Year : 2011 | Volume
: 1 | Issue : 1 | Page : 3--4
The 'Birth' of a new obstetric anaesthesia journal
Chief Editor, Journal of Obstetric Anaesthesia and Critical Care, Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029, India
Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
|How to cite this article:|
Trikha A. The 'Birth' of a new obstetric anaesthesia journal.J Obstet Anaesth Crit Care 2011;1:3-4
|How to cite this URL:|
Trikha A. The 'Birth' of a new obstetric anaesthesia journal. J Obstet Anaesth Crit Care [serial online] 2011 [cited 2021 Jan 16 ];1:3-4
Available from: https://www.joacc.com/text.asp?2011/1/1/3/84248
The first issue of the Journal of Obstetric Anaesthesia and Critical Care has finally been delivered and I must acknowledge that the birth has been a "laborious" one with many accelerations and decelerations in the heart rate without any kind of analgesia. However, once delivered, the Apgar score has been great and I can assure the future growth and development of this bundle of joy would be like any other healthy journal.
Initially, the journal would be published twice a year and would focus on the specialty of obstetric analgesia, anaesthesia and critical care. Through this journal, the Association of Obstetric Anaesthesiologists (AOA) would publish guidelines pertaining to anaesthesia and analgesia in parturients. The present issue carries one such set of guidelines on anaesthetic management of patients undergoing tubal ligation. The editorial board and the executive members of the AOA have formulated these guidelines after much deliberation taking into account the diversity of the health care in the Indian subcontinent. In developing countries like India, the diversity of health care facilities may vary tremendously - from well-equipped state of art corporate hospitals to financially starved public health centers. A large number of parturients undergo procedures in the latter hospitals, which necessitates the need for guidelines that are practical and possible in diverse circumstances. In the developed countries, tubal ligation is never done under local infiltration anaesthesia, but such a technique is not uncommon in India, even in well-equipped government hospitals. As correctly mentioned in the guidelines, such a practice needs to be discouraged and the onus lies on the public health system managers to ensure availability of qualified anesthesiologists and facilities for minimum monitoring for safe conduct of such procedures under anaesthesia. Suggestions and comments from every anesthesiologist are welcome regarding these. It is necessary that the available facilities for health care should be suitably altered and utilized in the best possible manner for imparting optimum care to the parturients, and the guidelines should help the medical personnel to do so.
The present issue carries a review on the anaesthetic management of patients with peripartum cardiomyopathy (PCM)  which is a very important cause of maternal mortality and morbidity. It is evident from the case reports mentioned in the review that neuraxial blockade (epidural, combined spinal epidural anaesthesia, continuous spinal anaesthesia), general anaesthesia and even infiltration anaesthesia have been administered in such patients both for analgesia and anaesthesia with just one peripartum maternal death. It is possible that many bad outcomes in such patients of PCM have not been reported. One fact that is evident from the details of the anaesthetic management of such cases is the necessity of invasive monitoring during the conduct of anaesthesia and the postoperative period for such parturients. However, the usefulness of pulmonary artery catheterization in such patients needs to be ascertained due to the complications associated with their usage. The present issue also has a report on two such cases of PCM,  which have been managed very well with positive outcomes. In one of these cases, pulmonary artery catheter was not inserted; however, intra-arterial blood pressure and central venous pressure were monitored in both. With decrease in the use of pulmonary artery catheterization and the increasing popularity of noninvasive cardiac output monitoring, both in the operation room and intensive care units, there is a strong possibility that in future such a noninvasive modality would be useful in managing such parturients. There are many techniques by which cardiac output can be monitored in a noninvasive fashion. , However, there are very few reports regarding the use of such devices in pregnancy. ,, Studies are needed to ascertain the most suitable modality for noninvasive cardiac output monitoring in parturients. Post delivery monitoring and management in an intensive care unit is essential which highlights the need for dedicated obstetric intensive care units with teams which should include obstetricians and facilities for continuous fetal heart monitoring.
Another interesting study published in the present issue is regarding knowledge, attitude and awareness about labor analgesia and caesarean section in 200 parturients attending the antenatal clinic in a women's hospital attached to a medical school in a city in India.  There are some interesting results that the authors have published. Only 9.5% of the parturients interviewed in this study were aware of the availability of pain relief during labor, though this awareness has been reported to be much more from studies conducted in Ibadan and Lagos in Nigeria. , The value 9.5% seems to be too less but could be attributed to the educational status of women, as majority of the women interviewed were undergraduates.  It is likely that this number may be different for parturients staying in metropolitan cities. Another interesting fact that Nathani et al. have reported is about the ignorance of the patients interviewed regarding the specialty of anesthesiology and the role an anesthesiologist plays during a caesarean section. In their study, 70% of patients interviewed were ignorant about the fact that anaesthesia was required for a caesarean section and 83% of these parturients had no knowledge about the person who administers anaesthesia. Such disturbing reports have been published earlier also. , In my opinion, all such studies prove the fact that anesthesiologists have not been able to project their expertise, skills and importance in patient care unlike our surgery colleagues. A lot needs to be done in this regard.
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