Inflammation and Epidural-Related Maternal Fever: Proposed Mechanisms.
Intrapartum fever is associated with excessive maternal interventions as well as higher neonatal morbidity. Epidural-related maternal fever (ERMF) contributes to the development of intrapartum fever. The mechanism(s) for ERMF has remained elusive. Here, we consider how inflammatory mechanisms may be modulated by local anesthetic agents and their relevance to ERMF. We also critically reappraise the clinical data with regard to emerging concepts that explain how anesthetic drug-induced metabolic dysfunction, with or without activation of the inflammasome, might trigger the release of nonpathogenic, inflammatory molecules (danger-associated molecular patterns) likely to underlie ERMF.
From the *Department of Anaesthesia, University College London Hospital, London, United Kingdom; †Department of Obstetrics and Maternal Fetal Medicine, University College London Hospital, London, United Kingdom; and ‡William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
Pervez
P
Sultan
Anna L
AL
David
Roshan
R
Fernando
Gareth L
GL
Ackland
D015360:Analgesia, Epidural / Q000009:adverse effects*; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects*; D000818:Animals; D005260:Female; D005334:Fever / Q000139:chemically induced* / Q000276:immunology / Q000378:metabolism / Q000628:therapy; D006801:Humans; D058847:Inflammasomes / Q000276:immunology / Q000378:metabolism; D007249:Inflammation / Q000139:chemically induced* / Q000276:immunology / Q000378:metabolism / Q000628:therapy; D018836:Inflammation Mediators / Q000276:immunology / Q000378:metabolism; D007744:Obstetric Labor Complications / Q000139:chemically induced* / Q000276:immunology / Q000378:metabolism / Q000628:therapy; D011247:Pregnancy; D011379:Prognosis; D012307:Risk Factors; D015398:Signal Transduction
D000779:Anesthetics, Local; D058847:Inflammasomes; D018836:Inflammation Mediators