Advertisement

Drug Safety

, Volume 6, Issue 4, pp 285–301 | Cite as

Risk-Benefit Assessment of Anaesthetic Agents in the Puerperium

  • Jussi Kanto
Review Article Risk-Benefit Assessment

Summary

A critical evaluation of anaesthetic agents in the puerperium is difficult because systematic, relevant studies are still lacking. Current knowledge of the effects of different agents used in labour and caesarean section indicates that significant residual effects on the mother and newborn are limited. In the early puerperium, based on physiological and/or hormonal changes, the mother could be more sensitive to inhalational anaesthetic agents and local analgesics. To date there is no evidence that any anaesthetic agent is excreted in breast milk in clinically significant amounts when given as a single dose. The only exception is perhaps in the case of very premature neonates whose mothers have had multidrug therapy before labour. Even then the importance of breast milk should be carefully assessed against possible adverse drug effect. However, repeated administration of long-acting benzodiazepines and continuous epidural administration of pethidine (meperidine) can have adverse effects on the neonate.

The essential conclusion of this review is that breast-feeding is best. The different anaesthetic agents are excreted in the milk in amounts so low that detrimental effects on the neonate should not be expected.

Keywords

Bupivacaine Breast Milk Anaesthetic Agent Clinical Pharmacokinetic Meperidine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Abboud TK, Read J, Miller F, Chen T, Valle R, et al. Use of glycopyrrolate in the parturient: effect on maternal and fetal heart rate and uterine activity. Obstetrics and Gynecology 57: 224–227, 1981bPubMedGoogle Scholar
  2. Abboud TK, Shnider SM, Wright RG, Rolbin SH, Craft JB, et al. Enflurane analgesia in obstetrics. Anaesthesia and Analgesia 60: 133–137, 1981Google Scholar
  3. Abouleish EI. Postpartum tubal ligation requires more bupivacaine for spinal anesthesia than does cesarean section. Anesthesia and Analgesia 65: 897–900, 1986PubMedGoogle Scholar
  4. Ali-Melkkilä T, Kaila T, Kanto J. Iisalo E. Pharmacokinetics of glycopyrrolate in parturients. Anaesthesia 45: 634–637, 1990PubMedGoogle Scholar
  5. Amiel-Tison C, Barrier G, Shnider SM. A new neurologic and adaptive capacity scoring system for evaluating obstetric medications in full term newborns. Anesthesiology 56: 340–350, 1982PubMedGoogle Scholar
  6. Anderson PO. Drugs and breast feeding. Seminars in Perinatology 3: 271–278, 1979PubMedGoogle Scholar
  7. Arant BS. Developmental patterns of renal functional maturation compared in the human neonate. Journal of Pediatrics 92: 705–711, 1978PubMedGoogle Scholar
  8. Atkinson HC, Begg EJ, Darlow BA. Drugs in human milk: clinical pharmacokinetic considerations. Clinical Pharmacokinetics 14: 217–240, 1988PubMedGoogle Scholar
  9. Bach V, Carl P, Ravlo O, Crawford ME, Jensen AC, et al. A randomized comparison between midazolam and thiopental for elective cesarean section: III. Placental transfer and elimination in neonates. Anesthesia and Analgesia 68: 238–242, 1989PubMedGoogle Scholar
  10. Baker PA, Schroeder D. Interpleural bupivacaine for postoperative pain during lactation. Anesthesia and Analgesia 69: 400–402, 1989PubMedGoogle Scholar
  11. Begley CM. The effect of ergometrine on breast feeding. Midwifery 6: 60–72, 1990PubMedGoogle Scholar
  12. Bennett PN. Working Group. Drugs and human lactation, Elsevier, Amsterdam, 1988Google Scholar
  13. Besunder JB, Reed MD, Blumer JL. Principles of drug biodisposition in the neonate: a critical evaluation of the pharmacokinetic-pharmacodynamic interface (part I). Clinical Pharmacokinetics 14: 189–216, 1988PubMedGoogle Scholar
