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Elane GL, Portela DA, Hobbs KJ, Bauck AG, Biedrzycki AH. Sedated cesarean sections are associated with increased kid survival compared to general anesthesia in goats: retrospective cohort of 45 cases (2011-2021). J Am Vet Med Assoc 2023; 261:391-396. [PMID: 36595366 DOI: 10.2460/javma.22.10.0466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To determine whether anesthesia type (sedation or general anesthesia) affects kid survival to discharge in caprine cesarean sections (C-sections). ANIMALS Retrospective cohort of 99 caprine C-sections (2011-2021). PROCEDURES All surgeries were performed via left flank laparotomy in right lateral recumbency. The number of kids alive at presentation, surgery, and discharge was recorded. Kids that were dead on presentation or euthanized intraoperatively were excluded. Goats were classified as "healthy" (American Society of Anesthesiologists status ≤ 2) or "sick" (≥ 3). RESULTS Kid survival was significantly higher for C-sections performed under sedation (47/52 [90%]) than for C-sections performed under general anesthesia (16/24 [66%]; P = .004). Relative risk was 1.4 and odds ratio was 4.7. CLINICAL RELEVANCE Performing C-sections in sedated goats may improve kid survival rates over those under general anesthesia.
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Affiliation(s)
- George L Elane
- 1Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - Diego A Portela
- 2Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - Kallie J Hobbs
- 1Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - Anje G Bauck
- 1Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - Adam H Biedrzycki
- 1Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
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2
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Li X, Li M, Wang M, Wu F, Liu H, Sun Q, Zhang Y, Liu C, Jin C, Yang J. Mapping white matter maturational processes and degrees on neonates by diffusion kurtosis imaging with multiparametric analysis. Hum Brain Mapp 2022; 43:799-815. [PMID: 34708903 PMCID: PMC8720196 DOI: 10.1002/hbm.25689] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/03/2021] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
White matter maturation has been characterized by diffusion tensor (DT) metrics. However, maturational processes and degrees are not fully investigated due to limitations of univariate approaches and limited specificity/sensitivity. Diffusion kurtosis imaging (DKI) provides kurtosis tensor (KT) and white matter tract integrity (WMTI) metrics, besides DT metrics. Therefore, we tried to investigate performances of DKI with the multiparametric analysis in characterizing white matter maturation. Developmental changes in metrics were investigated by using tract-based spatial statistics and the region of interest analysis on 50 neonates with postmenstrual age (PMA) from 37.43 to 43.57 weeks. Changes in metrics were combined into various patterns to reveal different maturational processes. Mahalanobis distance based on DT metrics (DM,DT ) and that combing DT and KT metrics (DM,DT-KT ) were computed, separately. Performances of DM,DT-KT and DM,DT were compared in revealing correlations with PMA and the neurobehavioral score. Compared with DT metrics, WMTI metrics demonstrated additional changing patterns. Furthermore, variations of DM,DT-KT across regions were in agreement with the maturational sequence. Additionally, DM,DT-KT demonstrated stronger negative correlations with PMA and the neurobehavioral score in more regions than DM,DT . Results suggest that DKI with the multiparametric analysis benefits the understanding of white matter maturational processes and degrees on neonates.
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Affiliation(s)
- Xianjun Li
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mengxuan Li
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Miaomiao Wang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fan Wu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Heng Liu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Biomedical Engineering, The Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Qinli Sun
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Biomedical Engineering, The Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Yuli Zhang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Congcong Liu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chao Jin
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jian Yang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Biomedical Engineering, The Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
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3
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Heesen M, Halpern S. Why we need systematic reviews and meta-analyses. Don't miss the forest for the trees. Int J Obstet Anesth 2020; 45:11-13. [PMID: 33309180 DOI: 10.1016/j.ijoa.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/08/2020] [Accepted: 11/01/2020] [Indexed: 11/16/2022]
Affiliation(s)
- M Heesen
- Department of Anaesthesia, Kantonsspital Baden, Baden, Switzerland.
| | - S Halpern
- Department of Anesthesiology and Pain Medicine, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Canada
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Lo Presti D, Dall’Orso S, Muceli S, Arichi T, Neumane S, Lukens A, Sabbadini R, Massaroni C, Caponero MA, Formica D, Burdet E, Schena E. An fMRI Compatible Smart Device for Measuring Palmar Grasping Actions in Newborns. SENSORS 2020; 20:s20216040. [PMID: 33114180 PMCID: PMC7660640 DOI: 10.3390/s20216040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 01/09/2023]
Abstract
Grasping is one of the first dominant motor behaviors that enable interaction of a newborn infant with its surroundings. Although atypical grasping patterns are considered predictive of neuromotor disorders and injuries, their clinical assessment suffers from examiner subjectivity, and the neuropathophysiology is poorly understood. Therefore, the combination of technology with functional magnetic resonance imaging (fMRI) may help to precisely map the brain activity associated with grasping and thus provide important insights into how functional outcomes can be improved following cerebral injury. This work introduces an MR-compatible device (i.e., smart graspable device (SGD)) for detecting grasping actions in newborn infants. Electromagnetic interference immunity (EMI) is achieved using a fiber Bragg grating sensor. Its biocompatibility and absence of electrical signals propagating through the fiber make the safety profile of the SGD particularly favorable for use with fragile infants. Firstly, the SGD design, fabrication, and metrological characterization are described, followed by preliminary assessments on a preterm newborn infant and an adult during an fMRI experiment. The results demonstrate that the combination of the SGD and fMRI can safely and precisely identify the brain activity associated with grasping behavior, which may enable early diagnosis of motor impairment and help guide tailored rehabilitation programs.
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Affiliation(s)
- Daniela Lo Presti
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (D.L.P.); (R.S.); (C.M.)
| | - Sofia Dall’Orso
- Division of Signal Processing and Biomedical Engineering, Department of Electrical Engineering, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden; (S.D.); (S.M.)
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK; (T.A.); (S.N.)
| | - Silvia Muceli
- Division of Signal Processing and Biomedical Engineering, Department of Electrical Engineering, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden; (S.D.); (S.M.)
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK; (T.A.); (S.N.)
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK; (T.A.); (S.N.)
- Paediatric Neurosciences, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK;
| | - Sara Neumane
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK; (T.A.); (S.N.)
- NeuroDiderot Unit UMR1141, Université de Paris, INSERM, F-75019 Paris, France
- UNIACT, Université Paris-Saclay, CEA, NeuroSpin, F-91191 Gif-sur-Yvette, France
| | - Anna Lukens
- Paediatric Neurosciences, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK;
| | - Riccardo Sabbadini
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (D.L.P.); (R.S.); (C.M.)
| | - Carlo Massaroni
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (D.L.P.); (R.S.); (C.M.)
| | - Michele Arturo Caponero
- Photonics Micro- and Nanostructures Laboratory, ENEA Research Center of Frascati, 00044 Frascati (RM), Italy;
| | - Domenico Formica
- Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction (NeXt Lab), Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy;
| | - Etienne Burdet
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK;
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (D.L.P.); (R.S.); (C.M.)
- Correspondence: ; Tel.: +39-062-2541-9650
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Puhto T, Kokki M, Hakomäki H, Spalding M, Gunnar T, Alahuhta S, Vakkala M. Single dose epidural hydromorphone in labour pain: maternal pharmacokinetics and neonatal exposure. Eur J Clin Pharmacol 2020; 76:969-977. [PMID: 32363420 PMCID: PMC7306027 DOI: 10.1007/s00228-020-02880-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/24/2020] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Epidural hydromorphone could be useful in obstetric analgesia as there is a need for a more water-soluble opioid than sufentanil or fentanyl with prolonged analgesic effect. To our knowledge, the pharmacokinetics of epidural hydromorphone has not been evaluated in parturients. MATERIALS AND METHODS In this pilot study, seven healthy parturients were given a single epidural dose of hydromorphone for labour pain. One parturient received 1.5 mg, two 0.75 mg and four 0.5 mg of hydromorphone hydrochloride. Dose was decreased due to nausea and pruritus. Hydromorphone's effect, adverse effects and plasma concentrations were evaluated. Neonatal drug exposure was evaluated by umbilical vein and artery opioid concentration at birth. Neonatal outcomes were assessed using Apgar and the Neurologic Adaptive Capacity Score (NACS). RESULTS All patients received additional levobupivacaine doses on parturients' requests. The first dose was requested at a median of 163 min (range 19-303 min) after hydromorphone administration. A total of 12 opioid related expected adverse events were reported by seven parturients. All newborn outcomes were uneventful. Hydromorphone's distribution and elimination after single epidural dose seem similar to that reported for non-pregnant subjects after intravenous hydromorphone administration, but further research is required to confirm this observation. CONCLUSIONS The optimal dose of hydromorphone in labour pain warrants further evaluation.
