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Journal of Feline Medicine and Surgery Nov 2020Procedural sedation and analgesia (PSA) describes the process of depressing a patient's conscious state to perform unpleasant, minimally invasive procedures, and is part... (Review)
Review
PRACTICAL RELEVANCE
Procedural sedation and analgesia (PSA) describes the process of depressing a patient's conscious state to perform unpleasant, minimally invasive procedures, and is part of the daily routine in feline medicine. Maintaining cardiopulmonary stability is critical while peforming PSA.
CLINICAL CHALLENGES
Decision-making with respect to drug choice and dosage regimen, taking into consideration the cat's health status, behavior, any concomitant diseases and the need for analgesia, represents an everyday challenge in feline practice. While PSA is commonly perceived to be an uneventful procedure, complications may arise, especially when cats that were meant to be sedated are actually anesthetized.
AIMS
This clinical article reviews key aspects of PSA in cats while exploring the literature and discussing complications and risk factors. Recommendations are given for patient assessment and preparation, clinical monitoring and fasting protocols, and there is discussion of how PSA protocols may change blood results and diagnostic tests. An overview of, and rationale for, building a PSA protocol, and the advantages and disadvantages of different classes of sedatives and anesthetics, is presented in a clinical context. Finally, injectable drug protocols are reported, supported by an evidence-based approach and clinical experience.
Topics: Analgesia; Anesthesia; Animals; Cats; Conscious Sedation; Risk Factors
PubMed: 33100168
DOI: 10.1177/1098612X20965830 -
Minerva Anestesiologica Dec 2018The demand for total knee arthroplasty (TKA) is rising worldwide. Controversy persists in the literature regarding the benefits of general versus neuraxial anesthesia... (Review)
Review
The demand for total knee arthroplasty (TKA) is rising worldwide. Controversy persists in the literature regarding the benefits of general versus neuraxial anesthesia and which anesthetic is associated with the best outcomes. Likewise, the abundance of analgesic options for post-TKA pain have led to debate regarding the safest, most effective regimens. In this paper, we evaluated a selection of recent publications regarding anesthetic and analgesic choices for TKA. High-quality studies and meta-analyses linking anesthetic agents and analgesic modalities to clinically important outcomes were chosen wherever possible. We included a range of clinical and population-based research, incorporating established and emerging techniques. Although not uniform, clinical and population-based data favor neuraxial anesthesia, and suggest less morbidity compared to general anesthesia. There is good evidence to support an opioid-minimizing, multimodal approach to post-TKA analgesia, featuring peripheral nerve blocks and/or peri-articular injection. The recently described IPACK (interspace between the popliteal artery and posterior capsule of the knee) block may address posterior knee pain after TKA. Ultrasound-guided regional analgesia techniques are cost and clinically effective. Liposomal bupivacaine represents an expanding topic of research in TKA-analgesia, but currently, data do not support routine use. Evidence to guide the creation of pathways of care for TKA abounds, but must be tailored to local practice to maximize chances of success. Recent data supports the use of neuraxial anesthesia and regional analgesia techniques for TKA. Recommendations for clinical practice and future research to improve the state of the art are provided.
Topics: Analgesia; Anesthesia; Arthroplasty, Replacement, Knee; Humans
PubMed: 29808972
DOI: 10.23736/S0375-9393.18.12383-2 -
CMAJ : Canadian Medical Association... Mar 2018
Topics: Analgesia; Headache; Headache Disorders, Secondary; Humans
PubMed: 29530871
DOI: 10.1503/cmaj.171101 -
Deutsches Arzteblatt International Apr 2010Painful procedures on children and adolescents often have to be performed with the aid of analgesia and sedation in order to prevent pain and emotional distress.... (Review)
Review
BACKGROUND
Painful procedures on children and adolescents often have to be performed with the aid of analgesia and sedation in order to prevent pain and emotional distress. Moreover, many procedures can be performed more rapidly and more effectively in a relaxed patient. Because the combination of analgesia and sedation can cause serious or even life-threatening complications, it must be accompanied by the same safety precautions as a general anesthetic.
METHODS
Selective review of the literature.
RESULTS
A high level of safety can be achieved by adherence to the published guidelines of the societies for anesthesiology and pediatrics. The depth of sedation during procedures performed under combined analgesia and sedation is often equivalent to that resulting from general anesthesia. Therefore, in order to avoid serious complications, combined analgesia and sedation should only be administered by physicians trained in pediatric anesthesia or pediatric critical care. This is particularly so when propofol is used, because it has a narrow therapeutic range and can cause cardiorespiratory respiratory problems without warning. As long as the appropriate safety precautions are followed, non-anesthesiologists can also administer propofol in combination with an analgesic, such as ketamine, to children and adolescents.
CONCLUSION
In children and adolescents, the combination of analgesia and sedation can prevent the emotional trauma that would result from a painful procedure, while often enhancing the quality of the procedure itself. This method should be considered a variant of general anesthesia. Accordingly, any non-anesthesiologist employing this method must be as well versed as an anesthesiologist in the management of its specific side effects and complications.