  14. Bonati M, Kanto J, Tognoni G. Clinical pharmacokinetics of cerebrospinal fluid. Clinical Pharmacokinetics 7: 312–335, 1982PubMedGoogle Scholar
  15. Bonica JJ. Obstetric Analgesia and Anesthesia, World Federation of Societies of Anaesthesiologists, Amsterdam, 1980Google Scholar
  16. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation, 2nd ed., Williams & Wilkins, Baltimore, 1986Google Scholar
  17. Bromage PR. Physiology and pharmacology of epidural analgesia. Anesthesiology 28: 592–604, 1967PubMedGoogle Scholar
  18. Brown WU, Bell GC, Alper MH. Acidosis, local anesthetics and the newborn. Obstetrics and Gynecology 48: 27–30, 1976PubMedGoogle Scholar
  19. Caldwell J, Wakile LA, Notarianni LJ, Smith RL, Correy GJ, et al. Maternal and neonatal disposition of pethidine in childbirth: a study using quantitative gas chromatography-mass spectrometry. Life Sciences 22: 589–596, 1978PubMedGoogle Scholar
  20. Celleno D, Capogna G, Tomasetti M, Costantino P, DiFeo G, et al. Neurobehavioural effects of propofol on the neonate following elective caesarean section. British Journal of Anaesthesia 62: 649–654, 1989PubMedGoogle Scholar
  21. Christensen JH, Andreasen F, Jansen A. Pharmacokinetics of thiopental in caesarean section. Acta Anaesthesiologica Scandinavica 25: 174–179, 1981PubMedGoogle Scholar
  22. Cooper LV, Stephen GW, Aggett PJA. Elimination of pethidine and bupivacaine in the newborn. Archives of Diseases in Childhood 52: 638–641, 1977Google Scholar
  23. Couper JL, Lombard TP. Comparison of propofol (Diprivan) with thiopentone as induction agent for elective Caesarean section. Canadian Journal of Anaesthesia 35: 132, 1988Google Scholar
  24. Crawford JS. Anaesthesia for Caesarean section: a proposal for evaluation, with analysis of a method. British Journal of Anaesthesia 34: 179–194, 1962PubMedGoogle Scholar
  25. Crawford JS, Hooi HWY. Binding of bromosulphthalein by serum albumin from pregnant women, neonates and subjects on oral contraceptives. British Journal of Anaesthesia 40: 723–730, 1968PubMedGoogle Scholar
  26. Crawford JS, Rudofsky S. Placental transmission of pethidine. British Journal of Anaesthesia 37: 929–933, 1965PubMedGoogle Scholar
  27. Crawford JS, Rudofsky S. Some altertions in the pattern of drug metabolism associated with pregnancy, oral contraceptives, and the newly-born. British Journal of Anaesthesia 38: 446–452, 1966PubMedGoogle Scholar
  28. Cree IE, Meyer J, Hailey DM. Diazepam in labour: its metabolism and effect on the clinical condition and thermogenesis of the newborn. British Medical Journal 4: 251–255, 1973PubMedGoogle Scholar
  29. Crone L-AL, Conly JM, Clark KM, Crichlow AC, Wardell GC, et al. Recurrent herpes simplex virus labialis and the use of epidural morphine in obstetric patients. Anesthesia and Analgesia 67: 318–323, 1988PubMedGoogle Scholar
  30. Dailland P, Cockshott ID, Lirzin JD, Jacquinot P, Jorrot JC, et al. Intravenous propofol during cesarean section: placental transfer, concentrations in breast milk, and neonatal effects. Anesthesiology 71: 827–834, 1989PubMedGoogle Scholar
  31. Dann WL, Hutchinson A, Cartwright DP. Maternal and neonatal responses to alfentanil administered before induction of general anaesthesia for caesarean section. British Journal of Anaesthesia 59: 1392–1396, 1987PubMedGoogle Scholar
  32. Datta S, Hurley RJ, Nalty JS, Stern P, Lambert DH, et al. Plasma and cerebrospinal fluid progesterone concentrations in pregnant and nonpregnant women. Anesthesia and Analgesia 65: 950–954, 1986PubMedGoogle Scholar
  33. Datta S, Lambert DH, Gregus J, Gissen AJ, Covino BG. Differential sensitivities of mammalian nerve fibers during pregnancy. Anesthesia and Analgesia 62: 1070–1072, 1983PubMedGoogle Scholar