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Affiliation(s)
- Terhi Puhto
- Department of Anaesthesiology, Medical Research Center Oulu (MRC Oulu), Oulu University Hospital, PO Box 21, 90029, Oulu, Finland.
| | - Merja Kokki
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
| | | | - Michael Spalding
- Department of Anaesthesiology, Medical Research Center Oulu (MRC Oulu), Oulu University Hospital, PO Box 21, 90029, Oulu, Finland
| | - Teemu Gunnar
- Forensic Toxicology Unit (THL), The Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Seppo Alahuhta
- Department of Anaesthesiology, Medical Research Center Oulu (MRC Oulu), Oulu University Hospital, PO Box 21, 90029, Oulu, Finland
| | - Merja Vakkala
- Department of Anaesthesiology, Medical Research Center Oulu (MRC Oulu), Oulu University Hospital, PO Box 21, 90029, Oulu, Finland
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Kinnunen M, Kokki H, Hautajärvi H, Tuovinen K, Kokki M. Oxycodone for pain management in the latent phase of labour - A pragmatic trial. Acta Anaesthesiol Scand 2020; 64:685-690. [PMID: 31950485 DOI: 10.1111/aas.13550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/22/2019] [Accepted: 01/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Parenteral opioids are used for pain relief in labour but there are little data for oxycodone in this context. The aim of this study was to evaluate the efficacy, foetal exposure and safety of subcutaneous oxycodone in the latent phase of labour. METHODS This pragmatic trial included 76 parturients, who received subcutaneous oxycodone for pain relief in the latent phase of labour according to the hospital protocol: an initial dose 0.1 mg/kg, and a second dose, 0.05 mg/kg, could be administered four hours later. Pain intensity and pain relief were assessed using a numerical rating scale of 0-10. After delivery, blood samples from the maternal and umbilical veins were collected, and plasma concentrations of oxycodone and its main metabolites were quantified using UPLC-MS/MS. The Apgar scores and maternal and neonatal adverse effects were recorded. RESULTS The foetal exposure at birth was low, the median oxycodone and oxymorphone umbilical vein plasma concentrations were 1.2 ng/mL (range 0.21-7.8) and 0.14 ng/mL (0-0.26), respectively. Pain scores decreased substantially, from a median pain score of 7/10 before oxycodone to median scores of 5/10 at 30 minutes after administration, 5/10 at 60 minutes and 6/10 at 120 minutes. The median Apgar score was 9 (range 2-10) at 1 minute and 9 (6-10) at 5 minutes. Maternal adverse effects were mild, and there were no oxycodone-related neonatal adverse effects. CONCLUSION Subcutaneous oxycodone provided effective analgesia during the latent phase of labour. Newborn exposure at birth was low, and oxycodone was well-tolerated.
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Affiliation(s)
- Mari Kinnunen
- School of Medicine University of Eastern Finland Kuopio Finland
| | - Hannu Kokki
- School of Medicine University of Eastern Finland Kuopio Finland
| | | | - Kaisa Tuovinen
- School of Medicine University of Eastern Finland Kuopio Finland
| | - Merja Kokki
- Department of Anaesthesia and Intensive Care Kuopio University Hospital Kuopio Finland
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7
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Kim W, Hur M, Park SK, Yoo S, Lim T, Yoon H, Kim JT, Bahk JH. Comparison between general, spinal, epidural, and combined spinal-epidural anesthesia for cesarean delivery: a network meta-analysis. Int J Obstet Anesth 2019; 37:5-15. [DOI: 10.1016/j.ijoa.2018.09.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/12/2018] [Accepted: 09/21/2018] [Indexed: 12/18/2022]
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El-Tahan MR, El Kenany S, Abdelaty EM, Ramzy EA. Comparison of the effects of low doses of dexmedetomidine and remifentanil on the maternal hemodynamic changes during caesarean delivery in patients with severe preeclampsia: a randomized trial. Minerva Anestesiol 2018. [PMID: 29516705 DOI: 10.23736/s0375-9393.18.12312-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Preoperative remifentanil administration blunts hemodynamic responses to tracheal intubation in parturients with severe preeclampsia. We hypothesized that the preoperative administration of low doses of remifentanil or dexmedetomidine would lead to comparable maternal neurohormonal responses and neonatal outcomes in patients with severe preeclampsia. METHODS Parturients diagnosed with severe preeclampsia undergoing caesarean delivery were randomLy allocated to receive remifentanil (0.1 µg/kg/min) or dexmedetomidine (0.4 µg/kg/h) at five min and 20 min before induction, respectively. Changes in maternal mean arterial BP(MAP), clinical recovery, cortisol level, and neonatal outcome, were recorded. RESULTS Patients who received remifentanil had higher response in MAP at the induction (94 9.8 vs. 104 4.5; P<0.001) and emergence from anesthesia (94 6.3 vs. 98 5.1; P<0.001), but shorter times to extubation (5.1 1.6 vs. 13.5 2.8 min; P<0.001). Five (27.8%) patients in the remifentanil group received ephedrine versus none in the dexmedetomidine group (P=0.023). The maternal plasma cortisol levels, the neonatal Neurologic and Adaptative Capacity Scores and acid-base satuses were similar in the two groups. Newborns in the remifentanil group presented lower Apgar scores at 1 minute (5.11 0.8 vs. 5.68 0.8; P=0.034) and a higher incidence of respiratory depression (72.2% vs. 36.8% P=0.048). CONCLUSIONS Compared with dexmedetomidine (0.4 µg/kg/h), the preoperative administration of remifentanil (0.1 µg/kg/min) produced a significantly higher effect on maternal hemodynamic responses to caesarean delivery in patients with severe preeclampsia, however maternal hypotension and neonatal respiratory depression were more common with the use of remifentanil.
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Affiliation(s)
- Mohamed R El-Tahan
- Department of Anesthesiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Al Khubar, Saudi Arabia -
| | - Samah El Kenany
- Department of Anesthesia, Surgical Intensive Care and Pain Medicine, College of Medicine, Mansoura University, Mansoura City, Egypt
| | - Ehsan M Abdelaty
- Department of Clinical Pathology, College of Medicine, Mansoura University, Mansoura City, Egypt
| | - Eiad A Ramzy
- Department of Anesthesia, Surgical Intensive Care and Pain Medicine, College of Medicine, Mansoura University, Mansoura City, Egypt
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The effect of nefopam on lactation after caesarean section: a single-blind randomised trial. Int J Obstet Anesth 2017; 31:84-90. [DOI: 10.1016/j.ijoa.2017.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/23/2017] [Accepted: 02/13/2017] [Indexed: 11/20/2022]
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Tie WJ, Gardner H, Lai CT, Hepworth AR, Al‐Tamimi Y, Paech MJ, Hartmann PE, Geddes DT. Changes in milk composition associated with pethidine-PCEA usage after Caesarean section. MATERNAL & CHILD NUTRITION 2017; 13:e12275. [PMID: 27040350 PMCID: PMC6865999 DOI: 10.1111/mcn.12275] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/27/2015] [Accepted: 11/29/2015] [Indexed: 12/01/2022]
Abstract
The effect of pethidine as patient-controlled epidural analgesia (PCEA) on specific biochemical components in breast milk in relation to the timing of secretory activation is not well investigated. The aim of this study was to compare biochemical timing of secretory activation between women who had a vaginal (V) or Caesarean birth with pethidine-PCEA (CBP). Several milk samples were collected daily from 36 mothers (17 V, 19 CBP) for the first 265 h post-partum. Protein and lactose concentrations and Na+ and K+ ion levels were measured. Samples were assigned to three time periods: 0-72, >72-165 and >165-265 h post-partum for statistical analyses. Data were analyzed using linear mixed effect models. In the first 72 h post-partum, the mean difference in lactose concentration was 5 gL-1 higher in group V (P < 0.05). From >72-165 h post-partum, protein and Na+ concentrations were lower in group V (P = 0.05, P = 0.02), and K+ levels were higher in group V (P < 0.001). From >165-265 h post-partum, there were no significant differences between the groups. Biochemically, secretory activation had occurred by 72 h post-partum in both groups. There were greater variations in measured biochemical components observed within group CBP initially. However, by 165 h post-partum, there were no differences in the biochemical components between the groups. This suggests that effects of pethidine-PCEA are diminished by 72 h post-partum and undetected by 165 h.
