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1.
Medicine (Baltimore) ; 99(1): e18673, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895835

RESUMO

The documents on the median effective concentration of local analgesic were many in primiparas during labor analgesia. However, the studies were fewer in multiparas. To explore the analgesic requirements in multiparas during epidural labor analgesia, we investigated the median effective concentration of ropivacaine with 2 µg/mL fentanyl for epidural labor analgesia in multiparas.Sixty-two women were recruited and assigned to the primipara group and multipara group in this prospective study. All the parturients received ropivacaine combined with 2 µg/mL fentanyl for epidural labor analgesia. The concentration of ropivacaine was determined by the up and down method and an initial concentration was set as 0.1% with a 0.01% interval. Effective analgesia was defined as the visual analog scale (VAS) ≤3 within 30 minutes after epidural administration when cervical dilatation is about 2 cm. The median effective concentration of ropivacaine was calculated by the up and down sequential method. The pain intensity was assessed using VAS. Hemodynamic parameters, the labor stages, and neonatal Apgar scores were recorded. Umbilical artery blood was drawn to analyze. The side effects, if any, were also recorded.The median effective concentration of ropivacaine was 0.057% (95% confidence interval [CI], 0.051-0.064%) in primiparas during epidural labor analgesia, and 0.068% (95% CI, 0.063-0.072%) in multiparas during epidural labor analgesia, there was significant difference between the groups (P = .02).This study indicated that the median effective concentration of ropivacaine with fentanyl for epidural labor analgesia was 0.068% (95% CI, 0.063-0.072%) and increased in multiparas compared with the primiparas (www.chictr.org.cn, registration number: ChiCTR-1800016486).


Assuntos
Analgesia Epidural , Analgesia Obstétrica , Anestésicos Locais/administração & dosagem , Paridade , Ropivacaina/administração & dosagem , Adulto , Feminino , Humanos , Gravidez
2.
Rev Fac Cien Med Univ Nac Cordoba ; 76(3): 170-173, 2019 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-31465185

RESUMO

AIM: To compare the effect on epidural catheter migration of three different types of dressing used in labor. INTRODUCTION: Failure of labor epidural is due to multiple factors including catheter migration. Epidural catheter migration has been showed to be related to body mass index and patient position. The dressing technique also influences catheter migration and the risk of epidural failure. METHODS: Patients were randomly allocated to one of three groups based on type of dressing of labor epidural: TegadermTM (Group T), TegadermTM with sticky pad (Group P), and TegadermTM with Steri-StripTM (Group S). Measured variables included parity, gestational age, body mass index (BMI), level of puncture and distance of epidural catheter migration. RESULTS: There was an overall difference in epidural catheter migration (ECM) distance among different groups (p<0.05). Pairwise comparison revealed only a significant difference between groups P and T (0.76±1.35 vs. -0.14±1.03, p<0.01). CONCLUSION: Taping the lumbar epidural catheter used for labor analgesia with TegadermTM is inferior to TegadermTM with sticky pad or with Steri-StripTM in terms of catheter migration. There is no association of catheter migration and BMI.


Assuntos
Analgesia Epidural/efeitos adversos , Analgesia Obstétrica/efeitos adversos , Migração de Corpo Estranho/prevenção & controle , Complicações do Trabalho de Parto/prevenção & controle , Adulto , Analgesia Epidural/instrumentação , Analgesia Epidural/métodos , Analgesia Obstétrica/instrumentação , Analgesia Obstétrica/métodos , Bandagens , Índice de Massa Corporal , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/instrumentação , Cateterismo Periférico/métodos , Feminino , Migração de Corpo Estranho/etiologia , Humanos , Complicações do Trabalho de Parto/etiologia , Gravidez , Fatores de Risco
3.
Artigo em Inglês | MEDLINE | ID: mdl-31443209

