Articles: anesthetics.
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Biol Res Pregnancy Perinatol · Jan 1984
ReviewObstetric analgesia: pharmacokinetics and its relation to neonatal behavioral and adaptive functions.
The neonatal pharmacokinetic and neurobehavioral properties of certain agents used in obstetric analgesia are reviewed (local anesthetics, opiates, inhalation agents, benzodiazepines). Fetal and neonatal pharmacokinetic alterations partly explain the neurobehavioral differences observed between different drug groups and ways of drug administration. The most effective and safest method with fewest neonatal neurobehavioral effects appears to be regional epidural analgesia performed with plain bupivacaine. ⋯ Inhalation agents and parenteral pethidine (meperidine) are still clinically useful alternative compounds in circumstances where epidural analgesia is not possible. Pharmacokinetically and according to neurobehavioral assessments, inhalation agents appear to be more attractive than pethidine. Benzodiazepines, especially after high or repeated doses, may cause the so-called floppy-infant syndrome, at least partly, due to a slow neonatal drug elimination.
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The problem of waste anesthetic gases must be addressed because of potential health hazards. However, solutions must be considered within a larger context than that of the operating room or dental suite. The impact of shifting wastes from the hospital into the atmosphere must be examined for both ecologic and ethical implications. ⋯ Are waste anesthetic gases an atmospheric pollutant with impact sufficient to cause concern? If not, do the economic considerations of recycling exhausted anesthetic and respiratory gases warrant implementation? Anesthesiologists need to consider these issues within the constraints of the environments in which they practice. The problem will exist as long as inhalation anesthesia is in use. Solution should not create new problems.
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Nursing literature concerned with epidural anesthesia in obstetrics is scant and does not offer a synopsis of the pharmacology of local anesthetic agents employed in epidural block. A comprehensive review of the pharmacology and clinical uses of the common agents used in obstetrical epidural anesthesia is presented. Implications for nursing care are also described.