Motor vehicle collision-related accidents in pregnancy.

AIM: Motor vehicle accidents (MVA) are a major contributor of worldwide morbidity and mortality; however, relatively little is known about the incidence and consequences of traffic accidents on pregnant women. Our aim is to compare rates and outcomes of motor vehicle collision-related accidents in pregnant women. MATERIAL AND METHODS: We conducted a population-based retrospective cohort study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from 2003 to 2011. The risk of different MVA and injuries were compared among pregnant and non-pregnant subjects using conditional logistic regression. RESULTS: We identified 5936 cases of collision-related MVA in pregnancy and age-matched them at a 1:10 ratio to 59,360 non-pregnant women with collision-related MVA. As compared to non-pregnant women, pregnant women who were admitted after an MVA suffered less severe injuries and consequently required fewer therapeutic interventions and a shorter hospital stay. Pregnant women who had a collision-related MVA were, however, at increased risk of requiring genitourinary surgery (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.24-1.69). When restricted to women with a fracture, pregnant women were even more likely to require genitourinary surgery (OR, 2.93; 95%CI, 2.32-3.71) as well as require a blood transfusion (OR, 1.21; 95%CI, 1.01-1.44). CONCLUSION: Pregnant women admitted to hospital after a collision-related MVA tend to sustain less severe injuries compared to non-pregnant women. However, the influence of admissions for fetal monitoring, rather than maternal injury, could not be determined from our dataset. Pregnant women who experienced a collision-related MVA also required less surgical intervention, with the exception of genitourinary surgery, which may be indicative of more cesarean deliveries.

Anesthesia considerations for robotic surgery in gynecologic oncology.

Robot-assisted gynecologic surgery is performed with a pneumoperitoneum and prolonged maximum Trendelenburg position which can result in adverse physiologic effects. The purpose of this study was to assess the feasibility of robot-assisted gynecologic oncology procedures and to identify anesthesia-related peri-operative adverse events. This is a case series performed on the first 133 patients who underwent a robot-assisted gynecologic oncology procedure at a tertiary care facility. Data was collected from electronically archived patient charts and from a prospective surgical database. Patient demographics were recorded and significant intra-operative and post-operative adverse events were reviewed. Robot-assisted surgery for gynecologic oncologic surgery with the use of extreme Trendelenburg in all patients was safely and successfully performed across a wide range of ages, American Society of Anesthesiologists physical status scores and body mass indices. Although most patients developed various degree of facial edema, only 5% of patients had a delayed extubation. Transient intra-operative hypoxemia (O2 saturation < 90%) occurred in 3.75% (5/133) of patients and hypercapnia (CO2 > 45 mmHg) in 18% (24/133). The mean duration of surgery was 254 min and median hospital stay was 1 day. Anesthetic and peri-operative complications are rare for patients undergoing robot-assisted gynecologic oncology surgeries despite the prolonged use of maximum Trendelenburg positioning and pneumoperitoneum. Although there are new anesthetic challenges, these surgeries were safely performed in a wide range of patients with minimal blood loss, short hospital stay and no significant cardiopulmonary complications.