Article Notes
Chris Tan
Although there remains much conflicting evidence, largely of a low-quality observational nature, the highest quality evidence to date refutes assertions that epidural fentanyl reduces breastfeeding rates.
Notably Lee et al.’s 2017 RCT of over 300 women showed no effect of epidural fentanyl up to 2 mcg/mL and successful maternal breastfeeding up to 6 weeks.
Daniel Jolley
The association of anesthesia in the sitting beach-chair position with intra-operative stroke, continues to be controversial. Although some studies have identified this as a risk, it is still a rare complication, albeit devastating.
Expert opinion suggests intra-arterial blood pressure monitoring is best practice, but most importantly with consideration for actual cerebral perfusion pressure given the sitting position.
Some research suggests regional anaesthesia, possibly combined with spontaneous ventilation GA (rather than relaxation GA with IPPV) offers unique benefits that better maintain cerebral oxygenation, although the exact difference is unclear.
Similarly, the benefit and role of non-invasive cerebral perfusion monitoring has not been conclusively shown, although it appears logical that it may offer benefit in these patients.
Case studies of patients suffering cerebral ischaemia under beach-chair, do point to combinations of poor intra-operative blood pressure management and possibly pre-existing mild cardiovascular disease (eg. hypertension) as contributing to some degree.
Daniel Jolley