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Affiliation(s)
- Wan Jun Tie
- School of Chemistry and BiochemistryUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Hazel Gardner
- School of Chemistry and BiochemistryUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Ching Tat Lai
- School of Chemistry and BiochemistryUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Anna Rachel Hepworth
- School of Chemistry and BiochemistryUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | | | - Michael James Paech
- School of Medicine and PharmacologyUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Peter Edwin Hartmann
- School of Chemistry and BiochemistryUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Donna Tracy Geddes
- School of Chemistry and BiochemistryUniversity of Western AustraliaPerthWestern AustraliaAustralia
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French CA, Cong X, Chung KS. Labor Epidural Analgesia and Breastfeeding: A Systematic Review. J Hum Lact 2016; 32:507-20. [PMID: 27121239 DOI: 10.1177/0890334415623779] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 11/27/2015] [Indexed: 11/16/2022]
Abstract
Despite widespread use of epidural analgesia during labor, no consensus has been reached among obstetric and anesthesia providers regarding its effects on breastfeeding. The purpose of this review was to examine the relationship between labor epidural analgesia and breastfeeding in the immediate postpartum period. PubMed, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature were searched for articles published in 1990 or thereafter, using the search term breastfeeding combined with epidural, labor epidural analgesia, labor analgesia, or epidural analgesia Of 117 articles, 23 described empirical studies specific to labor epidural analgesia and measured a breastfeeding outcome. Results were conflicting: 12 studies showed negative associations between epidural analgesia and breastfeeding success, 10 studies showed no effect, and 1 study showed a positive association. Most studies were observational. Of 3 randomized controlled studies, randomization methods were inadequate in 2 and not evaluable in 1. Other limitations were related to small sample size or inadequate study power; variation and lack of information regarding type and dosage of analgesia or use of other intrapartum interventions; differences in timing, definition, and method of assessing breastfeeding success; or failure to consider factors such as mothers' intention to breastfeed, social support, siblings, or the mother's need to return to work or school. It is also unclear to what extent results are mediated through effects on infant neurobehavior, maternal fever, oxytocin release, duration of labor, and need for instrumental delivery. Clinician awareness of factors affecting breastfeeding can help identify women at risk for breastfeeding difficulties in order to target support and resources effectively.
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Affiliation(s)
- Cynthia A French
- Columbia University, Graduate Program in Nurse Anesthesia, New York, NY, USA Yale New Haven Hospital, New Haven, CT, USA
| | - Xiaomei Cong
- University of Connecticut, School of Nursing, Storrs, CT, USA
| | - Keun Sam Chung
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
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12
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Su Q, Zhang H, Zhang Y, Zhang H, Ding D, Zeng J, Zhu Z, Li H. Maternal Stress in Gestation: Birth Outcomes and Stress-Related Hormone Response of the Neonates. Pediatr Neonatol 2015; 56:376-81. [PMID: 26363772 DOI: 10.1016/j.pedneo.2015.02.002] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 01/24/2015] [Accepted: 02/24/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Relatively few studies have been made on neurobehavioral outcomes of prenatal maternal stress during the newborn period, and little research has focused on umbilical cord stress hormones including cortisol, adrenocorticotropic hormone (ACTH), norepinephrine, and epinephrine. Our objective was to investigate the effects of prenatal maternal life stressors on neonatal birth outcomes, neurobehavioral development, and stress-related hormones levels. METHODS Participants were 142 mothers and their infants; 71 were selected as the prenatal life stressor exposed group and 71 as the control group matched on maternal age, gestational week, delivery type, socioeconomic and education status, and newborns' sex. Maternal life stressors during pregnancy were determined using the Life Events Scale for Pregnant Women. Neonatal neurobehavioral development was assessed with the Neonatal Behavioral Neurological Assessment. Umbilical cord plasma stress-related hormones, including ACTH, cortisol, norepinephrine, and epinephrine were measured using an enzyme-linked immunosorbent assay. RESULTS In the prenatal life stressors exposed group, newborns had significantly lower birth weight, smaller head circumference (p < 0.01, p < 0.01, respectively). Scores of Neonatal Behavioral Neurological Assessment were significantly reduced (p < 0.001). Cord plasma ACTH, norepinephrine, and epinephrine levels were significantly increased (p < 0.001), but cortisol levels were reduced (p < 0.001). CONCLUSION Prenatal maternal stress may negatively affect fetal birth outcomes, neurobehavioral development and affect neonates' cord plasma ACTH, cortisol, norepinephrine, and epinephrine.
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Affiliation(s)
- Qian Su
- Division of Neonatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Huifang Zhang
- Division of Neonatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; Division of Neonatology, Xi'an Children's Hospital, Xi'an, Shaanxi, China
| | - Yanyan Zhang
- Division of Neonatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; Department of Neonatology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Huiping Zhang
- Division of Neonatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ding Ding
- Division of Pediatrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Junan Zeng
- Division of Neonatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; Department of Neonatology, Child and Maternity Healthy Hospital of Shaanxi Province, Xi'an, Shaanxi, China
| | - Zhongliang Zhu
- Shaanxi Province Biomedicine Key Laboratory, College of Life Sciences Northwest University, Xi'an, Shaanxi, China; Department of Pharmacology, Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hui Li
- Division of Neonatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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Hashemi SJ, Jabalameli M, Mokhtary F. Effects of different anesthetic techniques on neurologic and adaptation capacity in newborn with elective cesarean section. Adv Biomed Res 2015; 4:249. [PMID: 26693474 PMCID: PMC4685640 DOI: 10.4103/2277-9175.170244] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 01/27/2014] [Indexed: 11/13/2022] Open
Abstract
Background: Neurologic and Adaptive Capacity Scoring (NACS) has been introduced as a screening test for diagnosis of central nervous system depression due to intrapartum drugs on the neonate. This test can show neurological and behavioral changes even in the presence of a normal Apgar score. NACS has 20 indicators, each indicator allocating to itself the score zero, one or two. The aim of this study was to compare the effects of different anesthetic techniques on the NACS values. Materials and Methods: This study was performed as a randomized, single-blind clinical trial on 75 infants born with elective cesarean in Shahid Beheshti Hospital, Isfahan. Simple Sampling method was carried out and the information was gathered by questionnaires. Anesthetic techniques included general, spinal or epidural anesthesia. NACS score was assessed at 15th min, 2 and 24 h after birth and then the anesthesia technique was recorded in the questionnaire. NACS score 35 or above was considered normal and 34 or less was abnormal. Results: In the present study, no significant correlation was found between the anesthesia techniques and NACS score. The mean NACS at 15 min after birthin the general, spinal and epidural groups were 33.5 ± 2.2, 33.0 ± 4.4 and 33.7 ± 1.6 respectively (P = 0.703). Conclusion: All three anesthetic techniques have identical effects on neurological and compatibility capacity of neonates born with elective cesarean; so, this could necessarily be a base to recommend the three methods equally.
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Affiliation(s)
- Seyed Jalal Hashemi
- Department of Anesthesiology and Critical Care, Al-Zahra Medical Center, Isfahan, Iran
| | - Mitra Jabalameli
- Department of Anesthesiology and Critical Care, Al-Zahra Medical Center, Isfahan, Iran
| | - Forough Mokhtary
- Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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El Kenany S, El Tahan MR. Effect of preoperative pregabalin on post-caesarean delivery analgesia: a dose-response study. Int J Obstet Anesth 2015; 26:24-31. [PMID: 26718698 DOI: 10.1016/j.ijoa.2015.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/28/2015] [Accepted: 11/06/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION We hypothesised that preoperative administration of a single-dose of pregabalin would be associated with lower morphine consumption after uncomplicated caesarean delivery. METHODS After Institutional Ethics Committee approval, 135 parturients scheduled for elective caesarean delivery under spinal anaesthesia were randomly allocated to receive either placebo, or oral pregabalin 150mg or 300mg, one hour before induction of anaesthesia. Maternal cumulative morphine requirement at 24h, pain scores, sedation scores, nausea and vomiting, pruritus, pregabalin-related adverse effects, Apgar scores, Neurologic and Adaptive Capacity scores and umbilical cord acid-base status were recorded. RESULTS Compared with placebo or pregabalin 150mg, the use of a preoperative dose of pregabalin 300mg resulted in significantly lower cumulative morphine consumption at 24h (mean dose: placebo 12.9mg [95% CI 11.6 to 14.2]; pregabalin 150mg 11.9mg; [95% CI 10.7 to 13.1]; pregabalin 300mg 6mg [95% CI 5.4 to 7.3]; P<0.001). Pregabalin 300mg resulted in lower pain scores at 4h and 6h after delivery (P<0.001), and fewer instances of nausea, vomiting and pruritus (P<0.009). Dizziness and abnormal vision were observed most frequently in the pregabalin 300mg group (P<0.05 and P<0.009, respectively). The three groups were similar in terms of maternal sedation, Apgar scores, Neurologic and Adaptive Capacity scores and umbilical cord acid-base status. Three babies in the pregabalin 300mg group (6.7%) experienced short-term poor latching-on for breastfeeding. CONCLUSION In our study, preoperative administration of pregabalin 300mg reduced postoperative morphine consumption and early postoperative pain in parturients undergoing elective caesarean delivery, although maternal side effects were more common.
