Nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin, which are available as "over-the counter" medications in most countries, are widely used by both pregnant and lactating women. They are popular non-opioid analgesics for the treatment of pain after vaginal and operative delivery. In addition, NSAIDs are used for tocolysis in premature labor, and low-dose aspirin has a role in the prevention of preeclampsia and recurrent miscarriage in antiphospholipid syndrome. NSAIDs and aspirin may affect fertility and increase the risk of early pregnancy loss. In the second trimester their use is considered reasonably safe, but has been associated with fetal cryptorchism. In the third trimester, NSAIDs and aspirin are usually avoided because of significant fetal risks such as renal injury, oligohydramnios, constriction of the ductus arteriosus (with potential for persistent pulmonary hypertension in the newborn), necrotizing enterocolitis, and intracranial hemorrhage. Maternal administration or ingestion of most NSAIDs results in low infant exposure via breastmilk, such that both cyclooxygenase-1 and cyclooxygenase-2 inhibitors are generally considered safe, and preferable to aspirin, when breastfeeding.

assessments, before the neuraxial drugs are cleared from the maternal and neonatal circulations, should be done to determine if they are associated with an early decrease in breastfeeding rates. Studies should complete the first assessments within 3 hours of delivery and then at the time of hospital discharge and, finally, over the long term.All of the factors mentioned above contribute to the deficiencies in studies that have examined intrapartum neuraxial analgesia and breastfeeding success. Studies should be randomized and control for all confounding variables. Knowledge of the behavior of opioids in the neonatal circulation will help to establish the physiological mechanism that creates the association between neuraxial analgesia and breastfeeding outcomes.Topics: Pharmacology, Obstetric Complications N onsteroidal anti-inflammatory drugs (NSAIDs) and aspirin are widely used by women of childbearing age and by pregnant or lactating women. NSAIDs can be taken by breastfeeding women with safety and the cyclooxygenase (COX)-2-selective NSAIDs are probably safe in lactating women as well. However, aspirin should be used cautiously or avoided by a woman who is breastfeeding her infant. NSAIDs are effective against childbirth perineal pain and abdominal postoperative pain. They also produce opioid dose-sparing effects when given with opioids, which can lead to fewer opioid-related side effects postsurgery and postdelivery. This review examines the safety and effectiveness of NSAIDs and aspirin during pregnancy and the postpartum period and during initiation of lactation along with their effect on fertility and on the fetus throughout pregnancy and on the breastfed neonate or infant.During the prepregnancy period and very early in pregnancy, particularly when fertility is evaluated, animal studies have shown a detrimental effect of NSAIDs on fertility in male mice, and studies in humans suggest an association between NSAID use and reduced female fertility. Therefore, women planning pregnancy should avoid or reduce doses of aspirin, NSAIDs, or COX-2 inhibitors. However, after in vitro fertilization procedures, low-dose aspirin therapy has not led to a significant difference in pregnancy or live birth rates when compared with placebo. In small randomized trials, no significant effect on pregnancy or implantation rates was found with the use of NSAID analgesia in women who underwent oocyte retrieval. Larger randomized controlled trials are needed before NSAID use can be recommended in this situation.Case-control and cohort studies examining spontaneous abortion in the first trimester have shown an increased risk when NSAIDs are used during early pregnancy. However, the higher rate of spontaneous abortion is not only when NSAIDs are given for uterine cramping pain because similar results were obtained when this indication was eliminated. Acetaminophen is not associated with an increased risk of abortion. Studies on the risk of congenital birth defects associated with NSAID or aspirin use have given conflicting results. ...

No abstract

No abstract

Anesthetists commonly encounter epileptic patients when undergoing surgery. This review article discusses the drugs used to treat epilepsy and their relevant effects on anesthesia.