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Biomedical subjects

R Jouppila

Publications and source records attributed to R Jouppila.

At least 37 records · Page 2Linked to original sources
PubMed1989

Comparison of the effects of general and epidural anaesthesia for caesarean section on the neurobehavioural responses of newborn infants.

Thirty-one neonates delivered by elective caesarean section were evaluated at the ages of 3 h, 1 day, 2 days and 4-5 days using Scanlon's Early Neonatal Neurobehavioural Scale and tests for orientation. Thirteen of the mothers received general anaesthesia and 18 epidural anaesthesia. All the mothers were healthy and not in labour. All the neonates weighed 2500 g or more and had Apgar scores of 7 or more at 1, 5 and 15 min. The neonates delivered with epidural anaesthesia scored significantly lower on rooting at the age of 3 h than those delivered with general anaesthesia, but the latter scored significantly lower on habituation to sound and orientation to both animate and inanimate visual stimuli. General anaesthesia seemed to depress the infants' interactive processes (orientation items), and their ability to make an appropriate response to repetitive stimuli (habituation) more than did epidural anaesthesia, indicating greater global depression. This depression was short-lived, however, and there were no differences between the groups on any of the parameters after 24 h.

Adult↗
PubMed1989

The effect of lumbar epidural analgesia on the neurobehavioural responses of newborn infants.

The effects of maternal lumbar epidural analgesia (Th10-L5) on the neonatal neurobehavioural response were studied at the ages of 3 h, 1 day, 2 days and 4-5 days. The subjects were healthy, full-term neonates, born vaginally to 15 mothers with lumbar epidural block and 19 mothers without analgesia. Those delivered with epidural analgesia scored significantly better on alertness at the age of 3 h, 2 days and 4-5 days than the control group. No other statistically significant differences were found between the groups. The formation of the two groups according to the mothers' desire for epidural analgesia may have contributed to differences in the process of labour, but with this reservation it may be suggested that lumbar epidural analgesia may enhance the infant's recovery from the stress of labour and vaginal delivery.

Analgesia, Epidural↗
PubMed1988

The effect of bupivacaine paracervical block on the neurobehavioural responses of newborn infants.

The effects of maternal bupivacaine paracervical block on neonatal neurobehavioural responses were studied at the ages of 3 h, 1 day, 2 days and 4-5 days. Subjects were healthy, term neonates born vaginally to 10 mothers with paracervical block and to 12 mothers without analgesia. No statistically significant differences were found in the responses between the groups. It is concluded that paracervical block with a small dose of bupivacaine, applied by experienced obstetricians to non-risk parturients with healthy foetuses, has no detrimental effects on newborn behaviour or neurological recovery.

Adult↗
PubMed1987

The effect of segmental epidural analgesia on the neurobehavioural responses of newborn infants.

The effects of maternal segmental epidural analgesia on neonatal neurobehavioural responses were studied at the ages of 3 h, 1 day, 2 days and 4-5 days. Subjects were healthy, term neonates born vaginally to 14 mothers with an epidural block and to 15 mothers without analgesia. The only statistically significant differences were found at the age of 1 day, when the epidural group infants habituated and oriented better to inanimate auditory stimuli. It is concluded that segmental epidural analgesia with a low dose of bupivacaine can be regarded as being a safe obstetric analgesic method as regards neonatal behavioural responses.

Acoustic Stimulation↗
PubMed1985

Natural killer cell activity after elective cesarean section under general and epidural anesthesia in healthy parturients and their newborns.

We studied the influence of elective cesarean section, under general and epidural anesthesia, on natural killer (NK) cell activity in 12 healthy parturients and in their newborns. The results of peripheral blood samples taken from the mothers before anesthesia and from the newborns 3 h after birth served as basal values against which the results of samples drawn on the 1st and 5th days following delivery were compared. A significant (p less than 0.05) decrease in the NK cell activity after surgery was found only in those mothers given general anesthesia. The differences between the studied groups were not, however, significant. NK activity in the peripheral blood samples of the newborns was not significantly different in the general anesthesia and in the epidural group during the follow-up period. The results show that the depression induced by operative stress on the NK cell function of parturients can be, at least partly, prevented by using epidural anesthesia.

Adult↗
PubMed1985

Maternal and fetal effects of epidural analgesia during labour.