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Affiliation(s)
- S El Kenany
- Department of Anaesthesia and Surgical Intensive Care, College of Medicine, Mansoura University, Mansoura, Egypt
| | - M R El Tahan
- Department of Anaesthesia and Surgical Intensive Care, College of Medicine, Mansoura University, Mansoura, Egypt.
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Niklasson B, Arnelo C, Öhman SG, Segerdahl M, Blanck A. Oral oxycodone for pain after caesarean section: A randomized comparison with nurse-administered IV morphine in a pragmatic study. Scand J Pain 2015; 7:17-24. [PMID: 29911601 DOI: 10.1016/j.sjpain.2015.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 01/09/2015] [Indexed: 11/18/2022]
Abstract
Background and aims The present randomized open label parallel group study was conducted to evaluate if an oral oxycodone (OXY) regimen can be at least equally effective and as safe for postoperative analgesia after caesarean section (CS) as a standard of care program using nurse-administered intravenous morphine (IVM), followed by oral codeine. Methods Eighty women (40 + 40) were scheduled for elective CS under spinal anaesthesia. All patients received postoperative multimodal analgesic therapy, including ibuprofen and paracetamol. The OXY group got standardized extended release and short acting oral treatment (and in a few cases intravenous OXY) as needed and the other group received current standard of care, IVM as needed for 24 h, followed by codeine. Opioid treatment lasted maximum five days. Outcome measures were pain intensity (numerical rating scale, NRS), opioid requirements, duration of administering opioids and safety for mother and newborn. All opioids in the study were expressed in OXY equivalents, using a conversion table. As the bioavailability of each opioid has a certain extent of interindividual bioavailability this conversion represents an approximation. The possible influence of opioids on the newborns was evaluated by the Neurological Adaptive Capacity Score at birth and at 24 and 48 h. Results During the first 24 h, there were no differences between treatments in opioid requirements or mean pain intensity at rest but pain intensity when asking for rescue medication was lower in the OXY than in the IVM group (mean ± SD; 5.41 ± 6.42 vs. 6.42 ± 1.61; p = 0.027). Provoked pain (uterus palpation) during the first 6h was also less in the OXY group (3.26 ± 2.13 vs. 4.60 ± 2.10; p = 0.007). During the 25-48 h period postoperatively, patients on OXY reported significantly lower pain intensity at rest (2.9 ± 1.9 vs. 3.8 ± 1.8; p = 0.039) and consumed less opioids (OXY equivalents; mg) (31.5 ± 9.6 vs. 38.2 ± 38.2; p = 0.001) than those on IVM/codeine. The total amount of opioids 0-5 days postoperatively was significantly lower in the OXY than in the IVM/codeine group (108.7 ± 37.6 vs. 138.2 ± 45.1; p = 0.002). Duration of administering opioids was significantly shorter in the OXY group. Time to first spontaneous bowel movement was shorter in the OXY group compared with the IVM/codeine group. No serious adverse events were recorded in the mothers but the total number of common opioid adverse effects was higher among women on IVM/codeine than among those receiving OXY (15 vs. 3; p = 0.007). No adverse outcomes in the newborns related to treatment were observed in either group. Conclusions In a multimodal protocol for postoperative analgesia after CS better pain control and lower opioid intake was observed in patients receiving oral OXY as compared to those on IVM/codeine. No safety risks for mother and child were identified with either protocol. Implications Our findings support the view that use of oral OXY is a simple, effective and time saving treatment for postoperative pain after CS.
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Affiliation(s)
- Boel Niklasson
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Obstetrics and Gynecology, Karolinska Institute at the Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden
- Sophiahemmet University, Box 5605, 114 86 Stockholm, Sweden
| | - Catarina Arnelo
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Obstetrics and Gynecology, Karolinska Institute at the Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden
| | - Susanne Georgsson Öhman
- Sophiahemmet University, Box 5605, 114 86 Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Solna, 171 77 Stockholm, Sweden
| | - Märta Segerdahl
- Department of Physiology and Pharmacology, Karolinska Institute, 171 77 Stockholm, Sweden
| | - Agneta Blanck
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Obstetrics and Gynecology, Karolinska Institute at the Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden
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Abstract
Clinicians have hypothesized a spectrum of minor neurologic manifestations, consistent with neuroanatomical reports and collectively termed as a "syndrome of bilirubin-induced neurologic dysfunction (BIND)," which can occur in the absence of classical kernicterus. The current review builds on these initial reports with a focus on clinical signs and symptoms that are assessed by standardized tools and manifest from neonatal age to childhood. These clinical manifestations are characterized by the following domains: (i) neuromotor signs; (ii) muscle tone abnormalities; (iii) hyperexcitable neonatal reflexes; (iv) variety of neurobehavior manifestations; (v) speech and language abnormalities; and (vi) evolving array of central processing abnormalities, such as sensorineural audiology and visuomotor dysfunctions. Concerns remain that the most vulnerable infants are likely to acquire BIND, either because their exposure to bilirubin is not identified as severe enough to need treatment or is prolonged but slightly below current threshold levels for intervention. Knowing that a total serum/plasma bilirubin (TB) level is not the most precise indicator of neurotoxicity, the role of expanded biomarkers or a "bilirubin panel" has yet to be validated in prospective studies. Future studies that correlate early "toxic" bilirubin exposure to long-term academic potential of children are needed to explore new insights into bilirubin's effect on the structural and functional maturation of an infant's neural network topology.
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Wang K, Cao L, Deng Q, Sun LQ, Gu TY, Song J, Qi DY. The effects of epidural/spinal opioids in labour analgesia on neonatal outcomes: a meta-analysis of randomized controlled trials. Can J Anaesth 2014; 61:695-709. [PMID: 25011701 DOI: 10.1007/s12630-014-0185-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 05/15/2014] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Epidural/spinal opioids are increasingly used to relieve parturients' pain in labour. Some studies indicate that opioids can induce side effects in neonates, such as respiratory depression and neurobehavioural changes. This meta-analysis aimed to clarify the effects of opioids in labour analgesia on neonates. SOURCE PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE™ were searched for relevant randomized controlled trials (RCTs). The neonatal data of Apgar scores, Neurological and Adaptive Capacity Scores (NACS), and umbilical cord pH values were extracted. Statistical analyses were carried out using Review Manager 5.2 and Stata(®) 10. PRINCIPAL FINDINGS Twenty-one trials with 2,859 participants were included in our meta-analysis. No difference in the incidence of Apgar scores < 7 was shown between the opioid and control groups at one minute (risk difference [RD] 0.0%, 95% confidence interval [CI]: -3.0 to 2.0, P = 0.78; I (2) = 0%, 95% CI: 0 to 50) and at five minutes (RD -1.0%, 95% CI: -2.0 to 1.0, P = 0.31; I(2) = 0%, 95% CI: 0 to 50). No significant differences were found in the NACS at two hours (mean difference [MD] -0.35, 95% CI: -1.70 to 1.01, P = 0.62; I(2) = 0%, 95% CI: 0 to 79) and at 24 hr (MD -0.45, 95% CI: -1.36 to 0.46, P = 0.33; I(2) = 3%, 95% CI: 0 to 26). Also, no significant differences were found in umbilical cord artery pH (MD -0.02, 95% CI: -0.06 to 0.03, P = 0.48; I(2) = 80%, 95% CI: 46 to 92) and vein pH (MD -0.03, 95% CI: -0.07 to 0.00, P = 0.08; I(2) = 77%, 95% CI: 36 to 91). No significant publication bias was found. CONCLUSION The common doses of fentanyl and sufentanil used with an epidural/spinal technique in labour analgesia are safe for neonates up to 24 hr after delivery. In future studies, more attention should be paid to the long-term side effects in neonates.
