title: [Epidural labor analgesia for a primipara with schizophrenia].
abstract: A 32-year-old primipara, who had been diagnosed as schizophrenia for a year and with good control of the disease by olanzapine administration, requested epidural labor analgesia. Olanzapine is an atypical antipsychotic, and is contraindicated to use with epinephrine, because the a receptor antagonistic action of olanzapine decreases the blood pressure in combination with epinephrine. Hypotention is one of the major complications during the labor epidural analgesia. In addition, this patient is at high risk of hypotension under antipsycotic medication. As hypotension leads to placental-fetal circulation insufficiency, extreme attention to prevent hypotension and to preserve uteroplacental blood flow should be paid. Olanzapine was discontinued before two days of the induction. Sufficient hydration with crystalloid was given beforehand to avoid hypotention. Both phenylephrine and norepinephrine were ready for an anticipated hypotention. Oxytocin infusion began after an epidural catheter was placed at L2-3 intervertebral space. She delivered a healthy baby under good pain control. Apgar score of the baby was 9 and 9 at 1 and 5 minutes after birth, respectively. Total volume of infusion was 2000 ml. No mental disturbance was observed during the labor and delivery. The patient and her baby were discharged on the 4th day postpartum.
authors: Department of Anesthesiology, Hamamatsu University School of Medicine, Hamamatsu 431-3192.
authors: Sakiko
authors: S
authors: Uchizaki
authors: Chieko
authors: C
authors: Nakagawa
authors: Hisako
authors: H
authors: Okada
authors: Mizuki
authors: M
authors: Taniguchi
authors: Shigehito
authors: S
authors: Sato
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D000077152:Olanzapine; D011247:Pregnancy; D011248:Pregnancy Complications; D012559:Schizophrenia / Q000150:complications* / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines; D000077152:Olanzapine