Biomedical subjects

T K Abboud

Publications and source records attributed to T K Abboud.

At least 37 records · Page 2Linked to original sources

PubMed1987

Comparative maternal, fetal, and neonatal effects of chloroprocaine with and without epinephrine for epidural anesthesia in obstetrics.

The effects of epidural chloroprocaine with and without 1:200,000 epinephrine during labor and delivery on uterine activity, progress of labor, fetal heart rate, maternal blood pressure, newborn Apgar scores, neonatal acid-base status, and the Neurologic and Adaptive Capacity Scoring System (NACS) were compared in 28 parturients. Patients in group I (n = 14) received 2% chloroprocaine with 1:200,000 epinephrine and patients in group II (n = 14) received 2% plain chloroprocaine. Addition of epinephrine to chloroprocaine had no significant effects on uterine activity, duration of first or second stages of labor, or fetal heart parameters. Apgar scores, neonatal acid-base status, and the NACS were equally good in the two groups. Duration of analgesia was significantly longer in group I than in group II patients (76 +/- 3.8 vs 42.9 +/- 1 min, P less than 0.001). We conclude that addition of epinephrine to chloroprocaine during epidural anesthesia in the normal parturient has no adverse effects on mother, fetus, neonate, or the progress of labor and that it significantly prolongs the duration of anesthesia.

Acid-Base Equilibrium↗

PubMed1987

Epidural butorphanol or morphine for the relief of post-cesarean section pain: ventilatory responses to carbon dioxide.

To determine the safety, efficacy, and the ventilatory responses to carbon dioxide (CO2) of epidurally administered butorphanol or morphine, 122 healthy women who underwent cesarean section with epidural anesthesia were studied. Patients were randomly assigned to receive one of four epidural regimens for the relief of postoperative pain: 5 mg morphine (n = 32), 4 mg butorphanol (n = 30), 2 mg butorphanol (n = 29), or 1 mg butorphanol (n = 31). Epidural morphine provided satisfactory analgesia with slow onset and long duration of approximately 21 hr. When butorphanol was administered, analgesia of rapid onset was seen with increasing duration and effectiveness observed with increasing dose; approximately 8 hr when using 4 mg. Sixty-two percent of the patients who received morphine had pruritus. Somnolence was the main side effect encountered in patients who received epidural butorphanol. The ventilatory response to CO2 was depressed after morphine and after 2 and 4 mg butorphanol, but the duration of depression was more prolonged after morphine. It is concluded that epidural butorphanol is effective in providing pain relief after cesarean section with minor side effects. However, patients must be observed closely because of possible respiratory depression.

Butorphanol↗

PubMed1986

Neonatal responses to alphaprodine administered during labor.

The effect of intravenously administered alphaprodine on newborn Apgar scores, neonatal acid-base status, and the Neurologic and Adaptive Capacity Scoring System (NACS) were compared in 30 parturients. Patients in group 1 (n = 15) received 20-40 mg increments of alphaprodine, with a total dose of 39.3 +/- 3.7 mg (mean +/- SEM). Group 2 patients (n = 15) received no medication during labor. Apgar scores, neonatal acid-base status, and the NACS were equally good in the two groups. The concentrations of alphaprodine in maternal vein, umbilical vein, and umbilical artery at delivery were measured using a gas-chromographic mass spectrophotometric technique. The results showed an umbilical vein-to-maternal vein ratio of 0.52 +/- 0.09. It is concluded that when administered as in this study, alphaprodine has no adverse effects on the neonate.

Adult↗

PubMed1985

Comparative maternal and neonatal effects of halothane and enflurane for cesarean section.

