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T K Abboud

Publications and source records attributed to T K Abboud.

52 records · Page 3Linked to original sources
PubMed1983

Effects of epidural anesthesia during labor on maternal plasma beta-endorphin levels.

Plasma beta-endorphin (beta-EP) was measured in 48 women. Twenty-three were in labor. In 13 of the 23 patients in labor, beta-EP was determined prior to and after complete onset of epidural anesthesia, and in 10 women, who served as controls, prior to and after injection of saline into the epidural space as part of the loss of resistance technique, but before injection of the local anesthetic. Venous blood also was obtained for plasma beta-EP determinations from 10 healthy non-pregnant women and from 15 patients scheduled for elective repeat cesarean section and who were not in labor. Human beta-EP was determined by radioimmunoassay following silicic acid extraction of plasma samples and separation of the beta-EP fraction by gel chromatography. In the 10 non-pregnant volunteers, plasma beta-EP averaged 11.3 +/- 1.5 fmol/ml (mean +/- SE) as compared with 43.7 +/- 6.5 fmol/ml observed in the 15 women with term pregnancies who were not in labor (P less than 0.005). In the 13 patients in labor who underwent epidural anesthesia, plasma beta-EP concentrations decreased (P less than 0.005) from 54.5 +/- 9.0 to 28.2 +/- 3.5 fmol/ml, whereas there was no significant change in plasma beta-EP levels in the 10 controls who averaged 64 +/- 20.5 and 55.8 +/- 13.6 fmol/ml prior to and following saline injection. These data confirm that plasma beta-EP levels are significantly higher in women with term pregnancies in labor than in non-pregnant women and also demonstrate that epidural anesthesia during labor is accompanied by a significant decrease in maternal plasma beta-EP concentrations.

Adult↗
PubMed1983

Epidural bupivacaine, chloroprocaine, or lidocaine for cesarean section--maternal and neonatal effects.

The effects of epidural anesthesia on maternal blood pressure, newborn Apgar scores, neonatal acid-base status, and the early neonatal neurobehavioral scale (ENNS) were studied in 54 pregnant women undergoing cesarean section. Maternal and neonatal blood levels of the local anesthetics were also determined. Group 1 (n = 16) received 0.75% bupivacaine, group 2 (n = 18) received 3% chloroprocaine, group 3 (n = 11) received 2% lidocaine, and group 4 (n = 9) received 2% lidocaine with 1:200,000 epinephrine. The incidence of maternal hypotension did not differ significantly among the four groups. Fetal outcome as determined by Apgar scores, acid-base status, and neurobehavioral testing was equally good in all four groups. At delivery, the fetal/maternal concentration ratio of bupivacaine was 0.27, that of lidocaine without epinephrine 0.48, and that of lidocaine with epinephrine 0.58. Chloroprocaine was detected in 12 maternal samples, in seven umbilical venous samples, and in six umbilical arterial samples. It is concluded that epidural anesthesia as administered in this study had no adverse effect on the newborn Apgar scores, cord acid-base status, or the ENNS.

Acid-Base Equilibrium↗
PubMed1983

Lack of adverse neonatal neurobehavioral effects of lidocaine.

The effects of epidural anesthesia on the early neonatal neurobehavioral scale (ENNS) following delivery were studied in 22 parturients given 1.5% lidocaine epidural anesthesia during labor and delivery. These results were compared to those obtained in a control group of 17 neonates whose mothers received no analgesics, medications, or local anesthetics for labor or delivery. There was no significant difference in ENNS in the two groups of neonates. Lidocaine as administered in this study has no adverse effects on the early neurobehavioral status of the neonate.

Anesthesia, Epidural↗
PubMed1983

Epidural morphine for the relief of postoperative pain after cesarean delivery.

To determine the safety, efficacy, and dose response of epidurally administered morphine for analgesia after cesarean delivery, 40 healthy women who underwent cesarean delivery with epidural anesthesia were randomly assigned to receive one of four regimens for relief of postoperative pain: intramuscular administration of morphine, 7.5 mg (N = 10); or epidural administration of morphine, 2 mg (N = 10), 5 mg (N = 10), or 7.5 mg (N = 10). Evaluations were made of intensity and relief of pain, time to administration of additional analgesic medications, changes in vital signs and blood-gas tensions, and adverse effects. Intramuscular administration of 7.5 mg of morphine effectively relieved pain for only a short time. When morphine was administered epidurally, 2 mg proved ineffective whereas both 5 mg and 7.5 mg provided substantial pain relief for approximately 24 h. There were no significant changes in vital signs or blood-gas tensions. Side effects included pruritus and nausea, which occurred frequently but were usually mild and easily treated. We concluded that either 5 mg or 7.5 mg of morphine epidurally administered was effective and safe in providing prolonged analgesia after cesarean delivery.

