined the effect of ultrasound-guided techniques specifically. Recently, many trials that use ultrasound approaches to TAP block have been published, which report conflicting analgesic results. This meta-analysis aims to evaluate the analgesic efficacy of ultrasound-guided TAP blocks exclusively for all types of abdominal surgeries in adult patients. METHODS: This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. The primary outcome was cumulative IV morphine consumption at 6 hours postoperatively, analyzed according to the type of surgery, the type of surgical anesthesia, the timing of injection, the block approach adopted, and the presence of postoperative multimodal analgesia. Secondary outcomes included IV morphine consumption at 24 hours postoperatively; pain scores at rest and on movement at 6 and 24 hours postoperatively; and postoperative nausea and vomiting, pruritus, and rates of complications. RESULTS: Thirty-one controlled trials including 1611 adult participants were identified. Independent of the type of surgery (abdominal laparotomy, abdominal laparoscopy, and cesarean delivery) but not independent of the type of surgical anesthesia (general anesthesia, spinal anesthesia with or without intrathecal long-acting opioid), ultrasound-guided TAP block reduced IV morphine consumption at 6 hours postoperatively by a mean difference of 6 mg (95% confidence interval [CI], -7 to -4 mg; I2 = 94%; P < 0.00001). The magnitude of the reduction in morphine consumption at 6 hours postoperatively was not influenced by the timing of injection (I2 = 0%; P = 0.72), the block approach adopted (I2 = 0%; P = 0.72), or the presence of postoperative multimodal analgesia (I2 = 73%; P = 0.05). This difference persisted at 24 hours postoperatively (mean difference, -11 mg; 95% CI, -14 to -8 mg; I2 = 99%; P < 0.00001). Pain scores at rest and on movement were reduced at 6 hours postoperatively (mean difference at rest, -10; 95% CI, -15 to -5; I2 = 92%; P = 0.0002; mean difference on movement, -9; 95% CI, -14 to -5; I2 = 58%; P < 0.00001). There were neither differences in the incidence of postoperative nausea and vomiting (I2 = 1%; P = 0.59) nor in the pruritus (I2 = 12%; P = 0.58) Two minor complications (1 bruise and 1 anaphylactoid reaction) were reported in 1028 patients. CONCLUSIONS: Ultrasound-guided TAP block provides marginal postoperative analgesic efficacy after abdominal laparotomy or laparoscopy and cesarean delivery. However, it does not provide additional analgesic effect in patients who also received spinal anesthesia containing a long-acting opioid. The minimal analgesic efficacy is independent of the timing of injection, the approach adopted, or the presence of postoperative multimodal analgesia. Because of heterogeneity of the results, these findings should be interpreted with caution.

Molecular and structural transmembrane determinants critical for embedding claudin-5 into tight junctions reveal a distinct four-helix bundle arrangement.

The mechanism of TJ (tight junction) assembly and the structure of TJ strand-forming Cldns (claudins) are unclear. To identify determinants of assembly of blood-brain barrier-related Cldn3 and Cldn5, chimaeric mutants were analysed by cellular reconstitution of TJ strands and live-cell imaging. On the basis of the rescue of mutants deficient for strand formation, we identified Cldn5 residues (Cys128, Ala132, Ile142, Ala163, Ile166 and Leu174) involved in Cldn folding and assembly. Experimental results were combined with structural bioinformatics approaches. Initially the experimentally validated previous model of the ECL2 (extracellular loop 2) of Cldn5 was extended to the flanking transmembrane segments (TM3/TM4). A coiled-coil interface probably caused by alternating small and large residues is supported by concomitant knob-into-hole interactions including Cldn5-specific residues identified in the present paper. To address arrangement of the TMs in a four-helix bundle, data from evolutionary sequence couplings and comparative modelling of intramolecular interfaces in the transmembrane region of Cldns led to a complete Cldn5 model. Our suggested Cldn subtype-specific intramolecular interfaces that are formed by conserved coiled-coil motifs and non-conserved residues in distinct TM positions were confirmed by the recently released crystal structure of Cldn15. The identified molecular and structural determinants essentially contribute to assembly of Cldns into TJ strands.

Serum anticholinergic activity and postoperative cognitive dysfunction in elderly patients.