The effects of placental transfer of enflurane and halothane were studied in 81 women undergoing cesarean sections. All patients had rapid sequence induction using thiopental, succinylcholine, and endotracheal intubation. They were then randomly assigned to one of five groups: Group I (n = 16) received N2O and oxygen, Group II (n = 16) N2O, oxygen, and 0.25% halothane, Group III (n = 18) N2O, oxygen, and 0.5% halothane, Group IV (n = 18) N2O, oxygen, and 0.5% enflurane, Group V (n = 13) N2O, oxygen, and 1% enflurane. At delivery, blood was drawn from the maternal artery, umbilical vein and artery for measurement of the halogenated agents using gas chromatography. The neonates were evaluated by Apgar scores, umbilical artery and vein acid base status and the Early Neonatal Neurobehavioral Scores (ENNS) at 2 and 24 h of age. Blood loss and the incidence of maternal awareness were also determined. The umbilical vein to maternal vein ratio was approximately 0.5 and 0.6 for enflurane and halothane, respectively. The umbilical artery to umbilical vein ratio was 0.5 with both agents; higher inspired anesthetic concentrations produced higher blood levels. All neonates had Apgar scores of 8 or more at 5 min with the exception of one neonate in the N2O group. Maternal and neonatal acid base status, blood loss, and ENNS were not affected by the addition of the halogenated agents. Of the patients who had N2O alone, 12% had awareness versus none in the other groups. These data demonstrate that low dose halothane or enflurane decreases the incidence of maternal awareness and does not adversely affect the neonate.

Adult↗

PubMed1985

The effects of naloxone associated with the intrathecal use of morphine in labor.

The efficacy of naloxone in reducing the incidence of side effects after intrathecal injection of morphine and the effects of maternal naloxone administration on the condition of the newborn were evaluated in 40 patients. Patients in labor were given a 1-mg intrathecal injection of morphine and, 1 hr later, either a 0.4-mg bolus of naloxone, followed by a 0.4-0.6 mg/hr intravenous infusion of naloxone, or an intravenous bolus of saline, followed by an intravenous infusion of saline. Intrathecal morphine provided at least 50% pain relief in 78% of patients given naloxone, and in 82% given saline. Intravenous naloxone significantly decreased the incidence of pruritus during labor and delivery. There was no significant decrease in the incidence of nausea, vomiting, somnolence, dizziness, or urinary retention in patients given naloxone. Despite placental transfer of naloxone, neonatal outcome was not adversely affected. For both groups, maternal beta-endorphin levels decreased significantly with the onset of analgesia and returned to control levels at delivery. We conclude that intravenous infusion of naloxone reduced pruritus after intrathecal injection of 1 mg of morphine for labor pain without lessening analgesia or adversely affecting maternal or neonatal status.

Anesthesia, Obstetrical↗

PubMed1985

Safety and efficacy of epinephrine added to bupivacaine for lumbar epidural analgesia in obstetrics.

The effects of epidural bupivacaine with and without 1:300,000 epinephrine on uterine activity, progress of labor, fetal heart rate, maternal blood pressure and heart rate, newborn Apgar scores, neonatal acid-base status, and Neurologic and Adaptive Capacity Scoring System (NACS) were compared in 32 parturients during labor and delivery. Patients in group I (n = 16) received 0.5% bupivacaine with 1:300,000 epinephrine and those in group II (n = 16) received 0.5% bupivacaine alone. Addition of epinephrine to bupivacaine had no significant effects on uterine activity, duration of first or second stages of labor, fetal heart rate and variability, or the incidence of abnormal fetal heart rate patterns. Maternal hypotension occurred less frequently in group I than in group II patients (P less than 0.05). Apgar scores, neonatal acid-base status, and the NACS were equally good in the two groups. Duration of analgesia was significantly longer in group I than in group II (186.8 +/- 11.6 vs 85.3 +/- 6.1 (mean +/- SEM) min, P less than 0.001). It is concluded that adding epinephrine to bupivacaine during epidural anesthesia in the normal parturient has no adverse effects on either mother, fetus, neonate, or the progress of labor; and that it significantly prolongs the duration of anesthesia and decreases the incidence of maternal hypotension.

Adult↗

PubMed1985

Comparison of the effects of general and regional anesthesia for cesarean section on neonatal neurologic and adaptive capacity scores.