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Affiliation(s)
- Kai Wang
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical College, Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical College, 99 West Huaihai Road, Xuzhou, 221006, PR China
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Dalal PG, Bosak J, Berlin C. Safety of the breast-feeding infant after maternal anesthesia. Paediatr Anaesth 2014; 24:359-71. [PMID: 24372776 DOI: 10.1111/pan.12331] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2013] [Indexed: 12/30/2022]
Abstract
There has been an increase in breast-feeding supported by the recommendations of the American Academy of Pediatrics and the World Health Organization. An anesthesiologist may be presented with a well-motivated breast-feeding mother who wishes to breast-feed her infant in the perioperative period. Administration of anesthesia entails acute administration of drugs with potential for sedation and respiratory effects on the nursing infant. The short-term use of these drugs minimizes the possibility of these effects. The aim should be to minimize the use of narcotics and benzodiazepines, use shorter acting agents, use regional anesthesia where possible and avoid agents with active metabolites. Frequent clinical assessments of the nursing infant are important. Available literature does suggest that although the currently available anesthetic and analgesic drugs are transferred in the breast milk, the amounts transferred are almost always clinically insignificant and pose little or no risk to the nursing infant.
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Affiliation(s)
- Priti G Dalal
- Department of Anesthesiology, Penn State University College of Medicine, Milton S Hershey Medical Center, Hershey, PA, USA
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Senel AC, Mergan F. A pré-medicação com midazolam antes de secção cesariana não tem efeitos adversos no neonato. Braz J Anesthesiol 2014. [DOI: 10.1016/j.bjan.2012.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Senel AC, Mergan F. Premedication with midazolam prior to caesarean section has no neonatal adverse effects. Braz J Anesthesiol 2013; 64:16-21. [PMID: 24565384 DOI: 10.1016/j.bjane.2012.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 08/27/2012] [Indexed: 11/30/2022] Open
Abstract
Like all surgical patients, obstetric patients also feel operative stress and anxiety. This can be prevented by giving patients detailed information about their operation and with preoperative pharmacological medications. Because of depressive effects of sedatives on newborns, pharmacological medications are omitted, especially in obstetric patients. The literature contains few studies concerning preoperative midazolam use in Caesarian section (C/S) patients. Our aim in this study was to help patients undergoing C/S surgery. One group scheduled for elective C/S received midazolam 0.025 mg kg(-1) intravenously, the other received saline. Maternal anxiety was evaluated using Amsterdam Preoperative Anxiety and Information Scale (APAIS) scores, and newborns were evaluated using Apgar and the Neonatal Neurologic and Adaptive Capacity Score (NACS). In conclusion, patients receiving midazolam 0.025 mg kg(-1) as premedication had significantly low anxiety scores, without any adverse effects on the newborns. Midazolam can therefore safely be used as a premedicative agent in C/S surgery.
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Affiliation(s)
- Ahmet Can Senel
- Department of Anesthesiology and Critical Care, School of Medicine, Karadeniz Technical University, Trabzon, Turkey.
| | - Fatih Mergan
- Department of Anesthesiology and Critical Care, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
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Abstract
BACKGROUND The aim of this work was to investigate in a prospective study whether moderate hyperbilirubinemia in healthy term neonates is associated with an increase of minor neurological dysfunction (MND) and behavioral problems up to 18 mo. METHOD We enrolled 43 healthy term infants with a bilirubin level ≥ 220 µmol/l (BILI group) at 72-96 h postnatally at the University Medical Center Groningen (UMCG), including eight referrals for hyperbilirubinemia. Seventy healthy term infants born at the UMCG with bilirubin level <220 µmol/l served as comparisons (COMP group). We evaluated the neurologic condition neonatally and at 3 and 18 mo; behavior was evaluated at birth and 18 mo. RESULTS Rates of MND in BILI and COMP groups were similar at all ages. However, bilirubin levels of ≥ 300 µmol/l (n = 10) were associated with an increased risk of complex MND (odds ratio: 4.21; 95% confidence interval: 1.02-17.37). Neonatally, BILI infants were more often lethargic than COMP infants (odds ratio: 3.54; 95% confidence interval: 1.32-9.51); at 18 mo, they had higher hyperactivity scores (effect: 0.32; 95% confidence interval: 0.08-0.56). CONCLUSION Occurrence of complex MND at 18 mo in infants with moderate hyperbilirubinemia was not different from that in comparison infants, but bilirubin level ≥ 300 was associated with an increased risk of complex MND. This study also suggests that minor behavioral effects of moderate hyperbilirubinemia cannot be excluded.
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Sakalidis VS, Williams TM, Hepworth AR, Garbin CP, Hartmann PE, Paech MJ, Al-Tamimi Y, Geddes DT. A comparison of early sucking dynamics during breastfeeding after cesarean section and vaginal birth. Breastfeed Med 2013; 8:79-85. [PMID: 22845858 DOI: 10.1089/bfm.2012.0018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The impact of cesarean section (CS) birth and pethidine for post-CS epidural analgesia on early breastfeeding behavior is unclear. This study aimed to measure infant sucking and breastfeeding behavior in infants of mothers who delivered by CS (CS group) and used pethidine patient-controlled epidural analgesia (PCEA) after CS with that of infants who were delivered by vaginal birth (V group), during secretory activation and again after the establishment of lactation. SUBJECTS AND METHODS Sucking dynamics and milk intake of breastfeeding infants were assessed on approximately 3 and 20 (follow-up) days postpartum (CS group, n=19; V group, n=15). Nipple diameters, tongue movement, and nipple position during sucking were measured from ultrasound scans of the intra-oral cavity during breastfeeding. Time of the first breastfeed and day of breast fullness were recorded, and infant neurobehavior was assessed. RESULTS CS infants displayed more anterior tongue movement on Day 3 than at follow-up compared with the V group, which showed a similar amount of movement at each assessment (p for interaction<0.001). Compared with the V group, the CS group showed faster suck rates, especially on Day 3 (p<0.001), later times to first breastfeed (p=0.01) and breast fullness (p=0.03), and lower neurobehavioral scores (p=0.047). Breastfeeding duration and milk intake were similar between groups. CONCLUSIONS Although the observed effect of CS birth followed by pethidine PCEA after CS during the period of secretory activation was small, our results indicate that successful initiation of lactation may require additional breastfeeding support and monitoring at Day 3 postpartum for mothers who undergo CS.
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Affiliation(s)
- Vanessa S Sakalidis
- School of Chemistry and Biochemistry, The University of Western Australia, Crawley, Western Australia, Australia.
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El-Tahan M, Mowafi H, Al Sheikh I, Khidr A, Al-Juhaiman R. Efficacy of dexmedetomidine in suppressing cardiovascular and hormonal responses to general anaesthesia for caesarean delivery: a dose–response study. Int J Obstet Anesth 2012; 21:222-9. [DOI: 10.1016/j.ijoa.2012.04.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 04/23/2012] [Accepted: 04/24/2012] [Indexed: 11/16/2022]
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The grasp reflex and moro reflex in infants: hierarchy of primitive reflex responses. Int J Pediatr 2012; 2012:191562. [PMID: 22778756 PMCID: PMC3384944 DOI: 10.1155/2012/191562] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 03/30/2012] [Indexed: 11/18/2022] Open
Abstract
The plantar grasp reflex is of great clinical significance, especially in terms of the detection of spasticity. The palmar grasp reflex also has diagnostic significance. This grasp reflex of the hands and feet is mediated by a spinal reflex mechanism, which appears to be under the regulatory control of nonprimary motor areas through the spinal interneurons. This reflex in human infants can be regarded as a rudiment of phylogenetic function. The absence of the Moro reflex during the neonatal period and early infancy is highly diagnostic, indicating a variety of compromised conditions. The center of the reflex is probably in the lower region of the pons to the medulla. The phylogenetic meaning of the reflex remains unclear. However, the hierarchical interrelation among these primitive reflexes seems to be essential for the arboreal life of monkey newborns, and the possible role of the Moro reflex in these newborns was discussed in relation to the interrelationship.