  34. Datta S, Ostheimer GW, Weiss JB, Brown WU, Alper MH. Neonatal effect of prolonged anesthetic induction for cesarean section. Obstetrics and Gynecology 58: 331–335, 1981PubMedGoogle Scholar
  35. Eisele JH, Wright R, Rogge P. Newborn and maternal fentanyl levels at cesarean section. Anesthesia and Analgesia 61: 179–180, 1982Google Scholar
  36. Erkkola R, Kanto J, Allonen H, Kleimola T. Excretion of methylergometrine (methylergonovine) into the human breast milk. International Journal of Clinical Pharmacology and Biopharmacy 16: 579–580, 1978PubMedGoogle Scholar
  37. Erkkola R, Kero P, Kanto J, Korvenranta H, Näntö V, et al. Delayed cord clamping in cesarean section with general anesthesia. American Journal of Perinatology 1: 165–169, 1984PubMedGoogle Scholar
  38. Finster M, Poppers PJ, Sinclair JC, Morishima HO, Daniel SS. Accidental intoxication of the fetus with local anesthetic drug during caudal anesthesia. American Journal of Obstetrics and Gynecology 92: 922–924, 1965PubMedGoogle Scholar
  39. Franklin RA, Aldridge A, Whwite C. Studies on the metabolism of meptazinol, a new analgetic drug. British Journal of Clinical Pharmacology 3: 497–502, 1976PubMedGoogle Scholar
  40. Freeman RM, Moreland TA, Blair AW. Diamorphine in the obstetric analgesia: a neurobehavioural and pharmacokinetic study in the neonate. Journal of Obstetrics and Gynecology 3: 102–106, 1982Google Scholar
  41. Frisoli G. Physiology and pathology of the puerperium. In Iffly & Kaminetzky (Eds) Principles and practice of obstetrics and perinatology, Vol. 2. p. 1657, Wiley, New York, 1981Google Scholar
  42. Gauntlett JS, Fisher DM, Hertzka RE, Kuhls E, Spellman MJ, et al. Pharmacokinetics of fentanyl in neonatal humans and lambs: effect of age. Anesthesiology 69: 683–687, 1988PubMedGoogle Scholar
  43. Grenman S, Erkkola R, Kanto J, Scheinin M, Viinamäki O, et al. Epidural and paracervical blockades in obstetrics: catecholamines, arginine vasopressin and analgesic effect. Acta Obstetrica et Gynecologica Scandinavica 65: 699–704, 1986Google Scholar
  44. Gustafsson LL, Schildt B, Jacobsen K. Adverse effect of extradural and intrathecal opiates: report of a nationwide survey in Sweden. British Journal of Anaesthesia 54: 479–486, 1982PubMedGoogle Scholar
  45. Hall AW, Moosa AR, Cark J, Cooley GR, Skinner DB. The effect of premedication drugs on the lower oesophageal high pressure zone and reflux status in rhesus monkeys and man. Gut 16: 347–352, 1975PubMedGoogle Scholar
  46. Haram K, Bagge OM, Johannessen KH, Lund T. Transplacental passage of diazepam during labor: influence of uterine contraction. Clinical Pharmacology and Therapeutics 24: 590–599, 1978PubMedGoogle Scholar
  47. Harrison RF, Brennan M. Evaluation of two local anaesthetic sprays for the relief of post-episiotomy pain. Current Medical Research and Opinion 10: 364–369, 1987PubMedGoogle Scholar
  48. Hervada AR, Feit E, Sagrames R. Drugs in breast milk. Perinatal Care 2: 19–25, 1978PubMedGoogle Scholar
  49. Hodgkinson R, Huff RW, Hayashi RH, Husain FJ. Double-blind comparison of maternal analgesia and neurobehaviour following intravenous butorphanol and meperidine. Journal of International Medical Research 7: 224–230, 1970Google Scholar
  50. Hodgkinson R, Husain FJ. The duration of effect of maternally administered meperidine on neonatal behaviour. Anesthesiology 56: 51–52, 1982PubMedGoogle Scholar
  51. Hodgkinson R, Marx GF, Kim SS, Miclat NM. Neonatal neurobehavioral tests following vaginal delivery under ketamine, thiopental and extradural anesthesia. Anesthesia and Analgesia 56: 548–553, 1977Google Scholar
  52. Houghton DJ. Use of lorazepam as a premedicant for caesarean section: an evaluation of its effects on the mother and neonate. British Journal of Anaesthesia 55: 767–771, 1983PubMedGoogle Scholar
