Current opinion in anaesthesiology
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Neuraxial analgesia is considered the gold standard of labour analgesia as it provides the most effective method of pain relief during childbirth. In this article, we explore the recent advances in the initiation and maintenance of epidural analgesia. ⋯ We examine these recent developments in pump technology and epidural delivery systems and evaluate how these have enhanced the mothers' birthing experiences.
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Curr Opin Anaesthesiol · Jun 2015
ReviewPatient-controlled intravenous analgesia remifentanil for labor analgesia: time to stop, think and reconsider.
Remifentanil is a relatively new but commonly used opioid alternative in the management of labor pain relief. The present article evaluates efficacy and safety of patient-controlled intravenous analgesia (PCIA) with remifentanil in the management of labor pain relief. ⋯ Remifentanil PCIA is a valuable analgesic strategy whenever regional analgesia is contraindicated. Using it as first line strategy seems to be contraindicated because of significant respiratory side-effects to the mother. Whenever used advanced and continuous monitoring using capnography, saturation monitoring and one-to-one midwifery care are mandatory!
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The term 'safe use of anesthesia in children is ill-defined and requires definition of and focus on the 'safe conduct of pediatric anesthesia'. ⋯ This initiative addresses the well known perioperative risks in young children, perioperative causes for cerebral morbidity as well as gaps in regulations, teaching and research. Defining the 'who', 'where', 'when' and 'how' in this context provides the framework for the safe conduct of pediatric anesthesia.
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Curr Opin Anaesthesiol · Jun 2015
ReviewThe role of cardiac output monitoring in obstetric anesthesia.
Haemodynamic monitoring in obstetric patients has evolved during the last decade, with the development of minimally invasive and noninvasive continuous cardiac output (CO) monitors. This review focuses on recent articles that improve our understanding of physiology and haemodynamic changes during spinal anaesthesia in healthy pregnant women, and pathophysiology in women with preeclampsia and other cardiovascular disease. ⋯ In healthy women, left lateral tilt remains an important clinical intervention during caesarean delivery, and phenylephrine is an essential early adjunct to fluid therapy. Noradrenaline may have a clinical benefit in selected patients. Carbetocin has similar haemodynamic effects to oxytocin. Haemodynamic changes associated with delivery per se may be minor compared with those due to oxytocin. Uncomplicated severe preeclampsia is usually associated with a normal to raised CO. Early-onset preeclampsia may be associated with more vasoconstriction and lower CO than late-onset disease. Passive leg raising may be useful to judge fluid responsiveness, and lung ultrasound may predict pulmonary oedema in preeclampsia. Further research is warranted to study the area of circulatory changes during delivery and the postpartum period, in healthy and preeclamptic women.
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Curr Opin Anaesthesiol · Jun 2015
ReviewPostcaesarean section analgesia: are opioids still required?
The use of opioids for postoperative pain relief after caesarean section is widely spread. Because of unwanted well known side-effects, alternative drugs and methods of pain relief have been introduced, either in addition to or instead of opioids. Can postcaesarean analgesia be achieved these days without opioids? ⋯ The dependency on opioids for postcaesarean analgesia is diminishing, but in order to develop effective, well tolerated alternatives, more research is needed.In the meantime, opioids are here to stay.