RESUMO

OBJECTIVE: To appraise the relationship between the length of exposure to epidural analgesia and the risk of non-spontaneous birth, and to identify additional risk factors. This study is framed within the MidconBirth project. STUDY DESIGN: A multicentre prospective study was conducted between July 2016 and November 2017 in three maternity hospitals in different Spanish regions. The independent variable of the study was the length of exposure to epidural analgesia, and the dependent variable was the type of birth in women with uncomplicated pregnancies. The data was analyzed separately by parity. A multivariate logistic regression was performed. The odds ratios (OR), using 95% confidence intervals (CI) were constructed. MAIN OUTCOME MEASURES: During the study period, 807 eligible women gave birth. Non-spontaneous births occurred in 29.37% of the sample, and 75.59% received oxytocin for augmentation of labour. The mean exposure length to epidural analgesia when non-spontaneous birth happened was 8.05 for primiparous and 6.32 for multiparous women (5.98 and 3.37 in spontaneous birth, respectively). A logistic regression showed the length of exposure to epidural during labour was the major predictor for non-spontaneous births in primiparous and multiparous women followed by use of oxytocin (multiparous group). CONCLUSIONS: The length of exposure to epidural analgesia during labour is associated with non-spontaneous births in our study. It highlights the need for practice change through the development of clinical guidelines, training programs for professionals and the continuity of midwifery care in order to support women to cope with labour pain using less invasive forms of analgesia. Women also need to be provided with evidence-based information.


Assuntos
Analgesia Epidural/efeitos adversos , Analgesia Obstétrica/efeitos adversos , Cesárea/métodos , Dor do Parto/tratamento farmacológico , Trabalho de Parto/efeitos dos fármacos , Tocologia/métodos , Parto/efeitos dos fármacos , Adulto , Feminino , Humanos , Razão de Chances , Gravidez , Estudos Prospectivos , Medição de Risco , Espanha , Fatores de Tempo
4.
Zhen Ci Yan Jiu ; 44(6): 434-8, 2019 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-31368267

RESUMO

OBJECTIVE: To investigate the efficacy of acupoint injection of Ropivacaine for labor analgesia and its effect on breastfeeding and prolactin secretion. METHODS: A total of 80 primipara who asked to receive labor analgesia were randomized into epidural analgesia group (n=35) and acupoint injection group (n=36), and other 36 primipara who refused to receive labor analgesia were subjected to the control group. The labor analgesia began to be performed when the puerpera's uterine orifice opened about ≥3 cm (the first stage of labor), including puerpera controlled epidural analgesia (PCEA, Sufentainil + 0.1% Ropivacaine hydrochloride, 5 µg/mL at L3-L4 interspace, till the birth of fetus) or acupoint injection of Ropivacaine (0.2%, 1 mL/acupoint) at bilateral Hegu (LI4) and Sanyinjiao (SP6). The delivery situations such as the duration of labor, and number of cases who used oxytocin, obstetric-forceps-aided delivery, cesarean delivery were recorded. The serum prolactin concentration was assayed by using ELISA. The visual analogue scale (VAS) scores at the time points of T0 (about 3 cm widening of the orifice of uterus and before performing analgesia), T1 (30 min after labor analgesia), T2(about 10 cm widening of the orifice of uterus) and T3(coming out of fetal head). The duration of labor, ratio of use of oxytocin, onset time of breastfeeding, and times of breastfeeding within 24 postpartum hours were recorded accordingly. RESULTS: The VAS scores at time-points of T1, T2 and T3 were significantly lower in both epidural analgesia and acupoint injection groups in comparison with their own T0 and the control group (P<0.05), and were also considerably higher in the acupoint injection group than in the epidural analgesia group (P<0.05). The duration of the 2nd stage of labor (from complete opening of the uterus orifice to complete birth of the fetus) was significantly longer, (P<0.05) and the number of oxytocin-using puerpera was obviously bigger in the epidural analgesia group than in the control group (P<0.05). After partum, the 1st breastfeeding time was obviously earlier and the frequency of breastfeeding notably increased in both epidural analgesia and acupoint injection groups than in the control group (P<0.05), the serum prolactin content was remarkably higher in the acupoint injection group than in the epidural analgesia group (P<0.05). No significant differences were found between the acupoint injection and the control groups in the duration of the 1st and 2nd stages of labor, and in the numbers of oxytocin-using puerpera, obstetric forceps-aided birth and cesarean delivery (P>0.05), and between the epidural analgesia group and control group in the serum prolactin levels (P>0.05).. CONCLUSION: Injection of Ropivacaine at LI4 and SP6 is effective for labor analgesia and raising prolactin level, and favorable to breastfeeding in the early postpartum period.


