Abstract
Purpose
This study compares plasma lidocaine concentrations in 16-sets of twin neonates to 16-singleton neonates all of whom were delivered by Cesarean section under lumbar epidural anesthesia (LEA).
Methods
Lidocaine 1.5% with epinephrine 5 μg·mL−1 was used for activation of LEA. Upon delivery plasma lidocaine concentrations were measured from the maternal vein (MV), neonatal umbilical vein (UV) and umbilical artery (UA) using TDx fluorescence polarization immunoassay.
Results
MV lidocaine concentrations were similar in both twin and singleton mothers. Both mean lidocaine UV and UA levels were 35% higher in twin A (first-delivered) compared to the singleton neonate, (P < 0.01, t test). Similarly twin B mean UV and UA lidocaine levels were 35% and 53% higher than the singleton value (P < 0.01). Mean UV and UA lidocaine fetal/maternal ratios in both twins were at least 18% higher than the singleton value (P < 0.05).
Conclusion
Even though there were no differences in neonatal outcome, a potential does exist for high plasma lidocaine concentrations in twin fetuses, suggesting that the total maternal dose of lidocaine must be regulated carefully.
Résumé
Objectif
Comparer les concentrations plasmatiques de lidocaïne chez 16 paires de nouveau-nés jumeaux et chez 16 nouveau-nés uniques, tous nés par césarienne sous anesthésie épidurale lombaire (AEL).
Méthode
L’activation de l’AE L a été réalisée avec de la lidocaïne à 1,5% et 5 μg·mL−1 d’épinéphrine. À l’accouchement, on a mesuré les concentrations plasmatiques de lidocaïne à partir d’échantillons de la veine maternelle (VM), de la veine ombilicale du nouveau-né (VO) et de l’artère ombilicale (AO) en utilisant l’immunodosage à polarisation de fluorescence TDx.
Résultats
Les concentrations de lidocaïne de la VM étaient comparables chez les mères de jumeaux et d’enfant unique. Les niveaux de lidocaïne de la VO et de l’AO ont été plus élevés de 35 % chez les jumeaux A (premier né) comparés aux nouveau-nés uniques (P < 0,01, test t). De même, la moyenne des niveaux de lidocaïne de la VO et de l’AO chez les jumeaux B a été de 35 % et de 53 % plus élevée que chez les enfants uniques (P < 0,01). Les ratios moyens de lidocaïne fœtale/maternelle des VO et AO ont été d’au moins 18 % plus élevés chez les deux jumeaux que chez les enfants uniques (P < 0,05).
Conclusion
Même si l’évolution néonatale ne présente pas de différence, il y a une possibilité de concentrations plasmatiques de lidocaïne élevées chez les fœtus jumeaux, ce qui incite à régler minutieusement la dose totale de lidocaïne maternelle.
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Vallejo, M.C., Ramanathan, S. Plasma lidocaine concentrations are higher in twin compared to singleton newborns following epidural anesthesia for Cesarean delivery. Can J Anesth 49, 701–705 (2002). https://doi.org/10.1007/BF03017449
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DOI: https://doi.org/10.1007/BF03017449