Fifty-two neonates delivered by elective cesarean section were evaluated using the Neonatal Neurologic and Adaptive Capacity Scores. Twenty of the mothers received general anesthesia, 14 received epidural, and 18 received spinal anesthesia. All mothers receiving regional anesthesia were prehydrated with 1000 ml of lactated Ringer's solution and were given oxygen via a transparent face mask. All mothers undergoing general anesthesia received thiopental for induction followed by N2O-O2 (4 L:4 L) and 0.5% enflurane until delivery of the baby. All mothers were healthy, not in labor, and were scheduled for elective cesarean section. All neonates weighed 2500 g or more, had Apgar scores of 7 or more at 1 and 5 min, and had normal acid base and blood gas data. Neonates delivered with general anesthesia scored significantly lower on some of the test items for adaptive capacity, passive tone, active tone, primary reflexes, and total scores at both 15 min and 2 hr of age (P less than 0.05) than those delivered with either epidural or spinal anesthesia. Neonates delivered with epidural anesthesia scored lower than those delivered with spinal anesthesia on supporting reaction and motor activity at 2 hr of age (P less than 0.05). All neonates had high scores at 24 hr, at which time there were no significant differences between the three groups.

Adaptation, Psychological↗

PubMed1984

Plasma beta-endorphin concentrations prior to and during pregnancy, in labor, and after delivery.

Beta-Endorphin was measured by radioimmunoassay in peripheral plasma of nonpregnant women (58 +/- 2.4 pg/ml, n = 17, mean +/- SE), during the first trimester (47 +/- 2.4 pg/ml, n = 11), the second trimester (33 +/- 1.9, n = 11), and the third trimester (49 +/- 2.7 pg/ml, n = 10) of pregnancy, during early (202 +/- 32 pg/ml, n = 12) and advanced labor (389 +/- 78 pg/ml, n = 10), and 30 to 60 minutes post partum (177 +/- 22 pg/ml, n = 12). Mean plasma levels of beta-endorphin were significantly lower in each trimester of gestation than the levels in nonpregnant control subjects. During labor and the early postpartum period, maternal plasma levels of beta-endorphin were significantly elevated. Furthermore, peripheral plasma levels of beta-endorphin during labor fell from 189 +/- 31 to 97.6 +/- 12 pg/ml (n = 13, p = 0.015) in response to epidural anesthesia, as compared to peripheral plasma concentrations of beta-endorphin of 223 +/- 71 and 193 +/- 47 pg/ml prior to and after injection of saline solution into epidural catheters, respectively, in 10 control subjects. Mean plasma levels of beta-endorphin in patients immediately prior to elective repeat cesarean section who were not in labor (151 +/- 23 pg/ml, n = 15) were significantly higher (p less than 0.005) than the levels in third-trimester control subjects. These data indicate that the pain associated with labor and the psychological stress of anticipating an operation are potent stimuli for the pituitary release of beta-endorphin.

Anesthesia, Epidural↗

PubMed1984

Effect of intrathecal morphine during labor on maternal plasma beta-endorphin levels.

Plasma beta-endorphin was measured in 16 patients in labor prior to and after complete onset of analgesia with 1 mg of morphine administered intrathecally. Human beta-endorphin levels were determined by radioimmunoassay following silicic acid extraction of plasma samples and separation of the beta-endorphin fraction by gel chromatography. Plasma beta-endorphin levels decreased significantly (p less than 0.005) after intrathecal morphine from 76 +/- 9.7 to 46.3 +/- 9.1 fmol/ml (mean +/- SE), possibly because of decreased pituitary beta-endorphin secretion in response to alleviation of labor pain.

Adult↗

PubMed1984

Beta-endorphin in pregnancy.

