What's New | Decker

The care of cardiac patients in pregnancy requires a multidisciplinary team approach with obstetricians skilled in the care of high-risk patients, cardiologists, anesthesiologists, intensivists, and genetic counselors when applicable. Delivery should be in a level III or level IV facility. There should be a detailed plan outlining delivery timing, fluid management, anesthesia planning, and the need for telemetry and invasive cardiac monitoring.
Risk assessment using the WHO classification, CARPREG risk score, or ZAHARA risk score system should be completed at the preconception or initial prenatal visit.
Most patients with cardiovascular disease can safely undergo vaginal delivery. The few instances when cesarean delivery should be considered include: Marfan syndrome with an aortic diameter greater than 40 to 45 mm, acute or chronic aortic dissection, and acute intractable heart failure.
Endocarditis prophylaxis is no longer recommended for pregnant patients with cardiovascular disease in labor due to the extremely low incidence.

Residual postoperative weakness is now known to lead to significant adverse events, including hypoxemia, aspiration, and pneumonia. Despite significant evidence of postoperative neuromuscular weakness in the postanesthesia recovery area, the use of neuromuscular monitoring and administration of reversal agents remain inconsistent between practitioners and across institutions. A more consistent standard of care has not yet been adopted by the anesthesia community.
Sugammadex is an encapsulating agent that allows for rapid reversal of rocuronium-induced neuromuscular blockade and immediate restoration of neuromuscular function, even within minutes of administration of 1.2 mg/kg of intravenous rocuronium. Many clinicians predict that this will decrease the use of succinylcholine for rapid sequence intubations since sugammadex will allow for immediate reversal of neuromuscular blockade in a cannot intubate, cannot ventilate situation. Intubating doses of rocuronium can also now be used for short surgical procedures.
Neuromuscular blocking agents are currently used much less frequently in the ICU. As critically ill patients often have multiorgan dysfunction and potential for significant drug accumulation due to decreased metabolism, they are at high risk for prolonged paralysis and drug side-effects. The role of neuromuscular blocking drugs in the development of critical illness–associated weakness is unclear, making it prudent to limit their use in this population.

Change from mechanical to electronic control systems have enabled customization of ventilation to patients’ needs.
Improved sensors for patient-assist mode has made for a better patient-machine interaction.
Outcome studies for different modes of ventilation have clarified the benefits.

Change from mechanical to electronic control systems have enabled customization of ventilation to patients’ needs.
Improved sensors for patient-assist mode has made for a better patient-machine interaction.
Outcome studies for different modes of ventilation have clarified the benefits.

Decrease in the rates of bacterial pharyngitis complications in developed countries: rheumatic fever, glomerulonephritis
Rapid antigen tests for effective and quick identification of group A streptococcal pharyngitis
Decreased incidence of acute epiglottitis as a result of Hib vaccination
Administration of other classes of antibiotics to circumvent growing resistance to previous conventional treatments

Decrease in the rates of bacterial pharyngitis complications in developed countries: rheumatic fever, glomerulonephritis
Rapid antigen tests for effective and quick identification of group A streptococcal pharyngitis
Decreased incidence of acute epiglottitis as a result of Hib vaccination
Administration of other classes of antibiotics to circumvent growing resistance to previous conventional treatments

DAS181 as novel agent under investigation for treatment of parainfluenza viruses in immunocompromised hosts, and possible influenza
Investigational agent ALN-RSV01 (small interfering RNA to N gene) may reduce risk of bronchiolitis obliterans syndrome in RSV-infected lung transplant recipients
Orally administered, capsid binding antiviral termed vapendavir and inhaled interferon beta under investigation in treating rhinovirus colds in asthmatic patients

DAS181 as novel agent under investigation for treatment of parainfluenza viruses in immunocompromised hosts, and possible influenza
Investigational agent ALN-RSV01 (small interfering RNA to N gene) may reduce risk of bronchiolitis obliterans syndrome in RSV-infected lung transplant recipients
Orally administered, capsid binding antiviral termed vapendavir and inhaled interferon beta under investigation in treating rhinovirus colds in asthmatic patients

Maternal Complications