Andrea Traynor

All Publications

• Method of anaesthesia impact on total operating room time for second-trimester procedural abortion. BMJ sexual & reproductive health Kaur, S., Ansari, J., Traynor, A. J., Blumenthal, P. D., Henkel, A. 2025

  Abstract

  Hospital-based second-trimester dilation and evacuation (D&E) procedures are often completed using general anaesthesia (GA) despite emerging evidence for the safety of monitored anaesthesia care (MAC). Limited data exist comparing these approaches for key clinical outcomes.This retrospective cohort study compared those who received GA versus MAC during second-trimester (14-24 weeks' gestation) hospital-based D&Es. The primary outcome was total operating room (OR) time; secondary outcomes included surgical time, anaesthetic time, post anaesthesia care unit (PACU) time, estimated blood loss, and respiratory complications. We hypothesised that MAC would reduce the total OR time. We estimated that a sample size of 63 participants in each group would detect a 15-min or greater difference in total OR time with 80% power and a significance level of 0.05. Propensity score matching was used for sensitivity analysis.During the study period, 125 patients received GA and 67 received MAC. Those receiving GA had significantly longer OR times (GA: 60.2±18.1 min vs MAC: 50.1±13.2 min, p=0.005) and greater estimated blood loss (GA: 150±286 mL vs MAC: 88±47 mL, p<0.001). No respiratory complications occurred in either group. A propensity score-matched analysis similarly found GA associated with longer OR time and higher blood loss.MAC may offer additional clinical benefits compared with GA during hospital-based D&E care. MAC reduces OR time and blood loss without compromising safety, which may optimise patient care and resource use in abortion care settings.

  View details for DOI 10.1136/bmjsrh-2025-202793

  View details for PubMedID 40533114

• Obstetric Anesthesia Workforce Survey: 40-year Update. Anesthesiology Bucklin, B. A., Hawkins, J. L., Asdigian, N. L., Kennerley, V., Pattee, J., Traynor, A. J. 2025

  Abstract

  For 40 years, Obstetric Anesthesia Workforce Surveys have been used every decade to assess trends in obstetric anesthesia practice and potential areas for improvement. Anesthesia providers from U.S. hospitals were surveyed in 2022-2023 and provided data for their hospital from 2021. Our primary hypothesis was that obstetric anesthesia services have changed in the last decade.Previous workforce surveys were used to develop the 32-question survey about contemporary obstetric anesthesia practice. A hospital sample (n= 1,180) was generated based on number of births per year and U.S. census region. Using web-push survey methodology, a QR code was assigned to the "Chief of Anesthesiology" at each hospital. A link to an online REDCap survey was emailed to individuals along with reminder communications. Nonresponding hospitals received paper surveys and self-addressed stamped envelopes for survey return. Results were analyzed using R statistical package at a significance level of p<0.05.There were 284 (24%) responses to the survey. Hospitals providing obstetric care have decreased 50% over 4 decades. Seventy-seven percent of respondents work in non-academic hospitals without residency programs. Comparing academic to non-academic hospitals, academic providers are less likely to have other clinical responsibilities, 35% vs 62% respectively. The weighted overall rate of neuraxial labor analgesia is 84%. Elective cesarean deliveries are usually performed with spinal anesthesia (85%). Neuraxial anesthesia is used in 86% of urgent cesareans while 14% use general anesthesia.This is the only study that reports longitudinal obstetric anesthesia data over 40 years. Despite stable annual birth rates in the U.S., the number of hospitals providing obstetric care decreased by 50% over the last 40 years. This study describes non-academic practice and not just academic teaching hospitals. Increased access to neuraxial labor analgesia is a dramatic step towards reducing in-hospital maternal mortality and improving health care disparities.

  View details for DOI 10.1097/ALN.0000000000005507

  View details for PubMedID 40237779

• Preoperative Fasting Times for Patients Undergoing Caesarean Delivery: Before and After a Patient Educational Initiative TURKISH JOURNAL OF ANAESTHESIOLOGY AND REANIMATION Yurashevich, M., Chow, A., Kowalczyk, J. J., Traynor, A. J., Carvalho, B. 2019; 47 (4): 282–86

  View details for DOI 10.5152/TJAR.2019.95770

  View details for Web of Science ID 000475857600002

• Obstetric Anesthesia Workforce Survey: A 30-Year Update ANESTHESIA AND ANALGESIA Traynor, A. J., Aragon, M., Ghosh, D., Choi, R. S., Dingmann, C., Zung Vu Tran, Z. V., Bucklin, B. A. 2016; 122 (6): 1939-1946