Concentrations of maternal plasma beta-endorphin (beta-EP) as measured by radioimmunoassay decline during pregnancy, reaching a nadir during the second trimester, rise during labor, remain elevated during the early postpartum period and are increased prior to elective cesarean section in the absence of labor. They decline in response to epidural anesthesia during labor and increase during induction of general but not regional anesthesia for cesarean section. Umbilical venous plasma beta-EP levels are not affected by the route or mode of delivery nor the presence or absence of labor, but rise in conjunction with fetal distress. In the presence of fetal distress, umbilical arterial plasma beta-EP levels appear to rise faster than umbilical venous beta-EP concentrations. Amniotic fluid beta-EP levels are higher during the second than third trimester. These data indicate that peripheral plasma beta-EP concentrations reflect stress in both mother and fetus. In the mother, pregnancy itself does not appear to be stressful, whereas pain associated with labor rather than uterine contractions as such increase plasma beta-EP levels. In the fetus, hypoxia and acidosis effectively raise plasma beta-EP concentrations. The origin and physiologic significance of amniotic fluid beta-EP, which appears to be unrelated to fetal maturity, remain to be established.

Adult↗

PubMed1984

Intrathecal administration of hyperbaric morphine for the relief of pain in labour.

Thirty healthy women in active labour received an intrathecal injection of morphine 0.5 mg (n = 12) or 1 mg (n = 18) in 7.5% dextrose. Both doses provided excellent analgesia for labour, 93% of patients obtaining at least 50% pain relief. Analgesia began 15-60 min after injection and did not decrease until 6-8 h after injection. Analgesia was satisfactory until distension of the perineum, either by forceps or the infant's head. The intrathecal injection of morphine did not adversely affect the condition of the infant. Eighty per cent of patients developed pruritus; 53%, nausea or vomiting, or both; 43%, urinary retention; and 43%, drowsiness. These side effects were decreased by naloxone, which did not affect the degree of analgesia. There was no significant depression of ventilation in any patient. These results suggest that morphine 0.5 mg or 1 mg, administered intrathecally, effectively decreases the pain of labour, and that i.v. administration of naloxone can alleviate the common side effects.

Anesthesia, Obstetrical↗

PubMed1984

Pharmacokinetics, placental transfer, and neonatal effects of vecuronium and pancuronium administered during cesarean section.

Vecuronium and pancuronium were compared for placental transfer, pharmacokinetic variables, and neonatal effects during cesarean section under general anesthesia. Eighteen women underwent rapid-sequence intravenous induction using d-tubocurarine, succinylcholine, thiopental, and oxygen. Immediately after tracheal intubation, an intravenous injection of vecuronium (n = 11) or pancuronium (n = 7), 0.04 mg/kg, was given. Maternal venous blood samples were obtained before induction and at frequent intervals for 4 h after administration of vecuronium or pancuronium. Also, maternal venous and umbilical-cord arterial and venous blood samples were obtained at delivery. To describe placental transfer and maternal pharmacokinetics of the drugs, serum drug concentrations were determined using single-ion-monitoring mass spectrometry. The Apgar score and Neurologic and Adaptive Capacity Score (NACS) were used to evaluate neonatal condition. Both drugs crossed the placenta, as demonstrated by low concentrations of vecuronium (8.5-26.4 ng/ml) or pancuronium (12.2-34.2 ng/ml) found in umbilical venous blood. At delivery, the ratio of the drug concentration in umbilical venous blood to that in maternal venous blood was 0.11 +/- 0.02 for vecuronium and 0.19 +/- 0.03 for pancuronium. Vecuronium had a more rapid clearance (6.4 +/- 0.4 ml X kg-1 X min-1, mean +/- SE) and a shorter elimination half-life (36 +/- 1.8 min) than pancuronium (3.0 +/- 0.1 ml X kg-1 X min-1 and 72 +/- 6 min, respectively). No other pharmacokinetic differences were found between the drugs. Neonatal outcome was not affected adversely by either muscle relaxant, as assessed by Apgar scores and NACSs . The short duration of action, the minimal placental transfer, and the apparent lack of clinical neuromuscular effects on the newborn suggest that vecuronium should be a useful muscle relaxant for cesarean section.

