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  • Print publication year: 2011
  • Online publication date: December 2011

Chapter 18 - Controversies surrounding airway management and cesarean delivery

Summary

Epidurals are the most effective mode of analgesia for labor pain. Neurological complications, although rare, remain one of the most important causes of anxiety in the parturient and it is important to provide reassurance while providing accurate data for informed consent. Central nervous system (CNS) lesions secondary to epidural analgesia are very rare. They can be classified into four etiologies: traumatic, ischemic, infective, or chemical, or can sometimes be a combination thereof. High-quality evidence supports that there is no causal relationship between epidural labor analgesia and the development of new chronic back pain. High-dose epidural fentanyl may be associated with an adverse effect on breastfeeding. Women who labor with epidural analgesia experience an increase in temperature, which is associated with administration of antibiotics to both mother and babies, increased neonatal sepsis workups, as well as possibly increased operative deliveries.

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Further reading

American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2003; 98: 1269–77.
HendersonJ J, PopalM T, LattoI P & PierceA C. Difficult Airway Society guidelines for management of the unanticipated difficult intubation. Anaesthesia 2004; 59: 675–94.
MhyreJ M & HealyD. Focused review: the unanticipated difficult intubation in obstetrics. Anesth Analg 2011; 112: 648–52.

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