International journal of obstetric anesthesia
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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
ReviewIntracranial subdural haematoma following neuraxial anaesthesia in the obstetric population: a literature review with analysis of 56 reported cases.
Intracranial subdural haematoma is a rare but serious complication of neuraxial anaesthesia. With early diagnosis and treatment, severe neurological sequelae can be avoided. A literature search of intracranial subdural haematoma following neuraxial anaesthesia in obstetric patients was performed. Based on the findings, a flow chart on how to assess postpartum headache following a neuraxial procedure is proposed. ⋯ Intracranial subdural haematoma following neuraxial anaesthesia in obstetric patients is rare but serious complications may result. Vigilance is required whenever a headache becomes non-postural, prolonged and/or whenever focal neurological signs occur.