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Biomedical subjects

R Jouppila

Publications and source records attributed to R Jouppila.

At least 55 records · Page 3Linked to original sources
PubMed1983

Epicutaneous application of A2358 compresses containing ketocaine for pain relief in labor. A multicenter double-blind trial.

In the present multicenter trial 147 primigravidae were treated for low-back pain during the first stage of labor. 72 parturients were treated with A2358 compresses containing ketocaine, which were applied to the sacral lower-back region for one hour, 75 parturients were treated identically with compresses without the anesthetic drug. The pain relieving effect was almost the same in both treatment groups. The low-back pain was alleviated in about half of the mothers at 0.5, 10 and 1.5 hours after the application of both A2358 or control compresses. Supplementary analgesics had to be administered in about 60% of the parturients in both groups. The results show that factors other than ketocaine are involved in pain relief after application of A2358 compresses.

Adult↗
PubMed1983

Albumin infusion does not alter the intervillous blood flow in severe pre-eclampsia.

Intervillous blood flow (IVBF) was measured by the 133Xe intravenous method before and after a 100 ml infusion of 20% human albumin in 13 cases of severe pre-eclampsia. In spite of the significant increase in serum albumin and colloid osmotic pressure values, no parallel direction of change in IVBF values could be seen to result from the immediate effects of volume expansion therapy. The results suggest that the use of albumin infusion is of no specific value in the treatment of severe pre-eclampsia in terms of evaluation at the level of placental circulation. The observation of an increase in placental blood flow in cases of real hypoalbuminemia calls for a further elucidation.

Albumins↗
PubMed1983

The effect of parturition on umbilical blood plasma levels of norepinephrine.

The norepinephrine concentration in 77 umbilical, arterial, and venous plasma samples, and in 31 simultaneous maternal plasma samples, was measured. The mean (+/- SEM) of 8.7 +/- 1.9 ng/ml in the umbilical artery was higher (P less than .001) than that of 3.6 +/- 0.9 ng/ml in the umbilical vein. In paired fetal-maternal venous samples the norepinephrine concentration of 3.8 +/- 1.7 ng/ml in the fetus was higher (P less than .05) than that of 0.3 +/- 0.1 ng/ml in the mother. Among the different types of vaginal deliveries the umbilical arterial norepinephrine concentrations were: 5.8 +/- 2.1 ng/ml in uncomplicated vaginal deliveries; 16.4 +/- 2.1 ng/ml in breech deliveries (P less than .05 as compared with uncomplicated vaginal deliveries); 8.8 +/- 2.5 ng/ml in vacuum extraction deliveries; and 0.8 +/- 0.3 ng/ml and 11.3 +/- 7.7 ng/ml in twin A and twin B deliveries, respectively. All these values were higher (P less than .001) than those after elective cesarean section, except that for twin A, which was lower (P less than .01) than that for twin B, indicating that labor and vaginal delivery induced activation of the fetal sympathoadrenal system.

Adult↗
PubMed1982

Effect of extradural analgesia using bupivacaine and 2-chloroprocaine on intervillous blood flow during normal labour.

The effect of lumbar extradural analgesia on intervillous blood flow (IBF) during labour was studied in 26 healthy parturients using an i.v. bolus injection of xenon-133. There was a 19% decrease (n.s.) in mean IBF in six parturients (non-extradural control group). Mean IBF increased by 37.5% when 0.25% bupivacaine 10 ml was used and by 35.2% when 2% 2-chloroprocaine 10 ml was used (n.s.). When the two extradural groups were combined, the mean difference between IBF1 and IBF2 was 45 +/- 112 ml min-1 dl-1. This increase is statistically significant (P less than 0.05). The improvement in IBF after extradural block was considered to be a result of the decreased uterine vascular resistance, as no significant changes were observed in arterial pressure, uterine activity or uterine tone.

Adult↗
PubMed1982

Production of prostacyclin and thromboxane during cesarean section.

