[Fetal and neonatal effects of perimedullary opioids used in obstetrical anesthesia].
The use of spinal or epidural narcotics is more and more frequent in obstetric patients since it enhances the analgesia induced by local anesthetics. However, specific information regarding their fetal and neonatal effects is rare. Fetal effects are mainly dependent on the respiratory and hemodynamic maternal effects, and thus usually limited when usual low dosages of intraspinal narcotics are used. Neonatal respiratory depression, which is the main neonatal risk, has not been fully studied. In contrast, the evaluation of Apgar and neurobehavioral scores, performed for all the narcotics used, shows little changes when low dosages are used. However, the use of larger dosages epidurally is associated with an increased frequency of low neurobehavioral scores. Therefore, the use of low dosages of epidural narcotics is recommended since there is little available information about the risk of neonatal respiratory depression and no clear maternal advantage of higher dosages.
Hamza
J
J
Département d'Anesthésie-Réanimation, Hôpital Saint-Vincent-de-Paul, Paris.
D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D000701:Analgesics, Opioid / Q000009:adverse effects*; D003864:Depression, Chemical; D005260:Female; D005333:Fetus / Q000187:drug effects*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000139:chemically induced*; D011247:Pregnancy; D012119:Respiration / Q000187:drug effects*
D000701:Analgesics, Opioid
Effets foetaux et néonatals des morphiniques par voie périmédullaire utilisés en anesthésie obstétricale.