We can state that an effective pain relief during labour, like epidural analgesia, is indicated and it prevents or modifies the pain-induced harmful effects on mother and the fetus. Maternal and fetal ACTH or BE response in labour are not altered, but the increase of maternal cortisol secretion is reduced, thus probably suggesting a lesser maternal stress, to which also point the changes of PRL. Epidural analgesia prevents harmful maternal metabolic changes like hyperventilation, hypocapnia, metabolic acidosis and lactic acid accumulation. These beneficial effects are also reflected in a better fetal and neonatal condition. Carbohydrate and fat metabolism, on the contrary, seem not to be significantly changed by epidural analgesia. Epidural analgesia is beneficial also by reducing the pain induced catecholamine release, and by improving the intervillous blood flow, especially in pre-eclamptic parturients.

Acid-Base Equilibrium↗
PubMed1985

Effects of anaesthesia for caesarean section on the computerized EEG of the neonate.

The effects of anaesthetic techniques and drugs on 18 neonates born after elective Caesarean section were studied, employing computerized EEG. Three different groups, epidural, spinal and general anaesthesia, were compared with each other and with a control group after normal vaginal delivery. A new computerized EEG method, Zero Band Power Rate (ZBPR) analysis, was devised for this study and implemented together with conventional spectral EEG estimates of five frequency bands. ZBPR analysis was found to be much more sensitive than conventional spectral analyses for detecting differences between the study groups. Significant differences occurred between the general anaesthesia group and the epidural and control groups and also between the spinal group and the epidural and control groups. No significant difference was seen between the epidural group and the control group. Significant differences were attributed to the clinical use of two drugs: thiopentone in the general anaesthesia group and ephedrine in the spinal group. The effects of these drugs on the neonatal EEG were reflected in decreased ZBPR values, particularly during sleep.

Adolescent↗
PubMed1984

Placental blood flow during caesarean section performed under subarachnoid blockade.

Subarachnoid blockade using 0.5% bupivacine after a "preload" of Ringer's lactate solution 1500-2000 ml i.v. was studied in nine patients undergoing elective Caesarean section. Ephedrine infusion 50 mg in 500 ml was instituted at the first signs of maternal hypotension in seven patients. Although significant decreases in mean maternal systolic, mean and diastolic arterial pressures were recorded, the individual decreases in pressure were less than 30 mm Hg in all except two patients. In general placental blood flow did not change, although there was a marked increase in one patient with toxaemia and a decrease in one woman with diabetes mellitus. The babies were unaffected at delivery. Preventive measures, especially the "preload" infusion, are important in the maintenance of adequate placental perfusion in patients undergoing Caesarean section under subarachnoid blockade.

Adult↗
PubMed1984

Maternal and umbilical cord plasma noradrenaline concentrations during labour with and without segmental extradural analgesia, and during caesarean section.

Serial measurements of maternal and umbilical cord plasma noradrenaline concentrations were obtained in 10 patients undergoing normal vaginal delivery with segmental extradural analgesia, in 10 patients undergoing normal vaginal delivery without extradural analgesia, and in 12 patients undergoing elective Caesarean section under general anaesthesia. Maternal noradrenaline concentrations increased significantly during delivery in all three groups, the peak concentrations occurring at delivery. However, the increase in the maternal noradrenaline concentration during delivery in the extradural group was lower than in the non-extradural group (P less than 0.05). Umbilical venous and arterial concentrations of noradrenaline were lower after Caesarean section than after vaginal delivery. However, extradural analgesia did not affect the fetal noradrenaline concentrations. Since noradrenaline is probably required for the adaptation of the newborn to extrauterine life, the unaltered fetal response may be beneficial.

Anesthesia, Epidural↗
PubMed1984

Intervillous blood flow during caesarean section with prophylactic ephedrine and epidural anaesthesia.

We administered a 15 mg i.v. bolus of ephedrine at the commencement of epidural blockade to nine healthy parturients scheduled for elective caesarean section. Nine other patients did not receive prophylactic ephedrine before epidural anaesthesia (control group). Lactated Ringer solution, 30 ml/kg, was infused before and during blockade, and left uterine displacement was used to minimize aortocaval compression. A133Xe i.v. technique was used to measure intervillous blood flow (IBF) before and 20-25 min after epidural block. The mean arterial pressure (MAP) decreased after epidural blockade in the ephedrine group by 0.67 +/- 0.8 (mean +/- s.d.) kPa and by 1.20 +/- 1.1 (mean +/- s.d.) kPa in the control group. In spite of the decrease in MAP, IBF increased by 6% in patients receiving ephedrine (N.S.), whereas it decreased by 11% in the control group (N.S.). In the ephedrine group there was in this preliminary study a trend to increasing IBF during falling perfusion pressure (MAP). The results of this preliminary study suggest that ephedrine will not affect IBF, but to prevent maternal hypotension ephedrine should be used as an i.v. infusion instead of a bolus injection.