Adult↗
PubMed1982

Effects of spinal anesthesia on maternal circulating catecholamines.

This study evaluated the effects of spinal anesthesia on maternal circulating catecholamines. Spinal anesthesia was administered in two groups of patients undergoing cesarean section. Nine patients were in labor; 14 were not in labor. Spinal anesthesia was followed by a significant reduction in norepinephrine (NE) in patients in labor (p less than 0.05). No such reduction was observed in the patients not in labor despite sensory levels of the fourth thoracic vertebra--or higher. There were no changes in epinephrine (E) levels in either groups. Ephedrine was administered to seven patients not in labor who developed hypotension. There were no significant changes in either NE or E.

Adult↗
PubMed1982

Neonatal neurobehavioral effects of inhalation analgesia for vaginal delivery.

The authors studied the neonatal neurobehavioral effects of nitrous oxide:oxygen and enflurane:oxygen inhalation analgesia for vaginal delivery. Parturients were assigned randomly to receive no inhalation agent (Group 1, n = 21); enflurane, 0.3 to 0.8 per cent, and oxygen (Group 2, n = 22); or nitrous oxide, 30 to 50 per cent, and oxygen (Group 3, n = 18). Infants were tested at 15 min, 2 h, and 24 h of age using the Neurologic and Adaptive Capacity Score (NACS); and at 2 and 24 h using the Early Neonatal Neurobehavioral Scale (ENNS). No significant differences in neurobehavioral status occurred. For all groups, scores tended to be lowest at two hours of age. We conclude that neither enflurane nor nitrous oxide analgesia adversely affects neonatal neurobehavioral status at 15 min, 2 h, or 24 h of age.

Alphaprodine↗
PubMed1982

Maternal, fetal, and neonatal responses after epidural anesthesia with bupivacaine, 2-chloroprocaine, or lidocaine.

The effects of epidural analgesia on fetal heart rate, fetal heart rate variability, uterine activity, maternal blood pressure, newborn Apgar scores, neonatal acid base status, and the early neonatal neurobehavioral status were studied in 150 parturients during labor and delivery. Group I (n = 50) received 0.5% bupivacaine, group II (n = 50) received 2% 2-chloroprocaine, and in group III (n = 50) received 1.5% lidocaine. None of the three local anesthetics used had any significant effect on either base line fetal heart rate, beat-to-beat variability, or uterine activity. In cases in which monitoring of fetal heart rate was both technically satisfactory and continuous, late deceleration patterns were seen in 8 of 42, 0 of 34, and 3 of 47 of the fetuses in group I, II, and III, respectively. The difference in incidence of late deceleration patterns between groups I and II was statistically significant (p less than 0.025). Early neonatal neurobehavioral status did not differ among the three groups of neonates nor did any of the neonates in the three groups score lower than a control group of 20 neonates whose mothers did not receive any analgesia or medications for labor or delivery. It is concluded that epidural anesthesia as administered in this study has no significant effect on the base line fetal heart rate, uterine activity, or neurobehavioral status of the neonate, and that bupivacaine is associated with a higher incidence of what appears to be transient abnormalities of fetal heart rate.

Adolescent↗
PubMed1981

Enflurane analgesia in obstetrics.

The effects of enflurane analgesia (approximately 0.5%) were studied in 55 patients during the second stage of normal vaginal delivery and were compared with effects of nitrous oxide (approximately 40%) in 50 similar patients. The enflurane and oxygen mixture was rated satisfactory by 89% of the mothers and 80% of the anesthesiologists. These ratings did not differ significantly from those for nitrous oxide. Obstetricians, however, rated the enflurane and oxygen mixture superior. The newborns of mothers receiving both agents wee vigorous and comparable when assessed by Apgar scores and cord blood gas tensions. The estimate of blood loss was similar in both groups. Serum inorganic fluoride concentrations in the mother after anesthesia were not significantly increased from preanesthetic levels with either agent. There was no biochemical evidence of renal toxicity. In neonates of mothers given enflurane, the mean umbilical cord concentration of serum inorganic fluoride ions was 2.4 +/- 0.2 micromoles/L, a value well below that associated with nephrotoxicity.

