Ann Acad Med Singap
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The prevalence of recreational drug abuse among young adults, including women, has increased markedly over the last 2 decades. Nearly 90 % of these women are of childbearing age. Marijuana remains the drug most commonly used for recreational purposes in pregnancy. However, there appears to be an absence of uniform guidelines for obstetric and anaesthetic management of pregnant patients with a history of marijuana abuse. ⋯ In the absence of uniform anaesthetic guidelines for pregnant patients with a history of drug abuse, including abuse of marijuana, the decision regarding administration of peripartum analgesia or anaesthesia should be individualised and conducted on a case-by-case basis.
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Molecular adsorbent recirculating system (MARS) for albumin liver dialysis has been used as a bridge to liver transplantation in patients with fulminant hepatic failure (FHF). This review examines the available data on its clinical use, its technical aspects and present gaps in knowledge. ⋯ MARS is an effective and, thus far, safe homeostatic tool in treating FHF. More studies are needed to delineate its role as a homeostatic tool in less severe forms of ALF, including that which occurs in multi-organ failure and in AoCLF. Other studies need to focus on the optimal timing of initiation of and intensity of MARS albumin liver dialysis. The larger issue is to compare MARS with bio-assist liver devices in treating the whole spectrum of ALF.