  Abstract

  Obstetric Anesthesia Workforce Surveys were conducted in 1981, 1992, and 2001, and the 10-year update was conducted in 2012. Anesthesia providers from US hospitals were surveyed to identify the methods used to provide obstetric anesthesia. Our primary hypothesis was that the provision of obstetric anesthesia services has changed in the past 10 years.A sample of hospitals was generated based on the number of births per year and US census region. Strata were defined as follows: I ≥ 1500 annual births (n = 341), II ≥ 500 to 1499 annual births (n = 438), and III < 500 annual births (n = 414). Contact email information for the anesthesia provider in charge of obstetric services was obtained by phone call. Electronic questionnaires were sent through email.Administration of neuraxial (referred to as "regional" in previous surveys) labor analgesia was available 24 hours per day in all stratum I hospitals responding to the survey. Respondents across all strata reported high rates of in-house coverage, with 86.3% (95% confidence interval [CI] = 82.7%-90%) of stratum I providers reporting that they provided in-house anesthesiology services for obstetrics. The use of patient-controlled epidural analgesia in stratum I hospitals was reported to be 35% in 2001 and 77.6% (95% CI = 73.2%-82.1%) in this survey. Independent Certified Registered Nurse Anesthetists were reported to provide obstetric anesthesia services in 68% (95% CI = 57.9%-77.0%) of stratum III hospitals. Although 76% (95% CI = 71.2%-80.3%) of responding stratum I hospitals allow postpartum tubal ligations, 14% report inadequate staffing to provide anesthesia either always or at off-hours.Since 2001, there have been significant changes in how responding hospitals provide obstetric anesthesia care and staff the labor and delivery ward. Obstetric anesthesia surveys, updated every 10 years, continue to provide information about changes in obstetric anesthesia practice.

  View details for DOI 10.1213/ANE.0000000000001204

  View details for Web of Science ID 000376463000033

  View details for PubMedID 27088993

• Experimental heat pain for detecting pregnancy-induced analgesia in humans ANESTHESIA AND ANALGESIA Carvalho, B., Angst, M. S., Fuller, A. J., Lin, E., Mathusamy, A. D., Riley, E. T. 2006; 103 (5): 1283-1287

  Abstract

  Animal studies suggest that increased circulating estrogen and progesterone, and activation of the endorphin system cause prenancy-induced antinociceptive effects. Human studies have provided inconsistent results and have often lacked a nonpregnant control group. In this study, we compared sensitivity to experimental heat and cold pain in pregnant and nonpregnant women. Nineteen healthy nonpregnant female volunteers and 20 pregnant women at term were enrolled. Pain threshold and tolerance were examined using experimental heat-induced pain and cold pressor pain models. Subjects were evaluated pre- and 1-2 days post-delivery (pregnant), or on consecutive days (nonpregnant). Heat pain tolerance was significantly increased in the pregnant women during pre and postdelivery when compared with nonpregnant controls (50.0 +/- 1.0 vs 49.0 +/- 1.2 and 50.1 +/- 0.7 vs 49.2 +/- 1.2 degrees C; mean +/- sd). However, pain induced by the cold pressor test was endured for a similar amount of time by both study groups. Pregnancy-induced analgesic effects at term can be detected in a model of experimental heat pain. These effects persist during the first 24-48 h after delivery. Experimental heat pain is a suitable modality for further characterizing the phenomenon of pregnancy-induced analgesia in humans.

  View details for DOI 10.1213/01.ane.0000239224.48719.28

  View details for PubMedID 17056970

• Valdecoxib for postoperative pain management after cesarean delivery: A randomized, double-blind, placebo-controlled study 37th Annual Meeting of the Society-for-Obstetric-Anesthesia-and-Perinatology Carvalho, B., Chu, L., Fuller, A., Cohen, S. E., Riley, E. T. LIPPINCOTT WILLIAMS & WILKINS. 2006: 664–70

  Abstract

  Although nonsteroidal antiinflammatory drugs (NSAIDs) improve postoperative pain relief after cesarean delivery, they carry potential side effects (e.g., bleeding). Perioperative cyclooxygenase (COX)-2 inhibitors show similar analgesic efficacy to nonsteroidal antiinflammatory drugs in many surgical models but have not been studied after cesarean delivery. We designed this randomized double-blind study to determine the analgesic efficacy and opioid-sparing effects of valdecoxib after cesarean delivery. Healthy patients undergoing elective cesarean delivery under spinal anesthesia were randomized to receive oral valdecoxib 20 mg or placebo every 12 h for 72 h postoperatively. As a result of cyclooxygenase-2 inhibitors safety concerns that became apparent during this study, the study was terminated early after evaluating 48 patients. We found no differences in total analgesic consumption between the valdecoxib and placebo groups (121 +/- 70 versus 143 +/- 77 morphine mg-equivalents, respectively; P = 0.26). Pain at rest and during activity were similar between the groups despite adequate post hoc power to have detected a clinically significant difference. There were also no differences in IV morphine requirements, time to first analgesic request, patient satisfaction, side effects, breast-feeding success, or functional activity. Postoperative pain was generally well controlled. Adding valdecoxib after cesarean delivery under spinal anesthesia with intrathecal morphine is not supported at this time.

  View details for DOI 10.1213/01.ane.0000229702.42426.a6

  View details for PubMedID 16931678

• Epidural anesthesia for elective cesarean delivery with intraoperative arterial occlusion balloon catheter placement 36th Annual Meeting of the Society-for-Obstetric-Anesthesia-and-Perinatology Fuller, A. J., Carvalho, B., Brummel, C., Riley, E. T. LIPPINCOTT WILLIAMS & WILKINS. 2006: 585–87

  Abstract

  Obstetric hemorrhage is a leading cause of maternal mortality. We describe the anesthetic management of elective cesarean delivery in patients at high risk for hemorrhage. The utility and limitations of intraarterial balloon catheter placement and epidural anesthesia are described.

  View details for DOI 10.1213/01.ane.0000189551.61937.ea

  View details for Web of Science ID 000234912900049

  View details for PubMedID 16428566