Assuntos
Pontos de Acupuntura , Analgesia Obstétrica , Analgesia por Acupuntura , Anestésicos Locais , Aleitamento Materno , Feminino , Humanos , Gravidez , Prolactina , Ropivacaina
5.
Br J Anaesth ; 123(2): e434-e441, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31331592

RESUMO

BACKGROUND: Several randomised controlled trials show that maintenance of labour epidural analgesia with programmed intermittent epidural bolus reduces the maternal motor block compared with maintenance with a continuous infusion. However, these trials were usually restricted to healthy nulliparous parturients. To assess the generalisability of these randomised controlled trials to 'real-world' conditions, we compared maternal motor function (modified Bromage score) over time between healthy nulliparous and parous women using routinely collected quality-control data. METHODS: After ethical approval, all parturients receiving programmed intermittent epidural bolus labour analgesia between June 2013 and October 2014 were included in this prospective cohort study. Bupivacaine 0.1% with fentanyl 2 µg ml-1 was used allowing for patient-controlled bolus every 20 min. The maternal motor function (primary outcome) was regularly assessed from insertion of the epidural catheter until delivery. RESULTS: Of the 839 parturients included, 553 (66%) were nulliparous and 286 (34%) were parous. The parous women had a shorter median duration of epidural analgesia (3 h 59 min vs 5 h 45 min) and a higher incidence of spontaneous delivery (66% vs 37%). The probability of being in a certain Bromage category at birth was similar in nulliparous and parous women in a general additive model adjusting for duration of epidural analgesia, number of rescue top-ups, and number of catheter manipulations (cumulative odds ratio: 1.18; 95% confidence interval: 0.98-1.41). Parous women required a higher time-weighted number and volume of rescue top-ups. CONCLUSIONS: The results of the randomised controlled trials on a reduced motor block with programmed intermittent epidural bolus seem generalisable to parturients typically not included in these trials.


Assuntos
Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Analgesia Controlada pelo Paciente/métodos , Trabalho de Parto , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Adolescente , Adulto , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Estudos de Coortes , Feminino , Fentanila/administração & dosagem , Humanos , Pessoa de Meia-Idade , Gravidez , Estudos Prospectivos , Adulto Jovem
6.
Medicine (Baltimore) ; 98(28): e16282, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305411