Topics: Adolescent; Analgesia; Child; Conscious Sedation; Humans; Pain; Patient Care Team; Risk Assessment
PubMed: 20436776
DOI: 10.3238/arztebl.2010.0241 -
Medicine Feb 2023Severe pain has been linked to depression, which raises the question of whether neuraxial analgesia during childbirth is associated with a reduced risk of postpartum... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Severe pain has been linked to depression, which raises the question of whether neuraxial analgesia during childbirth is associated with a reduced risk of postpartum depression. This association has been explored, but previous studies did not control or analyze relevant confounders. We conducted a systematic review and meta-analysis to determine the association between neuraxial analgesia and postpartum depression.
METHODS
A systematic review was conducted using PubMed, Embase, and the Cochrane Central Register of Controlled Trials. Studies that tested the effect of neuraxial analgesia during labor on depression or depressive symptoms in the first year postpartum were included. Relevant articles were extracted independently by 2 authors.
RESULTS
In total, 14 studies (86,231 women) were included. The association between neuraxial analgesia and the long-term incidence of postpartum depression after childbirth was the risk ratio = 0.75, 95% confidence interval (CI): 0.56-1.00, P = .05; I2 = 79%, P < .00001. There was a significant association (pooled risk ratio = 0.55, 95% CI: 0.34-0.90, P = .02; I2 = 55%, P = .06) between neuraxial analgesia and the incidence of postpartum depression in the first week after delivery. The subgroup analysis showed a trend suggesting that in Asian populations, those who received neuraxial analgesia had lower postpartum depression rates than those who received non-neuraxial analgesia (risk ratio = 0.57, 95% CI: 0.38-0.86; P = .008; I2 = 82%) at ≥4 weeks after delivery.
CONCLUSION
Neuraxial analgesia may be beneficial for the short-term and long-term mental effects of parturient women, especially for short term after delivery. High-quality studies addressing the role of neuraxial analgesia during labor and its impact on postpartum depression remain necessary.
Topics: Pregnancy; Female; Humans; Depression, Postpartum; Pain Management; Labor, Obstetric; Analgesia; Pain; Analgesia, Epidural; Analgesia, Obstetrical
PubMed: 36827052
DOI: 10.1097/MD.0000000000033039 -
Human Reproduction (Oxford, England) May 2017Are boys who are born to mothers who use analgesics during pregnancy at increased risk of cryptorchidism compared to those born to mothers who do not take analgesia? (Meta-Analysis)
Meta-Analysis Review
STUDY QUESTION
Are boys who are born to mothers who use analgesics during pregnancy at increased risk of cryptorchidism compared to those born to mothers who do not take analgesia?
SUMMARY ANSWER
In this systematic review and meta-analysis of 10 published studies, we observed only weak evidence of an association between analgesia use during pregnancy and risk of cryptorchidism in the son.
WHAT IS KNOWN ALREADY
Concentrations of analgesia relevant to human exposure have been implicated as causing endocrine disturbances in the developing foetal testis. However, when viewed collectively there appears to be conflicting evidence regarding an association between maternal use of analgesics and development of cryptorchidism.
STUDY DESIGN, SIZE, DURATION
A systematic review and meta-analysis of studies on analgesia use during pregnancy and risk of cryptorchidism was performed. The search terms used were (analges* OR paracetamol OR acetaminophen) AND (cryptorchidism OR cryptorchism OR undescended test* OR non-descended test* OR non descended test*) for the databases Ovid Medline, Embase, Scopus and Web of Science. The search included all published articles up until 23 May 2016 and no limits were set in terms of language.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Abstracts were screened by one reviewer to remove irrelevant studies, with a 10% random sample of these verified by a second reviewer. The full text of all remaining papers was assessed by two reviewers. Abstracts included in the final analysis were studies which reported associations between the exposure (analgesia) and the outcome (cryptorchidism). Studies were only included if data were provided from which summary associations (odds ratios (ORs) or relative risks) and their 95% CIs could be calculated, or if summary associations were provided by the authors themselves. For each included study, two reviewers independently extracted study meta-data in line with PRISMA recommendations. We assessed study quality and potential for bias using the criteria outlined in the Newcastle-Ottawa Quality Assessment Scale, but did not determine a quality score. Two reviewers independently assessed study quality against these criteria.
MAIN RESULTS AND THE ROLE OF CHANCE
After screening 350 manuscripts, 10 were included in our review (5 case-control studies, 5 cohort studies). We observed weak evidence of an association between ever use of analgesia and risk of cryptorchidism (pooled crude OR: 1.11, 95% CI: 1.00-1.23), with case-control studies revealing a marginally stronger association (1.23, 95% CI: 0.85-1.78) than cohort studies (1.09, 95% CI: 0.97-1.22). We observed weak evidence of a dose-response relationship between increasing weeks of analgesia exposure and risk of cryptorchidism, as well as weak evidence of an effect of timing on analgesia exposure and risk of cryptorchidism. Assessment of study quality via the Newcastle-Ottawa criteria revealed little (if any) evidence of substantial bias that may have meaningfully affected a given study's results.