  53. Husemeyer RP, Cummings AJ, Rosankiewicz JR, Davenport HT. A study of pethidine kinetics and the analgesia in women in labour following intramuscular and epidural administration. British Journal of Clinical Pharmacology 13: 171–176, 1982PubMedGoogle Scholar
  54. Husemeyer RP, Davenport HT, Cummings AJ, Rosankiewicz JR. Comparison of epidural and intramuscular pethidine for analgesia in labour. British Journal of Obstetrics and Gynaecology 88: 711–717, 1981PubMedGoogle Scholar
  55. Jackson MBA, Robson PJ. Preliminary clinical and pharmacokinetic experiences in the newborn when meptazinol is compared with pethidine as an obstetric analgesic. Postgraduate Medical Journal 59 (Suppl. 1): 47–51, 1983PubMedGoogle Scholar
  56. Jacqz-Algrain E, Wood C, Robieux I. Pharmacokinetics of midazolam in critically ill neonates. European Journal of Clinical Pharmacology 39: 191–192, 1990Google Scholar
  57. Kangas L, Erkkola R, Kanto J, Eronen M. Transfer of free and conjugated oxazepam across the human placenta. European Journal of Clinical Pharmacology 17: 301–304, 1980PubMedGoogle Scholar
  58. Kangas L, Erkkola R, Kanto J, Mansikka M. Halothane anaesthesia in caesarean section. Acta Anaesthesiologica Scandinavica 20: 189–194, 1976PubMedGoogle Scholar
  59. Kangas-Saarela T, Jouppila R, Alahuhta S, Jouppila P, Hollmen A. The effect of lumbar epidural analgesia on the neurobehavioral responses of newborn infants. Acta Anaesthesiologica Scandinavica 33: 320–325, 1989aPubMedGoogle Scholar
  60. Kangas-Saarela T, Jouppila R, Jouppila P, Hollmen A, Puukka M, et al. The effect of segmental epidural analgesia on the neurobehavioural responses of newborn infants. Acta Anaesthesiologica Scandinavica 31: 347–351, 1987PubMedGoogle Scholar
  61. Kangas-Saarela T, Jouppila R, Puolakka J, Jouppila P, Hollmen A, et al. The effect of bupivacaine paracervical block on the neurobehavioural responses of the newborn infants. Acta Anaesthesiologica Scandinavica 32: 566–570, 1988PubMedGoogle Scholar
  62. Kangas-Saarela T, Koivisto M, Jouppila R, Jouppila P, Hollmen A. Comparison of the effects of general and epidural anaesthesia for caesarean section on the neurobehavioural responses of newborn infants. Acta Anaesthesiologica Scandinavica 33: 313–319, 1989bPubMedGoogle Scholar
  63. Kanto JH. Use of benzodiazepines during pregnancy, labour and lactation with particular reference to pharmacokinetic considerations. Drugs 23: 354–380, 1982PubMedGoogle Scholar
  64. Kanto J. Obstetric analgesia: clinical pharmacokinetic considerations. Clinical Pharmacokinetics 11: 283–298, 1986PubMedGoogle Scholar
  65. Kanto J, Aaltonen L, Erkkola R, Äärimaa L. Pharmacokinetics and sedative effect of midazolam in connection with caesarean section performed under epidural analgesia. Acta Anaesthesiologica Scandinavica 28: 116–118, 1984cPubMedGoogle Scholar
  66. Kanto J, Aaltonen L, Kangas L, Erkkola R, Pitkänen Y. Placental transfer and breast milk levels of flunitrazepam. Current Therapeutic Research 26: 539–576, 1979Google Scholar
  67. Kanto J, Erkkola R. Epidural and intrathecal opiates in obstetrics. International Journal of Clinical Pharmacology, Therapy and Toxicology 22: 316–323, 1984aGoogle Scholar
  68. Kanto J, Erkkola R. Obstetric analgesia: pharmacokinetics and its relation to neonatal and adaptive functions. Biological Research and Perinatology 5: 23–35, 1984bGoogle Scholar
  69. Kanto J, Erkkola R, Mansikka M, ÄÄrimaa L. Segmental epidural analgesia: a modern method for safe and effective management of labour pains. Biological Research in Pregnancy and Perinatology 4: 172–176, 1983bPubMedGoogle Scholar
  70. Kanto J, Erkkola R, Sellman R. Accumulation of diazepam and N-demethyldiazepam in fetal blood during labour. Annals of Clinical Research 5: 375–379, 1973PubMedGoogle Scholar