Adult↗

PubMed1984

Efficacy of clear antacid prophylaxis in obstetrics.

We studied 33 women scheduled to undergo general anesthesia for cesarean section. Prior to induction of anesthesia, each patient received in a random fashion one of two prophylactic antacids. Group I (n = 17) received 30 ml Gelusil orally and Group II (n = 16) received 30 ml of 0.3 mol/l sodium citrate. After induction of general anesthesia an oro-gastric tube was passed. The amount and pH of the gastric aspirate were measured at the time of delivery and 45 min after delivery "before extubation." Both antacids elevated gastric pH above 3.5 in all patients but one in the Gelusil group. The pH remained elevated 45 min later. It is concluded that 0.3 mol/l sodium citrate is effective as an antacid when given orally prior to induction of anesthesia.

Adult↗

PubMed1984

Maternal, fetal, and neonatal effects of lidocaine with and without epinephrine for epidural anesthesia in obstetrics.

The effects of epidural lidocaine with and without 1:300,000 epinephrine on uterine activity, progress of labor, fetal heart rate, maternal blood pressure and heart rate, newborn Apgar scores, neonatal acid-base status, and the Neurologic and Adaptive Capacity Scoring System were compared in 30 parturients during labor and delivery. Patients in group I (n = 16) received 1.5% lidocaine with 1:300,000 epinephrine and those in group II (n = 14) 1.5% lidocaine alone. Addition of epinephrine to lidocaine did not have any significant effects on uterine activity, duration of first or second stages of labor, fetal heart rate variability, or the incidence of abnormal fetal heart rate patterns. Maternal heart rate and the incidence of hypotensive episodes did not differ significantly between the two groups of patients. Apgar scores, neonatal acid-base status, and the NACS were equally good in the two groups. Duration of analgesia was significantly longer in group I as compared to group II patients (106.9 +/- 6.6 vs 66.2 +/- 4.4 min, P less than 0.001). Umbilical venous concentrations of lidocaine and umbilical vein to maternal vein ratios of lidocaine were significantly higher in group II patients (P less than 0.05). It is concluded that addition of epinephrine to lidocaine during epidural anesthesia in the normal parturient has no adverse effects on mother, fetus, neonate, or the progress of labor and it significantly prolongs the duration of anesthesia and limits the placental transfer of lidocaine.

Acid-Base Equilibrium↗

PubMed1984

Maternal and neonatal effects of epidural morphine for labor and delivery.

To determine the efficacy of epidural morphine during labor and delivery, 40 healthy parturients who requested epidural analgesia were randomly given either a single injection of morphine sulfate (2 mg, n = 9; 5 mg, n = 10; or 7.5 mg, n = 11) or 0.5% bupivacaine (n = 10). Bupivacaine provided excellent analgesia in all patients. Morphine (2 or 5 mg) did not produce adequate analgesia and needed to be supplemented by local anesthesia. Morphine (7.5 mg) gave satisfactory analgesia in 7 of 11 patients until the end of the first stage of labor, and, in an additional patient, for almost 13 hr, at which time cephalopelvic disproportion was diagnosed. In all patients given epidural morphine, local anesthesia was needed for the second stage of labor if instrumentation or episiotomy was required. The only side effect was pruritus, which occurred in three patients. Epidural morphine did not produce neonatal depression, as evidenced by Apgar scores and neurologic and adaptive capacity scores. We conclude that 7.5 mg of epidural morphine can give satisfactory pain relief during labor but not delivery, and that 2 or 5 mg of morphine is ineffective. Although 0.5% bupivacaine provided better anesthesia, epidural morphine might prove useful for selected patients.

Acid-Base Equilibrium↗

PubMed1984

Continuous infusion epidural analgesia in parturients receiving bupivacaine, chloroprocaine, or lidocaine--maternal, fetal, and neonatal effects.

