2021
What’s New in Neuraxial Labor Analgesia
Toledano RD, Leffert L. What’s New in Neuraxial Labor Analgesia. Current Anesthesiology Reports 2021, 11: 340-347. PMID: 34466127, PMCID: PMC8390543, DOI: 10.1007/s40140-021-00453-6.Peer-Reviewed Original ResearchNeuraxial labor analgesiaEpidural drug deliveryLabor analgesiaObstetric patientsCesarean delivery anesthesiaNeuraxial analgesiaGeneral anesthesiaDelivery anesthesiaObstetric anesthesiaNeuraxial proceduresCOVID-19Spinal epidural hematoma formationSARS-CoV-2 infectionSerious adverse eventsEmergency cesarean deliveryCommon serious complicationEpidural labor analgesiaEpidural hematoma formationPain of childbirthAnalgesia techniquesEpidural blockadeAdverse eventsCesarean deliveryRisk/benefit decisionsAnesthetic managementThe Society for Obstetric Anesthesia and Perinatology Coronavirus Disease 2019 Registry: An Analysis of Outcomes Among Pregnant Women Delivering During the Initial Severe Acute Respiratory Syndrome Coronavirus-2 Outbreak in the United States
Katz D, Bateman BT, Kjaer K, Turner DP, Spence NZ, Habib AS, George RB, Toledano RD, Grant G, Madden HE, Butwick AJ, Lynde G, Minehart RD, Beilin Y, Houle TT, Sharpe EE, Kodali B, Bharadwaj S, Farber MK, Palanisamy A, Prabhu M, Gonzales NY, Landau R, Leffert L. The Society for Obstetric Anesthesia and Perinatology Coronavirus Disease 2019 Registry: An Analysis of Outcomes Among Pregnant Women Delivering During the Initial Severe Acute Respiratory Syndrome Coronavirus-2 Outbreak in the United States. Anesthesia & Analgesia 2021, 133: 462-473. PMID: 33830956, DOI: 10.1213/ane.0000000000005592.Peer-Reviewed Original ResearchMeSH KeywordsAdultAnalgesia, ObstetricalAnesthesia, GeneralAnesthesia, ObstetricalCase-Control StudiesCesarean SectionCOVID-19Delivery, ObstetricFemaleGestational AgeHumansInfant, PrematurePregnancyPregnancy Complications, InfectiousPremature BirthRegistriesRisk AssessmentRisk FactorsUnited StatesYoung AdultConceptsSARS-CoV-2 patientsSARS-CoV-2 infectionWeeks of gestationCesarean deliveryObstetric anesthesiaPositive SARS-CoV-2 polymerase chain reaction testSARS-CoV-2 polymerase chain reaction testAcute respiratory syndrome coronavirus 2 infectionSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infectionSARS-CoV-2-infected patientsSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreakSyndrome coronavirus 2 infectionMaternal respiratory failureAdverse pregnancy outcomesCoronavirus 2 infectionNeuraxial labor analgesiaUS cohort studyDays of deliveryUS medical centersPolymerase chain reaction testComposite outcome measureAnalysis of outcomesChain reaction testPeripartum outcomesAsymptomatic patientsThe Society for Obstetric Anesthesia and Perinatology Interdisciplinary Consensus Statement on Neuraxial Procedures in Obstetric Patients With Thrombocytopenia
Bauer ME, Arendt K, Beilin Y, Gernsheimer T, Perez Botero J, James AH, Yaghmour E, Toledano RD, Turrentine M, Houle T, MacEachern M, Madden H, Rajasekhar A, Segal S, Wu C, Cooper JP, Landau R, Leffert L. The Society for Obstetric Anesthesia and Perinatology Interdisciplinary Consensus Statement on Neuraxial Procedures in Obstetric Patients With Thrombocytopenia. Anesthesia & Analgesia 2021, 132: 1531-1544. PMID: 33861047, DOI: 10.1213/ane.0000000000005355.Peer-Reviewed Original ResearchConceptsSpinal epidural hematomaObstetric patientsNeuraxial proceduresImmune thrombocytopeniaEpidural hematomaGeneral anesthesiaRisk factorsObstetric risk factorsRisk-benefit discussionsDiagnosis of thrombocytopeniaRelevant professional societiesInterdisciplinary consensus statementGestational thrombocytopeniaThrombocytopenia etiologyHypertensive disordersPatient comorbiditiesCesarean deliveryProfessional societiesAirway examinationPotential morbidityPlatelet countPatient preferencesObstetric anesthesiaAirway equipmentAffected patients