The effect of cesarean section on the production of the antiaggregatory prostacyclin and proaggregatory thromboxane A2 was studied in 12 women by measuring the stable metabolites of prostacyclin and thromboxane A2, 6-ketoprostaglandin F1 alpha and thromboxane B2, respectively, from serial maternal blood samples collected before, during, and after the operation. The plasma 6-keto-prostaglandin F1 alpha concentration was similar to the initial concentrations before the start of anesthesia (mean 121.6 +/- SE 11.5 pg/ml), at the time of skin incision (148.0 +/- 21.0 pg/ml), and at delivery of the infant (136.3 +/- 11.2 pg/ml), but was elevated at the end of the operation (454.8 +/- 56.2 pg/ml) (P less than .001) and one hour later (233.1 +/- 39.5 pg/ml) (P less than .01). These increases were similar whether the patients were operated on under general (N = 6) or epidural (N = 6) anesthesia. The serum thromboxane B2 concentration did not change, indicating no influence of cesarean section on the capacity of the platelets to produce thromboxane B2 during spontaneous clotting. The increased output of prostacyclin may originate from the myometrium and/or intrauterine tissues, which are manipulated during cesarean section. The increased output may play a role in preventing thromboembolic complications during and after cesarean section.

6-Ketoprostaglandin F1 alpha↗
PubMed1981

Epinephrine does not alter human intervillous blood flow during epidural anesthesia.

The effect of epinephrine given epidurally with local anesthetics on uterine blood flow is controversial. Previous work in pregnant ewes demonstrated a transient but significant (14 per cent) decrease in uterine blood flow when 2-chloroprocaine with epinephrine (10 micrograms/l) was used. The authors administered 2-chloroprocaine, 10 ml, with epinephrine (5 micrograms/ml) to 12 healthy women during the first stage of labor. By use of intravenously injected 133Xe, intervillous blood flow was measured before and 15-20 min after epidural anesthesia to a somatic level of at least T10. Intervillous blood flow did not change significantly despite a decrease in mean blood pressure of 11 torr. These conflicting results are probably best explained by methodologic and species differences. It is postulated that human placental vasculature, unlike that of the ewe, undergoes vasodilation when perfusion pressure is decreased to maintain placental blood flow.

Adult↗
PubMed1981

Maternal and foetal drug levels after epicutaneous application of a local anaesthetic formulation containing ketocaine for possible use as pain relief in labour.

A local anaesthetic formulation (A 2358) containing ketocaine, a local anaesthetic drug, was applied epicutaneously to the low back. Two compresses soaked with A 2358 were applied for 1 hour in 26 normal labours for relieving referred pain from the low back. The maternal blood ketocaine levels remained low, compared to higher systemic levels reported in other studies. Maternal heart rate and blood pressure were stable during the application time. The mean umbilical vein/maternal vein and umbilical artery/maternal vein concentration ratios were 0.20 +/- 0.10 and 0.21 +/- 0.09. In addition, the foetal heart rate findings and the conditions of the neonates were satisfactory, thus suggesting the foetal safety of this analgesic method.

Adolescent↗
PubMed1981

Maternal, fetal and aminiotic fluid ACTH, cortisol and prolactin in association with medical beta-adrenergic stimulation.

In view of observations indicating accelerated fetal pulmonary maturation after tocolytic therapy with beta-adrenergic agonists, this study was undertaken to determine whether the phenomenon is related to enhanced maternal or fetal ACTH, cortisol or prolactin secretion. The concentrations of ACTH, cortisol and prolactin in maternal venous blood, umbilical arterial and venous blood, and amniotic fluid were similar after short-term maternal intravenous infusion of isoxsuprine, fenoterol or isotonic saline, and they did not increase in the maternal venous blood during these treatments or during long-term treatment with intravenous ritodrine. These results suggest that the accelerated fetal pulmonary maturation induced by beta-adrenergic stimulation is not mediated by ACTH, cortisol or prolactin.

Adrenergic beta-Agonists↗
PubMed1980

Laryngeal oedema as an obstetric anaesthesia complication: case reports.