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Feng S, Cao Y, Wang W, Liu Y, Shen X. Addition of Adrenaline to Chloroprocaine Provides a Moderate Duration Time for Epidural Anaesthesia in Elective Caesarean Section. J Int Med Res 2012; 40:1099-107. [PMID: 22906283 DOI: 10.1177/147323001204000329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE: Epidural anaesthesia using chloroprocaine with or without adrenaline and lidocaine with adrenaline were compared. METHODS: Sixty parturients undergoing elective caesarean section under epidural anaesthesia were randomized to receive 3% chloroprocaine (group C), 3% chloroprocaine with adrenaline (group CA) or 2% lidocaine with adrenaline (group LA). Onset time, duration time and various maternal, fetal and neonatal parameters were monitored. Pain was assessed using a visual analogue scale. RESULTS: The onset time of analgesia in group CA was similar to that in group C but was shorter than that in group LA. Duration of analgesia, loss of cold sensation and motor blockade in group CA were prolonged compared with group C, but were shorter than those in group LA. No differences in maternal, fetal or neonatal effects were seen. A higher pain score was reported in group C than in groups CA or LA at the end of surgery. CONCLUSIONS: Epidural anaesthesia using chloroprocaine with adrenaline has a quick onset and moderate duration and is an attractive alternative to lidocaine and adrenaline or chloroprocaine alone for caesarean section.
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Affiliation(s)
- Sw Feng
- State Key Laboratory of Reproductive Medicine, Department of Anaesthesiology, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Y Cao
- State Key Laboratory of Reproductive Medicine, Department of Anaesthesiology, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Wg Wang
- State Key Laboratory of Reproductive Medicine, Department of Anaesthesiology, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Ys Liu
- State Key Laboratory of Reproductive Medicine, Department of Anaesthesiology, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Xf Shen
- State Key Laboratory of Reproductive Medicine, Department of Anaesthesiology, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing, China
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Kokki M, Franco MG, Raatikainen K, Välitalo P, Sankilampi U, Heinonen S, Neuvonen PJ, Kokki H. Intravenous oxycodone for pain relief in the first stage of labour--maternal pharmacokinetics and neonatal exposure. Basic Clin Pharmacol Toxicol 2012; 111:182-8. [PMID: 22448718 DOI: 10.1111/j.1742-7843.2012.00884.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 03/16/2012] [Indexed: 11/30/2022]
Abstract
Physiological changes during pregnancy may change pharmacokinetics of compounds. Oxycodone is an increasingly used opioid agonist in acute pain management but its pharmacokinetics in labouring women has not been established. We studied the maternal pharmacokinetics and neonatal exposure of intravenous oxycodone for pain relief in the first stage of labour. The study was prospective, open-labelled and with a control group. After informed consent, 15 nulliparous parturients and newborns, and newborns in a control group were studied. In the study group, oxycodone boluses of 1 mg i.v., up to a cumulative dose of 5 mg, was administered when labour pain score was 5/10 or higher. As the control group, 30 other newborns after uncomplicated deliveries with no systemic opioids were assessed for the neonatal outcome. In the study group, maternal pharmacokinetics of oxycodone was measured from plasma concentrations during labour, and neonatal exposure was assessed from umbilical plasma samples using population pharmacokinetic methods. Maternal plasma oxycodone concentration decreased with a median half-life of 2.6 hr (range, 1.8-2.8). Oxycodone concentrations in the umbilical plasma 2.7 μg/l (0.3-14.5) were similar as in maternal plasma 2.4 (0.1-14.8) μg/l at the time of birth. No severe or unexpected adverse effects were noted. To conclude, firstly, maternal elimination half-life of i.v. oxycodone was significantly shorter than that reported in non-pregnant women, and secondly, maternal plasma oxycodone at the birth correlated well with neonatal umbilical concentrations and may, thus, be used as an estimate of neonatal exposure.
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Affiliation(s)
- Merja Kokki
- Department of Anaesthesia and Operative Services, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, Finland.
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Sirvinskiene G, Zemaitiene N, Zaborskis A, Markuniene E, Jusiene R. Infant difficult behaviors in the context of perinatal biomedical conditions and early child environment. BMC Pediatr 2012; 12:44. [PMID: 22494700 PMCID: PMC3348010 DOI: 10.1186/1471-2431-12-44] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 04/11/2012] [Indexed: 12/04/2022] Open
Abstract
Background Problems experienced within the first year of an infant's life can be precursors of later mental health conditions. The purpose of this study was to examine the frequency and continuity of difficult behaviors in infants at 3 and 6 months of age and the associations of these difficulties with biomedical and psychosocial factors. Methods This study was a part of an ongoing prospective birth-cohort study. Study participants were 189 uniparous mothers and their full-term newborns. The index of infant difficult behavior was constructed. This index was then associated with the following factors: delivery mode, newborn function after birth, maternal emotional well-being, risk behavior, subjective evaluation of the quality of the relationship of the couple, and attitudes toward infant-rearing. Results Common difficult behaviors, including crying, sleeping and eating problems, were characteristic for 30.2% of 3 month old and for 22.2% of 6 month old full-term infants. The expression of infant difficult behaviors at the age of 3 months increased the likelihood of the expression of these difficulties at 6 months by more than 5 times. Factors including younger maternal age, poor prenatal and postnatal emotional well-being, prenatal alcohol consumption, low satisfaction with the couple's relationship before pregnancy, and deficiency of infant-centered maternal attitudes towards infant-rearing increased the likelihood of difficult behaviors in infants at the age of 3 months. Low maternal satisfaction with the relationship of the couple before pregnancy, negative emotional reactions of both parents toward pregnancy (as reported by the mother) and the deficiency of an infant-centered maternal attitude towards infant-rearing increased the likelihood of infant difficult behaviors continuing between the ages of 3 to 6 months. Perinatal biomedical conditions were not related to the difficult behaviors in infants. Conclusions Our study suggests that early onset of difficult behavior highly increases the risk for the continuation of difficult behavior during infancy. In general, the impact of prenatal psychosocial environment on infant behavior decreases from the ages of 3 to 6 months; however, some prenatal and preconceptional psychosocial factors have direct associations with the continuity of difficult behaviors through the first half-year of an infant's life.
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Affiliation(s)
- Giedre Sirvinskiene
- Institute for Health Research, Lithuanian University of Health Sciences, Academy of Medicine, Kaunas, Lithuania.
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Bernardi JR, Ferreira CF, Nunes M, da Silva CH, Bosa VL, Silveira PP, Goldani MZ. Impact of Perinatal Different Intrauterine Environments on Child Growth and Development in the First Six Months of Life--IVAPSA Birth Cohort: rationale, design, and methods. BMC Pregnancy Childbirth 2012; 12:25. [PMID: 22471837 PMCID: PMC3378440 DOI: 10.1186/1471-2393-12-25] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 04/02/2012] [Indexed: 11/23/2022] Open
Abstract
Background In the last twenty years, retrospective studies have shown that perinatal events may impact the individual health in the medium and long term. However, only a few prospective studies were designed to address this phenomenon. This study aims to describe the design and methods of the Impact of Perinatal Environmental Variations in the First Six Months of Life - the IVAPSA Birth Cohort. Method/Design This is a clinical study and involves the recruitment of a birth cohort from hospitals in Porto Alegre, Rio Grande do Sul, Brazil. Mothers from different clinical backgrounds (hypertensive, diabetics, smokers, having an intrauterine growth restricted child for idiopathic reasons, and controls) will be invited to join the study twenty-four hours after the birth of their child. Data on economic, social, and maternal health care, feeding practices, anthropometric measures, physical activity, and neuropsychological evaluation will be obtained in interviews at postpartum, 7 and 15 days, 1, 3 and 6 months of life. Discussion To our knowledge, this is the first thematic cohort focused on the effects of intrauterine growth restriction to prospectively enroll mothers from different clinical backgrounds. The IVAPSA Birth Cohort is a promising research platform that can contribute to the knowledge on the relationship between perinatal events and their consequences on the children's early life.
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Affiliation(s)
- Juliana Rombaldi Bernardi
- Núcleo de Estudos da Saúde da Criança e do Adolescente - Hospital de Clínicas de Porto Alegre - Faculdade de Medicina - Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, CEP 90035-903 - Porto Alegre/RS - Brazil
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Paech MJ, Salman S, Ilett KF, OʼHalloran SJ, Muchatuta NA. Transfer of Parecoxib and Its Primary Active Metabolite Valdecoxib via Transitional Breastmilk Following Intravenous Parecoxib Use After Cesarean Delivery. Anesth Analg 2012; 114:837-44. [DOI: 10.1213/ane.0b013e3182468fa7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Al-Tamimi Y, Ilett K, Paech M, O’Halloran S, Hartmann P. Estimation of infant dose and exposure to pethidine and norpethidine via breast milk following patient-controlled epidural pethidine for analgesia post caesarean delivery. Int J Obstet Anesth 2011; 20:128-34. [DOI: 10.1016/j.ijoa.2010.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 12/09/2010] [Accepted: 12/11/2010] [Indexed: 10/18/2022]
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Sury MRJ, Bould MD. Defining awakening from anesthesia in infants: a narrative review of published descriptions and scales of behavior. Paediatr Anaesth 2011; 21:364-72. [PMID: 21324047 DOI: 10.1111/j.1460-9592.2011.03538.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES A descriptive tool or validated scale of consciousness is desirable in infants to test the value of any depth of anesthesia monitor. METHODS We have reviewed published descriptions and scales of observed behavior that may be applicable to the study of infants during the transition from anesthesia to wakefulness. RESULTS Potentially useful scales were found that had been developed for the assessment and study of natural sleep, neurological state, arousal, anesthesia, sedation, coma, and pain. Scales or criteria of behavior had been developed for anesthetised children, but there were no agreed definitions or criteria specifically for anesthetised infants or neonates. CONCLUSION Criteria for awakening of infants from anesthesia need to be developed and agreed.