2020
Pragmatic approach to neuraxial anesthesia in obstetric patients with disorders of the vertebral column, spinal cord and neuromuscular system
Walsh E, Zhang Y, Madden H, Lehrich J, Leffert L. Pragmatic approach to neuraxial anesthesia in obstetric patients with disorders of the vertebral column, spinal cord and neuromuscular system. Regional Anesthesia & Pain Medicine 2020, 46: 258-267. PMID: 33115718, DOI: 10.1136/rapm-2020-101792.Peer-Reviewed Original ResearchConceptsNeuraxial anesthesiaObstetric patientsSpinal cordCesarean delivery anesthesiaCesarean deliveryLabor analgesiaNeuraxial analgesiaVertebral columnCase seriesGeneral anesthesiaObstetrical patientsRetrospective studyDelivery anesthesiaPatient injuryAnesthesiaPatient harmPatientsNarrative reviewAvailable evidenceUnwarranted fearsNeuromuscular systemAdditional riskPresent unique challengesAnalgesiaCordLumbar Neuraxial Procedures in Thrombocytopenic Patients Across Populations: A Systematic Review and Meta-analysis
Bauer M, Toledano R, Houle T, Beilin Y, MacEachern M, McCabe M, Rector D, Cooper J, Gernsheimer T, Landau R, Leffert L. Lumbar Neuraxial Procedures in Thrombocytopenic Patients Across Populations: A Systematic Review and Meta-analysis. Obstetric Anesthesia Digest 2020, 40: 118-118. DOI: 10.1097/01.aoa.0000693644.32975.42.Peer-Reviewed Original ResearchNeuraxial anesthetic proceduresSpinal epidural hematomaEpidural hematomaThrombocytopenic patientsNeuraxial proceduresAnesthetic proceduresSystematic reviewThreshold platelet countCesarean deliveryFetal factorsNeuraxial anesthesiaGeneral anesthesiaPlatelet countSide effectsMeta-AnalysisHematomaPatientsAnesthesiaReviewPopulationStroke in Pregnancy: A Focused Update.
Miller EC, Leffert L. Stroke in Pregnancy: A Focused Update. Anesthesia & Analgesia 2020, 130: 1085-1096. PMID: 31124843, PMCID: PMC7035913, DOI: 10.1213/ane.0000000000004203.Peer-Reviewed Original ResearchConceptsHemorrhagic strokeCesarean deliveryPregnant womenIschemic strokeGeneral anesthesiaObstetric anesthesiologistHigh-risk obstetriciansLarge stroke trialsPregnancy-related strokeHigh-risk groupRisk of herniationMaternal strokeObstetric indicationsTherapeutic anticoagulationExtremity weaknessStroke neurologistsAcute strokeDevastating complicationNeuraxial analgesiaNonpregnant womenStroke subtypesIntracranial hypertensionRecent strokeVaginal deliveryStroke trials
2018
Implementation of a Quality Improvement Initiative to Decrease Opioid Prescribing After Cesarean Delivery
Prabhu M, Dubois H, James K, Leffert LR, Riley LE, Bateman BT, Henderson M. Implementation of a Quality Improvement Initiative to Decrease Opioid Prescribing After Cesarean Delivery. Obstetrics And Gynecology 2018, 132: 631-636. PMID: 30095765, PMCID: PMC6105442, DOI: 10.1097/aog.0000000000002789.Peer-Reviewed Original ResearchConceptsOpioid refill ratesOpioid tabletsCesarean deliveryOpioid prescribingRefill ratesAnalgesic useMean numberProspective quality improvement studyNonopioid analgesic useDays of dischargeNumber of opioidsPhase 2Quality improvement protocolPhase 1Quality improvement studyQuality improvement initiativesQuality improvement effortsDischarge providersAnalgesic prescriptionOpioid prescriptionsSecondary outcomesDischarge prescriptionsPrimary outcomeΧ analysisOpioidsAnesthetic Treatment of Cardiac Disease During Pregnancy
Cohen KM, Minehart RD, Leffert LR. Anesthetic Treatment of Cardiac Disease During Pregnancy. Current Treatment Options In Cardiovascular Medicine 2018, 20: 66. PMID: 30019160, DOI: 10.1007/s11936-018-0657-4.Peer-Reviewed Original ResearchPhysiologic changesCardiac diseaseCardiac pathologyMaternal-fetal medicine specialistsNormal physiologic changesInterdisciplinary care teamFetal medicine specialistsHemodynamic goalsObstetric indicationsPregnant patientsCesarean deliveryNeuraxial analgesiaAnesthetic managementCoronary diseaseMedical therapyNeuraxial anesthesiaValvular diseaseAnesthetic approachVasoactive agentsPeripartum periodCare teamAnesthetic treatmentMaternal wellbeingMedicine specialistsCardiothoracic surgeonsThe Role of the Anesthesiologist in Preventing Severe Maternal Morbidity and Mortality
