Anesthesiology
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Randomized Controlled Trial Clinical Trial
Epidural anesthesia with bupivacaine for Cesarean section: neonatal blood levels and neurobehavioral responses.
A recent study found no neurobehavioral change in infants whose mothers received bupivacaine epidural anesthesia (112 +/- 7 mg) for labor and vaginal delivery. The present study was undertaken to examine the possibility that the larger doses of bupivicaine necessary for cesarean section might cause neurobehavioral changes in the neonate. Ten infants delivered by cesarean section with bupivacaine epidural anesthesia (168 +/- 7 mg) was assessed by Scanlon's neonatal neurobehavioral examination. ⋯ By 24 hours of age bupivacaine was no longer detectable in newborn blood samples. Infants in the experimental group were indistinguishable from control infants in terms of their motor organization, responsiveness to external stimuli, and habituation to repetitive stimuli. Detectable neurobehavioral effects were absent despite the fact that 1.5 times the dose of bupivacaine used for labor and vaginal delivery was employed in this study.
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The American Society of Anesthesiologists' (ASA) Physical Status Classification was tested for consistency of use by a questionnaire sent to 304 anesthesiologists. They were requested to classify ten hypothetical patients. Two hundred fifty-five (77.3 percent) responded to two mailings. ⋯ Academic anesthesiologists rated a greater number identical than did those in private practice (P less than 0.01). There was no difference in ratings between those who used the classification for billing purposes and those who did not. The ASA Physical Status Classification is useful but suffers from a lack of scientific precision.