Effects on the fetus and newborn of maternal analgesia and anesthesia: a review

Abstract

P Pu ur rp po os se e: : To review the effects of maternal anesthesia and analgesia on the fetus and newborn.M Me et th ho od ds s: : An on-line computerized search of Medline, Embase, and the Cochrane Collaboration via PubMed was conducted. English language articles were selected. The bibliographies of relevant articles and additional material from other published sources were retrieved and reviewed.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : No one test clearly separates the effects on the fetus/newborn, if any, of maternally administered medication during labour and delivery, or during surgery for non-obstetric indications. Supposition in this regard is limited in part by methodology previously used to study the transplacental passage of various drugs. This work needs to be repeated using a human model. Routine maternal supplemental oxygen administration is being questioned in light of research showing that free radical generation and oxidative stress are implicated as the underlying mechanisms in several neonatal conditions. Maternal hypotension is associated with neonatal acidemia and base excess correlates with neonatal outcome. Common postpartum analgesics transfer minimally into breast milk. Maternal or fetal surgery conducted during pregnancy necessitates modification of both anesthetic and surgical approaches. The key to resuscitation of the fetus is resuscitation of the mother: intra-uterine maneuvers, including perimortem Cesarean section, aim to reverse treatable causes of fetal asphyxia, restore fetal oxygenation, and correct fetal acidosis.C Co on nc cl lu us si io on ns s: : The well-being of the infant is a major criterion for evaluating the anesthetic management of pregnant women. Many tools exist to assist with this determination for the fetus, whereas few are available to evaluate the newborn. Méthode : Une recherche informatisée en ligne des bases Medline et Embase et du Centre de collaboration Cochrane via PubMed a été réalisée. Des articles de langue anglaise ont été sélectionnés. Les bibliographies d'articles pertinents et du matériel additionnel d'autres publications ont été retenus et passés en revue. Constatations principales : Aucun test ne sépare clairement les effets sur le foetus/nouveau-né, si effet il y a, des médicaments administrés à la mère pendant le travail et l'accouchement ou pendant une intervention chirurgicale non obstétricale. Les hypothèses possibles

Breastfeeding Problems Following Anesthetic Administration

“…One of the parents' first responsibilities is giving informed consent (or refusal) for medical procedures that may impact the health of their infant. Mothers should ask questions and weigh the risks and benefits of any drug that is to be administered (Lang, Geldner, & Wulf, 2003;Littleford, 2004).…”

Volume mediano efetivo de cristaloides na prevenção de hipotensão arterial em pacientes submetidas à cesariana com raquianestesia

“…However, recent literatures show that despite the high prevalence of maternal hypotension, term infants can tolerate this placental blood perfusion challenge without any major negative consequences 28 . Meanwhile, a range of studies also have not found any sequel from the fluid interventions in patients undergoing Cesarean section with neuraxial blockade 27,29,30 . Our results are consistent with these findings, where fluid preloading produced little effect on infants' Apgar and neurobehavioral assessment scorings, as well as on the arterial umbilical-cord pH values.…”

Pre-Incisional Intravenous Low-Dose Ketamine Does Not Cause Pre- Emptive Analgesic Effect Following Caesarean Section under Spinal Anaesthesia

“…While analysis of umbilical cord blood gases remains the gold standard for assessment of the newborn, [28] assessment of all the newborn in this study was also carried out using the Apgar [29] scoring system. In our study, the mean umbilical cord venous blood pH was 7.35±0.05 and that of the arterial blood pH was 7.28±0.05.…”