International journal of obstetric anesthesia
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Int J Obstet Anesth · Feb 2016
Observational StudyPreferences of Jehovah's Witnesses regarding haematological supports in an obstetric setting: experience of a single university teaching hospital.
Jehovah's Witnesses have been shown to be at increased risk of mortality and morbidity as a consequence of obstetric haemorrhage and refusal of blood products. Since 2004, however, Jehovah's Witnesses have been allowed to accept minor fractions of blood at their own discretion. We sought to determine the preferences of pregnant Jehovah's Witnesses regarding haematological supports since this policy change. ⋯ The spectrum of acceptance of blood products is wide ranging within our obstetric Jehovah's Witnesses population. Recombinant factors are not universally acceptable despite their identification as non-blood products. A multidisciplinary approach with individualized consent is recommended.
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Int J Obstet Anesth · Feb 2016
ReviewRemifentanil for labor analgesia: an evidence-based narrative review.
This manuscript reviews the available literature on remifentanil patient-controlled intravenous analgesia in labor focusing on efficacy and safety. Remifentanil compares favorably to other potent systemic opioids but with fewer opioid-related neonatal effects. However, remifentanil provides modest and short-lasting labor analgesia that is consistently inferior when compared to neuraxial analgesia. ⋯ In several studies, remifentanil induced significant respiratory depressant effects in laboring women with episodes of desaturation, hypoventilation and even apnea. Given the safety concerns, we recommend that remifentanil patient-controlled intravenous analgesia should not be a routine analgesia technique during labor. In cases where neuraxial analgesia is refused or contraindicated and the use of remifentanil justified, continuous and careful monitoring is required to detect respiratory depression to provide safe care of both the pregnant woman and unborn child.
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Int J Obstet Anesth · Feb 2016
Randomized Controlled Trial Comparative StudyProgrammed intermittent epidural bolus versus continuous epidural infusion for pain relief during termination of pregnancy: a prospective, double-blind, randomized trial.
Pain is a major concern during medical abortion but no evidence-based recommendations for optimal analgesia during medical termination of pregnancy are available. We compared two methods of epidural analgesia during second trimester termination of pregnancy, with the primary aim of assessing the incidence of motor block. ⋯ During second trimester termination of pregnancy in our patient groups, a programmed intermittent epidural bolus technique was associated with less motor block and greater patient satisfaction than continuous epidural infusion. Both techniques had similar analgesic efficacy.