McQUAID E, Leffert LR, Bateman BT. The Role of the Anesthesiologist in Preventing Severe Maternal Morbidity and Mortality. Clinical Obstetrics & Gynecology 2018, 61: 372-386. PMID: 29319586, DOI: 10.1097/grf.0000000000000350.Peer-Reviewed Original ResearchMeSH KeywordsAirway ManagementAnesthesia, EpiduralAnesthesia, GeneralAnesthesiologistsAnesthetics, LocalBlood TransfusionEchocardiographyEpidural AbscessFemaleHeadacheHematoma, Epidural, SpinalHumansIntubation, IntratrachealMaternal DeathMeningitisMonitoring, PhysiologicObstetric Labor ComplicationsPhysician's RolePregnancyPuerperal DisordersRespiratory AspirationRisk FactorsConceptsObstetric anesthesiologistSevere maternal morbidityLife-saving interventionsMaternal morbidityCesarean deliveryUnstable patientsGeneral anesthesiaObstetric suiteObstetric proceduresBedside managementClinical scenariosAnesthesiologistsIntensivistsAnesthesiaGreater experienceDeliveryAnalgesiaMorbidityPatientsUnique roleMortalityCliniciansNeuraxial Anesthesia in Obstetric Patients Receiving Thromboprophylaxis With Unfractionated or Low–Molecular-Weight Heparin
Leffert L, Dubois H, Butwick A, Carvalho B, Houle T, Landau R. Neuraxial Anesthesia in Obstetric Patients Receiving Thromboprophylaxis With Unfractionated or Low–Molecular-Weight Heparin. Obstetric Anesthesia Digest 2018, 38: 3-4. DOI: 10.1097/01.aoa.0000529964.63597.d5.Peer-Reviewed Original ResearchSpinal epidural hematomaObstetric patientsNeuraxial anesthesiaWeight heparinVenous thromboembolismCesarean deliveryEpidural hematomaPregnant womenNeuraxial blockadeNational guidelinesPatientsThromboprophylaxisHeparinAnesthesiaSafe useWomenLow-MolecularThromboembolismHematomaBlockadeReview reportsPresent review reportsThe Society for Obstetric Anesthesia and Perinatology Consensus Statement on the Anesthetic Management of Pregnant and Postpartum Women Receiving Thromboprophylaxis or Higher Dose Anticoagulants
Leffert L, Butwick A, Carvalho B, Arendt K, Bates SM, Friedman A, Horlocker T, Houle T, Landau R, Dubois H, Fernando R, Houle T, Kopp S, Montgomery D, Pellegrini J, Smiley R, Toledo P. The Society for Obstetric Anesthesia and Perinatology Consensus Statement on the Anesthetic Management of Pregnant and Postpartum Women Receiving Thromboprophylaxis or Higher Dose Anticoagulants. Anesthesia & Analgesia 2018, 126: 928-944. PMID: 29099429, DOI: 10.1213/ane.0000000000002530.Peer-Reviewed Original ResearchConceptsHigh-dose anticoagulantsConsensus statementMaternal deathsObstetric anesthesiaNeuraxial proceduresPerinatology Consensus StatementPharmacodynamics of anticoagulantsUse of thromboprophylaxisRisk-benefit discussionsKey preventive measuresObstetric populationObstetric surgeryCesarean deliveryNeuraxial analgesiaVenous thromboembolismAnesthetic managementObstetric patientsDifficult airwayNeuraxial anesthesiaGeneral anesthesiaPostpartum womenPregnant womenFetal harmPostpartum periodLeading cause
2017
A Shared Decision-Making Intervention to Guide Opioid Prescribing After Cesarean Delivery
Prabhu M, McQuaid-Hanson E, Hopp S, Burns SM, Leffert LR, Landau R, Lauffenburger JC, Choudhry NK, Kaimal A, Bateman BT. A Shared Decision-Making Intervention to Guide Opioid Prescribing After Cesarean Delivery. Obstetrics And Gynecology 2017, 130: 42-46. PMID: 28594762, PMCID: PMC5482786, DOI: 10.1097/aog.0000000000002094.Peer-Reviewed Original ResearchConceptsCesarean deliveryDecision-making interventionLeftover opioid medicationsNumber of opioidsNumber of tabletsPain resolutionPostcesarean painOpioid medicationsOpioid prescribingOpioid useOxycodone tabletsMedian numberWomenPrescribingPrescriptionComputer-based decision aidDeliveryInterventionDecision aidStandard prescriptionPromising strategyHospitalizationMedicationsOpioidsPainPatterns of Opioid Prescription and Use After Cesarean Delivery