Three cases of laryngeal oedema leading to endotracheal intubation difficulties in obstetric anaesthesia are described. The first case occurred immediately postpartum in a patient who developed a swollen face from strenuous bearing down efforts in the second stage of labour. The other two cases were patients with severe preeclampsia including marked generalized oedema. The possibility of the occurrence of laryngeal oedema with resultant endotracheal intubation difficulties in obstetrics should be remembered when endotracheal intubation is considered to avoid the hazard of acid aspiration. The authors prefer the use of regional anaesthetic techniques (if not contraindicated) in obstetrics, and emphasize the use of prophylactic methods to minimize the risk of acid aspiration in connection with general anaesthesia, particularly where endotracheal intubation may be difficult.

Adult↗
PubMed1980

The effect of segmental epidural analgesia on maternal prolactin during labour.

Maternal plasma prolactin (PRL) concentrations were determined during the course of induced labours in 18 normal parturients. Every second mother was given segmental epidural analgesia for pain relief during the first stage of labour and the remaining parturients served as controls. The maternal PRL level declined during labour in both groups, which contrasts with the increased output seen in nonpregnant patients subjected to stress. The lowest levels were reached during the first stage of labour. The reduction in PRL levels was statistically significant in the control group but not in the epidural group of patients.

Adolescent↗
PubMed1980

Maternal, fetal and neonatal effects of beta-adrenergic stimulation in connection with cesarean section.

To investigate the combined metabolic effects of beta-mimetic therapy and general anesthesia on maternal and fetal/neonatal metabolism, 14 patients were treated with isotonic saline, 11 with intravenous fenoterol (3 microgram/min) and 9 with intravenous isoxsuprine (150 microgram/min) for 30 minutes prior to cesarean section. The maternal heart rate and blood pressure as well as the maternal and fetal acid-base balance were followed. The neonatal glucose level was monitored for 36 hours after delivery. The heart rate and the diastolic and systolic blood pressure values increased during the operation in each group, without any marked differences between the groups. At delivery, the mean maternal BD (base-deficit) value was higher in the fenoterol patients than in the control patients, indicating a trend towards metabolic acidosis. The other values of acid-base balance in the maternal and umbilical arterial and venous blood did not reveal any differences between the groups. The neonatal glucose level at 2 hours after delivery was higher in the fenoterol group than in the control group. The other values recorded during 36 hours revealed no differences between the groups. Beta-mimetic treatment preceding general anesthesia in cesarean section does not have unfavorable effects on the mother, the fetus or the newborn. Such therapy thus does not seem contraindicated when uterine contractions should be rapidly suppressed in cases of fetal distress before operation.

Acid-Base Equilibrium↗
PubMed1979

Epidural analgesia and placental blood flow during labour in pregnancies complicated by hypertension.

Placental blood flow was measured during the first stage of labour in pregnancies complicated by essential hypertension or severe pre-eclampsia using a 133Xe clearance technique before and after segmental epidural analgesia. Analgesia was produced with 0.5 per cent plain bupivacaine in six patients with essential hypertension and in 11 patients with severe pre-eclampsia. After segmental epidural analgesia the placental blood flow was slightly but insiginificantly improved in most of the patients with pre-eclampsia and in half of the patients with essential hypertension, thus suggesting this analgesic method to be safe in hypertensive pregnancies in the absence of any substantial change in systemic blood pressure.

Anesthesia, Epidural↗
PubMed1979

Effect of induction of general anesthesia for cesarean section on intervillous blood flow.

Intervillous blood flow was measured by a new intravenous 133Xe method before and during induction of general anesthesia for cesarean section in 10 healthy mothers. The flow values showed a highly significant decrease (p less than 0.001) (35 per cent on an average) at the time of anesthesia compared with the control values. The impairment was observed in all the cases. The role of the maternal changes in hemodynamic parameters and acid-base balance as a background of this decrease is discussed.

Acid-Base Equilibrium↗