Current opinion in anaesthesiology
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Although childbirth is considered a natural event, some deliveries may necessitate instrumentation or surgical intervention. In contrast with trauma or surgery, persistent pain after delivery has received little attention until recently, despite the large number of individuals potentially at risk. ⋯ Some recent findings on the development of persistent pain after childbirth are intriguing and might open the way to interesting perspectives for the treatment of persistent pain caused by trauma or surgery.
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Curr Opin Anaesthesiol · Jun 2013
ReviewTechniques for the maintenance of epidural labor analgesia.
After initiating neuraxial labor analgesia, there are many techniques that can be used to maintain analgesia for the duration of labor. In this review, we have examined the new techniques of maintenance of epidural labor analgesia recently proposed to overcome the undesirable effects of continuous infusion and patient-controlled epidural analgesia (PCEA). ⋯ Technology has now provided us with more advanced drug delivery systems that may have the potential to fulfill the maternal requirements of a safe, natural, and painless childbirth, tailoring the analgesic regimen for each parturient's need.
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To describe adolescent development within the context of perioperative anesthetic management. ⋯ Adolescents are a very healthy population subject to unintentional and intentional injury. Emotional and judgmental maturation is a cofactor in these injuries, better appreciated through improved understanding of developmental neurobiology. In addition, increases in muscle mass, requirements for nutrition and rest, maladaptive behavior, and health choices are important for optimal perioperative care.
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Curr Opin Anaesthesiol · Jun 2013
ReviewAnesthesia for the patient with congenital heart disease presenting for noncardiac surgery.
To summarize recent publications emphasizing the changes in the population of patients with congenital heart disease and trends in the anesthetic and perioperative care of these patients presenting for noncardiac procedures. ⋯ The identification of high-risk patients, multidisciplinary decision-making and planning and careful anesthetic management and monitoring are critical for optimizing outcomes in children with congenital heart disease presenting for noncardiac procedures.
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Curr Opin Anaesthesiol · Jun 2013
ReviewProphylaxis and treatment of the side-effects of neuraxial morphine analgesia following cesarean delivery.
Neuraxial morphine is commonly used for analgesia after cesarean delivery, but is frequently associated with postoperative nausea and vomiting (PONV) and pruritus. This review describes the recent advances in the management of those side-effects. ⋯ PONV and pruritus are frequent side-effects of neuraxial morphine. Future studies investigating combination antiemetic therapy, long-acting antiemetics, and strategies to manage pruritus are needed.