Journal of clinical anesthesia
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Complications of ophthalmologic nerve blocks are rare, but they can have serious life- and sight-threatening consequences. Knowledge of the potential complications is essential for the anesthesiologist who performs ophthalmologic nerve blocks. However, most anesthesiologists are unfamiliar with these complications because the majority have been reported in the ophthalmology literature. We review the complications that may occur during the placement of ophthalmologic blocks and their appropriate prompt treatment.
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Anesthesia-related complications are the sixth leading cause of pregnancy-related maternal mortality in the United States. Difficult or failed intubation following induction of general anesthesia for cesarean delivery remains the major contributory factor to anesthesia-related maternal complications. Although the use of general anesthesia has been declining in obstetric patients, it may still be required in selected cases. Because difficult intubation in obstetric anesthesia practice is frequently unexpected, careful and timely preanesthetic evaluation of all parturients should identify the majority of patients with difficult airway and avoid unexpected difficult airway management.
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Fever is a common clinical problem in labor and delivery suites. It can result from a variety of infectious microorganisms, tissue trauma, malignancy, drug administration, and endocrine and immunologic disorders. ⋯ The diagnosis of infection in pregnancy often raises questions about the safety of regional anesthesia in febrile patients. Despite this concern, and lack of universal guidelines, it has now been well established that the presence of infection and fever in labor does not always contraindicate the administration of regional anesthesia.
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Substance abuse has crossed social, economic, and geographic borders and--throughout the world--remains one of the major problems facing society today. The prevalence of substance abuse in young adults (including women) has increased markedly over the past 20 years. ⋯ The diverse clinical manifestations of drug abuse combined with physiologic changes of pregnancy, and pathophysiology of coexisting pregnancy-related disease may lead to life-threatening complications and significantly impact the practice of obstetrical anesthesia. Regardless of the drug(s) ingested and clinical manifestations, it is always difficult to predict the exact anesthetic implications in chemically dependent patients.
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When intrathecal and epidural opioids are administered, pruritus occurs as an unwanted and troublesome side effect. The reported incidence varies between 30% and 100%. The exact mechanisms of neuraxial opioid-induced pruritus remain unclear. ⋯ The treatment of intrathecal opioid-induced pruritus remains a challenge. Many pharmacological therapies, including antihistamines, 5-HT(3)-receptor antagonists, opiate-antagonists, propofol, nonsteroid antiinflammatory drugs, and droperidol, have been studied. In this review, we will summarize pathophysiological and pharmacological advances that will improve understanding and ultimately the management of this troublesome problem.