Enhancing Healthier Birth Outcomes by Creating Supportive Spaces for Pregnant African American Women Living in Milwaukee

Abstract

Objectives Nationwide, African American women report higher stress levels and less access to pre- and postnatal resources. Wisconsin mirrors national infant mortality trends that show a persistent four-decade gap in infant survival between African American and White populations. The objective of the Milwaukee Birthing Project (MBP) was to implement a community-based health promotion intervention to improve birth outcomes for pregnant, low-income African American women, evaluate its effectiveness, and document its usefulness to inform development of future interventions. The project involved a mentoring and supportive relationship between 28 volunteer mentors (Sister Friends) and 20 pregnant women (Little Sisters). Methods The project implementation and evaluation were informed by the lifecourse perspective and a postcolonial feminist framework. Thematic analysis was used to analyze ethnographic data from monthly meetings and interviews with pregnant Little Sisters and Sister Friends. Results Our findings showed patterns both in community spaces and spaces created during the MBP. Program spaces contrasted with everyday life spaces and allowed women to experience community support. Based on our analysis, we classify these spaces as: (1) community spaces lacking support, (2) safe spaces of belonging and understanding, (3) spaces that foster meaningful interaction, and (4) safe, supportive spaces for other women in the future. Conclusions for Practice Future interventions should consider intentionally developing safe spaces to attain health goals. From a postcolonial feminist perspective, the voices of women who are at greatest risk for experiencing poor birth outcomes are crucial to the development of effective policies.

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Effect of Intravenous Dexamethasone on the Regression of Isobaric Bupivacaine Spinal Anesthesia: A Randomized Controlled Trial

The effect of intravenous dexamethasone on the regression of sensory and motor block after isobaric bupivacaine spinal anesthesia is unknown. We conducted a prospective, double-blind, randomized controlled trial on 60 patients who received intravenously either placebo (group P) or 8-mg dexamethasone (group D) during the intrathecal injection of 12-mg isobaric bupivacaine 0.5%. Primary outcome was the time from bupivacaine injection to regression of 2 dermatomes in relation to the highest dermatome blocked by the spinal local anesthetic. Time to 2-dermatome regression was 85 minutes (74–96 minutes) in group P versus 87 minutes (76–98 minutes) in group D (P = .79). Accepted for publication June 18, 2018. Funding: Internal. The authors declare no conflicts of interest. Clinical Trials identifier: NCT03078062. Protocol available at: https://ift.tt/2OsukBR NCT03078062. Reprints will not be available from the authors. Address correspondence to Stephan R. Williams, MD, PhD, Département d'anesthésiologie, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, QC H2L 4M1, Canada. Address e-mail to stephan.williams@umontreal.ca. © 2018 International Anesthesia Research Society

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Laryngeal Mask Airway Versus Other Airway Devices for Anesthesia in Children With an Upper Respiratory Tract Infection: A Systematic Review and Meta-analysis of Respiratory Complications

There is an association between upper respiratory tract infection (URTI) and an increased incidence of perioperative respiratory adverse events (PRAEs), which is a major risk for morbidity during pediatric anesthesia. The aim of the present study was to compare the risk of PRAEs among different airway devices during anesthesia in children with a URTI. A systematic review according to the Cochrane Handbook and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. Only randomized clinical trials evaluating anesthesia in children with a URTI and who were submitted to any of the airway devices were included. From 1030 studies identified, 5 randomized clinical trials were included in the final analysis. There were no statistical differences between laryngeal mask airway (LMA®) and endotracheal tube (ETT) regarding breath holding or apnea (risk ratio [RR], 0.82; 95% confidence interval [CI], 0.41–1.65), laryngospasm (RR, 0.74; 95% CI, 0.18–2.95), and arterial oxygen desaturation (RR, 0.44; 95% CI, 0.16–1.17). The quality of evidence was low for the first outcome and very low for the 2 other outcomes, respectively. The LMA use produced a significant reduction of cough (RR, 0.75; 95% CI, 0.58–0.96, low quality of evidence) compared with ETT. The ideal airway management in children with a URTI remains obscure given that there are few data of perioperative respiratory complications during anesthesia. This systematic review demonstrates that LMA use during anesthesia in children with URTI did not result in decrease of the most feared PRAEs. However, LMA was better than ETT in reducing cough. Further research is needed to define the risks more clearly because cough and laryngospasm have similar triggers, and both bronchospasm and laryngospasm trigger cough. Accepted for publication June 18, 2018. Funding: This research was carried out without funding. A.L.R.C. was granted a scholarship from Coordination of Improvement for Higher Academic Staff (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior [CAPES]). P.T.S.S. received a scholarship from São Paulo Research Foundation (Fundação de Amparo à Pesquisa do Estado de São Paulo [FAPESP]; #2014/16734–6). CAPES and FAPESP are Brazilian governmental agencies dedicated to promoting scientific research. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Preliminary data for this study were presented as European Society of Anaesthesiology (ESA) Best Abstract Prize Competition at the ESA Euroanaesthesia May 30, 2015 to June 2, 2015, Berlin, Germany. LMA is a registered trademark of Teleflex Incorporated or its affiliates. Reprints will not be available from the authors. Address correspondence to Ana Lygia R. de Carvalho, MD, PhD, Departamento de Anestesiologia, Universidade Estadual Paulista, UNESP, Faculdade de Medicina de Botucatu, Av. Prof. Mário Rubens Guimarães Montenegro, s/n, Bairro: UNESP, Campus de Botucatu, Botucatu, SP, Brazil. Address e-mail to analygiacarvalho@yahoo.com.br. © 2018 International Anesthesia Research Society