  71. Kanto J, Erkkola R, Sellman R. Perinatal metabolism of diazepam. British Medical Journal 2: 641–642, 1974Google Scholar
  72. Kanto J, Kentala E, Kaila T, Pihlajamäki K. Pharmacokinetics of scopolamine during caesarean section: relationship between serum concentration and effect. Acta Anaesthesiologica Scandinavica 33: 482–486, 1989PubMedGoogle Scholar
  73. Kanto J, Lindberg R, Pihlajamäki K, Scheinin M. Placental and blood-CSF transfer of intramuscularly administered atropine in the same person. Pharmacology and Toxicology 60: 108–109, 1987PubMedGoogle Scholar
  74. Kanto J, Sjövall S, Erkkola R, Himberg J-J, Kangas L. Placental transfer and maternal midazolam kinetics. Clinical Pharmacology and Therapeutics 33: 786–791, 1983aPubMedGoogle Scholar
  75. Kanto J, Virtanen R, Iisalo E, Mäenpää K, Liukko P. Placental transfer and pharmacokinetics of atropine after a single maternal intravenous and intramuscular administration. Acta Anaesthesiologica Scandinavica 25: 85–88, 1981PubMedGoogle Scholar
  76. Kileff ME, James FM, Dewan DM, Floyd HM. Neonatal neurobehavioural responses after epidural anesthesia for cesarean section using lidocaine and bupivacaine. Anesthesia and Analgesia 63: 413–417, 1984PubMedGoogle Scholar
  77. Knott C, Reynolds F. Therapeutic drug monitoring in pregnancy. Rationale and current status. Clinical Pharmacokinetics 19: 425–433, 1990PubMedGoogle Scholar
  78. Knowles JA. Excretion of drugs in milk: a review. Pediatric Pharmacology and Therapeutics 66: 1068–1082, 1965Google Scholar
  79. Koren G, Butt W, Chinyanga H, Soldin S, Tan Y-K, et al. Postoperative morphine infusion in newborn infants: assessment of disposition characteristics and safety. Journal of Pediatrics 107: 963–967, 1985PubMedGoogle Scholar
  80. Kosaka Y, Takahashi T, Mark LC. Intravenous thiobarbiturate anesthesia for cesarean section. Anesthesiology 31: 489–506, 1969PubMedGoogle Scholar
  81. Kuhnert BR, Kuhnert PM, Philipson EH, Syracuse CD. Disposition of meperidine and normeperidine following multiple doses in labor. American Journal of Obstetrics and Gynecology 151: 410–415, 1985bPubMedGoogle Scholar
  82. Kuhnert BR, Kuhnert PM, Prochaska AL, Sokol RJ. Meperidine disposition in mother, neonate and nonpregnant females. Clinical Pharmacology and Therapeutics 27: 486–491, 1980PubMedGoogle Scholar
  83. Kuhnert BR, Kuhnert PM, Tu AL, Lin DCK. Meperidine and normeperidine levels following meperidine administration during labour: II. Fetus and neonate. American Journal of Obstetrics and Gynecology 133: 909–914, 1979bPubMedGoogle Scholar
  84. Kuhnert BR, Kuhnert PM, Tu AL, Lin DCK, Foltz RL. Meperidine and normeperidine levels following meperidine administration during labour: I. Mother. American Journal of Obstetrics and Gynecology 133: 904–908, 1979aPubMedGoogle Scholar
  85. Kuhnert BR, Lin PL, Kennard MJ, Kuhnert PM. Effects of low doses of meperidine on neonatal behavior. Anesthesia and Analgesia 64: 335–342, 1985aPubMedGoogle Scholar
  86. Kwit NT, Hatcher RA. Excretion of drugs in milk. American Journal of Diseases of Children 49: 900–904, 1974Google Scholar
  87. Levine RL, Fredericks WR, Rapaport SI. Entry of bilirubin into the brain due to opening of the blood-brain barrier. Pediatrics 61: 225–259, 1982Google Scholar
  88. Levinson G, Shnider SM. Systemic medication for labor and delivery. In Shnider & Levinson (Eds) Anesthesia for obstetrics, pp. 89–108, Williams & Wilkinson, Los Angeles, 1987Google Scholar
  89. Lirzin JD, Jacquinot P, Dailland P, Jorrot JC, Jasson J, et al. Controlled trial of extradural bupivacaine with fentanyl, morphine and placebo for pain relief in labour. British Journal of Anaesthesia 62: 641–644, 1989PubMedGoogle Scholar
