Abstract
The use of intravenous (iv) patient-controlled fentanyl analgesia during labour in a parturient with unexplained thrombocytopenia (70 × 103 · ml−1) is described. The patient self-administered boluses of 25 μg of fentanyl with a lock-out interval often min. In addition, a concurrent fentanyl infusion of 25 μg · hr−1 was given. Effective analgesia was achieved during labour and a total of 1025 μg of fentanyl was infused over 11 hr 55 min until delivery of a vigorous infant with Apgar scores of 9 after one and five min. Respiratory depression or undue sedation were not observed in the mother either during labour or in the post-partum period. At birth, maternal total plasma fentanyl concentration was 1.11 ng · ml−1, whereas neonatal umbilical total plasma fentanyl concentration was 0.43 ng · ml−1. Newborn plasma protein binding of fentanyl was lower compared to the mother (63% vs 89%). Thus, free fentanyl concentrations (0.16 ng · ml−1) were identical in the mother and newborn at delivery.
Résumé
Les auteurs décrivent l’usage de l’ACP intraveineuse au fentanyl durante le travail d’une parturiente porteuse d’une thrombocytopénie (70 × 103 · ml−1). La patiente s’est administrée ellemême des bolus de 25 μg de fentanyl avec un intervalle réfractaire de dix minutes. En même temps, elle recevait une perfusion continue de fentanyl de 25 μg · hr−1. Une analgésie efficace a été obtenue pendant le travail. Une dose totale de 1025 μg de fentanyl a été administrée sur une période de 11 heures 55 minutes jusqu’à la naissance d’un bébé vigoureux. L’Apgar a été de 9 après une et cinq minutes. On n’a pas observé de dépression respiratoire ou de sédation excessive chez la mère pendant le travail ou dans le post-partum. A la naissance, la concentration maternelle plasmatique totale de fentanyl a été mesurée a 1.11 ng · ml−1 et celle du sang veineux ombilical a été de 0,43 ng · ml−1. La fraction de fentanyl liée aux protéines plasmatiques du nouveauné était plus basse que celle de la mère (63% vs 86%) de sorte que les concentrations de fentanyl libre (0, 16ng · ml−1) ont été indiques pour les deux.
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Rosaeg, O.P., Kitts, J.B., Koren, G. et al. Maternal and fetal effects of intravenous patient-controlled fentanyl analgesia during labour in a thrombocytopenic parturient. Can J Anaesth 39, 277–281 (1992). https://doi.org/10.1007/BF03008789
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DOI: https://doi.org/10.1007/BF03008789