title: Maternal and fetal effects of intravenous patient-controlled fentanyl analgesia during labour in a thrombocytopenic parturient.
abstract: The use of intravenous (i.v.) patient-controlled fentanyl analgesia during labour in a parturient with unexplained thrombocytopenia (70 x 10(3).ml-1) is described. The patient self-administered boluses of 25 micrograms of fentanyl with a lock-out interval of ten min. In addition, a concurrent fentanyl infusion of 25 micrograms.hr-1 was given. Effective analgesia was achieved during labour and a total of 1025 micrograms of fentanyl was infused over 11 hr 55 min until delivery of a vigorous infant with Apgar scores of 9 after one and five min. Respiratory depression or undue sedation were not observed in the mother either during labour or in the post-partum period. At birth, maternal total plasma fentanyl concentration was 1.11 ng.ml-1, whereas neonatal umbilical total plasma fentanyl concentration was 0.43 ng.ml-1. Newborn plasma protein binding of fentanyl was lower compared to the mother (63% vs 89%). Thus, free fentanyl concentrations (0.16 ng.ml-1) were identical in the mother and newborn at delivery.
authors.affiliation: Department of Anaesthesia, Ottawa Civic Hospital, University of Ottawa, Ontario.
authors.forename: O P
authors.initials: OP
authors.lastname: Rosaeg
authors.forename: J B
authors.initials: JB
authors.lastname: Kitts
authors.forename: G
authors.initials: G
authors.lastname: Koren
authors.forename: L J
authors.initials: LJ
authors.lastname: Byford
mesh_terms: D000328:Adult; D016362:Analgesia, Obstetrical; D016058:Analgesia, Patient-Controlled; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D005312:Fetal Blood / Q000737:chemistry; D006801:Humans; D007231:Infant, Newborn; D007275:Injections, Intravenous; D007743:Labor, Obstetric; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D011485:Protein Binding; D013921:Thrombocytopenia / Q000503:physiopathology*
chemical_list: D005283:Fentanyl