Maternal and foetal cardiovascular and acid-base changes during ketamine anaesthesia in pregnant ewes.
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Biomedical subjects
Publications and source records attributed to S M Shnider.
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STUDY OBJECTIVE: To determine the maternal and fetal effects of the addition of epidural sufentanil to 0.5% bupivacaine for cesarean delivery. DESIGN: Randomized, double-blind, prospective study. SETTING: University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium. PATIENTS: Sixty women at term scheduled for elective cesarean section, all of whom had elected epidural anesthesia. INTERVENTIONS: The 60 women were divided into three groups of 20, with each group receiving a different 1 ml study solution: saline (control) or sufentanil 20 micrograms or sufentanil 30 micrograms added to 0.5% bupivacaine and epinephrine (1:200,000). MEASUREMENTS AND MAIN RESULTS: In the mother, the quality of anesthesia, the duration of postoperative analgesia, the volume of anesthetic, and the frequency of side effects were examined. The neonates were evaluated at 5 and 10 minutes after birth by Apgar scores and between 60 and 120 minutes after birth by both the screening test developed by Prechtl and the Neurological and Adaptive Capacity Scoring System. Immediately after delivery, maternal and umbilical vein blood were drawn and assayed for sufentanil levels. Adding sufentanil significantly improved the quality of anesthesia without depressing the neurobehavioral status of the baby. CONCLUSION: The epidural injection of sufentanil added to 0.5% bupivacaine with epinephrine improved the quality of anesthesia during elective cesarean section without jeopardizing the safety of the baby.
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An exploratory study of 77 primiparous women during the first 48 hours postpartum tested for differences between those who had received epidural anesthesia, those who had received analgesia during labor with local or pudendal block for delivery, and those who had received no analgesia and either no anesthesia or local or pudendal block for delivery. No group differences were found in self-esteem, feelings about the childbirth experience at the time of delivery, or maternal perception of her infant as compared to her perception of an average infant. Those receiving epidural anesthesia had less positive feelings about the childbirth experience at the time of the interview, but they described their views of their infants at birth more positively and with more identifying remarks than either of the other two groups. No differences were found in self-esteem, feelings about the childbirth experience at time of delivery or at the time of interview, or maternal perception of the newborn compared to that of an average infant by those who attended childbirth classes and those who did not.