  90. Lyren S, Nyberg F, Lutsch H, Lindberg B, Terenius L. Cerebrospinal fluid dynorphin 1–17 and beta-endorphin in late pregnancy and six months after delivery: no influence of acupuncture treatment. Acta Endocrinologica 115: 253–258, 1987Google Scholar
  91. Maduska AL. Butorphanol in obstetrical anesthesia. Anesthesiology Review 3: 14–17, 1981Google Scholar
  92. Marx GF, Oka Y, Orkin LR. Cerebrospinal fluid pressures during labour. American Journal of Obstetrics and Gynecology 84: 213–219, 1967Google Scholar
  93. Matheson J, Lunde PKM, Bredersen JE. Midazolam and nitrazepam in the maternity ward: milk concentrations and clinical effects. British Journal of Clinical Pharmacology 30: 787–793, 1990PubMedGoogle Scholar
  94. McAuley DM, O’Neill MP, Moore J, Dundee JWA. Lorazepam premedication for labour. British Journal of Obstetrics and Gynaecology 89: 149–154, 1982PubMedGoogle Scholar
  95. McGuinnes GA, Merkow AJ, Kennedy RL, Erenberg A. Epidural anesthesia with bupivacaine for cesarean section: neonatal blood levels and neurobehavioural responses. Anesthesiology 49: 270–273, 1978Google Scholar
  96. Mendez R, Eisenach JC, Kashtan K. Epidural clonidine analgesia after cesarean section. Anesthesiology 73: 848–852, 1990PubMedGoogle Scholar
  97. Merryman W. Progesterone ‘anesthesia’ in human subjects. Journal of Clinical Endocrinology and Metabolism 14: 1567–1569, 1954PubMedGoogle Scholar
  98. Miles MV. Pediatric pharmacokinetics. In Mingall (Ed.) Applied clinical pharmacokinetics pp. 367–388, Raven Press, New York, 1983Google Scholar
  99. Moore J, Bill KM, Flynn RJ, McKeating KT, Howard PJ. A comparison between propofol and thiopentone as induction agents in obstetric anaesthesia. Anaesthesia 44: 753–757, 1989PubMedGoogle Scholar
  100. Moore RG, McBride WG. The disposition kinetics of diazepam in pregnant women at parturition. European Journal of Clinical Pharmacology 13: 275–284, 1978PubMedGoogle Scholar
  101. Morgan DJ, Blackman GL, Pauli JD, Wolf LJ. Pharmacokinetics and plasma binding of thiopental: II. Studies at cesarean section. Anesthesiology 54: 474–480, 1981PubMedGoogle Scholar
  102. Morishima HO, Covino BG. Toxicity and distribution of lidocaine in non-asphyxiated and asphyxiated baboon fetuses. Anesthesiology 54: 182–186, 1981PubMedGoogle Scholar
  103. Morishima HO, Daniel SS, Finster M, Poppers PJ, James LS. Transmission of mepivacaine hydrochloride (Carbocaine) across the human placenta. Anesthesiology 27: 147–154, 1966PubMedGoogle Scholar
  104. Morselli PL, Franco-Morselli R, Bossi L. Clinical pharmacokinetics in newborns and infants: age related differences and therapeutic implications. Clinical Pharmacokinetics 5: 485–527, 1980PubMedGoogle Scholar
  105. Muller-Holve W, Von Meyer L, Nagler P. The concentration of bupivacaine in fetal organs during obstetrical epidural analgesia. Journal of Perinatal Medicine 14: 219–225, 1986PubMedGoogle Scholar
  106. Murray AD, Dolby RM, Nation RL, Thomas DB. Effects of epidural anesthesia on newborns and their mothers. Child Development 52: 71–82, 1981PubMedGoogle Scholar
  107. Nau H. Clinical pharmacokinetics in pregnancy and perinatology: I. Placental transfer and fetal side-effects of local anesthetic agents. Developmental Pharmacology and Therapeutics 8: 149–181, 1985PubMedGoogle Scholar
  108. Naulty JS, Ostheimer G, Datta S, Weiss JB. Bupivacaine in breast milk following epidural anesthesia for vaginal delivery. Regional Anesthesia 8: 44–45, 1983Google Scholar
  109. Nimmo WS, Wilson J, Prescott LF. Narcotic analgesics and delayed gastric emptying in labour. Lancet 1: 890–893, 1975PubMedGoogle Scholar
  110. Nybell-Lindahl G, Calsson C, Ingemarsson I, Westgren M, Paalzow L. Maternal and fetal concentrations after epidural administration during labor. American Journal of Obstetrics and Gynecology 139: 20–21, 1981PubMedGoogle Scholar
