Seminars in perinatology
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Seminars in perinatology · Apr 2002
ReviewEpidural analgesia: effects on labor progress and maternal and neonatal outcome.
The intended and unintended effects of epidural labor analgesia are reviewed. Mothers randomized to epidural rather than parenteral opioid analgesia have better pain relief. Fetal oxygenation is not affected by analgesic method; however, neonates whose mothers received intravenous or intramuscular opioids rather than epidural analgesia require more naloxone and have lower Apgar scores. ⋯ Epidural analgesia has no affect but intrapartum opioids decrease lactation success. Epidural use and urinary incontinence are weakly, but probably not causally, associated. Epidural labor analgesia would improve if the mechanisms of these unintended effects could be determined.
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Several new techniques and medications are available for epidural labor analgesia. Two significant additions are ropivacaine and levobupivacaine. ⋯ The clinical implications of patient controlled epidural analgesia and ambulatory epidural techniques are discussed. The controversies surrounding epidural test dose and fluid preloading are examined.
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Seminars in perinatology · Apr 2002
ReviewAnesthesia for nonobstetric surgery in the pregnant patient.
Each year over 75,000 pregnant women in the United States undergo nonobstetric surgery. The operations include those directly related to pregnancy, such as cerclage, those indirectly related to pregnancy, such as ovarian cystectomy, and those unrelated to gestation, such as appendectomy. When a pregnant woman presents for surgery, it is a stressful event for everyone involved. ⋯ This article reviews the physiologic and anatomic changes that affect anesthetic care during pregnancy. The author also reviews the effects of anesthetic drugs and perioperative events on the fetus and on the pregnancy outcome. The relatively small number of published series are reviewed as well as the controversial recommendations regarding fetal and maternal monitoring during surgery.
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Seminars in perinatology · Apr 2002
ReviewCombined spinal-epidural analgesia for labor: breakthrough or unjustified invasion?
The combined spina-epidural (CSE) technique has become increasingly popular for labor analgesia. The advantages of the CSE include more rapid onset of analgesia, reduced total drug dosage, minimal or no motor blockade, and increased patient satisfaction. ⋯ Despite these potential advantages, the indications for CSE versus epidural analgesia remain unclear and controversial. This review should allow better understanding of the benefits and risks of this technique, and bearing in mind that no ultimate neuraxial analgesic exists, it would seem that CSE should be considered a major breakthrough in the management of labor analgesia.
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Seminars in perinatology · Apr 2002
ReviewComplications associated with regional anesthesia in the obstetric patient.
The majority of obstetric patients are concerned about labor pains but also have fears regarding regional anesthesia and its potential effects on themselves and their babies. Anesthesiologists and obstetricians alike must be familiar with potential complications of obstetric regional anesthesia and analgesia, and also be able to provide the information and reassurance each patient needs. ⋯ This article discusses the diagnostic clues, laboratory tests, and management of neurologic complications related to obstetric delivery and regional anesthesia, as well as the topics of infections, obstetric- and anesthetic-related neurologic deficits, and special tips on neurologic examination. The most common neurologic complication of spinal and epidural anesthesia, postdural puncture headache, will not be discussed in detail here.