Obstetric anesthesia for a patient with malignant hyperthermia susceptibility.
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This study examined the effects of carefully controlled amounts of analgesic premedications and anesthetics administered to mothers during delivery on the behavior of the newborn over the first ten days of life. The subjects were selected to minimize the synergistic effects of medication and other stress factors, such as abnormalities of pregnancy, labor, or delivery. The effects of these drugs on the behavior of these infants was small. The data provide a picture of the behavioral recovery of a group of minimally stressed newborns.
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26 healthy pregnant women at term were divided into 2 groups and anaesthetized with either 1 mg/kh or 2 mg/kg ketamine - N20/02 - for primary caesarean section. Maternal venous ketamine plasma levels, neonatal ketamine plasma levels (umbilical artery and umbilical vein) and blood gases were measured. Maternal venous ketamine plasma levels in group I exceeded those in group II by 2.8 (30-60 sec after injection) and 2.0 (at the time of delivery) respectively. Independent of the dose used, the plasma levels of ketamine in the umbilical artery or the umbilical vein were found to be identical in the two groups of newborn infants. Neonatal blood gases and acid base parameters did not significantly differ between the two groups, except for the oxygen tension in group II which slightly exceeded the PO2 values in group I 15, 60 and 120 min after delivery. pH and standard bicarbonate values were found to be higher (1 and 5 min) in both groups, compared to pH and standard bicarbonate levels in a group of newborns delivered spontaneously.--The results of this study show: 1. Independent of a low or high ketamine dosage, neonatal blood concentration of the drug remain low, probably due to a placental barrier effect.--2. The post partum recovery of the newborns was neither influenced by the ketamine anesthesia itself nor by different drug doses.
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