Articles: analgesia.
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Although variable, labor pain is among the most severe of pain syndromes, and has been described as severe to excruciating in 50 to 70 percent of primiparas. "Twilight sleep" or amnesia was commonly used in the first half of this century via potent intramuscular, intravenous and inhalational agents. Subsequently, epidural anesthesia, first caudal then lumbar was used which offered superior pain relief without clouding the sensorium. However, epidurals with local anesthetics also contributed to dense sensory and motor blocks which are not necessary for labor. Presently, both spinal and epidural opioids are used along with decreasing doses of local anesthetics, rendering the laboring patient a relatively pain-free labor but allowing her more mobility and control of her environment.
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Although hypothermia has been reported during epidural anesthesia performed for nonobstetrical surgery or cesarean section, epidural analgesia for labor may lead to hyperthermia. Its incidence, time-course and intensity are influenced by multiple factors including site of measurement, duration of labor preceding epidural analgesia and perhaps ambient temperature and occurrence of shivering. During the first 2-5 h of epidural analgesia, a significant increase in temperature is not usually observed. ⋯ However, fetal tachycardia may occur and the potential for a deleterious effect on the fetus remains controversial. Various measures for cooling the mother have been proposed but their efficacy has not been evaluated. The recognition that epidural analgesia may provoke hyperthermia may help to avoid inappropriate use of antibiotics or fetal extraction.
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Paediatric anaesthesia · Jan 1997
Randomized Controlled Trial Clinical TrialDiclofenac vs oxybuprocaine eyedrops for analgesia in paediatric strabismus surgery.
Forty children undergoing strabismus surgery as day patients were randomly allocated to receive oxybuprocaine 0.4% eyedrops or 0.1% diclofenac eyedrops for perioperative analgesia. A non-invasive anaesthetic technique using the reinforced laryngeal mask airway was used. The study demonstrated that both topical analgesics provided good to excellent analgesia and the anaesthetic technique was associated with a relatively low incidence of nausea and vomiting. Complications were limited to two children who were admitted with persistent postoperative nausea and vomiting.
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Paediatric anaesthesia · Jan 1997
Case ReportsRespiratory depression following epidural morphine in an infant of three months of age.
Epidural administration of combinations of opioids and a local anaesthetic provides prompt and effective analgesia and is increasingly used in paediatric anaesthesia. However, respiratory depression by rostral spread of opioid in the CSF is by far the greatest concern after epidural morphine. An infant of three months of age underwent portoenterostomy (Kasai's operation) for extrahepatic biliary duct atresia. ⋯ Low arterial saturation (SpO2) was detected by pulse oximetry and confirmed by blood gas analysis. An intravenous bolus of 5 micrograms.kg-1 naloxone followed by a 3-h infusion of 2 micrograms.kg-1.h-1 resulted in complete reversal of signs and symptoms of respiratory depression. Epidural opioids should be limited to paediatric patients admitted to specialized recovery units for the first postoperative day.