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 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
The 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 roleMortalityCliniciansThe 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
Neuraxial 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