Anesthesiology clinics
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The peripartum management of the anticoagulated parturient represents a significant clinical challenge to both the obstetrician and the anesthesiologist. This review discusses the causes of thrombosis in the pregnant population, the anticoagulants used for prophylaxis, and treatment of these disorders, along with recommendations for neuraxial blockade in parturients who receive peripartum anticoagulation.
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Remifentanil has been proposed as the most suitable systemic opioid for use in obstetrics. Although the onset and offset are rapid, it cannot achieve maximum effect within the time period of a single uterine contraction. ⋯ As an adjunct to general anesthesia, it is successful in blunting responses to airway manipulation and providing hemodynamic stability in high-risk women. Neonatal effects when used in labor are minimal, but when combined with general anesthesia neonatal depression is unpredictable and more likely with an infusion dose greater than 0.1 microg/kg/min.
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Anesthesiology clinics · Mar 2008
ReviewUltrasound-facilitated epidurals and spinals in obstetrics.
Regional anesthesia is currently the gold standard of practice for pain control in obstetrics. Failures and complications of regional anesthesia can be related to many causes, one of the most important being the blind nature of such techniques. ⋯ The use of preprocedure ultrasound imaging or, eventually, real-time ultrasound guidance should improve not only clinical practice, but also teaching. This article describes the techniques, challenges, and benefits related to the use of ultrasound in guiding lumbar spinals and epidurals.
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Anesthesiology clinics · Dec 2007
ReviewDocumentation and potential tools in long-term opioid therapy for pain.
The field of pain medicine is experiencing increased pressure from regulatory agencies and other sources regarding the continuation, or even initial use, of opioids in pain patients. Therefore, it is essential that pain clinicians provide rationale for engaging in this modality of treatment and provide ample documentation in this regard. Thus, assessment and documentation are cornerstones for both protecting your practice and obtaining optimal patient outcomes while on opioid therapy. Several potential tools and documentation strategies are discussed that will aid clinicians in providing evidence for the continuation of this type of treatment for their patients.