RESUMO

RATIONALE: Pain management is an essential part of good obstetrical care. The rapid onset of pain relief after combined spinal-epidural (CSE) analgesia may cause a transient imbalance in maternal catecholamine level, leading to uterine hyperactivity and fetal heart rate (FHR) abnormalities. How to manage the uterine basal tone and FHR abnormalities after labor analgesia still remains controversial. PATIENT CONCERNS: A 33-year-old nulliparous woman at 40 weeks' gestation underwent induction of labor after premature rupture of membranes. CSE analgesia was provided when the patient described her pain as the top on a scale of 10 during induction of labor with oxytocin infusion. DIAGNOSES: Uterine hypertonus and fetal bradycardia were diagnosed within 10 minutes after CSE analgesia. INTERVENTIONS: Oxytocin infusion and CSE analgesia were immediately suspended, and measures of staying in left lateral decubitus position and giving supplemental oxygen were attempted to resuscitating the baby. Because of suspicious fetal distress, the baby was rapidly delivered by emergency cesarean section. OUTCOMES: The Apgar score of the baby was 8 and 10 at 1 and 5 minutes after birth. Subsequent follow-up confirmed that both mother and baby were in good condition. LESSONS: The loss of the tocolytic effect of epinephrine after CSE analgesia and continuous oxytocin infusion may work together to form a totally synergistic function, finally leading to inevitable uterine hypertonus and fetal bradycardia. Both the obstetrical provider and anesthesiologist should carefully monitor all patients in the first 15 minutes after CES analgesia induction. Oxytocin administration in this critical period deserves attention. Additionally, intraprofessional collaboration is also necessary to ensure high quality and safe delivery for all childbearing women.


Assuntos
Analgesia Obstétrica , Bradicardia/etiologia , Doenças Fetais/etiologia , Trabalho de Parto Induzido , Hipertonia Muscular/etiologia , Doenças Uterinas/etiologia , Adulto , Analgesia Epidural/efeitos adversos , Analgesia Obstétrica/efeitos adversos , Feminino , Humanos , Recém-Nascido , Ocitócicos , Ocitocina
7.
Anesthesiology ; 131(4): 840-849, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31299658

RESUMO

BACKGROUND: Hispanic women choose epidural labor analgesia less commonly than non-Hispanic women. This may represent a healthcare disparity related to a language barrier and inadequate opportunities for labor analgesia education. It was hypothesized that a language-concordant, educational program regarding labor epidurals would improve epidural utilization in two independent cohorts of Hispanic and non-Hispanic women. METHODS: A randomized controlled trial, blinded to anesthesia, nursing, and obstetric providers, was completed at an academic hospital (February 2015 to February 2017). Two cohorts of Medicaid beneficiaries of Hispanic (English- and/or Spanish-speaking) and non-Hispanic ethnicity were enrolled concurrently. The patients were randomized to routine care alone or routine care and an additional educational program comprised of three components: a video show, corresponding pamphlet, and in-person counseling. The primary endpoint was use of epidural labor analgesia. The secondary endpoint was change in response before and after delivery on common misconceptions based on a 12-point epidural questionnaire. RESULTS: Hispanic women randomized to the intervention group were 33% more likely to choose epidural analgesia compared to the routine care group (40 of 50 [80%] vs. 30 of 50 [60%]; risk ratio, 1.33 [95% CI, 1.02 to 1.74]; P = 0.029). For the non-Hispanic cohort, no difference was detected in epidural use between the intervention and routine care groups (41 of 50 [82%] vs. 42 of 49 [86%]; risk ratio, 0.96 [95% CI, 0.80 to 1.14]; P = 0.62), but the study was underpowered to determine a result of no difference. Patients assigned to the intervention had a greater improvement in epidural understanding compared with routine care, among both Hispanic (2.26 vs. 0.74, respectively; difference in change from baseline, 1.52 [95% CI, 0.77 to 2.27]; P < 0.001) and non-Hispanic (1.36 vs. 0.33, respectively; difference in change from baseline, 1.03 [95% CI, 0.23 to 1.75]; P = 0.005) cohorts. There were no adverse events during the trial. CONCLUSIONS: The educational program increased epidural use among Hispanic women. The educational program reduced misconceptions regarding epidural analgesia in both Hispanic and non-Hispanic cohorts.


