By Robin Russell
This most up-to-date contribution to the FAAM sequence presents a finished and recent dialogue of anaesthetic administration in being pregnant, in the course of supply, and in sufferers present process gynaecological surgical procedure. With authoritative contributions from overseas specialists it's a sensible reference for all anaesthetists and expert clinicians.
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Extra resources for Anaesthesia for Obstetrics and Gynaecology: Fundamentals of Anaesthesia and Acute Medicine
Anesthesiology 1986;64:790-4. 86 Shiono PH, Mills JL. Oral clefts and diazepam use during pregnancy. N E n g l J Med 1984;311:919-920. 87 Reddy BK, Pizer B, Bull PT. Neonatal serum cortisol suppression by etomidate compared with thiopentone, for elective caesarean section. E u r J Arraesrhesiol 1988;5: 17 1. 88 Basford A, Fink BR. Teratogenicity of halothane in the rat. Arresthesiology 1968;29: 1167-73. 89 Pope WDB, Halsey MJ, Lansdown ABG, et al. Fetotoxicity in rats following chronic exposure to halothane, nitrous oxide or methoxyflurane.
The FIM ratio at this time depends on the pKa of the drug, the p H gradient across the placenta, and the extent of plasma protein binding. Although net maternal-to-fetal transfer occurs during this period, by the time equilibrium is reached both the maternal and W plasma concentrations have fallen well below peak maternal plasma concentration. Thus unlike the mother, the baby never experiences the full extent of drug effect. However, with repeated doses or infusions, fetal tissue concentrations of many drugs approximate to maternal plasma concentrations and any drug effects are similar to those in the mother.
Chronic exposure to barbiturates may be associated with fetal anomalies although evidence is contradictory. Reproductive studies in animals have suggested that propofol may lead to delayed or abnormal ossification. However, the effect of administering propofol to humans during early pregnancy has not been investigated and its use is therefore controversial. Studies using propofol during caesarean section at term suggest it is a safe agent to use in the third trimester although neonatal depression has been reported.