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Affiliation(s)
- Michael R J Sury
- Portex Unit of Anaesthesia, University College London Institute of Child Health, London, UK.
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Reynolds F. Labour analgesia and the baby: good news is no news. Int J Obstet Anesth 2011; 20:38-50. [DOI: 10.1016/j.ijoa.2010.08.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 08/02/2010] [Accepted: 08/31/2010] [Indexed: 02/09/2023]
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Kiremitci S, Tuzun F, Yesilirmak DC, Kumral A, Duman N, Ozkan H. Is gastric aspiration needed for newborn management in delivery room? Resuscitation 2011; 82:40-4. [DOI: 10.1016/j.resuscitation.2010.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 07/30/2010] [Accepted: 09/01/2010] [Indexed: 02/04/2023]
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Reynolds F. The effects of maternal labour analgesia on the fetus. Best Pract Res Clin Obstet Gynaecol 2010; 24:289-302. [DOI: 10.1016/j.bpobgyn.2009.11.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 11/16/2009] [Indexed: 02/02/2023]
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Douma M, Verwey R, Kam-Endtz C, van der Linden P, Stienstra R. Obstetric analgesia: a comparison of patient-controlled meperidine, remifentanil, and fentanyl in labour. Br J Anaesth 2010; 104:209-15. [DOI: 10.1093/bja/aep359] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hewitson L, Houser LA, Stott C, Sackett G, Tomko JL, Atwood D, Blue L, White ER. Delayed acquisition of neonatal reflexes in newborn primates receiving a thimerosal-containing hepatitis B vaccine: influence of gestational age and birth weight. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2010; 73:1298-1313. [PMID: 20711932 DOI: 10.1080/15287394.2010.484709] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This study examined whether acquisition of neonatal reflexes in newborn rhesus macaques was influenced by receipt of a single neonatal dose of hepatitis B vaccine containing the preservative thimerosal (Th). Hepatitis B vaccine containing a weight-adjusted Th dose was administered to male macaques within 24 h of birth (n = 13). Unexposed animals received saline placebo (n = 4) or no injection (n = 3). Infants were tested daily for acquisition of nine survival, motor, and sensorimotor reflexes. In exposed animals there was a significant delay in the acquisition of root, snout, and suck reflexes, compared with unexposed animals. No neonatal responses were significantly delayed in unexposed animals. Gestational age (GA) and birth weight (BW) were not significantly correlated. Cox regression models were used to evaluate main effects and interactions of exposure with BW and GA as independent predictors and time-invariant covariates. Significant main effects remained for exposure on root and suck when controlling for GA and BW, such that exposed animals were relatively delayed in time-to-criterion. Interaction models indicated there were various interactions between exposure, GA, and BW and that inclusion of the relevant interaction terms significantly improved model fit. This, in turn, indicated that lower BW and/or lower GA exacerbated the adverse effects following vaccine exposure. This primate model provides a possible means of assessing adverse neurodevelopmental outcomes from neonatal Th-containing hepatitis B vaccine exposure, particularly in infants of lower GA or BW. The mechanisms underlying these effects and the requirements for Th requires further study.
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Affiliation(s)
- Laura Hewitson
- Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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Prakash S, Pramanik V, Chellani H, Salhan S, Gogia A. Maternal and neonatal effects of bolus administration of ephedrine and phenylephrine during spinal anaesthesia for caesarean delivery: a randomised study. Int J Obstet Anesth 2010; 19:24-30. [DOI: 10.1016/j.ijoa.2009.02.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 02/10/2009] [Indexed: 10/20/2022]
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A randomized study of the effects of perioperative i.v. lidocaine on hemodynamic and hormonal responses for cesarean section. J Anesth 2009; 23:215-21. [DOI: 10.1007/s00540-009-0738-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 01/05/2009] [Indexed: 12/19/2022]
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Excretion of Ropivacaine in Breast Milk During Patient-Controlled Epidural Analgesia After Cesarean Delivery. Reg Anesth Pain Med 2009; 34:126-9. [DOI: 10.1097/aap.0b013e3181958f39] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nakamura G, Ganem EM, Módolo NSP, Rugolo LMSDS, Castiglia YMM. Labor analgesia with ropivacaine added to clonidine: a randomized clinical trial. SAO PAULO MED J 2008; 126:102-6. [PMID: 18553032 DOI: 10.1590/s1516-31802008000200007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Accepted: 03/28/2008] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE Previous studies have led to speculation that the association between ropivacaine and clonidine might be more effective than ropivacaine alone. We examined the maternal-fetal effects of two pharmacological approaches: a low dose of ropivacaine or a lower dose of ropivacaine plus clonidine for epidural analgesia during labor. DESIGN AND SETTING Prospective study at Department of Anesthesiology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista. METHODS Thirty-two pregnant women in American Society of Anesthesiologists physical status I and II randomly underwent epidural analgesia using 15 ml of ropivacaine 0.125% (R group) or 15 ml of ropivacaine 0.0625% plus 75 microg clonidine (RC group). Pain intensity, sensory block level, latency time, motor block intensity, duration of labor analgesia and duration of epidural analgesia were evaluated. The newborns were evaluated using Apgar scores and the Amiel-Tison method (neurological and adaptive capacity score). RESULTS There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75% of the RC group newborns were found to be neurologically healthy at the 24-hour examination. RESULTS There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75% of the RC group newborns were found to be neurologically healthy at the 24-hour examination. CONCLUSION Both low-dose ropivacaine and a lower dose plus clonidine relieved maternal pain during obstetric labor. Newborns of mothers who received only ropivacaine showed better neurological and adaptive capacity scores.
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Affiliation(s)
- Giane Nakamura
- Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
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Ilett KF, Paech MJ, Page-Sharp M, Sy SK, Kristensen JH, Goy R, Chua S, Christmas T, Scott KL. Use of a sparse sampling study design to assess transfer of tramadol and its O-desmethyl metabolite into transitional breast milk. Br J Clin Pharmacol 2008; 65:661-6. [PMID: 18294329 DOI: 10.1111/j.1365-2125.2008.03117.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT There are presently no published data on tramadol transfer into breast milk or on its effects in the breastfed infant. WHAT THIS STUDY ADDS We have provided quantitative data on the absolute and relative infant doses of rac-tramadol and it rac-O-desmethyl metabolite for the breastfed infant. We have also demonstrated a novel sparse sampling data collection method for investigating infant exposure via milk. AIMS To investigate the transfer of rac-tramadol and its rac-O-desmethyl metabolite into transitional milk, and assess unwanted effects in the breastfed infant. METHODS Tramadol HCl (100 mg six hourly) was administered to 75 breastfeeding mothers for postoperative analgesia on days 2-4 after Caesarian section. Milk and plasma samples were collected after administration of four or more doses. Rac-tramadol and rac-O-desmethyltramadol were measured by high performance liquid chromatography. Milk : plasma ratio (M : P) and infant doses were calculated by standard methods. The behavioural characteristics of the exposed breastfed infants and a matched control group of infants not exposed to tramadol were also studied. RESULTS At steady-state, mean (95% CI) M : P was 2.2 (2.0, 2.4) for rac-tramadol and 2.8 (2.5, 3.1) for rac-O-desmethyltramadol. The estimated absolute and relative infant doses were 112 (102, 122) microg kg(-1) day(-1) and 30 (28, 32) microg kg(-1) day(-1), and 2.24% (2.04, 2.44)% and 0.64% (0.59, 0.69)% for rac-tramadol and rac-O-desmethyltramadol, respectively. The exposed infants and control breastfed infants had similar characteristics, including Apgar scores at birth and Neurologic and Adaptive Capacity Scores. CONCLUSIONS The combined relative infant dose of 2.88% at steady-state was low. The similarity of NACS in exposed infants and controls suggests that there were no significant behavioural adverse effects. We conclude that short-term maternal use of tramadol during establishment of lactation is compatible with breastfeeding.
