Neuraxial anesthesia in a parturient with common variable immunodeficiency: a case report

Choosing whether or not to initiate neuraxial anesthesia in pregnant women with immune system defects may be challenging. Anesthesiologists have the responsibility of making the best decision in terms of anesthesia management for both mother and baby during the labor and delivery process. Whether neuraxial anesthesia is associated with an increased risk of central nervous system infection in immunocompromised compared with healthy patients is unknown. It is also unclear if maternal immune modulation required for fetal tolerance makes pregnant women susceptible to pathogens and causes an altered immune response. Infection-related complications of neuraxial anesthesia are rare but may be severe, especially in immunocompromised parturients. There are no guidelines regarding the indications and limitations of regional anesthesia procedures in these patients. Immunocompromised patients are now seen more commonly, and it is essential to adopt a multidisciplinary approach to their care while tailoring anesthetic plans to the individual. We present the case of a 37-year-old parturient who had a congenital immune deficiency and who developed aseptic meningitis after receiving spinal anesthesia for cesarean delivery.     

Otosclerosis surgery: Assessment of patient comfort

ObjectivesTo evaluate operative comfort and stress in patients undergoing stapedotomy for otosclerosis under local versus general anesthesia.Material and methodsConsecutive otosclerosis patients managed over a 9-month period responded to 3 validated questionnaires to assess peri- and post-operative comfort: Glasgow Benefit Inventory, Cohen's Perceived Stress Scale and the Posttraumatic Stress Disorder Checklist Scale. These results and audiometric data were compared between local and general anesthesia groups.ResultsTwenty-one patients were included in the local anesthesia group and 7 in the general anesthesia group, after exclusion of patients with history of otosclerosis surgery. There was no significant inter-group difference on Glasgow Benefit Inventory (P = 0.38) or Posttraumatic Stress Disorder Checklist Scale (P = 0.86). Perceived Stress Scale scores were higher in the general anesthesia group (P = 0.038). In total, 67% of patients reported no discomfort under local anesthesia, and 86% were ready to undergo the procedure under local anesthesia again. There were no significant differences in postoperative symptoms, or in air-bone gap ≤ 10 dB (local anesthesia 81%, general anesthesia 71%; P = 0.156).ConclusionsLocal anesthesia in otosclerosis surgery did not increase stress or postoperative symptoms compared to general anesthesia. Audiometric results were not affected by type of anesthesia.     

Mechanical ventilation and prone positioning in pregnant patients with severe COVID-19 pneumonia: experience at a quaternary referral center

BackgroundWe present the care of 17 consecutive pregnant patients who required mechanical ventilation for Coronavirus Disease 2019 (COVID-19) pneumonia at a quaternary referral center in the United States. We retrospectively describe the management of these patients, maternal and fetal outcomes, as well as the feasibility of prone positioning and delivery.MethodsBetween March 2020 and June 2021, all pregnant and postpartum patients who were mechanically ventilated for COVID-19 pneumonia were identified. Details of their management including prone positioning, maternal and neonatal outcomes, and complications were noted.ResultsSeventeen pregnant patients required mechanical ventilation for COVID-19. Thirteen patients received prone positioning, with a total of 49 prone sessions. One patient required extracorporeal membrane oxygenation. All patients in this series survived until at least discharge. Nine patients delivered while mechanically ventilated, and all neonates survived, subsequently testing negative for SARS-CoV-2. There was one spontaneous abortion. Four emergent cesarean deliveries were prompted by refractory maternal hypoxemia or non-reassuring fetal heart rate after maternal intubation.ConclusionsOverall, maternal and neonatal survival were favorable even in the setting of severe COVID-19 pneumonia requiring mechanical ventilation. Prone positioning was well tolerated although the impact of prone positioning or fetal delivery on maternal oxygenation and ventilation are unclear.     

广义可加混合模型在婴幼儿生长发育研究中的应用

目的使用广义可加混合模型,分析婴幼儿体重增长的影响因素,探讨广义可加混合模型在婴幼儿生长发育研究中的应用。方法采用出生队列随访资料,通过R语言软件mgcv包拟合广义可加混合模型。结果本研究共纳入儿童819名,儿童体重的影响因素包括:月龄(F=516.17,P<0.001),出生体重(F=13.19,P<0.001),辅食添加频率得分(F=18.10,P<0.001),母亲产后体重(F=30.55,P<0.001),配方奶摄入量(F=11.28,P<0.001),月龄×配方奶摄入量(F=6.47,P<0.001),月龄×辅食添加频率得分(F=72.70,P<0.0001),月龄×睡眠总时长(F=2.63,P<0.05)。结论广义可加混合模型拟合效果较好,可探测变量间的复杂关系,适用于婴幼儿生长发育研究。