Effects of obstetric analgesics and anesthetics on the neonate

A review

Jay E. Mattingly, John D'Alessio, Jaya Ramanathan

Research output: Contribution to journalReview article

70 Citations (Scopus)

Abstract

Most anesthetic and analgesic agents in current use traverse the placental barrier in varying degrees, but are well tolerated by the fetus if judiciously administered. For labor analgesia, many options are available. Systemic administration of opioids and sedatives is one such option. Repeated maternal administration of opioids such as pethidine (meperidine) results in significant fetal exposure and neonatal respiratory depression. Patient-controlled analgesia with synthetic opioids such as fentanyl, alfentanil, and the new ultra-short-acting remifentanil may be used for labor analgesia in selected patients. Other options for labor analgesia include epidural and combined spinal-epidural techniques. With such techniques, neonatal exposure to opioids and sedatives can be minimized or totally avoided. While limiting the fetal exposure to the harmful effects of depressant drugs, epidural anesthesia and/or analgesia improves placental perfusion and oxygenation of the fetus, which is beneficial, especially in conditions such as pregnancy-induced hypertension. Regional blocks are also administered for the majority of cesarean deliveries because of the overwhelming and unequivocal evidence of maternal and fetal safety compared with general anesthesia for this indication. However, in some instances, administration of general anesthesia is unavoidable. Neonatal respiratory depression with low Apgar scores, and umbilical arterial and venous pH associated with general anesthesia, is often transient. A properly administered anesthetic, whether regional or general, has no significant adverse fetal or neonatal effects.

Original languageEnglish (US)
Pages (from-to)615-627
Number of pages13
JournalPediatric Drugs
Volume5
Issue number9
DOIs
StatePublished - Oct 2 2003

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Opioid Analgesics
Obstetrics
Analgesics
Anesthetics
Newborn Infant
General Anesthesia
Meperidine
Epidural Analgesia
Hypnotics and Sedatives
Respiratory Insufficiency
Analgesia
Fetus
Mothers
Alfentanil
Anesthesia and Analgesia
Umbilicus
Patient-Controlled Analgesia
Pregnancy Induced Hypertension
Apgar Score
Epidural Anesthesia

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Pharmacology (medical)

Cite this

Effects of obstetric analgesics and anesthetics on the neonate : A review. / Mattingly, Jay E.; D'Alessio, John; Ramanathan, Jaya.

In: Pediatric Drugs, Vol. 5, No. 9, 02.10.2003, p. 615-627.

Research output: Contribution to journalReview article

Mattingly, Jay E. ; D'Alessio, John ; Ramanathan, Jaya. / Effects of obstetric analgesics and anesthetics on the neonate : A review. In: Pediatric Drugs. 2003 ; Vol. 5, No. 9. pp. 615-627.
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