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Pediatric Drugs

, Volume 5, Issue 9, pp 615–627 | Cite as

Effects of Obstetric Analgesics and Anesthetics on the Neonate

A Review
  • Jay E. Mattingly
  • John D’Alessio
  • Jaya RamanathanEmail author
Review Article

Abstract

Most anesthetic and analgesic agents in current use traverse the placental barrier in varying degrees, but are well tolerated by the fetus if judiciously administered. For labor analgesia, many options are available. Systemic administration of opioids and sedatives is one such option. Repeated maternal administration of opioids such as pethidine (meperidine) results in significant fetal exposure and neonatal respiratory depression. Patient-controlled analgesia with synthetic opioids such as fentanyl, alfentanil, and the new ultra-short-acting remifentanil may be used for labor analgesia in selected patients.

Other options for labor analgesia include epidural and combined spinal-epidural techniques. With such techniques, neonatal exposure to opioids and sedatives can be minimized or totally avoided. While limiting the fetal exposure to the harmful effects of depressant drugs, epidural anesthesia and/or analgesia improves placental perfusion and oxygenation of the fetus, which is beneficial, especially in conditions such as pregnancy-induced hypertension. Regional blocks are also administered for the majority of cesarean deliveries because of the overwhelming and unequivocal evidence of maternal and fetal safety compared with general anesthesia for this indication. However, in some instances, administration of general anesthesia is unavoidable. Neonatal respiratory depression with low Apgar scores, and umbilical arterial and venous pH associated with general anesthesia, is often transient. A properly administered anesthetic, whether regional or general, has no significant adverse fetal or neonatal effects.

Keywords

Remifentanil Epidural Analgesia Alfentanil Etomidate Desflurane 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

The authors would like to gratefully acknowledge the assistance of Nannette Wells-Brooks, CRNA, and David M. Armbruster, PhD, in the preparation of this manuscript.

No sources of funding were used to assist in the preparation of this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

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Copyright information

© Adis Data Information BV 2003

Authors and Affiliations

  • Jay E. Mattingly
    • 1
  • John D’Alessio
    • 2
  • Jaya Ramanathan
    • 1
    • 3
    Email author
  1. 1.Department of AnesthesiologyUniversity of Tennessee Health Sciences CenterMemphisUSA
  2. 2.Department of AnesthesiologyVanderbilt UniversityNashvilleUSA
  3. 3.Department of Obstetrics and GynecologyUniversity of Tennessee Health Sciences CenterMemphisUSA

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