Adult↗
PubMed1984

Effect of segmental epidural analgesia on changes in peripheral blood leucocyte counts, lymphocyte subpopulations, and in vitro transformation in healthy parturients and their newborns.

Changes in the peripheral blood leucocyte count, lymphocyte subpopulations, and in 'in vitro' responses of lymphocytes to phytohaemagglutinin and tuberculin after induced labour were investigated in 10 normal parturients and their newborns. Every other parturient was given segmental epidural analgesia at level T 10-12 for pain relief during the first stage of labour. The remaining mothers served as controls. The results of blood samples taken from the mothers before induction of labour and from the newborns immediately after delivery served as basal values against which the results of samples drawn on the 1st and on the 5th day following delivery were compared. A significant (p less than 0.05) increase from the basal values in the total leucocyte count after delivery was found only in those mothers not given epidural analgesia and in their newborns. Similarly, a significant (p less than 0.01) decrease in the T cell count characterized by both E rosette formation and acid alpha-naphthyl acetate esterase staining was found in the peripheral blood only in the mothers (but not the newborns) without epidural analgesia. The differences between the research groups were not, however, significant. The lymphocyte response to phytohaemagglutinin on the 1st and on the 5th day after delivery was also significantly (p less than 0.05) lower in the newborns of the mothers not given epidural analgesia than in those of the mothers given it. The present results show that the depression induced by the stress of parturition in some parameters of cell-mediated immunity of mothers and newborns can be at least partly prevented by using segmental epidural analgesia.

Adult↗
PubMed1984

Maternal and fetal effects of low-dosage bupivacaine paracervical block.

Vasoconstriction of the uterine arteries, hypertonus of the uterus, and the direct toxic effects of a local anesthetic on the fetus or a combination of the above have been presented as etiological factors of fetal bradycardia following paracervical block. The reduce fetal side-effects a superficial and lowdosage technique of PCB have been advocated. We have studied the effects of 25 mg of bupivacaine PCB using the above technique on fetal heart rate pattern (FHR), fetal acid-base balance, uterine activity, placental blood flow and maternal and fetal plasma levels of bupivacaine in 38 patients. The analgesic effect of a single 25 mg of bupivacaine PCB was good in 76%, moderate in 12% and poor in 12% of the cases. No changes in maternal heart rate or in blood pressure were noted. Fetal bradycardia defined as a decrease of mean fetal heart rate of at least 20 bpm or an absolute rate less than 100 bpm and a duration greater than two minutes occurred in 12% of the cases. The mean amplitude of the baseline fetal heart rate variability decreased significantly after PCB and a silent pattern (an amplitude less than 5 bpm) was observed in 20% of the cases. The most frequent (27%) pathological finding in our study was the disappearance of FHR accelerations after PCB. Similarly early and late decelerations of FHR occurred more often after PCB than during the control period before the block. The fetal pH from scalp blood samples did not, on average, decrease after PCB, but did so in cases with fetal bradycardia. Intervillous blood flow as measured by the 133Xe washout method did not change when measured before and after PCB. In addition in three cases with fetal bradycardia the changes in the intervillous blood flow were minimal. No significant changes in the mean uterine tone, amplitude and frequency of contractions were observed after PCB. However, an obvious uterine hypertonus was observed after PCB was observed in three cases of fetal bradycardia but not in two other cases of bradycardia or in the 8 cases of silent FHR pattern. Mean maternal bupivacaine concentration 20 minutes after PCB was 0.14 +/- 0.06 microgram/ml and 0.07 +/- 0.04 microgram/ml at birth. Simultaneous fetal and umbilical venous and arterial concentrations were correspondingly 0.04 +/- 0.02 microgram/ml, 0.03 +/- 0.01 microgram/ml and 0.03 +/- 0.01 microgram/ml, and they were significantly lower than respective maternal concentrations.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1984

Regional anaesthesia and uterine blood flow.

Sufficient placental blood flow is mandatory for the well-being of the fetus. The delicate balance between uterine perfusion pressure and uterine vascular resistance can be critically disturbed during epidural anaesthesia. Maternal hypotension is common when extensive block for Caesarean Section is used. If hypotension as well as aortocaval compression is avoided and sufficient preload (Ringer's lactate) is used intervillous blood flow (IBF) will not significantly change. Ephedrine given to prevent or treat maternal hypotension will not adversely effect IBF. Lumbar epidural analgesia used for pain relief during labor (10 ml dose of local anaesthetic (1.a.] will significantly (p less than 0.05) improve IBF in healthy parturients. Epinephrine (less than or equal to 50 micrograms), added to the local anaesthetic, will not decrease IBF. IBF can be severely reduced in pregnancy-induced hypertension (PIH) since the fetus is chronically asphyxiated it is crucial to avoid any further decrease in IBF. Extensive sympathetic blockade (T8) using epidural analgesia (10 ml dose of 1.a.) has been shown to significantly (p less than 0.01) improve IBF in parturients with PIH by decreasing uteroplacental vascular resistance.

