Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2008
ReviewMaintaining labour epidural analgesia: what is the best option?
The intensity of labour pain is influenced by a multitude of factors. In this article, we discuss recent advances in the administration of labour epidural analgesia which have been targeted at creating a more satisfactory birthing experience for the parturient while safeguarding maternal and fetal well being. ⋯ Recent advances in medical technology have equipped us with many novel drug delivery modalities, which will enable us to customize a suitable analgesic regimen for each parturient.
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Clinical practices in oxygen administration are in need of change based on the increasing understanding of oxygen toxicity. Hypoxemia is due to many pathophysiological causes; avoiding hypoxemia is an important objective during neonatal anesthesia. Nevertheless, the only known cause for hyperoxemia is the excess and unnecessary administration of oxygen by healthcare providers. To avoid hyperoxemia is an important objective during neonatal anesthesia. ⋯ Even brief neonatal exposures to pure oxygen must be avoided during neonatal anesthesia. When any dose of supplemental oxygen is given, a reliable pulse oximeter aiming to avoid hyperoxemia is necessary. Even though further research is essential, administration of oxygen by healthcare providers when it is not necessary is a foe and a neonatal health hazard.
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Haemorrhage remains a cause of significant maternal morbidity and mortality. This review summarizes the prevention, management and treatment of obstetric haemorrhage and highlights recent advances and developments. ⋯ Accurate diagnosis and appropriate management of obstetric haemorrhage can reduce maternal morbidity and mortality. This review outlines the current evidence.
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To look at different anesthetic approaches to different surgical techniques used in fetal procedures and the influence of maternal and fetal factors on anesthetic management. ⋯ Open fetal surgery remains a major invasive procedure for mother and fetus both, requiring general anesthesia with adequate invasive monitoring. Minimal invasive fetal procedures can be performed with local anesthesia alone or, for the more complex fetoscopic procedures, with a neuraxial locoregional technique. Fetal anesthesia and analgesia can then be provided by different routes. Ex-utero intrapartum treatment procedures are open fetal procedures, but they can be performed with locoregional anesthesia, when uterine relaxation can be achieved without volatile anesthetics with the use of intravenous nitroglycerin.