Adult↗
PubMed1981

Use of glycopyrrolate in the parturient: effect on the maternal and fetal heart and uterine activity.

The effects of intravenous glycopyrrolate on maternal and fetal heart rate, heart rate variability, and maternal electromechanical intervals and blood pressure were evaluated in 20 term parturients in labor. Direct continuous fetal heart rate and intrauterine pressure were monitored via an intrauterine catheter. Maternal heart rate and R-pulse-wave intervals were measured and maternal blood pressure was recorded at 5-minute intervals. There were no significant changes in fetal heart rate or fetal heart rate variability. The maternal heart rate increased in all cases and the electromechanical interval decreased with the onset of maternal tachycardia. There were no significant changes in maternal blood pressure. Uterine activity increased in all cases; however, this increase does not appear to be greater than that expected in uterine activity as labor progresses.

Blood Pressure↗
PubMedDate not supplied

Effect of subarachnoid morphine on the incidence of spinal headache.

BACKGROUND AND OBJECTIVES: The addition of fentanyl to hyperbaric local anesthetics has been shown to reduce the incidence of post dural puncture headache in the obstetric patient. This study was undertaken to evaluate the effects of subarachnoid morphine on the incidence of headache. METHODS: Eighty-two healthy patients undergoing cesarean delivery with spinal anesthesia were studied. All patients were hydrated with 1500 ml lactated Ringer's solution. Patients were randomly assigned to receive, in a double-blind fashion, 0.2 mg of either morphine (Group 1, n = 40) or saline (Group 2, n = 42) in 0.2 ml volume mixed with 0.75% bupivacaine in 8.25% dextrose plus 0.2 ml 1:1000 epinephrine. Spinal anesthesia was induced using a 25-gauge spinal needle at L3-4 interspace with the bevel, in most cases, parallel to the dural fibers. Patients were followed for three days to evaluate the incidence and severity of headache using a four-category rank scale (none, mild, moderate, severe). Data were analyzed for statistical significance using Student's t-test or chi-square test as appropriate. A p value less than 0.05 was considered significant. Results. The incidence of post dural puncture headache did not differ significantly between groups. Eight patients in Group 1 versus nine patients in Group 2 developed headache (p greater than 0.05). Similarly, the use of blood patch or intravenous caffeine sodium benzoate to treat the headache did not differ significantly between groups. CONCLUSION: It is concluded from our study that subarachnoid morphine did not decrease the incidence of post dural puncture headache in the obstetric patient.

Adult↗
PubMedDate not supplied

Epidural butorphanol augments lidocaine sensory anesthesia during labor.

To determine the efficacy and safety of epidural butorphanol combined with lidocaine, 50 healthy parturients were studied during labor and delivery. All patients received a test dose of 3 ml 1.5% lidocaine with 1:200,000 epinephrine. Patients were then randomly assigned to receive 7 ml of one of two epidural regimens in a double-blind fashion: Group 1 patients received 1.5% lidocaine plus 1 mg butorphanol plus 1:300,000 epinephrine; Group 2 patients received 1.5% lidocaine plus 1:300,000 epinephrine. Each group consisted of 25 patients. The study ended at the time of redosing. All subsequent epidural injections were made with one bolus of plain 0.25% bupivacaine followed by continuous infusion of 0.125% bupivacaine. Duration of anesthesia was significantly longer for Group 1 compared to Group 2 (p less than 0.01), 124 +/- 8 minutes versus 99 +/- 6 minutes (mean +/- SEM). There were no difference between groups in duration of first and second stages of labor, method of delivery or neonatal outcome. Umbilical cord acid-base status and neurologic adaptive capacity scores did not differ significantly between the two groups. The authors conclude that adding small doses of butorphanol to epidural lidocaine during labor is effective and safe.

Adult↗
PubMedDate not supplied

Continuous infusion epidural anesthesia during labor: a randomized, double-blind comparison of 0.0625% bupivacaine/0.002% butorphanol and 0.125% bupivacaine.

