Anesthesia for the Inner-City Parturient

  • D. J. Birnbach
Part of the Developments in Critical Care Medicine and Anesthesiology book series (DCCA, volume 30)


The “inner-city parturient” can present many challenges to the obstetric anesthesiologist. The unusual and clinically challenging situations that may arise in this patient population may be due to drug abuse, an unstable home environment, poor diet, failure to receive medical treatment during pregnancy, or the presence of untreated co-existing disease. The patient at greatest risk is the unregistered patient—that is, the obstetric patient in labor who arrives at Labor and Delivery never having seen an obstetrician or midwife. Table 1 summarizes some of the problems that can be seen in the unregistered obstetric patient.

Table 1. Problems seen in the unregistered parturient.
  • Preterm labor

  • Fetal distress

  • Abruptio placenta

  • Preeclampsia/eclampsia

  • Drug abuse

  • Hepatitis

  • Sexually transmitted disease

  • AIDS

  • Poor interaction with medical staff


Regional Anesthesia Cocaine Abuse Epidural Blood Patch Acute Withdrawal Rapid Sequence Intubation 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Matera C, Warren W, Moomjy M et al: Prevalence of use of cocaine and other substances in an obstetric population. Am J Obstet Gynecol 163:797–801, 1990PubMedGoogle Scholar
  2. 2.
    McCalla S, Minkoff HL, Feldman J et al: Predictors of cocaine use in pregnancy. Obstet Gynecol 79;641–644, 1992PubMedGoogle Scholar
  3. 3.
    Knisely JS, Spear ER, Green DJ et al: Substance abuse patterns in pregnant women. NIDA Res Monogr Ser 108:280–281, 1991Google Scholar
  4. 4.
    Birnbach DJ, Stein DJ, Thomas K et al: Cocaine abuse in the parturient. What are the implications to the anesthesiologist? Anesthesiology 79:A988, 1993Google Scholar
  5. 5.
    Abelson HI, Miller JD: National Inst Drug Abuse Res Monogr Ser 61:35, 1985Google Scholar
  6. 6.
    Birnbach DJ, Stein DJ, Thomas K et al: Instant recognition of the cocaine abusing parturient. Evaluation of a new technique. Anesthesiology 79:A987, 1993Google Scholar
  7. 7.
    Schutzman DL, Frankenfield-Chernicoff M, Clatterbaugh HE et al: Incidence of intrauterine cocaine exposure in a suburban setting. Pediatrics 88:825–827, 1991PubMedGoogle Scholar
  8. 8.
    Streissguth AP, Grant TM, Barr HM et al: Cocaine and the use of alcohol and other drugs during pregnancy. Am J Obstet Gynecol 164:1239–1243, 1991PubMedGoogle Scholar
  9. 9.
    Little BB, Snell LM, Klein VR et al: Cocaine abuse during pregnancy: Maternal and fetal implications. Obstet Gynecol 73:157–160, 1989PubMedGoogle Scholar
  10. 10.
    Ramoska E, Sacchetti A: Propranolol induced hypertension in the treatment of cocaine intoxication. Ann Emerg Med 14:112, 1985CrossRefGoogle Scholar
  11. 11.
    Gay GR, Loper KA. The use of labetalol in the management of cocaine crisis. Ann Emerg Med 17: 282–283, 1988PubMedCrossRefGoogle Scholar
  12. 12.
    Ong BH: Dextroamphetamine poisoning. N Engl J Med 266:1321–1322, 1962PubMedCrossRefGoogle Scholar
  13. 13.
    Eliot RH, Rees GB: Amphetamine ingestion presenting as eclampsia. Can J Anaesth 37:130–133, 1990CrossRefGoogle Scholar
  14. 14.
    Michel R, Adams AP: Acute amphetamine abuse. Anaesthesia 34:1016, 1979PubMedCrossRefGoogle Scholar
  15. 15.
    Giuffrida JG: Anesthetic management of the drug abuser. Anesth Analg 49:272–278, 1970PubMedCrossRefGoogle Scholar
  16. 16.
    Gomar C, Luis M, Nalda MA: Sacro-ilitis in a heroin addict. A contraindication to spinal anesthesia. Anaesthesia 39:167, 1984PubMedCrossRefGoogle Scholar
  17. 17.
    Koppel BS, Tuchman AJ, Mangiardi JR et al: Epidural spinal infec-tion in intravenous drug abusers. Arch Neurol 45:1331–1337, 1988PubMedCrossRefGoogle Scholar
  18. 18.
    Tornabene VW: Narcotic withdrawal syndrome caused by naltrexone. Ann Intern Med 81: 785–786, 1974PubMedGoogle Scholar
  19. 19.
    Weintraub SJ, Naulty JS: Acute abstinence syndrome after epidural injection of butorphanol. Anesth Analg 64:452–453, 1985PubMedCrossRefGoogle Scholar
  20. 20.
    HIV Quarterly Surveillance Report. CDC, Atlanta, GA. February 1993Google Scholar
  21. 21.
    Chu S, Buehler JW, Berkelman RL: Impact on human immunodeficiency virus epidemic on mortality of women of reproductive age, United States. JAMA 264:225–229, 1990PubMedCrossRefGoogle Scholar
  22. 22.
    Hughes SC, Dailey PA, Landers D et al: The HIV+ parturient and regional anesthesia: Clinical and immunologic response. Anesthesiology 77:A1036, 1992CrossRefGoogle Scholar
  23. 23.
    Tom DJ, Gulevich SJ, Shapiro HM et al: Epidural blood patch in the HIV-positive patient: Review of clinical experience. Anesthesiology 76:943–947, 1992PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1995

Authors and Affiliations

  • D. J. Birnbach

There are no affiliations available

Personalised recommendations