Differential Sensitivities of Mammalian Nerve Fibers during Pregnancy

Datta, Sanjay; Lambert, Donald H.; Gregus, J.; Gissen, Aaron J.; Covino, Benjamín G.

doi:10.1213/00000539-198312000-00004

Cited by 115 publications

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“…However, reversible maternal as well as fatal reactions secondary to convulsions and cardiac arrest have been reported for bupivacaine in human labour due to excessive doses, low individual toxic thresholds or unrecognized intravascular injections (Editorial 1986;Moore et al 1971;Ryan 1973;Hodgkinson 1978;Albright 1979;Thornburn & Moir 1984). Animal studies suggest an increase in systemic toxicity (both cardioand neurotoxicity) following administration of bupivacaine in a late state of pregnancy (Morishima et al 1985;Crandell & Kotelko 1985;Ravindran et al 1982;Datta et al 1983). Serious foetalheonatal reactions seem to be very rare, but have been reported after paracervical block, most likely as a result of the direct entry of bupivacaine into the placental circulation (Beazley 1972).…”

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confidence: 99%

Toxicity of Bupivacaine and Ropivacaine in Relation to Free Plasma Concentrations in Pregnant Rats: A Comparative Study

Danielsson¹,

Danielson²,

Böö³

et al. 1997

Pharmacology & Toxicology

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Abstract:The relationship between free drug concentration and toxicity of bupivacaine and ropivacaine, a new local anaesthetic agent, was studied in a pregnant rat model. The compounds were given subcutaneously to rats in late pregnancy. Dose levels (bupivacaine 5.5 to 24 mgikg and ropivacaine 5.3 to 26 mg/kg) were selected based upon the proposed human dosage and the known pharmacological activity of the compounds. Chewing, spasm, dyspnoea, drowsiness, salivation and convulsions were observed in a dose-dependent manner in the animals given 14 to 24 mg/kg of bupivacaine, while only a few animals receiving 26 mg/kg of ropivacaine showed less severe symptoms. Deaths from clonic convulsions were occasionally seen in animals receiving 14 mg/kg or more of bupivacaine. No animals receiving ropivacaine died. No effects on litter size, offspring loss or weight of the offspring at birth were observed with one exception. After 24 mgikg of bupivacaine an increased postnatal loss of the offsprings were noticed, most likely due to impaired maternal care. Protein binding, at expected C, , , , were significantly lower for ropivacaine (around 49%) compared with bupivacaine (around 69%) at dose levels. The results suggest an increased safety margin before onset of toxic side effects after treatment with ropivacaine, compared to bupivacaine, in pregnant rase.Clinical data confirm that bupivacaine is a useful drug in obstetric anaesthesia if proper precautions are taken (Editorial 1986;Moore et al. 1971). However, reversible maternal as well as fatal reactions secondary to convulsions and cardiac arrest have been reported for bupivacaine in human labour due to excessive doses, low individual toxic thresholds or unrecognized intravascular injections (Editorial 1986;Moore et al. 1971;Ryan 1973;Hodgkinson 1978;Albright 1979;Thornburn & Moir 1984). Animal studies suggest an increase in systemic toxicity (both cardioand neurotoxicity) following administration of bupivacaine in a late state of pregnancy (Morishima et al. 1985; Crandell & Kotelko 1985;Ravindran et al. 1982;Datta et al. 1983). Serious foetalheonatal reactions seem to be very rare, but have been reported after paracervical block, most likely as a result of the direct entry of bupivacaine into the placental circulation (Beazley 1972).Ropivacaine is a new long-acting local anaesthetic agent with pharmacodynamic properties similar to those of bupivacaine (Akerman et al. 1988). Unlike bupivacaine, which is a racemic mixture, ropivacaine is exclusively the S(-)-enantiomer. Ropivacaine is less cardio-and neurotoxic in non-pregnant animals than bupivacaine (Rutten et al. 1989; Arthur et al. 1986) and has been less prone to produce central nervous and cardiovascular symptoms after intravenous injection in human volunteers (Scott et al. 1989). Comparative data regarding its toxicity in humans are for obvious reasons very difficult to obtain. The main objective of this investigation was to compare the threshold for the induction of toxic effects in pregnant rats in relation to the p...

