Analgesia onset was most rapid with CSE with no difference between DPE and EPL techniques. The DPE technique has improved block quality over the EPL technique with fewer maternal and fetal side effects than the CSE technique for parturients requesting early labor analgesia.

(Anesth Analg. 2017;124(2):560–569) Epidural (EPL) and combined spinal epidural (CSE) are commonly used and effective labor analgesia neuraxial techniques. EPL has minimal adverse effects, but has a slow onset time and may result in insufficient sacral spread/patchy sensory blockade. In contrast, CSE has rapid onset and excellent sacral coverage but has greater risk of adverse effects. The dural puncture epidural (DPE) technique (passing a spinal needle through the EPL needle, puncturing the dura but not injecting medication into the intrathecal space) has been shown to improve caudal spread of analgesia compared with the EPL technique, without the side effects seen with CSE. In the present study, the authors determined whether or not overall analgesia characteristics and side effects would favor the DPE technique, and hypothesized that onset of labor analgesia is most rapid with CSE, followed by DPE and EPL.

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Epidural analgesia may be safely used in patients undergoing major hepatic resection, providing that they have normal pre-operative coagulation and catheters are removed only when resection-induced perioperative coagulopathy has resolved or has been corrected.

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(Int J Obstet Anesth. 2016;25:23–29) Epidural analgesia is a popular technique for labor pain management. A relatively common complication of this procedure is inadvertent dural puncture (IDP), which will lead to postdural puncture headache (PDPH) in some patients. The objective of this current study was to evaluate whether there was a difference in labor outcomes when IDP was managed with insertion of an intrathecal catheter versus resiting of an epidural catheter. The authors hypothesized that patients who received an intrathecal catheter would be less likely to have a prolonged second stage of labor with no difference in cesarean delivery rate compare with patients who had another epidural catheter placed.

Context:Alterations in taste and smell, including but not limited to anosmia, ageusia, hypogeusia, and dysgeusia, have been described in association with various medications, including anesthetic agents. Frequently, these symptoms occur 1-2 weeks after medication administration and last several months. While such a phenomenon is a rare occurrence, it nonetheless can significantly impact patients’ satisfaction and quality of life.Evidence Acquisition:The methodology consisted of a thorough literature search using the MEDLINE and Cochrane databases utilizing keywords such as anosmia, ageusia, olfactory disorders, postoperative, and anesthesia.Results:Our results yielded several previously published case report, and were not limited to a specific type of anesthesia. Based on available literature, we review the physiology of taste and smell as well as the medications associated with loss of these senses. We describe perioperative agents that could lead to postoperative complications associated with anosmia and and ageusia.Conclusions:Based on available literature recommendations for anesthesiologists caring for patients at risk for this occurrence are presented in this review. The symptoms are usually temporary as in the majority of the patients the sensory receptor cells are able to regenerate themselves after injury. Anesthesia providers need to aware of this phenomenon to be able to reassure patients and possibly avoid anesthetic techniques associated with anosmia and ageusia.

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