Current opinion in anaesthesiology
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Caudal epidural blockade remains the cornerstone of pediatric regional anesthesia. In this article we provide a comprehensive review of the recent developments in caudal anesthesia in infants and children. ⋯ The addition of ketamine or clonidine to a caudal local anesthetic prolong the duration of the block. However, a preservative-free preparation of ketamine that is suitable for neuraxial use is not widely available. Ultrasound imaging and electrical stimulation are promising options to accurately position a caudal needle. However, because ultrasound imaging is more difficult in older children, nerve stimulation is a more-suitable technique to accurately guide caudal catheters in this patient population. Although complications associated with caudal block are rare, the risks and benefits must be carefully considered on an individual basis.
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Curr Opin Anaesthesiol · Jun 2005
Recent advances in patient-controlled epidural analgesia for labour.
Patient-controlled epidural analgesia (PCEA) is a relatively new mode of maintenance of labour analgesia. The purpose of this review is to demonstrate that PCEA has several advantages over continuous-infusion analgesia and to discuss recent refinements in the use of PCEA for labour. ⋯ PCEA has proven to be a safe, convenient, and highly effective way to maintain labour analgesia. Parturients appreciate the control they have over the analgesia received throughout labour when this method is used.
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With the continuous development of technological advances for diagnosis and treatment comes the increased need for anesthesia outside of the operating room. Children, because of their inability to cooperate with lengthy imaging procedures or painful treatments, form the largest group needing non operating room anesthesia (NORA). As the distinction between deep sedation and general anesthesia becomes less clear, it has become increasingly common for institutions to dedicate resources for pediatric NORA (as opposed to sedation services) to improve predictability, comfort, and safety. ⋯ NORA is a specific microsystem environment that must integrate operating room systems with those of other departments and specialties. Often the children that require these procedures have chronic illnesses and return at frequent intervals with complex medical, psychological, and behavioral issues. Special knowledge, training, and support infrastructure are required to provide optimal care for these expanding services.
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To review the most recent data on labor analgesia and the risk of fetal heart rate changes. ⋯ Despite the potential of neuraxial analgesia to cause fetal heart rate problems, neuraxial analgesia is the most effective and safest form of labor analgesia. Specific techniques of labor analgesia, such as high-dose spinal opioids or intrathecal clonidine, must be avoided based on the most recent evidence. Maternal and neonatal outcome is good following regional analgesia.
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During the last few years, drug abuse has risen to the point that almost 20 million Americans are current abusers of illicit substances. These patients present to us as anesthesiologists in a variety of circumstances: in obstetrics for labor and emergencies, in trauma for emergency surgeries or life-saving (resuscitative) situations and in everyday elective surgeries. Therefore it is important for anesthesiologists to know about the most common illicit drugs being used, to know their side effects and clinical presentation if abused or intoxicated, and to know what anesthetic options would be beneficial or detrimental. ⋯ Illicit substance abuse is a major health concern in the United States. Drug use, either acute or chronic, has potentially grave consequences which include changes affecting the pulmonary, cardiovascular, nervous, renal and hepatic systems. Anesthesiologists come into contact with these patients in emergency and everyday situations. Due to the diverse clinical presentations that may arise from single substance or polysubstance abuse, anesthetic management should be tailored to each individual and universal precautions should always be followed when providing care.