Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2009
Editorial CommentPatient safety revisited: reliability is paramount.
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Patient-controlled epidural analgesia (PCEA) for labor was introduced into clinical practice 20 yr ago. The PCEA technique has been shown to have significant benefits when compared with continuous epidural infusion. We conducted a systematic review using MEDLINE and EMBASE (1988-April 1, 2008) of all randomized, controlled trials in parturients who received PCEA in labor in which one of the following comparisons were made: background infusion versus none; ropivacaine versus bupivacaine; high versus low concentrations of local anesthetics; and new strategies versus standard strategies. ⋯ Many strategies with PCEA can provide effective labor analgesia. High volume, dilute local anesthetic solutions with a continuous background infusion appear to be the most successful strategy. Research into new delivery strategies, such as mandatory programmed intermittent boluses and computerized feedback dosing, is ongoing.
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Anesthesia and analgesia · Mar 2009
Meta AnalysisMethemoglobinemia related to local anesthetics: a summary of 242 episodes.
The purpose of this article is to summarize all episodes of local anesthetic-related methemoglobinemia found in the medical literature. ⋯ Benzocaine should no longer be used. Prilocaine should not be used in children younger than 6-mo-old, in pregnant women, or in patients taking other oxidizing drugs. The dose should be limited to 2.5 mg/kg.