BACKGROUND: Cerebral cholinergic transmission plays a key role in cognitive function, and anticholinergic drugs administered during the perioperative phase are a hypothetical cause of postoperative cognitive dysfunction (POCD). We hypothesized that a perioperative increase in serum anticholinergic activity (SAA) is associated with POCD in elderly patients. METHODS: Seventy-nine patients aged >65 years undergoing elective major surgery under standardized general anesthesia (thiopental, sevoflurane, fentanyl, and atracurium) were investigated. Cognitive functions were assessed preoperatively and 7 days postoperatively using the extended version of the CERAD-Neuropsychological Assessment Battery. POCD was defined as a postoperative decline >1 z-score in at least 2 test variables. SAA was measured preoperatively and 7 days postoperatively at the time of cognitive testing. Hodges-Lehmann median differences and their 95% confidence intervals were calculated for between-group comparisons. RESULTS: Of the patients who completed the study, 46% developed POCD. Patients with POCD were slightly older and less educated than patients without POCD. There were no relevant differences between patients with and without POCD regarding gender, demographically corrected baseline cognitive functions, and duration of anesthesia. There were no large differences between patients with and without POCD regarding SAA preoperatively (pmol/mL, median [interquartile range]/median difference [95% CI], P; 1.14 [0.72, 2.37] vs 1.13 [0.68, 1.68]/0.12 [-0.31, 0.57], P = 0.56), SAA 7 days postoperatively (1.32 [0.68, 2.59] vs 0.97 [0.65, 1.83]/0.25 [-0.26, 0.81], P = 0.37), or changes in SAA (0.08 [-0.50, 0.70] vs -0.02 [-0.53, 0.41]/0.1 [-0.31, 0.52], P = 0.62). There was no significant relationship between changes in SAA and changes in cognitive function (Spearman rank correlation coefficient preoperatively of 0.03 [95% CI, -0.21, 0.26] and postoperatively of -0.002 [95% CI, -0.24, 0.23]). CONCLUSIONS: In this panel of patients with low baseline SAA and clinically insignificant perioperative anticholinergic burden, although a relationship cannot be excluded in some patients, our analysis suggests that POCD is probably not a substantial consequence of anticholinergic medications administered perioperatively but rather due to other mechanisms.

Disentangling the multiorbital contributions of excitons by photoemission exciton tomography.

Excitons are realizations of a correlated many-particle wave function, specifically consisting of electrons and holes in an entangled state. Excitons occur widely in semiconductors and are dominant excitations in semiconducting organic and low-dimensional quantum materials. To efficiently harness the strong optical response and high tuneability of excitons in optoelectronics and in energy-transformation processes, access to the full wavefunction of the entangled state is critical, but has so far not been feasible. Here, we show how time-resolved photoemission momentum microscopy can be used to gain access to the entangled wavefunction and to unravel the exciton's multiorbital electron and hole contributions. For the prototypical organic semiconductor buckminsterfullerene (C60), we exemplify the capabilities of exciton tomography and achieve unprecedented access to key properties of the entangled exciton state including localization, charge-transfer character, and ultrafast exciton formation and relaxation dynamics.

XUV coherent diffraction imaging in reflection geometry with low numerical aperture.

We present an experimental realization of coherent diffraction imaging in reflection geometry illuminating the sample with a laser driven high harmonic generation (HHG) based XUV source. After recording the diffraction pattern in reflection geometry, the data must be corrected before the image can be reconstructed with a hybrid-input-output (HIO) algorithm. In this paper we present a detailed investigation of sources of spoiling the reconstructed image due to the nonlinear momentum transfer, errors in estimating the angle of incidence on the sample, and distortions by placing the image off center in the computation grid. Finally we provide guidelines for the necessary parameters to realize a satisfactory reconstruction within a spatial resolution in the range of one micron for an imaging scheme with a numerical aperture NA < 0.03.

Improving high-order harmonic yield using wavefront-controlled ultrashort laser pulses.

In this work we show that it is possible to increase the high-order harmonic yield when using wavefront-shaped laser beams. The investigation of the beam profile near the interaction region shows that the optimized beam is asymmetric and has a larger diameter. Thus, the optimized beam leads to a higher yield even if the peak intensity is lower compared to an unoptimized beam. This indicates that the wavefront of the fundamental laser beam and, accordingly, the focal profile play an important role in the efficient generation of high-order harmonic radiation.

Helicopter rescue involving the winching of a physician.

INTRODUCTION: We sought to study the operational and medical aspects of helicopter rescue missions involving the use of a winch. SETTING: A single helicopter-based medical service of a pre-alpine region of Switzerland. METHODS: We prospectively studied consecutive primary rescue interventions involving winching of a physician, from October 1, 1998 to October 1, 2002. Demographic, medical and operational aspects as well as outcome at 48 hours were analyzed. RESULTS: We included 133 patients. Most (74%) were male, with traumatic injuries (77%). The median scene time of the nine severely injured patients (Injury Severity Scale [ISS] > 15) was significantly longer compared with the other patients (54 vs 37 minutes; P < .05). The main medical procedures performed were orotracheal intubation (n = 5), fracture reductions (n = 5), major analgesia with sedation (n = 4), and intravenous fluid administration of more than 1,500 mL (n = 4). Fourteen (10%) patients suffering from minor injuries were triaged by the physician and not airlifted to the hospital. All 133 patients were alive at 48 hours. Sixty-nine (52%) were still hospitalized. No secondary interhospital transfer was required. CONCLUSION: Our study provides a better knowledge of injury profile, medical aspects, and outcomes of patients rescued necessitating a winching procedure.