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Perioperative Blood Pressure Monitoring in Patients With Obesity

Blood pressure monitoring plays a key part in the preoperative, intraoperative, and postoperative care of all patients. In patients with obesity, hypertension indicates increased metabolic and surgical risk and may signal the presence of significant medical comorbidities, including obstructive sleep apnea. Avoidance of hypertension postoperatively is necessary to minimize bleeding risk after surgery. Hypotension in the postoperative period may be the first sign of significant complications that require urgent management. With the problem of being overweight or obese now affecting two-thirds of adults in Western countries, the proportion of patients with obesity in perioperative environments is similarly increasing. Detection of aberrations in blood pressure is contingent on the accuracy of blood pressure measurement methods. Patients with obesity tend to have a large arm circumference and "cone-shaped arms." Standard blood pressure cuffs fit such patients poorly, and this compromises the accuracy of measurements. Alternatives to arm blood pressure cuffs, some made specifically for individuals with obesity, have been evaluated but are not widely available to clinicians. This focused narrative review will discuss the relevance of hypertension management in the care of patients with obesity, highlight the currently available methods for perioperative monitoring of blood pressure, and explore the opportunities that exist to improve the perioperative blood pressure care in patients with obesity undergoing surgical procedures. Accepted for publication June 6, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Victoria A. Eley, PhD, Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Butterfield St, Herston, QLD 2006, Australia. Address e-mail to va_eley@hotmail.com. © 2018 International Anesthesia Research Society

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Postoperative Hypotension and Surgical Site Infections After Colorectal Surgery: A Retrospective Cohort Study

BACKGROUND: Hypotension compromises local tissue perfusion, thereby reducing tissue oxygenation. Hypotension might thus be expected to promote infection. Hypotension on surgical wards, while usually less severe than intraoperative hypotension, is common and often prolonged. In this retrospective cohort study, we tested the hypotheses that there is an association between surgical site infections and low postoperative time-weighted average mean arterial pressure and/or postoperative minimum mean arterial pressure. METHODS: We considered patients who had colorectal surgery lasting ≥1 hour at the Cleveland Clinic between 2009 and 2013. We defined blood pressure exposures as time-weighted average (primary) and minimum mean arterial pressure (secondary) within 72 hours after surgery. We assessed associations between continuous blood pressure exposures with a composite of deep and superficial surgical site infection using separate severity-weighted average relative effect generalized estimating equations models, each using an unstructured correlation structure and adjusting for potentially confounding variables. RESULTS: A total of 5896 patients were eligible for analysis. Time-weighted mean arterial pressure and surgical site infection were not significantly associated, with an estimated odds ratio (95% CI) of 1.03 (0.99–1.08) for a 5-mm Hg decrease (P = .16). However, there was a significant inverse association between minimum postoperative mean arterial pressure and infection, with an estimated odds ratio of 1.08 (1.03–1.12) per 5-mm Hg decrease (P = .001). CONCLUSIONS: Postoperative time-weighted mean arterial pressure was not associated with surgical site infection, but lowest postoperative mean arterial pressure was. Whether the relationship is causal remains to be determined. Accepted for publication June 12, 2018. Huseyin O. Yilmaz, MD, is currently affiliated with the Department of Critical Care, Turkish Ministry of Health, Health Sciences University, Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Turkey. Rovnat Babazade, MD, is currently affiliated with the Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas. Wael Saasouh, MD, is currently affiliated with the Department of Anesthesiology, Detroit Medical Center, Detroit, Michigan. Funding: Institutional and/or departmental. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Alparslan Turan, MD, Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Ave, P-77, Cleveland, OH 44195. Address e-mail to turana@ccf.org. © 2018 International Anesthesia Research Society

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In Response

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Discharge Hemoglobin Level and 30-Day Readmission Rates After Coronary Artery Bypass Surgery

BACKGROUND: Restrictive transfusion strategies supported by large randomized trials are resulting in decreased blood utilization in cardiac surgery. What remains to be determined, however, is the impact of lower discharge hemoglobin (Hb) levels on readmission rates. We assessed patients with higher versus lower Hb levels on discharge to compare 30-day readmission rates after coronary artery bypass grafting (CABG). METHODS: We retrospectively evaluated 1552 patients undergoing isolated CABG at our institution from January 2013 to May 2016. We evaluated 2 Hb cohorts: "high" (above) and "low" (below) the mean discharge Hb level of 9.4 g/dL, comparing patient characteristics, blood utilization, and clinical outcomes including 30-day readmission rates. We further evaluated the effects of the lowest (12 g/dL), "mild anemia" (10–11.9 g/dL), "moderate anemia" (8–9.9 g/dL), and "severe anemia" (

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