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Affiliation(s)
- Kenneth F Ilett
- Pharmacology and Anaesthesiology Unit, School of Medicine and Pharmacology, University of Western Australia, Crawley, Australia.
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Kroeker R, Sackett G, Reynolds J. Statistical methods for describing developmental milestones with censored data: effects of birth weight status and sex in neonatal pigtailed macaques. Am J Primatol 2007; 69:1313-24. [PMID: 17437288 DOI: 10.1002/ajp.20440] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Neurobehavioral tests are used to assess early neonatal behavioral functioning and detect effects of prenatal and perinatal events. However, common measurement and data collection methods create specific data features requiring thoughtful statistical analysis. Assessment response measurements are often ordinal scaled, not interval scaled; the magnitude of the physical response may not directly correlate with the underlying state of developmental maturity; and a subject's assessment record may be censored. Censoring occurs when the milestone is exhibited at the first test (left censoring), when the milestone is not exhibited before the end of the study (right censoring), or when the exact age of attaining the milestone is uncertain due to irregularly spaced test sessions or missing data (interval censoring). Such milestone data is best analyzed using survival analysis methods. Two methods are contrasted: the non-parametric Kaplan-Meier estimator and the fully parametric interval censored regression. The methods represent the spectrum of survival analyses in terms of parametric assumptions, ability to handle simultaneous testing of multiple predictors, and accommodation of different types of censoring. Both methods were used to assess birth weight status and sex effects on 14 separate test items from assessments on 255 healthy pigtailed macaques. The methods gave almost identical results. Compared to the normal birth weight group, the low birth weight group had significantly delayed development on all but one test item. Within the low birth weight group, males had significantly delayed development for some responses relative to females.
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Affiliation(s)
- Rose Kroeker
- Department of Psychology, University of Washington, Seattle, WA 98195, USA
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Effect of maternal facial oxygen on neonatal behavioural scores during elective Caesarean section with spinal anaesthesia. Eur J Anaesthesiol 2007. [DOI: 10.1097/00003643-200701000-00011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Backe SK, Kocarev M, Wilson RC, Lyons G. Effect of maternal facial oxygen on neonatal behavioural scores during elective Caesarean section with spinal anaesthesia. Eur J Anaesthesiol 2006; 24:66-70. [PMID: 16895615 DOI: 10.1017/s0265021506001153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2006] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE For many, the administration of additional oxygen to the women receiving regional anaesthesia for Caesarean section is traditional, but for others it is controversial because of doubts about its efficacy. The aim of our study was to determine if beneficial effects of maternal oxygen therapy on the fetus could be revealed using a neonatal behavioural scoring system. METHODS Sixty women with a normal singleton pregnancy beyond 36 weeks gestation, undergoing elective Caesarean section under spinal anaesthesia were randomized into two groups: Group 1 received air and oxygen mixture through a Hudson style face mask (FiO2 of 0.21-0.25). Group 2 received FiO2 of 0.40-0.60 through an identical Hudson style face mask. Neurologic Adaptive Capacity Score on all the infants within 5 min of birth and between 10 and 24 h after the Caesarean delivery was performed. Apgar score, umbilical venous blood oxygen tension and umbilical artery standardized base excess were recorded. RESULTS Initial Neurologic Adaptive Capacity Scores at birth in Groups 1 and 2 were 32.6 (SD 4.6) and 31.3 (SD 4.3), respectively. Latter scores were 36.0 (SD 3.0) and 36.5 (SD 1.9), respectively. Neither were statistically significant. There were no significant differences between the groups for any of the recorded variables. CONCLUSIONS Administering maternal oxygen using a standard commercial Hudson style face mask does not appear to significantly improve oxygen delivery to, nor does it influence acidosis or behavioural effects in, the normal neonate at elective Caesarean delivery with spinal anaesthesia.
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Affiliation(s)
- S K Backe
- Wansbeck General Hospital, Department of Anaesthesia, Ashington, UK
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Karaman S, Akercan F, Aldemir O, Terek MC, Yalaz M, Firat V. The maternal and neonatal effects of the volatile anaesthetic agents desflurane and sevoflurane in caesarean section: a prospective, randomized clinical study. J Int Med Res 2006; 34:183-92. [PMID: 16749414 DOI: 10.1177/147323000603400208] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study compared maternal and neonatal outcomes in women undergoing elective caesarean section under general anaesthesia with desflurane or sevoflurane; the neonatal effects were also compared with those in women undergoing epidural anaesthesia. Fifty women requesting general anaesthesia were randomly assigned to receive either 3% desflurane or 1% sevoflurane. Twenty-five women requesting regional anaesthesia received epidural anaesthesia with ropivacaine. Comparing desflurane sevoflurane with respect to their maternal haemodynamic effects, maternal blood pressure levels were higher and tachycardia was more frequent in the desflurane group. Comparing general and epidural anaesthesia, no significant differences were detected in terms of neonatal Apgar scores or neurological adaptive capacity scores. In conclusion, 3% desflurane or 1% sevoflurane for general anaesthesia and ropivacaine for epidural anaesthesia for elective caesarean section had similar effects on neonatal outcomes. In women who received desflurane, blood pressure and heart rate elevation were significantly higher than in the sevoflurane group, though this difference did not have any clinical importance.
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Affiliation(s)
- S Karaman
- Department of Anaesthesiology and Reanimation, Ege University Faculty of Medicine, Izmir, Turkey.
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Neurobehavioral Functioning and Breastfeeding Behavior in the Newborn. MCN Am J Matern Child Nurs 2006. [DOI: 10.1097/00005721-200603000-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Capogna G, Celleno D, Sebastiani M, Muratori F, Costantino P, Cipriani G, Passarelli F, Varrassi G. Propofol and thiopentone for caesarean section revisited: maternal effects and neonatal outcome. Int J Obstet Anesth 2006; 1:19-23. [PMID: 15636791 DOI: 10.1016/0959-289x(91)90025-l] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In 56 women undergoing elective caesarean section, general anaesthesia was induced with either propofol 1% or thiopentone 2.5% followed by 50% nitrous oxide in oxygen and isoflurane 0.75% until delivery. In the thiopentone group the arterial pressure rose following tracheal intubation and skin incision, while in the propofol group there was a significant tendency to hypotension immediately following induction of anaesthesia. There were differences in electroencephalogram (EEG) between the groups, while laryngoscopy, intubation and surgical stimulation had no effect on EEG pattern. Recovery after anaesthesia did not differ between groups. None of the patients had recall of the intraoperative period, but 53% of patients induced with propofol showed signs of light anaesthesia between induction and delivery. Neonates in the propofol group had lower Apgar scores 1 min after birth than those in the thiopentone group, but these differences were no longer significant at 5 min. No differences were noted in neurobehavioural status at 1, 4 and 24 h.
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Affiliation(s)
- G Capogna
- Department of Anaesthesia, Fatebenefratelli General Hospital, Isola Tiberina, Rome, Italy
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Mahajan J, Mahajan RP, Singh MM, Anand NK. Anaesthetic technique for elective caesarean section and neurobehavioural status of newborns. Int J Obstet Anesth 2006; 2:89-93. [PMID: 15636857 DOI: 10.1016/0959-289x(93)90085-v] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ninety healthy parturients undergoing elective caesarean section were randomly allocated to receive either general (n = 30), epidural (n = 30) or spinal (n = 30) anaesthesia. Acid-base status, Apgar score and neurobehavioural status, using the neurologic and adaptive capacity scoring (NACS) system, were studied in the newborn. Apgar scores and acid-base parameters were similar in all the three groups. NACS testing revealed significantly more vigorous babies in the spinal anaesthesia group than in the other two groups at 15 min and 2 h interval after delivery, despite a higher incidence of maternal hypotension. We conclude that newborns tend to have a better neurobehavioural status in the early post-delivery period if their mothers receive spinal anaesthesia rather than general or epidural anaesthesia for caesarean section.
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Affiliation(s)
- J Mahajan
- Department of Neonatology and Paediatrics, Safdarjang Hospital, New Delhi, India
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Lussos SA, Datta S. Anesthesia for cesarean delivery. Part I: general considerations and spinal anesthesia. Int J Obstet Anesth 2006; 1:79-91. [PMID: 15636805 DOI: 10.1016/0959-289x(92)90007-q] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- S A Lussos
- Department of Anesthesiology, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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