LIMITATIONS, REASONS FOR CAUTION
While confounding does not appear to be important, misclassification of the exposure is possibly an important source of measurement error in this context. The systematic review is open to reporting bias. Owing to scant data, no meta-analyses for two key questions (relating to dose-response and timing of exposure) could be performed. Medications were grouped based on their common effect and this offers little insight into the relation between specific types of analgesia and cryptorchidism. Finally, there are limitations in assuming that analgesia use reported by mothers is synonymous with actual intrauterine exposure.
WIDER IMPLICATIONS OF THE FINDINGS
The ubiquity of analgesia use during pregnancy makes this exposure particularly important from a population health perspective. About 9 of the 10 studies were conducted in Europe or USA, limiting generalizability of our observations. While the observations from our systematic review and meta-analysis suggest that analgesia use during pregnancy is not strongly associated with cryptorchidism development in the son, they also highlight the need for further detailed assessments of this relationship.
STUDY FUNDING/COMPETING INTEREST(S)
This study was funded by the Health Research Council of New Zealand (reference #: 14/052). The authors have no conflict of interest to declare.
REGISTRATION NUMBER
CRD42016041414.
Topics: Analgesia; Analgesics; Cryptorchidism; Female; Humans; Male; Pain Management; Pregnancy; Risk
PubMed: 28333256
DOI: 10.1093/humrep/dex047 -
JAMA Sep 2021
Topics: Analgesia, Epidural; Analgesia, Obstetrical; Autism Spectrum Disorder; Female; Humans; Labor, Obstetric; Pregnancy
PubMed: 34581752
DOI: 10.1001/jama.2021.15369 -
PloS One 2023Postpartum depression is a significant episode of depression beginning after giving birth. The prevalence of postpartum depression is approximately 20% in Jeddah, Saudi... (Observational Study)
Observational Study
INTRODUCTION
Postpartum depression is a significant episode of depression beginning after giving birth. The prevalence of postpartum depression is approximately 20% in Jeddah, Saudi Arabia. Epidural analgesia is the gold standard for labour pain management. Conflicting results exist regarding the association between postpartum depression and epidural analgesia use during labour. Accordingly, this study assessed the association between epidural analgesia use and postpartum depression incidence.
METHODS
A prospective observational study of 170 mothers was conducted, with surveys administered after labour and at six weeks postpartum. Surveys included the following: mothers' demographics, obstetric history, postpartum depression (Edinburgh Postnatal Depression Scale), and pain severity (Visual Analogue Scale).
RESULTS
In the final analysis, 91 patients were enrolled. Epidural analgesia was administered to 48.4% of mothers during labour. Nearly two-thirds of mothers learned about EA via sources including family members and social media. However, more than half reported worries regarding epidural analgesia. Edinburgh Postnatal Depression Scale scores showed that 38 mothers (41.8%) likely had depressive symptoms within two days following delivery. Further, 35 (38.5%) met criteria for postpartum depression at six weeks postpartum. For both groups regardless use of analgesia, the mean Visual Analogue Scale score at two days postpartum was 4.16 ± 2.13. Data revealed no correlation between epidural analgesia use and Edinburgh Postnatal Depression Scale within two days and at six weeks postpartum. Multiple regression analysis showed Edinburgh Postnatal Depression Scale scores correlated with Visual Analogue Scale scores but not epidural analgesia use at 1-2 days postpartum.
CONCLUSION
This study showed that depressive symptoms resolved in three percent of participants. This suggests that institutions should increase postpartum depression awareness during the antenatal period and implement effective post-delivery screening systems for postpartum depression.
Topics: Pregnancy; Female; Humans; Analgesia, Epidural; Depression, Postpartum; Incidence; Labor, Obstetric; Pain Management; Pain; Analgesia, Obstetrical
PubMed: 37906559
DOI: 10.1371/journal.pone.0289595 -
Zoological Research Jan 2023
Topics: Animals; Pain; Analgesia; Sound
PubMed: 36594395
DOI: 10.24272/j.issn.2095-8137.2022.524 -
American Family Physician Nov 1998Epidural analgesia is a commonly employed technique of providing pain relief during labor. The number of parturients given intrapartum epidural analgesia is reported to... (Review)
Review
Epidural analgesia is a commonly employed technique of providing pain relief during labor. The number of parturients given intrapartum epidural analgesia is reported to be over 50 percent at many institutions in the United States. The procedure has few contraindications, the primary ones being patient refusal, maternal hemorrhage and coagulopathy. Induction of epidural analgesia in early labor remains controversial. However, many physicians induce analgesia as soon as the diagnosis of active labor has been established and the patient has requested pain relief. The most common complications occurring with epidural analgesia are maternal hypotension and postdural puncture headache. Retrospective studies have demonstrated an association between epidural analgesia and increases in duration of labor, instrumental vaginal delivery and cesarean section for labor. However, several recent prospective studies have concluded that epidural analgesia does not adversely affect the progress of labor or increase the rate of cesarean section. These remain controversial issues among practicing physicians.
Topics: Analgesia, Epidural; Analgesia, Obstetrical; Contraindications; Female; Humans; Labor, Obstetric; Patient Selection; Pregnancy; Time Factors
PubMed: 9835854
DOI: No ID Found