The effects of epidural analgesia for labor and delivery using a continuous infusion technique on fetal heart rate, uterine activity, maternal blood pressure, Apgar scores, neonatal acid-base status, and the Neurologic and Adaptive Capacity Scoring System were studied in 61 parturients. Group I (n = 23) received initial test and therapeutic doses of 2 and 6 ml of 0.5% bupivacaine followed by an infusion of 0.125% at a rate of 14 ml/hr. Group II (n = 19) received 2 and 6 ml of 2% chloroprocaine followed by an infusion of 0.75% at a rate of 27 ml/hr. Group III (n = 19) received 2 and 6 ml of 1.5% lidocaine followed by an infusion of 0.75% at a rate of 14 ml/hr. None of the three local anesthetics used had any significant effect on baseline fetal heart rate or uterine activity. In cases in which monitoring of fetal heart rate was both technically satisfactory and continuous, late and variable decelerations in fetal heart rate were seen in 10 of 17, 3 of 18, and 2 of 19 of the fetuses in groups I, II, and III, respectively. The incidence was significantly higher in group I than in groups II or III (P less than 0.05). Apgar scores and neonatal acid-base status were equally good in all three groups. Neurologic and adaptive capacity scores did not differ among the three groups of neonates, nor did any of the neonates in the three groups score lower than a control group of 19 neonates whose mothers did not receive any analgesia or medications for labor and delivery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1983

Maternal catecholamines decrease during labor after lumbar epidural anesthesia.

To determine whether epidural anesthesia during labor affects maternal circulating catecholamines, blood samples were obtained from 15 patients at the peak of and immediately after two consecutive painful contractions. A lumbar epidural local anesthetic without epinephrine was then administered. After the onset of analgesia, four blood samples were again drawn. All samples were analyzed by a radioenzymatic assay for epinephrine and norepinephrine concentrations. Before anesthesia, the mean (+/-SEM) plasma epinephrine level was 280 +/- 49 pg/ml, and the mean norepinephrine level was 866 +/- 122 pg/ml. After anesthesia, epinephrine levels decreased 56% (p less than 0.01). Although norepinephrine levels decreased approximately 19%, this reduction was not statistically significant. At the height of a contraction, catecholamine levels did not differ significantly from those occurring between contractions. Lumbar epidural anesthesia during labor reduces maternal epinephrine levels, probably by eliminating the psychological and physical stress associated with painful uterine contractions or by denervating the adrenal medulla. Whatever the mechanism, reducing pain and activity of the sympathetic nervous system should increase uterine blood flow.

Anesthesia, Epidural↗

PubMed1983

Effects of induction of general and regional anesthesia for cesarean section on maternal plasma beta-endorphin levels.

Plasma beta-endorphin was measured in 40 healthy pregnant women undergoing cesarean section. Group 1 patients (N = 14) received general anesthesia by rapid-sequence induction and endotracheal intubation with curare, thiopental, and succinylcholine. Anesthesia was maintained with nitrous oxide, oxygen, and muscle relaxant until delivery. Group 2 patients (N = 26) received regional anesthesia (spinal, 14, and epidural, 12). Maternal blood samples were drawn from indwelling venous catheters prior to and after induction of either general or regional anesthesia. Plasma beta-endorphin was determined by radioimmunoassay following silicic acid extraction and gel chromatography. In the 14 patients who underwent general anesthesia, the mean (+/- SEM) plasma beta-endorphin increased significantly (p less than 0.025) from 46 +/- 7.4 to 111.6 +/- 8.9 fmol/ml. There was no significant change in plasma beta-endorphin level of the 26 patients who underwent regional anesthesia; beta-endorphin levels averaged 44.5 +/- 5.1 and 47.6 +/- 4.8 fmol/ml prior to and after induction of anesthesia, respectively. These data demonstrate that plasma beta-endorphin concentrations are elevated following induction of general anesthesia but not with induction of regional anesthesia, which suggests that less stress is associated with regional than with general anesthesia induction in patients undergoing cesarean section.

Anesthesia, Epidural↗