European Journal of Clinical Pharmacology

, Volume 21, Issue 3, pp 221–227 | Cite as

Comparison of the placental transfer of thiopental and diazepam in Caesarean section

  • O. M. Bakke
  • K. Haram
  • T. Lygre
  • G. Wallem
Originals

Summary

Drug concentrations were measured in whole blood obtained from mother and child after induction of general anaesthesia with thiopental or diazepam and delivery by Caesarean section. In 27 cases given thiopental 3 mg/kg intravenously the 5-min child/mother concentration ratio rose with increasing injection-delivery (I-D) interval up to 8–10 min. The concentration in the newborn at 2 h showed a similar trend. In 30 cases given diazepam 0.3 mg/kg for sleep induction, there were some low values in cases delivered within 4 min after the injection. However, higher neonatal concentrations and child/mother ratios were observed when the operation lasted 4–5 min, and there was no further increase in cases with longer I-D intervals. There is evidence to suggest that net transfer to the fetus proceeds at a slower rate with thiopental than with diazepam. However, in the present series of low risk elective Caesarean sections, there was no appreciable difference between the induction agents with regard to their effect on the newborn infant.

Key words

thiopental diazepam placental transfer Caesarean section neonatal depression 

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References

  1. Berlin A, Siwers B, Agurell S, Hiort Å, Sjöqvist F, Ström S (1972) Determination of bioavailability of diazepam in various formulations from steady state plasma concentration data. Clin Pharmacol Ther 13:733–744Google Scholar
  2. Blackman GL, Jordan GJ, Paull JD (1978) Analysis of thiopentone in human plasma by high-performance liquid chromatography. J Chromatogr 145:492–495Google Scholar
  3. Christensen JH, Andreasen F, Jansen JA (1980) Pharmacokinetics of thiopentone in a group of young women and a group of young men. Br J Anaesth 52:913–918Google Scholar
  4. Conklin KA, Graham CW, Murad S, Randall FM, Katz RL, Cabalum T, Lieb SM, Brinkman CR III (1980) Midazolam and diazepam: Maternal and fetal effects in the pregnant ewe. Obstet Gynecol 56:471–474Google Scholar
  5. Finster M, Mark LC, Morishima HO, Moya F, Perel JM, James LS, Dayton PG (1966) Plasma thiopental concentrations in the newborn following delivery under thiopental-nitrous oxide anesthesia. Am J Obstet Gynecol 95:621–629Google Scholar
  6. Finster M, Morishima HO, Mark LC, Perel JM, Dayton PG, James LS (1972) Tissue thiopental concentrations in the fetus and newborn. Anesthesiology 36:155–158Google Scholar
  7. Flowers CE (1963) Factors related to the placental transfer of thiopental in the hemochorial placenta. Am J Obstet Gynecol 85:646–657Google Scholar
  8. Ghoneim MM, Korttila K (1977) Pharmacokinetics of intravenous anaesthetics: Implications for clinical use. Clin Pharmacokinet 2:344–372Google Scholar
  9. Hamar C, Levy G (1980) Serum protein binding of drugs and bilirubin in newborn infants and their mothers. Clin Pharmacol Ther 28:58–63Google Scholar
  10. Haram K, Bakke OM (1980) Diazepam as an induction agent for Caesarean section: A clinical and pharmacokinetic study of fetal drug exposure. Br J Obstet Gynaecol 87:506–512Google Scholar
  11. Haram K, Bakke OM, Johannessen KH, Lund T (1978) Transplacental passage of diazepam during labor: Influence of uterine contractions. Clin Pharmacol Ther 24:590–599Google Scholar
  12. Haram K, Bakke OM, Sandvei R, Lund T (1979) Foetal drug exposure following intravenous injection of diazepam immediately before breech delivery. Ann Chir Gynaecol 68:104–108Google Scholar
  13. Hillestad L, Hansen T, Melsom H, Drivenes A (1974) Diazepam metabolism in normal man. I. Serum concentrations and clinical effects after intravenous, intramuscular, and oral administration. Clin Pharmacol Ther 16:479–484Google Scholar
  14. Klotz V, Antonin K-H, Bieck PR (1976) Pharmacokinetics and plasma binding of diazepam in man, dog, rabbit, guinea pig and rat. J Pharmacol Exp Ther 199:67–78Google Scholar
  15. Kurz H, Mauser-Ganshorn A, Stickel HH (1977) Differences in the binding of drugs to plasma proteins from newborn and adult man. I. Eur J Clin Pharmacol 11:463–467Google Scholar
  16. Mandelli M, Morselli PL, Nordio S, Pardio G, Principi N, Sereni F, Tognoni G (1975) Placental transfer of diazepam and its disposition in the newborn. Clin Pharmacol Ther 17:564–572Google Scholar
  17. Moore RG, McBride WG (1978) The disposition kinetics of diazepam in pregnant women at parturition. Eur J Clin Pharmacol 13:275–284Google Scholar
  18. Morselli PL, Franco-Morselli R, Bossi L (1980) Clinical pharmacokinetics in newborn and infants. Age-related differences and therapeutic implications. Clin Pharmacokinet 5:485–527Google Scholar
  19. Nation RL (1980) Drug kinetics in childbirth. Clin Pharmacokinet 5:340–364Google Scholar
  20. Price HL, Kovnat PJ, Safer JN, Conner EH, Price ML (1960) The uptake of thiopental by body tissues and its relation to the duration of narcosis. Clin Pharmacol Ther 1:16–22Google Scholar
  21. Rane A, Tomson G (1980) Prenatal and neonatal drug metabolism in man. Eur J Clin Pharmacol 18:9–15Google Scholar
  22. Rutherford DM, Okoko A, Tyrer PJ (1978) Plasma concentrations of diazepam and desmethyldiazepam during chronic diazepam therapy. Br J Clin Pharmacol 6:69–73Google Scholar
  23. Schepens P, Heyndrickx A (1975) Placental transfer of thiopental. Eur J Toxicol 8:87–93Google Scholar
  24. Scher J, Haily DM, Beard RW (1972) The effects of diazepam on the fetus. J Obstet Gynecol 79:635–638Google Scholar
  25. Stovner J, Vangen O (1974) Diazepam compared to thiopentone as induction agents for Caesarean Sections. Acta Anaesthesiol Scand 18:264–269Google Scholar

Copyright information

© Springer-Verlag 1981

Authors and Affiliations

  • O. M. Bakke
    • 1
    • 2
  • K. Haram
    • 1
    • 2
  • T. Lygre
    • 1
    • 2
  • G. Wallem
    • 1
    • 2
  1. 1.Clinical Pharmacology UnitLaboratory of Clinical BiochemistryNorway
  2. 2.Department of Obstetrics and Gynaecology, Haukeland SykehusUniversity of BergenNorway

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