  111. O’Brien TE. Excretion of drugs in human milk: a review. Pediatric Pharmacology and Therapeutics 66: 1068–1082, 1974Google Scholar
  112. O’Brien WF, Cafalo RC, Grissen MP, Vieras F, Golden SM, et al. The influence of asphyxia on fetal lidocaine toxicity. American Journal of Obstetrics and Gynecology 142: 205–208, 1982PubMedGoogle Scholar
  113. Palahniuk RJ, Shnider SM, Eger II EI. Pregnancy decreases the requirements for inhaled anesthetic agents. Anesthesiology 41: 82–83, 1974PubMedGoogle Scholar
  114. Pedersen H, Finster M, Morishima HO. Local anaesthetics in obstetrics. In Stanton-Hicks (Ed.) Regional anaesthesia: advances and selected topics, International Anesthesiology Topics, Vol. 16, pp. 73–89, Little-Brown, Boston, 1978Google Scholar
  115. Pereira GR, Barbosa NMM. Controversies in neonatal nutrition. Pediatric Clinics of North America 33: 65–89, 1986PubMedGoogle Scholar
  116. Pernoll ML, Metcalf J, Kovach PA, Wachtel R, Dunham MJ. Ventilation during rest and exercise in pregnancy and postpartum. Respiratory Physiology 25: 295–310, 1975Google Scholar
  117. Pihlajamäki K, Kanto J, Lindberg R, Karanko M, Kiilhoma P. Extradural administration of bupivacaine: pharmacokinetics and metabolism in pregnant and non-pregnant patients. British Journal of Anaesthesia 64: 556–562, 1990PubMedGoogle Scholar
  118. Pynnönen S, Kanto J, Sillanpaä M, Erkkola R. Carbamazepine: placental transport, tissue concentrations in foetus and newborn, and level in breast milk. Acta Anaesthesiologica et Toxicologica 41: 244–253, 1977Google Scholar
  119. Rane A, Wilson JT. Clinical pharmacokinetics in infants and children. Clinical Pharmacokinetics 1: 2–24, 1976PubMedGoogle Scholar
  120. Reynolds F. Extradural opioids in labour. British Journal of Anaesthesia 63: 251–252, 1989PubMedGoogle Scholar
  121. Roberts RB, Shirley MB. The obstetrician’s role in reducing the risk of aspiration pneumonitis with particular reference to the use of oral antacids. American Journal of Obstetrics and Gynecology 124: 611–617, 1976PubMedGoogle Scholar
  122. Robertson DM, Paganell R, Dinwiddie R, Levinsky RJ. Milk antigen absorption in the preterm and term neonate. Archives of Diseases in Childhood 57: 369–372, 1982Google Scholar
  123. Rosen MG, Scribetta JJ, Hochberg C. Human fetal electroencephalogram III pattern changes in the presence of fetal heart rate alteration and after use of maternal medication. Obstetrics and Gynecology 36: 132–138, 1970PubMedGoogle Scholar
  124. Scanion JW. Clinical neonatal neurobehavioural assessment: methods and significance. In Marx GF (Ed.) Clinical management of mother and newborn, Springer-Verlag, Heidelberg, 1979Google Scholar
  125. Scanlon JW, Brown WU, Weiss JB, Alper MH. Neurobehavioral responses of newborn infants after maternal epidural anesthesia. Anesthesiology 40: 121–124, 1974PubMedGoogle Scholar
  126. Shankar KB, Moseley H, Kumar Y, Vemula V, Krishnan A. Arterial to end-tidal carbon dioxide tension difference during anaesthesia for tubal ligation. Anaesthesia 42: 482–486, 1987PubMedGoogle Scholar
  127. Shnider SM. Serum cholinesterase activity during pregnancy, labor and puerperium. Anesthesiology 26: 335–339, 1965PubMedGoogle Scholar
  128. Shnider SM, Way EL. Plasma levels of lidocaine (Xylocaine) in mother and newborn following obstetrical conduction anesthesia: clinical applications. Anesthesiology 29: 951–958, 1968PubMedGoogle Scholar
  129. Smiler BG, Bartholomew EG, Sivak BV, Alexander GD, Brown EM. Physostigmine reversal of scopolamine delirium in obstetric patients. American Journal of Obstetrics and Gynecology 116: 326–329, 1973PubMedGoogle Scholar
  130. Smith B, Moya F, Shnider SM. Effects of anesthesia on liver function during labor. Current Research in Anesthesia and Analgesia 41: 24–29, 1962Google Scholar
