Recent advances in pre-eclampsia management: an anesthesiologist's perspective

Pre-eclampsia is an important cause of mortality and morbidity in parturients with varied presentations and controversial pathophysiology. The central pathology is a profound vasoconstriction in the vasculature leading to volume contraction and placental hypoperfusion. The management mainly involves a multi-disciplinary approach with the anesthesiologist playing a significant role for a positive outcome. Anesthesia for such parturients remains a challenge and starts with provision of labor analgesia which should be offered to all preeclamptic parturients. The neuraxial techniques of analgesia are most favourable for adequate pain relief and if contraindicated, intravenous PCA technique with the use of opioids should be used. Recent studies show favourable maternal and fetal outcomes with the use of patient controlled epidural analgesia technique with the combination of lower concentrations of local anesthetics with opioids. Regional anesthesia should be preferred in these parturients for cesarean section if not contraindicated. If general anesthesia is indicated, the techniques should be modified to prevent any stress response. A careful and prompt use of oxytocics should be done in all cases as the incidence of postpartum hemorrhage is high in these parturients

Management of acute postoperative pain in pediatric patients

Pain is an unpleasant experience which can produce changes in all the systems of the body. Pain in children is not different from that in adults and can lead to similar detrimental effects on the body. The anticipation and effective treatment of pain in pediatric patients is thus, an essential component of care. A careful assessment of pediatric pain using age-specific pain scoring systems allows for exact quantification of pain. The use of various analgesics should be done early and in adequate doses for them to be effective. The use of multimodal approach with weaker analgesics along with regional blocks is an effective modality to control pain and prevent severe adverse effects associated with higher doses of potent analgesics. The advancement in the pharmacology of analgesics allows for their more widespread use with minimal side-effects. The use of patient or nurse controlled analgesia and continuous regional nerve blocks with the use of indwelling catheters can augment the pediatric pain management

Labour analgesia in pre-eclampsia: the current perspectives

Pre-eclampsia is a disease of pregnancy involving various systems with associated high blood pressure and other changes. The pathophysiology of this disease is not well known but the main pathological change is vasoconstriction in the vascular bed of the parturient with abnormalities in the uteroplacental circulation. A multi-disciplinary approach is essential for proper management of this disease. The provision of analgesia during labor significantly reduces the stress response and thus is helpful in reducing the elevated blood pressure and also exerts beneficial effects on uteroplacental perfusion. The neuraxial analgesia technique is considered to be the gold standard and has been found to be effective and safe in pre-eclamptic parturients. The use of lower concentrations of local anesthetic drugs in combination with opioids results in less motor blockade, lesser dose of drugs and lesser incidence of significant side-effects. The patient-controlled epidural analgesia technique is very beneficial with excellent maternal satisfaction. The concern of coagulation abnormalities associated with pre-eclampsia should be kept in mind with the institution of neuraxial techniques with careful monitoring of neurological status. The reduction in stress response with consequent reduction in blood pressure in pre-eclamptic parturient is highly desirable irrespective of the technique of analgesia used