• C Sonnenschein, E Bonsing, J Jorgensen, and L Hemmingsen.
• Department of Anaesthesia, Central Hospital, Nykóbing Falster, Denmark.
• Int J Obstet Anesth. 1996 Jul 1; 5 (3): 165-7.

AbstractPregnant women at term need a smaller dose of local anaesthetic to produce the same spinal anaesthesia as non-pregnant women. The aim of the study was to see whether the concentrations of binding proteins were reduced in spinal fluid in pregnant women. The concentrations of the binding proteins [Formula: see text] glycoprotein (AAG) and albumin were measured in plasma and spinal fluid from 20 pregnant and 20 non-pregnant women, ASA 1. Mean spinal fluid albumin was 3.13 micromol/1 in non-pregnant and 1.97 micromol/1 in pregnant women (95% confidence interval of the difference: 0.62 - 1.50). Mean spinal fluid AAG was 0.152 micromol/1 in non-pregnant and 0.081 micromol/1 in pregnant women (95% confidence interval of the difference: 0.030 - 0.100). The concentrations in plasma were also reduced in late pregnancy. All the changes were statistically significant. Since only a minor fraction of bupivacaine seems to be protein bound in spinal fluid these differences may have only a little influence on the free fraction and cannot be solely responsible for the increased sensitivity of pregnant women to spinal anaesthesia.

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