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Biomedical subjects

F E Greifenstein

Publications and source records attributed to F E Greifenstein.

14 recordsLinked to original sources

Naloxone in the parturient and her infant.

Eighteen women in labor received analgesia with moderately large total doses of meperidien. Various doses of naloxone (8, 12, 18, 27, 40, or 60mug/kg of body weight) were given intravenously to the mothers before delivery in an attempt to find the dose that would prevent neonatal narcotic depression. Maternal and neonatal blood gas values, Apgar scores, and postnatal neurobehavioral examinations were used to assess the effects. Infants born of mothers who had received neither meperidine, promethazine, nor naloxone served as controls. After the naloxone injection, the mothers showed an improvement in consciousness and blood gas values. When the study infants, as a group, were compared with control infants, there was very little difference in blood gas values or neurobehavioral examination. Infants in the groups receiving naloxone in doses of 18, 27, and 40mug/kg compared most favorably with the control infants, indicating that naloxone may be effective in preventing neonatal narcotic depression.

Adult

Maternal and neonatal effects of 1% and 2% mepivacaine for lumbar extradural analgesia.

Continuous lumbar extradural analgesia with mepivacaine was administered to two groups of patients in normal labour. One group (26 patients: 1% mepivacaine) received a mean total dose of 342 mg (4.93 mg/kg) per patient, and developed a mean blood concentration of mepivacaine at delivery of 1.82 mug/ml. The neonatal umbilical vein concentration was 0.84 mug/ml. The other group (30 patients: 2% mepivacaine) received a mean total dose of 776 mg (11.65 mg/kg) per patient, and developed a mean blood concentration of mepivacaine at delivery of 3.47 mug/ml. The neonatal umbilical vein concentration was 2.61 mug/ml. Four of the infants of mothers who received 1% mepivacaine were depressed (1-min Apgar score 6 or less), and six of the other group were depressed also. Usually, depression appeared to be related to obstetric factors, rather than to analgesia. Eleven of the 56 infants had umbilical vein mepivacaine concentrations of 3 mug/ml or greater; of these, three were depressed. This does not agree with the concept that the toxic threshold for mepivacaine is 3 mug/ml. In both groups a significant linear correlation was obtained between umbilical vein concentration and total dose of mepivacaine. A maximal dose of 12 mg/kg maternal weight in the non-obese or 12 mg/kg lean body mass in the obese is suggested for continuous extradural analgesia with mepivacaine, although healthy mothers and infants may tolerate much more.

Anesthesia, Epidural

"Saddle block".

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Anesthesia, Spinal