Assuntos
Analgesia Epidural/estatística & dados numéricos , Analgesia Obstétrica/estatística & dados numéricos , Educação em Saúde/métodos , Hispano-Americanos/estatística & dados numéricos , Dor do Parto/tratamento farmacológico , Adulto , Parto Obstétrico , Feminino , Disparidades em Assistência à Saúde , Humanos , Trabalho de Parto , Masculino , Medicaid , Gravidez , Estados Unidos
8.
Anaesthesia ; 74(9): 1101-1111, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31256437

RESUMO

Pregnant women should receive information about what they might expect to experience during their delivery. Despite this, research shows many women are inadequately prepared for anaesthetic interventions during labour. We surveyed 903 postnatal women across 28 Greater London hospitals about: the analgesic and anaesthetic information that they recalled receiving during pregnancy and delivery; their confidence to make decisions on analgesia; and their satisfaction with the analgesia used. Wide variation was observed between hospitals. Overall, 67 of 749 (9.0%) women recalled receiving antenatal information covering all aspects of labour analgesia, and 108 of 889 (12.1%) covering anaesthesia for caesarean section. Regarding intrapartum information, 256 of 415 (61.7%) respondents recalled receiving thorough information before epidural insertion for labour analgesia, and 102 of 370 (27.6%) before anaesthesia for caesarean section. We found that 620 of 903 (68.7%) women felt well enough informed to be confident in their analgesic choices, and 675 of 903 (74.8%) stated that their analgesia was as expected or better. Receiving information verbally, regardless of provider, was the factor most strongly associated with respondents recalling receiving full information: odds ratio (95%CI) for labour analgesia 20.66 (8.98-47.53; p < 0.0001); epidural top-up for caesarean section 5.93 (1.57-22.35; p = 0.01); and general anaesthesia for caesarean section 12.39 (2.18-70.42; p = 0.01). A large proportion of respondents did not recall being fully informed before an anaesthetic intervention. Collaboration with current antenatal service providers, both in promoting information delivery and providing resources to assist with delivery, could improve the quality of information offered and women's retention of that information.


Assuntos
Analgesia Obstétrica , Anestesia Obstétrica , Comunicação em Saúde/métodos , Período Periparto , Adulto , Feminino , Humanos , Londres , Gravidez , Inquéritos e Questionários
9.
Anesth Analg ; 129(1): 168-175, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31210653

RESUMO

The "What's New in Obstetric Anesthesia Lecture" is presented every year at the annual meeting of the Society for Obstetric Anesthesia and Perinatology. This lecture was established in 1975 to update the membership on the most relevant articles that were published in the preceding calendar year. In 1995, the lecture was renamed as the "Ostheimer Lecture" in honor of Gerard W. Ostheimer, an obstetric anesthesiologist from the Brigham and Women's Hospital with significant contributions in the field. This review summarizes key articles published in 2017 that were presented in the 2018 Ostheimer Lecture with a focus on opioid prescriptions, anesthesia for external cephalic version, labor analgesia, maternal morbidity, and global health. A proposed list of action items based on the 2017 literature is also presented.


Assuntos
Analgesia Obstétrica/tendências , Anestesia Obstétrica/tendências , Pesquisa Biomédica/tendências , Analgesia Obstétrica/efeitos adversos , Analgesia Obstétrica/mortalidade , Analgésicos Opioides/efeitos adversos , Anestesia Obstétrica/efeitos adversos , Anestesia Obstétrica/mortalidade , Difusão de Inovações , Feminino , Previsões , Humanos , Saúde Materna , Mortalidade Materna , Gravidez , Fatores de Risco
11.
Int J Obstet Anesth ; 39: 29-34, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31230993

