2019 Division Update

Brendan Carvalho, Division Chief

Those within obstetric anesthe­siology are breaking with tradition by offering cesarean patients choices about their pain medica­tion. “There’s not a department in the world that has patient-choice analgesia for cesarean or surgery procedures,” says division chief Brendan Carvalho, MD, “so it’s very cutting-edge and different.”

The traditional approach to cesarean analgesia, Carvalho says, is to give each woman the same medication. He and Pamela Flood, MD, conducted studies allowing pa­tients to choose whether they would receive low, medium or high doses of painkillers.

“Patients have a lot of insight,” Carvalho says. “Women who choose the larger dose are more likely to have pain, which can be partially mitigated by giving them the higher dose that they are selecting. Those who choose a lower dose have less pain, so you can give them less and avoid a lot of negative side effects. It’s really patient-centered care.”

Carvalho says allowing patients to make their own decisions regard­ing analgesia was shown to improve their satisfaction. The division plans to incorporate choice in its clinical care model in coming months.

Another key initiative is the development of ObsQoR-10, a validated tool to measure recovery in the 24 to 48 hours following cae­sarian delivery, in which patients answer 10 questions about pain, mobility and mother-baby interac­tion during their hospital stay.

Pervez Sultan, MD, serves as principal investigator in an effort to then biotype and phenotype those patients with the goal of measuring, tracking and predicting their recov­ery. The research team hopes to understand from a biological stand­point why some patients are back to their normal selves two weeks after surgery, while others are still strug­gling to do so six weeks later.

“I think there’s been too much emphasis on pain and opioids after surgery, and not on meaningful metrics of recovery,” Carvalho says. “How do you get back to baseline? We want to understand that and track it over time.”

Sultan is one of the division’s three new additions. He is joined by new hire Jessica Ansari, MD, a former Stanford resident and fellow with an interest in family planning and high-risk patients, Carvalho says. Rounding out the new additions to the division is assistant professor Clemens Ortner, MD, who launched a fellow and faculty training program in transthoracic echocardiology and point-of-care ultrasound (POCUS) testing.

Carvalho says Ortner, who studied at the Medical University of Vienna in Austria, is a unique addition to the division because he is trained in both obstetric and cardiac anesthesia. The curriculum he designed at Stanford has already helped one fellow pass the echocar­diography board exam.

Also within the division, Alex Butwick, MD, and Gillian Abir, MD, are continuing to work with the California Maternal Quality Care Collaborative (CMQCC), which was founded at the Stanford University School of Medicine in 2006. Since it was created, maternal mortality rates have dropped drastically across the state. California is the only state to see such a decrease. CMQCC seeks to improve clinical care for mothers and babies by reviewing all California maternal deaths and mak­ing recommendations for improved maternal care.

Dr Carvalho (left) and Dr Abir (right) receiving the Stanford Center of Excellence Designation Award at SOAP 2019.

This past March, Stanford was among the inaugural group of universities and hospitals to be designated a Society of Obstetric Anesthesia and Perinatology (SOAP) Center of Excellence (COE). The des­ignation recognizes institutions and programs that demonstrate excel­lence in obstetric anesthesia care.

The division presented 18 abstracts at SOAP’s 51st-annual meeting in May in Phoenix and took home several accolades. Those included second and third place for Frederick P. Zuspan awards, which promote collaborative research with obstetricians and anesthesiologists, and being named a finalist for the Gertie Marx Symposium. Looking ahead, Carvalho says the new Stanford main hospital and the Lucile Packard Children’s Hospital will pose opportunities and challenges for his team. Patients look forward to private recovery rooms, he says, but the hospital footprint does not allow for clinical expansion and can make providing optimal care during busy times very challenging.

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