Bateman BT, Cole NM, Maeda A, Burns SM, Houle TT, Huybrechts KF, Clancy CR, Hopp SB, Ecker JL, Ende H, Grewe K, Corradini B, Schoenfeld RE, Sankar K, Day LJ, Harris L, Booth JL, Flood P, Bauer ME, Tsen LC, Landau R, Leffert LR. Patterns of Opioid Prescription and Use After Cesarean Delivery. Obstetrics And Gynecology 2017, 130: 29-35. PMID: 28594763, PMCID: PMC5600205, DOI: 10.1097/aog.0000000000002093.Peer-Reviewed Original ResearchConceptsAmount of opioidsOpioid prescriptionsCesarean deliveryMedian numberLeftover opioid medicationsPhone 2 weeksAcademic medical centerLeftover opioidsOpioid tabletsOpioid medicationsPain controlPain scoresPatient characteristicsOpioid analgesicsPatient satisfactionMedical CenterExcess medicationOpioidsMedicationsPrescriptionStructured interviewsConcomitant increaseWomenDeliveryAnalgesicsNeuraxial Anesthesia in Obstetric Patients Receiving Thromboprophylaxis With Unfractionated or Low-Molecular-Weight Heparin
Leffert LR, Dubois HM, Butwick AJ, Carvalho B, Houle TT, Landau R. Neuraxial Anesthesia in Obstetric Patients Receiving Thromboprophylaxis With Unfractionated or Low-Molecular-Weight Heparin. Anesthesia & Analgesia 2017, 125: 223-231. PMID: 28628578, DOI: 10.1213/ane.0000000000002173.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAnesthesia, ConductionAnesthesia, ObstetricalAnesthesiologyAnestheticsAnticoagulantsCesarean SectionDelivery, ObstetricFemaleHematoma, Epidural, SpinalHeparinHeparin, Low-Molecular-WeightHumansMiddle AgedNerve BlockPregnancyPregnancy Complications, CardiovascularThrombosisYoung AdultConceptsSpinal epidural hematomaCases of SEHNeuraxial anesthesiaObstetric patientsVenous thromboembolismWeight heparinAnesthesia Closed Claims Project databaseSystematic reviewPractice changePostpartum venous thromboembolismVaginal delivery hospitalizationsWeight heparin doseRisk of thromboembolismLarge-scale registriesMajority of womenEnglish-language studiesAnticoagulated womenDelivery hospitalizationsPharmacological thromboprophylaxisAnticoagulant doseCesarean deliveryEpidural hematomaHeparin doseVaginal deliveryGeneral anesthesia
2014
Continuous measurement of cardiac output with the electrical velocimetry method in patients under spinal anesthesia for cesarean delivery
Liu Y, Pian-Smith MC, Leffert LR, Minehart RD, Torri A, Coté C, Kacmarek RM, Jiang Y. Continuous measurement of cardiac output with the electrical velocimetry method in patients under spinal anesthesia for cesarean delivery. Journal Of Clinical Monitoring And Computing 2014, 29: 627-634. PMID: 25510959, DOI: 10.1007/s10877-014-9645-8.Peer-Reviewed Original ResearchConceptsPre-defined time pointsElective cesarean deliveryCardiac outputCesarean deliverySpinal anesthesiaStroke volumeNon-invasive CO monitorContinuous CO monitoringSystemic vascular resistanceTime pointsMajority of patientsPeripheral venous pressureTreatment of hypotensionOnset of hypotensionCO monitoringVascular resistanceHemodynamic profileVenous pressureHemodynamic changesPatient's hemodynamicsPhenylephrine bolusPhenylephrine administrationPatient outcomesObservational studyPatient managementOpioid Abuse and Dependence during Pregnancy
Maeda A, Bateman BT, Clancy CR, Creanga AA, Leffert LR. Opioid Abuse and Dependence during Pregnancy. Anesthesiology 2014, 121: 1158-1165. PMID: 25405293, DOI: 10.1097/aln.0000000000000472.Peer-Reviewed Original ResearchConceptsOpioid abuseObstetrical outcomesIntrauterine growth restrictionNationwide Inpatient SampleObstetrical morbidityPlacental abruptionPreterm laborCesarean deliveryMaternal deathsPremature rupturePregnant womenCardiac arrestRelevant confoundersInpatient SampleGrowth restrictionPreventive strategiesTherapeutic interventionsPregnancyLogistic regressionNationwide trendsHospitalizationPrevalenceAbuseOutcomesUnited States
