Systemic Analgesia: Parenteral and Inhalational Agents

Fernando, Roshan; Jones, Tanya

doi:10.1016/b978-0-323-05541-3.00022-3

Cited by 3 publications

(1 citation statement)

References 103 publications

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“…Providers may choose to use volatile agents at a minimum alveolar concentration (MAC) <0.5 or use exclusively IV techniques to decrease any tocolytic effect of volatile anesthetics. 29 In a randomized controlled trial, patients underwent D&E at 18 to 24 weeks of gestation with IV midazolam, IV fentanyl, IV propofol, and nitrous oxide, or this same anesthetic with the addition of sevoflurane administered via facemask at a rate of 2 to 4 L/min and a concentration of 2% to 4%. The sevoflurane group was more likely to have interventions for bleeding compared to those who received IV agents alone (25% vs 16.3%) and more likely to have a measured blood loss >300 mL (15% vs 7.5%).…”

Section: Anesthetic Typesmentioning

confidence: 99%

Anesthetic Considerations for Second-Trimester Surgical Abortions

Ozery

Ansari

Kaur

et al. 2022

Anesthesia &Amp; Analgesia

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Although most abortion care takes place in the office setting, anesthesiologists are often asked to provide anesthesia for the 1% of abortions that take place later, in the second trimester. Changes in federal and state regulations surrounding abortion services may result in an increase in second-trimester abortions due to barriers to accessing care. The need for interstate travel will reduce access and delay care for everyone, given limited appointment capacity in states that continue to support bodily autonomy. Therefore, anesthesiologists may be increasingly involved in care for these patients. There are multiple, unique anesthetic considerations to provide safe and compassionate care to patients undergoing second-trimester abortion. First, a multiday cervical preparation involving cervical osmotic dilators and pharmacologic agents results in a time-sensitive, nonelective procedure, which should not be delayed or canceled due to risk of fetal expulsion in the preoperative area. In addition, a growing body of literature suggests that the older anesthesia dogma that all pregnant patients require rapid-sequence induction and an endotracheal tube can be abandoned, and that deep sedation without intubation is safe and often preferable for this patient population through 24 weeks of gestation. Finally, concomitant substance use disorders, preoperative pain from cervical preparation, and intraoperative management of uterine atony in a uterus that does not yet have mature oxytocin receptors require additional consideration.

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Section: Anesthetic Typesmentioning

confidence: 99%

Anesthetic Considerations for Second-Trimester Surgical Abortions

Ozery

Ansari

Kaur

et al. 2022

Anesthesia &Amp; Analgesia

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Non-regional analgesia techniques for labour

Yuill¹

2015

Core Topics in Obstetric Anaesthesia

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Anesthetic Management and Postoperative Care of a Patient with CADASIL (Cerebral Arteriopathy, Autosomal Dominant, with Subcortical Infarcts and leukoencephalopathy) for Cesarean Section

Rasooli¹,

Moslemi²,

Tagavi³

2014

IJWHR

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Case descriptionWe describe the anesthetic management and postoperative care of a 36 years old pregnant woman with CADASIL disease who needed urgent cesarean section. According to her past medical history, she was already diagnosed as CADASIL syndrome 3 years ago. Her medical history included left hemi lateral paresis, accompanied by walking difficulties, urinary incontinence, psychiatric symptoms, apathy, diabetes mellitus, hypertension, and ovarian cyst. CADASIL diseases, was diagnosed after a hemi paretic attack when she was 32 years old. As a consequence of headache, was followed by neurologic symptoms. After admission to hospital, the clinical and neurological examination, MRI and CT-scan, and by genetic examinations, CADASIL disease was diagnosed. She got one dilatation and curettage due to a missed abortion pregnancy under sedation, 2 years ago at a primary care clinic. Now, her symptoms associated with CADASIL were intermittent headache and left hemi lateral paresis, and hypertension. She was taking methyldopa and aspirin (80 mg daily). Her diabetes was controlled by Insulin during pregnancy. She admitted to the Alzahra hospital due to hypertension one day ago. She received 5mg hydralazine and stopped aspirin. On preoperative evaluation, there were no abnormalities in laboratory tests and radiologic evaluations except slightly elevated U/A protein 1+. Her brain CT was checked two months ago revealed the confluent low densities at the subcortical and deep white matter of both cerebral hemispheres and several small old infarctions in both basal ganglia and thalami. But the neurologist who examined the patient after admission judged her still neurologically normal.Because of recent aspirin medication, we decided to conduct general anesthesia with informed consent. After premedication with ranitidine 50 mg and metoclopramide 10 mg IV, the patient was taken to the operating room. With standard monitoring (ECG, pulse oximetry, noninvasive blood pressure, and capnography) and preoxygenation, a rapid sequence induction with cricoid pressure using fentanyl, thiopental, and succinylcholine was carried out. For intubation used a cuffed 7.0 mm ETT. Neuromuscular block was achieved with atracurium, and anesthesia was maintained by controlled ventilation with an oxygen/N2O 50%/50% and isoflurane 1% mixture. With recommendations concerning the anaesthetic management of patients with CADASIL arteriopathy, we kept mean arterial blood pressure greater than 60 mm Hg and end-tidal carbon dioxide around 40 mm Hg so as to prevent any cerebral ischemic or vasospastic phenomenon. Patient's blood sugar within the perioperative was in the normal range. Moreover, the cerebral venous return was preserved by the patient received 8 ml/kg of ringer's solution in the left lateral position. The condition of neonate was assessed by apgar score at 1 st and 5 th after delivery who was 8 and 9 respectively. Mother received oxytocin 5 IU by continues infusion after delivery. Surgery and recovery were uneventful. The neurological examination ...

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Systemic Analgesia: Parenteral and Inhalational Agents

Cited by 3 publications

References 103 publications

Anesthetic Considerations for Second-Trimester Surgical Abortions

Anesthetic Considerations for Second-Trimester Surgical Abortions

Non-regional analgesia techniques for labour

Anesthetic Management and Postoperative Care of a Patient with CADASIL (Cerebral Arteriopathy, Autosomal Dominant, with Subcortical Infarcts and leukoencephalopathy) for Cesarean Section

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