Journal of anesthesia
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The low-dose technique of combined spinal/epidural analgesia is to be welcomed in obstetrics. Its merits include rapid onset of analgesia, with the flexibility of an epidural technique, and high maternal satisfaction. It is a safe and effective technique. ⋯ At our institution, we do not delay spinal anesthesia for urgent cesarean section in order to administer a predetermined volume of fluid; in such cases, we simultaneously administer a fluid preload and spinal anesthesia. Recent studies regarding the use of cell savers for blood conservation in obstetrics are based on small numbers of patients. These studies show great promise, particularly with the modern emphasis on avoiding blood transfusion, which can be massive in this usually young patient population.
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Because it is still in its clinical infancy, it is difficult to predict with confidence exactly what role remifentanil will ultimately play in the delivery of anesthesia (and in other settings). It is clear, however, that remifentanil is a new pharmacologic tool with exciting potential that was not possible with the longer-acting opioids. On the basis of its familiar, fentanyl-like pharmacodynamic behavior and its short-acting pharmacokinetic profile, remifentanil may well be advantageous in a variety of settings in which profound opioid effect with subsequent rapid return of spontaneous ventilation and consciousness is desirable. Ongoing research and wide-spread clinical use will be required before the theoretical advantages associated with a short-acting opioid can be fully explored and confirmed.