RESUMO

BACKGROUND: Intravenous remifentanil patient-controlled analgesia (PCA) has been routinely available for labouring women in our unit since 2004, the regimen using a 40 µg bolus available two minutely on demand, continuous pulse oximetry and mandatory one-to-one care. We examined remifentanil use and compared, with the other analgesic options available in our unit, outcomes such as mode of delivery, Apgar scores, neonatal resuscitation and admission to the neonatal intensive care unit. METHODS: We retrospectively identified women who delivered in our unit between 2005 and 2014 and received remifentanil, diamorphine or epidural analgesia during labour. Data were drawn from the Northern Ireland Maternity System electronic database, which records birth details from all obstetric units in Northern Ireland. Additional data were identified from paper survey forms, completed by the midwife post delivery for all women who received remifentanil in our unit. Outcomes were compared between women who received remifentanil, diamorphine or an epidural technique for labour analgesia. RESULTS: Over the 10-year period, remifentanil was the most popular form of analgesia, being selected by 31.9% (8170/25617) women. Compared with women selecting diamorphine or epidural analgesia, those having remifentanil had similar rates of instrumental and operative delivery. Neonatal Apgar scores were also similar. Neonatal resuscitation or neonatal unit admission were not more likely in women choosing remifentanil PCA. CONCLUSION: We found remifentanil PCA to be neither less safe nor associated with poorer outcomes than other analgesic options offered in our unit, when used within our guidelines for more than a 10-year period.


Assuntos
Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Analgesia Controlada pelo Paciente/métodos , Analgésicos Opioides/uso terapêutico , Remifentanil/uso terapêutico , Índice de Apgar , Feminino , Heroína/uso terapêutico , Humanos , Recém-Nascido , Gravidez , Remifentanil/efeitos adversos , Estudos Retrospectivos
12.
Am J Nurs ; 119(6): 23, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31135423

RESUMO

Editor's note: This is a summary of a nursing care-related systematic review from the Cochrane Library. For more information, see http://nursingcare.cochrane.org.


Assuntos
Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Bombas de Infusão/normas , Dor do Parto/tratamento farmacológico , Enfermagem Obstétrica/normas , Guias de Prática Clínica como Assunto , Adulto , Feminino , Humanos , Gravidez
13.
Curr Opin Anaesthesiol ; 32(3): 307-314, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31045638

RESUMO

PURPOSE OF REVIEW: Neuraxial techniques are the current gold standard for labour analgesia, but are associated with up to 25% incidence of breakthrough pain. In this review, we aim to update clinicians on the latest research pertaining to the optimization of neuraxial labour analgesia. RECENT FINDINGS: Attempts to improve the efficacy and reliability of epidural analgesia while minimizing adverse effects have resulted in the rising popularity of combined spinal epidural and the dural puncture epidural (DPE). Recent studies have focused on determining the safety, efficacy, and optimization of the DPE technique.Another research focus is on the development of individualized therapy in which patients may titrate their own labour analgesia according to their varying requirements, possibly augmented with computer-aided feedback systems and automated mandatory bolus techniques that automatically adjust drug delivery to the patients' analgesic requirements. The addition of a risk-stratification model based on maternal, anaesthetic, and obstetric factors will facilitate early institution of individualized therapy to forestall breakthrough pain in higher risk patients. SUMMARY: Recent advances in combined spinal epidural, DPE, automated mandatory bolus, and individualized therapies have advanced our goal of providing effective labour analgesia that is titrated to changing analgesic requirements during labour and delivery and reducing breakthrough pain.


Assuntos
Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Anestésicos Locais/administração & dosagem , Dor Irruptiva/terapia , Analgesia Epidural/efeitos adversos , Analgesia Epidural/instrumentação , Analgesia Obstétrica/efeitos adversos , Analgesia Obstétrica/instrumentação , Dor Irruptiva/diagnóstico , Dor Irruptiva/etiologia , Relação Dose-Resposta a Droga , Feminino , Humanos , Bombas de Infusão , Monitorização Fisiológica/métodos , Gravidez , Resultado do Tratamento
14.
Curr Opin Anaesthesiol ; 32(3): 263-267, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30985339