The efficacy of pain relief and the maternal and neonatal effects of continuous epidural infusion of 0.0625% bupivacaine/0.002% butorphanol was compared with the infusion of 0.125% bupivacaine alone in a randomized, double-blind study of 32 women in labor. A test dose of 2 ml 0.5% bupivacaine was given to every patient and followed by two epidural regimens in randomized, double-blind manner. Group B-B (bupivacaine/butorphanol) patients received 7.5 ml 0.125% bupivacaine plus 1 mg butorphanol (0.5 ml) followed by an infusion of 0.0625% bupivacaine/0.002% butorphanol at a rate of 12 ml/hour; Group B (bupivacaine alone) patients received 8 ml 0.25% bupivacaine followed by an infusion of 0.125% bupivacaine at a rate of 12 ml/hour. A bolus of 5 ml 0.125% bupivacaine or 0.0625% bupivacaine was given to Group B or B-B, respectively, if additional pain relief was required. Infusion of B-B combination resulted in similar pain relief and fewer patients with motor block than bupivacaine alone; 12% versus 38% in Groups B-B and B, respectively, had motor weakness. A smaller dose of bupivacaine was used in the B-B group compared to the B group; 71 +/- 14 versus 99 +/- 13 mg (mean +/- SEM; p less than 0.05). Progress of labor and the mode of delivery did not differ significantly between the two groups. All infants were vigorous and had normal acid-base status and neurologic adaptive capacity scores. Butorphanol appears to be useful as an adjunct to epidural bupivacaine for continuous epidural infusion during labor without adversely affecting the mother or the neonate.

Adult↗
PubMedDate not supplied

Epidural morphine or butorphanol augments bupivacaine analgesia during labor.

To determine the efficacy and the safety of epidural morphine or butorphanol combined with bupivacaine, 40 healthy parturients were studied during labor and delivery. All patients received an epidural test dose of 2 ml of 0.5% bupivacaine. Patients were then randomly assigned to receive one of four epidural regimens in a double-blind fashion: 0.25% bupivacaine + 1 mg butorphanol (Group I), 0.25% bupivacaine + 2 mg butorphanol (Group II), 0.25% bupivacaine + 2 mg morphine (Group III), or 0.25% bupivacaine alone (Group IV). Each group consisted of ten patients. All subsequent epidural injections were with plain 0.25% bupivacaine. Duration of analgesia was significantly longer for groups I, II, and III when compared to group IV (p less than or equal to .01); 139 +/- 111, 141 +/- 14, 199 +/- 29, and 96 +/- 6 minutes, X +/- SEM respectively. Quality of analgesia was significantly better in groups I, II, and III when compared with group IV. There were no differences between groups in duration of first and second stages of labor, uterine activity, or method of delivery. Thirty percent of patients in the morphine group (group III) developed mild pruritus that did not require any treatment. All neonates were vigorous at 5 minutes and had good Apgar Scores, umbilical cord acid base status, and Neurological Adaptive Capacity Scores. The authors conclude that adding small doses of either morphine or butorphanol to epidural bupivacaine during labor is effective and safe. Butorphanol may be preferable since none of the patients experienced pruritus.

Adult↗
PubMedDate not supplied

Bupivacaine/butorphanol/epinephrine for epidural anesthesia in obstetrics: maternal and neonatal effects.

The effects of epidural bupivacaine/butorphanol with and without 1:300,000 epinephrine on maternal analgesia, uterine activity, progress of labor, fetal heart rate, maternal blood pressure, newborn Apgar scores, neonatal acid base status and the neurologic and adaptive capacity scores (NACS) were compared in 33 parturients during labor and delivery. Patients in Group I (n = 17) received 0.25% bupivacaine plus 1 mg butorphanol plus 1:300,000 epinephrine, and those in Group II (n = 16) received the same agents without the epinephrine. Addition of epinephrine to bupivacaine/butorphanol did not have any adverse effects on uterine activity, duration of first or second stages of labor or fetal heart rate parameters. The incidence of maternal hypotensive episodes did not differ significantly between the two groups of patients. Apgar scores, neonatal acid base status and the NACS were equally good and did not differ significantly between the two groups. Duration of analgesia was significantly longer in Group I as compared to Group II patients (177.5 +/- 11 versus 131.8 +/- 10 minutes, p less than 0.01). It is concluded that addition of epinephrine 1:300,000 to bupivacaine/butorphanol during epidural anesthesia in the normal parturient has no adverse effects on the mother, fetus or neonate or on the progress of labor and it significantly prolongs the duration of analgesia.

Acid-Base Equilibrium↗