Current opinion in anaesthesiology
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Genomic research in pain, anesthesia and analgesia generated some hope that pharmacogenetics may guide anesthesiologists to provide effective medicine in a 'tailored' manner. Within the field of obstetric anesthesia, relatively few studies have evaluated the effect of polymorphisms on the perception of labor or postcesarean pain or the response to analgesics for childbirth. Because of the multifactorial nature of labor and delivery pain and particularly challenging clinical context, many consider that 'titration of drugs to the desired effect works just fine'. With recent evidence highlighting an association between severe postdelivery pain and persistent pain, early recognition of an increased susceptibility for acute pain has become particularly relevant. ⋯ Although still premature to anticipate clinical implications and a change in practice based on these recent discoveries, genetic variability clearly appears to affect pain perception, response to analgesics and predisposition for the development of chronic pain.
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Curr Opin Anaesthesiol · Jun 2010
ReviewPrevention of maternal hypotension after regional anaesthesia for caesarean section.
Hypotension during regional anaesthesia for caesarean section remains a common clinical problem, particularly for spinal anaesthesia. The purpose of this review is to evaluate recent research in this area with a focus on English language papers from the past 1-2 years. ⋯ Recent research supports decreased use of crystalloid prehydration and ephedrine and increased use of cohydration, colloids, smaller spinal doses and phenylephrine. Further research is required to investigate these techniques in high-risk patients and to evaluate novel monitoring techniques.
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Curr Opin Anaesthesiol · Jun 2010
ReviewPrevalence and predictors of chronic pain after labor and delivery.
Labor pain is a complex phenomenon with sensory, emotional, and perceptive components and can be regarded as one of the most serious kinds of pain. Different strategies to approach acute labor pain have been developed. Chronic pain after labor and delivery has not been studied so extensively. In this review recent findings about chronic pain after labor and delivery will be discussed. ⋯ Treatment of acute pain during labor and delivery is necessary to prevent chronic pain. Future studies should focus on the long-term effects of different analgesic regimens on the development of chronic pain after labor and delivery.
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Curr Opin Anaesthesiol · Jun 2010
ReviewIs the use of colloids for fluid replacement harmless in children?
Albumin has been regarded as the gold standard for maintaining adequate colloid osmotic pressure in children, but increased cost, the lack of clear-cut benefits for survival, and fear of transmission of unknown viruses have contributed to its replacement by hydroxyethyl starch and gelatin preparations. Each of the synthetic colloids has unique physicochemical characteristics that determine their likely efficacy and adverse effect profile. This review will examine the advantages and disadvantages of the use of different colloid solutions in children with a particular focus on their safety profile. ⋯ Tetrastarches offer the best currently available compromise between cost-effectiveness and safety profile in children with preexisting normal renal function and coagulation.
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Curr Opin Anaesthesiol · Jun 2010
ReviewUse of clotting factors and other prohemostatic drugs for obstetric hemorrhage.
To guide the optimal use of blood products and to clarify the indications for prohemostatic drugs in obstetric hemorrhage. ⋯ It seems reasonable to use blood products for transfusion earlier and in a 1: 1 fresh frozen plasma: red blood cell ratio during acute obstetric hemorrhage; however, this analysis is mainly based on trauma literature. Fibrinogen concentrate should be added if the fibrinogen plasma level remains below 1.0 g l(-1) and perhaps even as soon as it falls below 1.5-2.0 g l(-1); the addition of tranexamic acid (1 g) is cheap, likely to be useful and appears safe. Data on the proactive administration of platelets are insufficient to recommend this practice routinely. Presently, recombinant factor VIIa (60-90 microg kg(-1)) is advocated only after failure of other conventional therapies, including embolization or conservative surgery, but prior to obstetric hysterectomy. Prospective randomized controlled trials are highly desirable.