Frederick W. Hehre

Effects of maternal hyperoxia on the fetus: I. Oxygen tension☆

Abstract One hundred per cent oxygen was administered to 20 patients during labor for at least a period of 60 minutes. Simultaneous fetal scalp blood samples and maternal arterial blood samples were obtained prior to oxygen administration at 15, 30, 45, and 60 minutes of maternal hyperoxia and after oxygen was discontinued by 5 to 30 minutes. All patients had continuous fetal heart rate, uterine contractions, and maternal blood pressure recording. A statistically significant rise in fetal P o 2 was observed during maternal hyperoxia with a return to initial levels after oxygen was discontinued. The rise in fetal P o 2 blood was not proportional to the increase in maternal P o 2. There was no associated acidosis observed with the procedure.

Propranolol therapy throughout pregnancy: a case report.

The course of pregnancy and delivery of a patient who suffered cardiac arrest and required resuscitation in the 1st weeks of gestation, and who was treated with propranolol for the remainder, is described.Propranolol blocks responses to the hemodynamic demands placed on the pregnant womans circulation, blocks fetal responses to the stresses of labor and delivery, and extends into the neonatal period. The beta-adrenergic-blocked fetus may be expected to show growth retardation and to tolerate labor poorly.

Continuous lumbar peridural anesthesia in obstetrics

Abstract Lumbar peridural block has not attained popularity in obstetrical anesthesia although it has significant advantages for baby, parturient mother, and obstetrician. The use of continuous technique for long or short periods provides excellent anesthesia and good relaxation, and it does not affect the unborn child. The need for intrapartum barbiturates and narcotics is minimal or absent. Postlumbar puncture headache does not occur. Lumbar peridural anesthesia is satisfactory for vaginal delivery or cesarean section. Complications are few and the success rate high in trained hands.

Continuous lumbar peridural anesthesia in obstetrics. 8. Further observations on inadvertent lumbar puncture.

N 1962, we1 reported that the incidence I of inadvertent lumbar puncture during continuous lumbar peridural anesthesia at Yale-New Haven Hospital was 2.3 percent and the incidence of postlumbar-puncture headache was 16.6 percent. Many of the individuals in that series were surgical patients. Continuous lumbar peridural anesthesia has been used in the Delivery Suite at this hospital since 1958 for intrapartum pain relief during all stages of labor. The low-dose technic has been previously described in detail.2 Briefly, using a 16-gauge Huber-point needle (outside diameter 1.7 mm.),3 the peridural space is identified by the intermittent-pressure, loss-of-resistance technic, after which a polyvinyl catheter (outside diameter 0.99 mm.) 3 is inserted. This communication reviews experience with inadvertent lumbar puncture and postlumbar-puncture headache in parturients.

Continuous lumbar peridural anesthesia in obstetrics. VI. The fetal effects of transplacental passage of local anesthetic agents.

OCAL ANESTHETIC agents cross the plaL centa192 in both directions.3 Direct intoxication of the fetus during caudal anesthesia has been reported by Finster and associates.* Indirect fetal intoxication during paracervical block has been implied by Rosefsky and Petersiel.5 The subclinical effects of placental transmission of local anesthetic agent on the fetus are as yet undescribed. This paper reports a study of 60 women who received continuous lumbar peridural anesthesia during labor, in whom fetal and maternal blood levels of local anesthetic agent were measured at delivery. Thirty-six parturitions were monitored by fetal electrocardiographic studies. METHODS Sixty pregnant women in spontaneous or induced labor were given continuous lumbar peridural anesthesia by the low-dosage technic,6 using 2 percent lidocaine with 1:200,000 epinephrine or 2 percent prilocaine with 1: 200,000 epinephrine. Initial doses were 140 to 160 mg. (7 to 8 ml.) with hourly supplementary doses of 100 mg. (5 ml.) . Fetal electrocardiographic studies were by Hons method, and included quantitative measurement of the fetal beat-to-beat electrocardiographic interval.

Malignant hyperthermia with disseminated intrascular coagulation during general anesthesia: a case report.

ALIGNANT hyperthermia that occurs M during general anesthesia is characterized by a rapid rise in body temperature to levels above 106 F. (41.1 C.), profound respiratory and metabolic acidosis, tissue hypoxia, hypovolemia, and muscle rigidity. Approximately 75 percent of cases develop convulsions, coma, cardiac arrest, and death within hours. The majority of patients have been children or young adults. In a review of 40 cases, Wilson and associates found the average age to be 21.7 years. The syndrome has occurred more than once in the same patientl-3 and among members of the same family. Disorders of the musculoskeletal system have been a common, but not a universal, finding. Specific drugs have not been implicated as causative agents. Among 38 case reports providing specific information, 85 percent received halothane, 85 percent succinylcholine, and 100 percent either halothane or succinylcholine.l-l2 However, the syndrome is known to have occurred prior to the introduction into clinical practice of either succinylcholine or halothane.13

Continuous lumbar peridural anesthesia in obstetrics. V. Double-blind comparison of 2 percent lidocaine and 2 percent prilocaine.

Continuous lumbar peridural anesthesia was administered to women in normal labor by a technic described previously.:! Data were recorded on a specially designed check sheet and transferred to IBM pun& cards. These were proceased through the 7040/7094 Direct Couple System at the Yale Computer Center. The anesthesia was administered by several anesthesiologists. No attempt was made to influence the conduct of the anesthesia except to urge that all the unknown drug be used prior to supplementation with a known drug. The latter was invariably 2 percent lidocaine with 1:2OO,OOO epinephrine.

Peridural block complicating lumbar sympathetic block.

Anticholinergics are well known to cause pupillary dilatation and cycloplegia, however, a sense of light perception should still be intact. This was the initial sequence of events in the patient which we describe. Belladonna alkaloids have not been implicated in causing complete blindness, which was the sequela to the initial mydriasis and cycloplegia this patient experienced. We are aware of another case2 in which blindness developed in a patient following spinaI anesthesia for transurethral resection of the prostatic gland. However, that particular patient developed symptoms of true cortical blindness secondary to overhydration. On the basis of a central venous pressure of 8 cm H,O and subsequent normal diuresis, as well as the absence of pupillary response to light and power of accommodation, we excluded cortical blindness as a primary disorder.