2013
Spinal Anesthesia in Severe Preeclampsia
Henke VG, Bateman BT, Leffert LR. Spinal Anesthesia in Severe Preeclampsia. Anesthesia & Analgesia 2013, 117: 686-693. PMID: 23868886, DOI: 10.1213/ane.0b013e31829eeef5.Peer-Reviewed Original ResearchConceptsSevere preeclampsiaSpinal anesthesiaIntraoperative hemodynamic managementSpinal-induced hypotensionHealthy parturientsAnesthetic optionsCesarean deliveryEpidural catheterHemodynamic managementNeuraxial anesthesiaEpidural anesthesiaHigh incidencePreeclampsiaAnesthesiaHypotensionSignificant differencesParturientsContraindicationsCatheterIncidenceNeurofibromatosis type 1 and pregnancy complications: a population-based study
Terry AR, Barker FG, Leffert L, Bateman BT, Souter I, Plotkin SR. Neurofibromatosis type 1 and pregnancy complications: a population-based study. American Journal Of Obstetrics And Gynecology 2013, 209: 46.e1-46.e8. PMID: 23535241, DOI: 10.1016/j.ajog.2013.03.029.Peer-Reviewed Original ResearchMeSH KeywordsAdultCesarean SectionFemaleFetal Growth RetardationHumansHypertension, Pregnancy-InducedInfant, NewbornInternational Classification of DiseasesLogistic ModelsMaternal MortalityNeurofibromatosis 1Obstetric Labor, PrematurePre-EclampsiaPregnancyPregnancy ComplicationsRetrospective StudiesUnited StatesConceptsNeurofibromatosis type 1Diagnosis of NF1Deep venous thrombosis/pulmonary embolismPopulation-based retrospective cohort studyVenous thrombosis/pulmonary embolismType 1Pregnancy-related admissionsPregnancy-related hospitalizationsRetrospective cohort studyGeneral obstetric populationAcute cardiac eventsIntrauterine growth restrictionMultivariable logistic regressionPopulation-based studyGestational hypertensionMaternal morbidityObstetric populationPregnancy complicationsPreterm laborCardiac eventsCesarean deliveryCohort studyPeripartum complicationsPulmonary embolismCerebrovascular disease
2010
Management of a parturient with high-grade osteosarcoma of the proximal femur: a multidisciplinary approach
Quaye A, Raskin K, Ecker J, Leffert L. Management of a parturient with high-grade osteosarcoma of the proximal femur: a multidisciplinary approach. International Journal Of Obstetric Anesthesia 2010, 19: 340-342. PMID: 20627530, DOI: 10.1016/j.ijoa.2010.03.013.Peer-Reviewed Original ResearchConceptsHigh-grade osteosarcomaCommon primary malignant bone tumorPrimary malignant bone tumorWeeks of gestationMalignant bone tumorsNewborn baby boyFemoral neck resectionAdjuvant chemotherapyCesarean deliveryMultiparous womenPathologic fractureSpinal anesthesiaSubsequent surgeryLimb salvageThird trimesterOncologic therapyBone tumorsMultidisciplinary planningNeck resectionBaby boyProximal femurOsteosarcomaMultidisciplinary approachPregnancyMothersThe Epidemiology of Postpartum Hemorrhage in a Large, Nationwide Sample of Deliveries
Bateman BT, Berman MF, Riley LE, Leffert LR. The Epidemiology of Postpartum Hemorrhage in a Large, Nationwide Sample of Deliveries. Anesthesia & Analgesia 2010, 110: 1368-1373. PMID: 20237047, DOI: 10.1213/ane.0b013e3181d74898.Peer-Reviewed Original ResearchConceptsPostpartum hemorrhageUterine atonyRisk factorsCesarean deliveryRate of PPHCases of PPHIncidence of PPHSubstantial maternal morbidityIndependent risk factorClinical Modification codesNationwide Inpatient SampleLogistic regression modelingAntepartum haemorrhageDelivery complicationsHospital deathMaternal morbidityMaternal outcomesMultiple gestationsCommon complicationHospital admissionHypertensive diseaseCommon etiologyMaternal ageInpatient SampleContemporary epidemiology