Summary and Conclusions
Largactil 25 mgm. was given intravenously to 100 patienis during labour and the results compared with the course of labour m 100 similar cases. Following the administration of Largactil excellent psychic sedation was usually observed. The patients became relaxed immediately, slept between pains, but could be easily roused. Apprehension was relieved.
The best results were obtained when an analgesic was also used during the first stage of labour. Largactil was used to best advantage when given to primigravidae just before full cervical dilatation and to multigravidae when the cervix was about half dilated. If no analgesic had been given the simultaneous administration of Demerol 25 mgm. intravenously with the Largactil produced better sedation.
For the actual delivery, if general anaesthesia was necessary, the amounts necessary were greatly reduced, Nitrous Oxide-Oxygen being sufficient for most operative deliveries.
Post-partum sedation was required less often.
Vomiting during labour was relieved by Largactil and the incidence of nausea and vomiting after general anaesthesia and delivery was significantly decreased. No ill effects on mother or child weie observed.
It would appear that Largactil would be useful in premature deliveries as it does not have any apparent naicotizmg effect on the baby, and by its use the amounts of analgesics and anaesthetics can be greatly reduced.
Largactil sometimes appears to have a tendency to slow up labour, particularly in grand multiparae and those patients with poor uterme contractions. In Caesarean section, Largactil combined with light anaesthesia and a muscle relaxant appears to be effective and safe.
It is suggested that Largactil deserves further investigation of its uses in obstetrics.
RéSUMé
Cent patients en travail reçûrent 25 mgm. de Largactil en injection intra veineuse et les résultats obtenus furent comparés à ceux de 100 autres patients présentant la même condition.
Habituellement l’administration du Largactil fut suivie d’une excellente sédation psychique. Les patientes devinrent immédiatement calmes, dormièrent entre les douleurs mais purent être facilement éveillées. L’appréhension disparût. Les meilleurs résultats furent obtenus quand on utillsa aussi un analgésique durant la période initiale du travail. Le Largactil fut employé avec le maximum d’effet quand on l’injecta aux primipares avant dilatation complete du col et chez les multipares, quand le col était a moitie dilaté. Quand aucun analgésique n’avait été donné, l’injection simultanée en intra veineuse, de 25 mgm. de Demerol et du Largactil produisit une meilleure sédation.
Quand il fut nécessaire d’employer l’anesthésie générale au moment de la délivrance, la quantité en fut moindre et le plus souvent le mélange protoxyde d’azote-oxygene fut suffisant.
On n’eut moins besoin de sédation après le travail.
Le Largactil fit disparaître les vomissements durant le travail et diminua grandement l’incidence des nausées et vomissiments après l’anesthésie générale et la délivrance.
Aucun effet noscif sur la mère ou l’enfant fut observé. Il semble que le Largactil pourrait être employé avec succès dans les accouchements prématurés. Il n’a aucun effet narcotique sur le bébé et son emploie diminue de beaucoup la dose des analgésiques et anesthésiques. Paifois le Largactil semble avoir une tendance a ralentir le travail, particulièrement chez les grandes multipares ou chez les patients a faibles contractions utérines.
Dans les Césaréennes, le Largactil employé avec une anesthésie peu profonde et une curarisant semble effectif et sur. L’auteur suggère qu’on étudie davantage les possibihtés du Largactil en Obstétrique.
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Davies, J.I. The use of largactil in obstetrics. Canad. Anaesth. Soc. J. 2, 327–339 (1955). https://doi.org/10.1007/BF03015875
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DOI: https://doi.org/10.1007/BF03015875