ABSTRACT
Opioid abuse and dependence continues to rise in both the general population and pregnancy, with opioid overdose deaths having quadrupled in the last 15 years. Illicit drug use in last 30 days of pregnancy was over 4% with almost 0.6% documented maternal opiate use at time of birth. The management of the opioid-tolerant, buprenorphine-dependent or methadone-dependent patient in the peripartum period is reviewed. Options for treatment of opioid dependence, acute pain management, and perioperative multimodal analgesia are discussed. The effects of maternal management on neonatal abstinence syndrome are also reviewed.
Subject(s)
Analgesics, Opioid/administration & dosage , Buprenorphine, Naloxone Drug Combination/administration & dosage , Buprenorphine/administration & dosage , Methadone/administration & dosage , Neonatal Abstinence Syndrome/drug therapy , Opioid-Related Disorders/drug therapy , Pregnancy Complications/drug therapy , Analgesics, Opioid/adverse effects , Buprenorphine/adverse effects , Buprenorphine, Naloxone Drug Combination/adverse effects , Female , Humans , Methadone/adverse effects , Opiate Substitution Treatment/methods , Opioid-Related Disorders/diagnosis , Peripartum Period , Pregnancy , Pregnancy Complications/diagnosis , Treatment OutcomeABSTRACT
STUDY OBJECTIVES: To review the clinical and basic science literature regarding Zika viral illness and highlight relevant findings for obstetric anesthesiologists. This review provides a global review of Zika viral illness, transmission patterns, pathophysiology of disease, and anesthetic management of the parturient with Zika viral illness and associated comorbidities. DESIGN: Systematic review. SETTING: Large academic hospital. SUBJECTS: None. INTERVENTIONS: None. MEASUREMENTS: None. MAIN RESULTS: None. CONCLUSION: With the rapid spread of Zika virus and expected increase of spread in the summer of 2016, this review provides anesthesiologists with current recommendations, physiologic alterations, and anesthetic considerations in regard to the parturient with Zika viral illness and associated diseases.