Large Distortion of Fused Aromatics on Dielectric Interlayers Quantified by Photoemission Orbital Tomography.

Polycyclic aromatic compounds with fused benzene rings offer an extraordinary versatility as next-generation organic semiconducting materials for nanoelectronics and optoelectronics due to their tunable characteristics, including charge-carrier mobility and optical absorption. Nonplanarity can be an additional parameter to customize their electronic and optical properties without changing the aromatic core. In this work, we report a combined experimental and theoretical study in which we directly observe large, geometry-induced modifications in the frontier orbitals of a prototypical dye molecule when adsorbed on an atomically thin dielectric interlayer on a metallic substrate. Experimentally, we employ angle-resolved photoemission experiments, interpreted in the framework of the photoemission orbital tomography technique. We demonstrate its sensitivity to detect geometrical bends in adsorbed molecules and highlight the role of the photon energy used in experiment for detecting such geometrical distortions. Theoretically, we conduct density functional calculations to determine the geometric and electronic structure of the adsorbed molecule and simulate the photoemission angular distribution patterns. While we found an overall good agreement between experimental and theoretical data, our results also unveil limitations in current van der Waals corrected density functional approaches for such organic/dielectric interfaces. Hence, photoemission orbital tomography provides a vital experimental benchmark for such systems. By comparison with the state of the same molecule on a metallic substrate, we also offer an explanation why the adsorption on the dielectric induces such large bends in the molecule.

Endogenous CD317/Tetherin limits replication of HIV-1 and murine leukemia virus in rodent cells and is resistant to antagonists from primate viruses.

Human CD317 (BST-2/tetherin) is an intrinsic immunity factor that blocks the release of retroviruses, filoviruses, herpesviruses, and arenaviruses. It is unclear whether CD317 expressed endogenously in rodent cells has the capacity to interfere with the replication of the retroviral rodent pathogen murine leukemia virus (MLV) or, in the context of small-animal model development, contributes to the well-established late-phase restriction of human immunodeficiency virus type 1 (HIV-1). Here, we show that small interfering RNA (siRNA)-mediated knockdown of CD317 relieved a virion release restriction and markedly enhanced the egress of HIV-1, HIV-2, and simian immunodeficiency virus (SIV) in rat cells, including primary macrophages. Moreover, rodent CD317 potently inhibited MLV release, and siRNA-mediated depletion of CD317 in a mouse T-cell line resulted in the accelerated spread of MLV. Several virus-encoded antagonists have recently been reported to overcome the restriction imposed by human or monkey CD317, including HIV-1 Vpu, envelope glycoproteins of HIV-2 and Ebola virus, Kaposi's sarcoma-associated herpesvirus K5, and SIV Nef. In contrast, both rat and mouse CD317 showed a high degree of resistance to these viral antagonists. These data suggest that CD317 is a broadly acting and conserved mediator of innate control of retroviral infection and pathogenesis that restricts the release of retroviruses and lentiviruses in rodents. The high degree of resistance of the rodent CD317 restriction factors to antagonists from primate viruses has implications for HIV-1 small-animal model development and may guide the design of novel antiviral interventions.

[Risk factors associated with maternal satisfaction during childbirth: a retrospective cohort study]. / Satisfaction maternelle de la prise en charge anesthésique durant l'accouchement: une étude de cohorte rétrospective.

PURPOSE: Factors associated with maternal satisfaction of anesthetic management during labour and delivery are poorly known. The purpose of this study was to assess these factors. METHODS: We performed a retrospective cohort study on parturients admitted between January 2004 and December 2008. Data on patients' demographics, comorbidities, procedures performed and various aspects of their anesthetic experience were retrieved from the anesthetic records. Maternal satisfaction was measured using a numerical scale from 0 to 10 (0 = not satisfied at all, 10 = very satisfied). A cutoff of ≤ 6 was taken as poor satisfaction. We performed a multivariate analysis to identify the different predictors of maternal satisfaction and more specifically those related to pain, overall experience with the technique, delays, and presence of anesthetic, obstetrical and neonatal complications. RESULTS: There were 15,386 parturients admitted during the study period. Of these, 10,034 had complete information in the chart and 761 (7.6%) parturients were dissatisfied with their anesthetic care. Factors decreasing patient satisfaction were high risk pregnancy [odds ratio (OR) 95% confidence interval (CI) 0.59 (0.34-1.02)] and difficult delivery [OR (95% CI) 0.62 (0.52-0.74)]. Pain, a negative experience of the procedure, delays, poor coordination in management, and the presence of complications decreased patient satisfaction [OR (95% CI) 0.07 to 0.71]; P < 0.001. CONCLUSION: Maternal satisfaction with anesthesia care is largely determined by the effectiveness and correct performance of the procedure carried from the technical and human point of view. However, other factors such as a good coordination in patient management and the absence of complications also influence maternal satisfaction.