International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2017
Review Meta AnalysisIntrathecal clonidine as an adjuvant for neuraxial anaesthesia during caesarean delivery: a systematic review and meta-analysis of randomised trials.
Clonidine is used as adjuvant to local anaesthetics for spinal anaesthesia. Its potential harm and benefits have not been systematically reviewed in obstetrics, and medical regulatory authorities do not recommend its intrathecal administration. The aim of this study was to assess the safety and efficacy of intrathecal clonidine for caesarean delivery. ⋯ Clonidine is an effective and safe adjuvant to local anaesthetics for spinal anaesthesia for caesarean delivery. This opens the debate as to whether intrathecal clonidine as an "off label" prescription should be reconsidered by medical regulatory authorities.
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Each calendar year the Society for Obstetric Anesthesia and Perinatology invites an individual to conduct a review of the medical literature, identifying clinically relevant publications of interest to the obstetric anesthesia provider. This report of that effort covers the publications from 2015 and includes the categories of anesthesia and analgesia, complications of neuraxial procedures, and the effects of anesthesia on the fetus. Neuraxial procedures represent the foundation of obstetric anesthesia; advances in anesthesia and analgesia include novel modes of administration, and refinements in care of the medically complex patient. ⋯ Finally, there are potential effects of anesthesia on the fetal/neonatal brain, much of which remains poorly defined. An analysis of recent papers suggests that epidural fever is not an independent cause of adverse neurologic fetal injury. On the other hand, evidence continues to grow to support the hypothesis that anesthetic drugs impact neonatal neurologic outcome.