Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Sep 2003
Review Comparative StudySpinal anaesthesia for obstetrics.
For a long time, epidural anaesthesia has been considered the method of choice for Caesarean delivery. The increased incidence of hypotension by the rapid onset of sympathetic blockade under spinal anaesthesia has been associated with a decline in uteroplacental blood flow and significant fetal acidosis, which may compromise neonatal well-being. Nevertheless, a decrease in fetal pH has not been shown to reduce neonatal Apgar or neurobehavioural assessment scores. ⋯ Spinal anaesthesia is now considered the method of choice for urgent Caesarean section. The use of intrathecal opioids has profoundly changed the quality of spinal anaesthesia, with improved analgesia, a reduction in local anaesthetic requirements and shorter duration of motor blockade. Preliminary studies indicate that spinal anaesthesia may be safely performed in patients with severe pre-eclampsia, in whom spinal anaesthesia was previously considered contraindicated.
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Best Pract Res Clin Anaesthesiol · Sep 2003
Case Reports Comparative StudyIntrathecal neurolytic blocks for the relief of cancer pain.
Intrathecal neurolytic blocks for the treatment of chronic pain were first described by Dogliotti in 1931. Since then, many authors have described the intrathecal injection of various neurolytic substances for the treatment of oncologic pain. In recent years, alcohol and phenol have been the substances most commonly used for this purpose. ⋯ Four cases of cancer patients whose intractable pain was treated by the authors using intrathecal neurolysis are presented. Pertinent literature is reviewed. In this account, the emphasis is on proper selection of patients and techniques.
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The use of spinal anaesthesia in children has been primarily limited to situations in which general anaesthesia was considered to pose an excessive risk. The ex-premature infant and the neurologically impaired child account for the majority of spinal anaesthetics used today. Spinal anaesthesia, compared with general anaesthesia, in the ex-premature infant undergoing inguinal hernia repair has decreased postoperative respiratory complications (e.g. apnoeic events, prolonged mechanical ventilation). ⋯ Advances in spinal needle design have decreased the incidence of postdural puncture headache (PDPH). Catastrophic events have occurred with neuraxial techniques. Care must be taken in evaluating the relative risks of anaesthetic approaches in infants and children.