Anesthesia, Epidural↗
PubMed1983

Maternal and umbilical venous plasma immunoreactive beta-endorphin levels during labor with and without epidural analgesia.

Maternal and umbilical venous plasma immunoreactive beta-lipotropin/beta-endorphin levels were determined during labor in 23 healthy parturient women at term. Eleven of the mothers received a segmental epidural analgesic for relief of pain, whereas the other 12 mothers were nearly pain-free and needed no analgesia. Maternal immunoreactive beta-lipotropin/beta-endorphin levels were already significantly elevated at the beginning of labor in both groups in comparison with nonpregnant young women. Maximum levels of immunoreactive beta-lipotropin/beta-endorphin were reached at delivery, and these mean levels were significantly higher than the initial mean levels in the epidural group (p less than 0.05) and in the control group (p less than 0.001). There were statistically no significant differences between the groups at any time. The umbilical venous plasma immunoreactive beta-lipotropin/beta-endorphin levels did not differ from each other in the epidural and the control groups. These results suggest that the stress of labor causes an increase in the maternal secretion of immunoreactive beta-lipotropin/beta-endorphin which is not related to the degree of pain itself. Epidural analgesia has also no effect on umbilical venous plasma immunoreactive beta-lipotropin/beta-endorphin.

Adult↗
PubMed1983

Placental transfer and hormonal effects of metoclopramide.

In order to study the transplacental transfer of metoclopramide, and its endocrine effects, measurements were made of its concentration in maternal and fetal blood, and in the amniotic fluid, together with maternal and fetal plasma concentrations of prolactin, TSH and oestradiol, during delivery by selective Caesarean section. The drug, 10 mg, was injected i.m. 12 and 2 h and just before the onset of anaesthesia. Metoclopramide was detectable in all the umbilical arterial and venous and amniotic fluid samples, in mean concentrations of 50, 63 and 75 ng/ml, respectively. The mean ratio between the umbilical venous and maternal plasma concentrations was 0.63. Accurate maternal plasma half-lives could not be established but they must have averaged 2 to 4 h. The high amniotic fluid concentrations and relatively high umbilical venous and arterial concentrations soon after administration suggest that metoclopramide equilibrates relatively rapidly between the mother and fetus. Metoclopramide raised the maternal plasma prolactin levels from 315 +/- 128 ng/ml (SD) before therapy to 357 +/- 112 ng/ml at the time birth. No statistically significant difference in cord arterial or venous plasma prolactin levels was seen between the control and metoclopramide-treated groups. Metoclopramide did not affect maternal plasma TSH or oestradiol levels. The only change was a slight but significant increase in TSH level in cord blood taken from the umbilical artery after metoclopramide treatment.

Anesthesia, Obstetrical↗
PubMed1983

The influence of maternal oxygen inhalation on human placental and umbilical venous blood flow.

The effect of maternal short-term inhalation of oxygen (51/min) on intervillous (IVBF) and umbilical vein blood flow (UVBF) was studied in 22 cases during the third trimester of pregnancy. The maternal paO2 levels increased significantly (P less than 0.001) after O2 inhalation. The mean IVBF level was 190 +/- 66 (SD) ml/min per 100 ml of the intervillous space before inhalation and 125 +/- 58 ml afterwards, the decrease being significant (P less than 0.01). UVBF maintained its original level after O2 inhalation. The human fetus seems not to compensate for alterations in oxygen delivery and reduced IVBF after maternal oxygen inhalation, by means of changes in UVBF.

Female↗
PubMed1983

Effect of segmental epidural analgesia on neonatal serum bilirubin concentration and incidence of neonatal hyperbilirubinemia.

Neonatal serum bilirubin levels were determined at the ages of 12 hrs, 2 days, 3 days, 4 days and 5 days in 80 infants. Forty-three mothers had received segmental epidural analgesia at the height of Th 10-12 for pain relief during the first stage of labor. The analgesic agent used was 0.5% bupivacaine. The individual doses were of 4 ml. Thirty-seven mothers served as a control group. The groups were further divided into smaller groups according to whether oxytocin was used for induction or acceleration of labor--or not. The results showed no statistically significant differences in the neonatal serum bilirubin levels at different times between the epidural and the control groups, whether oxytocin was used or not. Nor did the incidence of neonatal hyperbilirubinemia cases differ between the groups.

Anesthesia, Epidural↗