Comprehensive Review of Anesthetic Evaluation and Management in Obese Female Patients Undergoing In Vitro Fertilization.

Obesity has become a global health epidemic with profound implications for various medical specialties, including reproductive medicine. This comprehensive review focuses on the anesthetic evaluation and management of obese patients undergoing in vitro fertilization (IVF) procedures. Obesity, as defined by BMI, is associated with infertility and poses unique challenges for anesthetic care. The review also addresses the timing of anesthesia concerning IVF procedures, the impact of obesity on IVF success rates, and the importance of emotional and psychological support for obese patients undergoing IVF. Challenges and future directions in the field are highlighted, focusing on ongoing research, emerging technologies, and the role of multidisciplinary teams in managing these complex cases. In conclusion, this review underscores the critical role of tailored anesthesia and perioperative care in optimizing outcomes for obese patients undergoing IVF. It provides valuable insights for anesthetic providers, reproductive specialists, and healthcare teams, emphasizing the need for a patient-centered approach to address the unique challenges posed by obesity in the context of assisted reproductive technology.

Intrathecal Adjuvant Midazolam Versus Fentanyl With Hyperbaric Bupivacaine for Post-operative Analgesia in Women Undergoing Total Abdominal Hysterectomy.

Background The administration of adequate analgesia post-operatively has been associated with fewer cardiopulmonary complications, lower morbidity and mortality, lower healthcare costs, and higher patient satisfaction. One of the most effective ways to raise the standard of healthcare would be standardization of multimodal analgesia with enhanced recovery after surgery. Adjuncts to spinal anesthetists can achieve a better post-operative pain relief with less doses of rescue analgesia. Methods This was a prospective, randomized trial conducted on 60 women undergoing abdominal hysterectomy under spinal anesthesia. We evaluated the impact of adding 0.5 mL (2.5 mg) of intrathecal midazolam versus 25 mcg of intrathecal fentanyl (0.5 mL) with 2.5 mL injection of 0.5% bupivacaine (hyperbaric) (12.5 mg). The outcomes were prolongation of analgesia in the post-operative period, onset and duration of sensory and motor blockade, stable hemodynamics, and any adverse reactions to the study drugs. Results The two groups, group M (midazolam + hyperbaric bupivacaine) and group F (fentanyl + hyperbaric bupivacaine), had similar distribution for age, weight, and type and duration of surgical procedure. Both groups had stable vital parameters and experienced a similar onset of sensory and motor blockade. Intraoperative modified Ramsay sedation score was better in group M in comparison to group F. However, mean of elapsed time of two-segment regression of sensory block, from T12 to L1 level, and mean time to regression, from Bromage score 3 to 2, were longer in group F. Group F also had a better visual analogue scale (VAS) score in the post-operative period than group M, and group F experienced a longer average post-operative analgesic duration (lasting for 367.73 minutes) as compared to group M (lasting for 254.9 minutes), having a difference that was of statistical significance (p < 0.001). No substantial adverse reactions were seen in either group. Conclusion The duration of post-operative analgesia is significantly prolonged when 25 mcg of adjuvant intrathecal fentanyl is used with 0.5% bupivacaine (hyperbaric) as compared to intrathecal midazolam 0.5 mL (2.5 mg) in women undergoing abdominal hysterectomy under spinal anesthesia. Both fentanyl and midazolam have minimal adverse reactions and are safe to use as adjuvants to 0.5% of bupivacaine (hyperbaric) in surgeries conducted in the lower abdomen.

Anesthetic Management in Peripartum Cardiomyopathy: A Contemporary Review.

Peripartum cardiomyopathy (PPCM) is an uncommon disorder of the cardiovascular system and is linked to high rates of morbidity and mortality. It is an idiopathic condition characterized by left ventricular systolic dysfunction with an ejection fraction of approximately 45% near the end of pregnancy or immediately after delivery. Anesthesia management in these women is challenging due to low physiological reserve and potential negative effects on the fetus. To ensure that mother and child are supported safely through delivery, careful anesthesia control is required. Here, in this review article, we discuss the anesthetic implications in preoperative, operative, and postoperative phases in women with perioperative cardiomyopathy undergoing vaginal delivery or cesarean section.

Efficacy of antibacterial sealing gel and O-ring to prevent microleakage at the implant abutment interface: an in vitro study.

Gaps and hollow spaces at the implant abutment interface will act as a bacterial reservoir that may cause peri-implantitis. Hence, the sealing ability of O-ring (in addition to polysiloxane) and GapSeal (an antibacterial sealing gel) was evaluated. A total of 45 identical implant systems (ADIN Dental Implant Systems) were divided into 3 groups of 15 implants each: an unsealed group, a group sealed with O-rings, and a group sealed with GapSeal gel. The implant and abutment were gamma sterilized after assembly. Two implants from each group were randomly incubated in sterile brain heart infusion (BHI) broth tubes and checked for sterility. The remaining 13 implants were incubated in BHI broth inoculated with Enterococcus and incubated for 5 days. They were then removed from the tubes, dried aseptically, placed in 2% sodium hypochlorite solution for 30 minutes, and washed with sterile saline for 5 minutes. Next, the assembly was dried aseptically and put in sterile BHI broth tubes and incubated for 24 hours to check surface sterility. Keeping 2 implants as controls from each group, the remaining 11 implants were dismantled group-wise and placed in liquid BHI broth; the test tubes were then shaken thoroughly so that the broth would come in contact with all implant surfaces. The solution from this tube was poured on pre-prepared sterile agar plates and incubated for 24 hours. The colonies formed on the agar plate were then counted using a digital colony counter. The data thus obtained were subjected to statistical analysis by Kruskal-Wallis analysis of variance and Mann-Whitney U test. It was concluded that though microbial growth is seen in all the 3 groups, the least growth was seen in the GapSeal group followed by the O-ring group.