Articles: analgesics.
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Cahiers d'anesthésiologie · Jan 1992
Review[Fetal and neonatal effects of perimedullary opioids used in obstetrical anesthesia].
The use of spinal or epidural narcotics is more and more frequent in obstetric patients since it enhances the analgesia induced by local anesthetics. However, specific information regarding their fetal and neonatal effects is rare. Fetal effects are mainly dependent on the respiratory and hemodynamic maternal effects, and thus usually limited when usual low dosages of intraspinal narcotics are used. ⋯ In contrast, the evaluation of Apgar and neurobehavioral scores, performed for all the narcotics used, shows little changes when low dosages are used. However, the use of larger dosages epidurally is associated with an increased frequency of low neurobehavioral scores. Therefore, the use of low dosages of epidural narcotics is recommended since there is little available information about the risk of neonatal respiratory depression and no clear maternal advantage of higher dosages.
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Erroneous presumptions about children's reactions to pain have misguided professionals' management of this issue. Recent recognition and understanding of the pain experience in children have prompted research and clinical advances in treatment and care. Considerable study is still needed to further comprehend the difference between the perception and reaction to pain in the pediatric population.
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The use of patient-controlled analgesia in children and adolescents undergoing major surgery is safe and effective provided that patients are carefully selected, adequate information is provided to patients, adequate training is given to hospital staff and efficacy as well as side-effects are appropriately monitored. Practical guidelines and examples of complications are given.
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Four patients with severe and intractable cancer pain were treated with continuous subarachnoid analgesia (CSA). All patients underwent placement of a 32-gauge subarachnoid catheter attached to an infusion pump allowing continuous administration of local anesthetic agent and morphine. ⋯ At present, CSA is not a routine treatment, because it may lead to severe complications. CSA produces excellent pain relief without disturbing consciousness and is recommended for the treatment of severe and intractable cancer pain.