RESUMO

PURPOSE OF REVIEW: As the application of a test dose after epidural catheter insertion in obstetrics has recurrently been associated with serious adverse events affecting both maternal and foetal outcomes, the question whether to test or not remains a controversial issue. RECENT FINDINGS: Present guidelines do not provide clear recommendations in this regard and several recent surveys indicate a heterogeneity in clinical routine. SUMMARY: Physiological alterations during pregnancy and labour restrict the use and also the validity of traditional test agents. Epinephrine is not appropriate to detect a vascular insertion in labour and the application of a local anaesthetic test dose may lead to dose-dependent fatal consequences should the catheter be intrathecal, due to an increased sensitivity in parturients. Given the current practice of opioid-amended-low-concentration epidurals, the waiving of a test dose results at worst in a failed epidural, a stark contrast to the potentially severe to fatal complications of a 'traditional' test dose. Hence, an originally preventive measure providing potentially more harm than the consequences of the situation aimed to prevent, should not be recommended. A simple fractionated administration of the initial analgesic dose seems reasonable though.


Assuntos
Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Anestésicos Locais/administração & dosagem , Cateterismo/métodos , Epinefrina/administração & dosagem , Analgesia Epidural/efeitos adversos , Analgesia Epidural/instrumentação , Analgesia Epidural/normas , Analgesia Obstétrica/efeitos adversos , Analgesia Obstétrica/instrumentação , Analgesia Obstétrica/normas , Anestésicos Locais/efeitos adversos , Cateterismo/efeitos adversos , Cateterismo/instrumentação , Cateterismo/normas , Cateteres/efeitos adversos , Relação Dose-Resposta a Droga , Espaço Epidural , Epinefrina/efeitos adversos , Feminino , Humanos , Injeções Epidurais/efeitos adversos , Injeções Epidurais/instrumentação , Injeções Epidurais/métodos , Injeções Epidurais/normas , Guias de Prática Clínica como Assunto , Gravidez
15.
Clin Perinatol ; 46(2): 349-366, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31010564

RESUMO

When opioid misuse rises in the United States, pregnant women and their neonates are affected. This article summarizes the use of Food and Drug Administration-approved products, including methadone, buprenorphine, and the combination formulation of buprenorphine and naloxone to treat adult opioid use disorder during the perinatal period. All labels include pregnancy, neonatal, and lactation information and note the accepted use of these medications during the perinatal period if the benefits outweigh the risks. A summary of the neonatal abstinence syndrome definition, its assessment tools, treatment approaches, and future genetic directions are provided.


Assuntos
Analgésicos Opioides/uso terapêutico , Síndrome de Abstinência Neonatal/terapia , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/terapia , Complicações na Gravidez/terapia , Analgesia Obstétrica , Analgésicos/uso terapêutico , Aleitamento Materno , Buprenorfina/uso terapêutico , Combinação Buprenorfina e Naloxona/uso terapêutico , Clonidina/uso terapêutico , Feminino , Humanos , Hipnóticos e Sedativos/uso terapêutico , Recém-Nascido , Método Canguru , Troca Materno-Fetal , Metadona/uso terapêutico , Terapia Ocupacional , Manejo da Dor , Educação de Pacientes como Assunto , Fenobarbital/uso terapêutico , Modalidades de Fisioterapia , Gravidez , Alojamento Conjunto
16.
Int J Obstet Anesth ; 39: 82-87, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31000314

RESUMO

BACKGROUND: With over 90% of parturients searching the internet for health information, the quality of information is important. Web-based patient education materials (PEMs) related to labor analgesia are frequently of low readability. This study compares the readability, content, quality and accuracy of labor analgesia-related PEMs from relevant healthcare society websites and the top internet search results. METHODS: The first ten PEMs from Google searches for "labor epidural" and "labor pain relief" were compared with PEMs from North American and United Kingdom anesthesiology, obstetric and medical society websites. Readability was assessed utilizing five validated readability indices. Quality was assessed using Patient Education Materials Assessment Tool for Print (PEMAT). The PEMs were graded for accuracy by four obstetric anesthesiologists. Readability, quality and accuracy scores were compared using the independent t-test and content using Chi-square analysis. RESULTS: Society PEMs were significantly more readable than non-society PEMs for three of five readability indices, though the mean of both groups was at or above an eighth-grade (average age 13-14 years-old) reading level. The PEMAT understandability and accuracy scores were significantly higher for society websites. The most frequently mentioned topics were benefits, effects of epidural analgesia on labor and delivery, definitions, post-dural puncture headache and alternative analgesics. CONCLUSIONS: Google search results for labor analgesia lead to PEMs of variable quality and readability. For readers to be better informed, web-based PEMs should be improved or women directed to society PEMs. Inaccurate information may lead to incorrect expectations and conflict during labor, with potentially lower maternal satisfaction.