  131. Song CS, Merkatz IR, Rifkind AB, Gillette PN, Kappas A. The influence of pregnancy and oral contraceptive steroids on the concentration of plasma proteins. American Journal of Obstetrics and Gynecology 108: 227–231, 1970PubMedGoogle Scholar
  132. Stefani SJ, Hughes SC, Shnider SM, Levinson G, Abbaud T, et al. Neonatal neurobehavioral effects of inhalation analgesia for vaginal delivery. Anesthesiology 56: 351–355, 1982PubMedGoogle Scholar
  133. Thomas TA, Fletcher JE, Hill RG. Influence of medication, pain, and progress of labour on plasma beta-endorphin-like immunoactivity. British Journal of Anaesthesia 54: 401–408, 1982PubMedGoogle Scholar
  134. Tindall VR, Beazley JM. Assessment of changes in liver function during normal pregnancy using modified bromosulphthalein test. Journal of Obstetrics and Gynaecology of the British Commonwealth 72: 717–725, 1965PubMedGoogle Scholar
  135. Tomson G, Lunell NO, Sundwall A, Rane A. Transplacental passage and kinetics in the mother and newborn of oxazepam given during labour. Clinical Pharmacology and Therapeutics 25: 74–81, 1979PubMedGoogle Scholar
  136. Tucker GT, Mather LE. Clinical pharmacokinetics of local anaesthetics. Clinical Pharmacokinetics 4: 33–39, 1975Google Scholar
  137. Ueland K. Maternal cardiovascular dynamics: VII. Intrapartum blood volume changes. American Journal of Obstetrics and Gynecology 126: 671–677, 1976PubMedGoogle Scholar
  138. Ueland K, Novy MJ, Peterson EN. Maternal cardiovascular dynamics: IV. The influence of gestational age on the maternal cardiovascular response to posture and exercise. American Journal of Obstetrics and Gynecology 104: 856–864, 1969PubMedGoogle Scholar
  139. Valtonen M, Kanto J, Rosenberg P. Comparison of propofol and thiopentone for induction of anaesthesia for elective caesarean section. Anaesthesia 44: 758–762, 1989PubMedGoogle Scholar
  140. Viby-Mogensen J. Correlation of succinylcholine duration of action with plasma cholinesterase activity in subjects with the genotypically normal enzyme. Aesthesiology 53: 517–520, 1980Google Scholar
  141. Way WL, Costley EC, Way EL. Respiratory sensitivity of the newborn infant to meperidine and morphine. Clinical Pharmacology and Therapeutics 6: 454–461, 1965PubMedGoogle Scholar
  142. Weissman DB, Ehrenwerth J. Prolonged neuromuscular blockade in a parturient associated with succinylcholine. Anesthesia and Analgesia 62: 444–446, 1983PubMedGoogle Scholar
  143. Wilson JT. Determinants and consequences of drug determination in breast milk. Drug Metabolism Review 4: 619–652, 1983Google Scholar
  144. Wilson JT, Brown RD, Cherek D, Dailey JW, Hilman B, et al. Drug excretion in breast milk: principles, pharmacokinetics and projected consequences. Clinical Pharmacokinetics 5: 1–66, 1980PubMedGoogle Scholar
  145. Wilson JT, Brown RD, Hinson JL, Dailey JW. Pharmacokinetic pitfalls in estimation of the breast milk (M/P) ratio for drugs. Annual Review of Pharmacology and Toxicology 25: 667–689, 1985PubMedGoogle Scholar
  146. Wittels B, Scott DT, Sinatra RS. Exogenous opioids in human breast milk and acute neonatal neurobehavior: a preliminary study. Anesthesiology 73: 864–869, 1990PubMedGoogle Scholar
  147. Yannone ME, McCurcy JR, Goldfein A. Plasma progesterone levels in normal pregnancy, labor and puerperium: II. Clinical data. American Journal of Obstetrics and Gynecology 101: 1058–1061, 1968PubMedGoogle Scholar
  148. Zagorzycki MT. General anesthesia in cesarean section: effect on mother and neonate. Obsterical and Gynecological Survey 39: 134–137, 1984Google Scholar

Copyright information

© Adis International Limited 1991

Authors and Affiliations

  • Jussi Kanto
    • 1
  1. 1.Departments of Anaesthesiology and Clinical PharmacologyTurku University HospitalTurkuFinland

Personalised recommendations