Assuntos
Analgesia Obstétrica , Compreensão , Internet , Educação de Pacientes como Assunto , Feminino , Humanos , Gravidez
17.
J Law Med ; 26(3): 549-556, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30958648

RESUMO

For most prospective mothers, pain in childbirth is their greatest fear. However, intolerable labour pain should no longer be accepted by the health professions. Without adequate pain control in labour fetal damage can be significant. Moreover, if relief from pain is a fundamental human right then surely standards of good obstetric care should include a definition of adequate pain relief in labour and obstetricians should pay due attention to alleviating that pain. At present actions in tort focus on poor medical management of injuries or diseases. Pain and suffering are generally a secondary consequence of that negligence although in the tort of negligence pain can constitute damage. However, it is argued that failure to address pain adequately as a primary issue should be considered medical malpractice or at least unsatisfactory professional performance if there is proof of failure to exercise reasonable care. The possibilities for untreated labour pain to be deemed medical negligence could include maternal post-traumatic stress disorder, fetal brain injury resulting from maternal acidosis and utero-placental hypo-perfusion or even negligent infliction of mental harm on the family members witnessing their family relative in intolerable pain. In this article the nature of labour pain and its fetal effects will be discussed. Effective pain control in labour should be good medicine as well as humane treatment.


Assuntos
Analgesia Obstétrica/normas , Dor do Parto , Trabalho de Parto , Feminino , Humanos , Imperícia , Gravidez , Estudos Prospectivos , Padrão de Cuidado/legislação & jurisprudência
19.
Br J Anaesth ; 122(5): 587-604, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30916011

RESUMO

Nitrous oxide (N2O) is one of the oldest drugs still in use in medicine. Despite its superior pharmacokinetic properties, controversy remains over its continued use in clinical practice, reflecting in part significant improvements in the pharmacology of other anaesthetic agents and developing awareness of its shortcomings. This narrative review describes current knowledge regarding the clinical use of N2O based on a systematic and critical analysis of the available scientific literature. The pharmacological properties of N2O are reviewed in detail along with current evidence for the indications and contraindications of this drug in specific settings, both in perioperative care and in procedural sedation. Novel potential applications for N2O for the prevention or treatment of chronic pain and depression are also discussed. In view of the available evidence, we recommend that the supply of N2O in hospitals be maintained while encouraging its economic delivery using modern low flow delivery systems. Future research into its potential novel applications in prevention or treatment of chronic conditions should be pursued to better identify its role place in the developing era of precision medicine.


Assuntos
Anestésicos Inalatórios/farmacologia , Óxido Nitroso/farmacologia , Analgesia Obstétrica/métodos , Analgésicos não Entorpecentes/efeitos adversos , Analgésicos não Entorpecentes/farmacologia , Analgésicos não Entorpecentes/uso terapêutico , Anestesia Dentária/métodos , Anestésicos Inalatórios/efeitos adversos , Antidepressivos/uso terapêutico , Dor Crônica/prevenção & controle , Sedação Consciente/métodos , Contraindicações de Medicamentos , Transtorno Depressivo Maior/tratamento farmacológico , Medicina Baseada em Evidências/métodos , Humanos , Óxido Nitroso/efeitos adversos , Óxido Nitroso/uso terapêutico
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