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mentioning

confidence: 99%

Toxicity of Bupivacaine and Ropivacaine in Relation to Free Plasma Concentrations in Pregnant Rats: A Comparative Study

Danielsson¹,

Danielson²,

Böö³

et al. 1997

Pharmacology & Toxicology

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Section: Discussionmentioning

confidence: 99%

“…1,7 It also causes alterations in excitability of nerve and muscle membranes, through diminished depolarisation. 1 It might be due to redistribution of fluids, hormonal changes, tenosynovitis and vulnerability of the peripheral nerves. 4 Thus following the same hypothesis many researchers have found increased sensory/motor latencies and decreased amplitudes and slowed conduction velocities, particularly in cases of CTS associated with pregnancy.…”

Section: Discussionmentioning

confidence: 99%

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Effect of pregnancy on median and ulnar nerve conduction

Motewar¹,

Bachewar²

2017

Int J Res Med Sci

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INTRODUCTIONPregnancy causes altered function of excitable membranes such as muscle and nerve, due to hormonal changes and edema.1 Carpal tunnel syndrome (CTS) is a frequent complication of pregnancy. The pathology involves the compression of the median nerve passing through the carpal tunnel in the hand. Its prevalence is as high as 62% in some populations during third trimester of pregnancy.2 Available published research points towards various causes of CTS in pregnant woman as influence of hormonal changes, neural oedema, anatomically narrow carpal tunnel etc.2,3 However increase incidence of CTS in woman on regular hormonal contraception and cessation of CTS symptoms in post-partum period suggest the hormonal theory to be true. [2][3][4] Thus to supplement this hypothesis and association of nerve conduction abnormalities with pregnancy, we focused on this research. We failed to find any studies focusing on the issue of nerve conduction during pregnancy, in India. Thus present study aims to see the difference between nerve conduction parameters viz. motor and sensory conduction, in pregnant and non-pregnant women. Our objective was to study the electrophysiological changes in median and ulnar nerve conduction during pregnancy, who have no symptoms of carpal tunnel syndrome during the third trimester in our local population. METHODSThis was a cross-sectional research carried out in randomly selected 30 pregnant women, of any age, in 28-ABSTRACT Background: Pregnancy causes altered function of excitable membranes such as muscle and nerve, due to hormonal changes and edema. We failed to find any studies focusing on the issue of nerve conduction during pregnancy, in India. Thus present study aims to see the difference between nerve conduction parameters viz. motor and sensory conduction, in pregnant and non-pregnant women. Methods: This was a cross-sectional study carried out in randomly selected 30 pregnant women, of any age, in 28-40 weeks of gestation and age matched non-pregnant controls. We studied distal motor latency, compound muscle action potential amplitude, motor nerve conduction velocity, F-minimum latency, sensory latency, sensory nerve action potential amplitude and sensory nerve conduction velocity in bilateral median and ulnar nerves using Aleron-RMS. Results: Present study found no statistically significant difference between motor and sensory conduction of above said nerves in pregnant and nonpregnant women, except F minimum latency of left median nerve in pregnant women and sensory latency of left ulnar nerve in non-pregnant women were prolonged significantly (p<0.05). Conclusions: All motor and sensory parameters of bilateral median and ulnar nerves were normal as compared to non-pregnant controls.

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“…La progesterona predispone a mayor sensibilidad al efecto de los anestésicos locales, es decir, el factor hormonal del género femenino constituye un factor de riesgo 2,23 . La obesidad aumenta la incidencia de hipotensión casi el doble en comparación con pacientes no obesos, probablemente secundario al efecto de masa del contenido abdominal sobre la vena cava inferior, distendiendo la red venosa extradural y reduciendo el volumen de líquido cefalorraquídeo, o por el estado de disfunción endotelial y aumento en inflamación vascular haciendo que fisiopatológicamente se dé un cuadro similar al de hipertensión arterial 2 .…”

Section: Fisiopatologia Y Factores De Riesgounclassified

Hipotensión bajo anestesia regional subaracnoidea en población no obstétrica

López-Hernández

Meléndez-Flórez

2017

revmed

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RESUMENIntroducción: la anestesia regional subaracnoidea es una técnica muy útil; sin embargo, su principial efecto secundario afecta el sistema cardiovascular. Los estudios en población no obstetrica son escasos; la variedad de comorbilidades y tipos de pacientes dificultan el diagnóstico y manejo. Objetivo: revisar la fisiopatología, enfatizar en factores de riesgo y actualizar el manejo de la hipotensión bajo anestesia subaracnoidea en pacientes no obstétricos. Metodología de Búsqueda: se realizó una búsqueda en las bases bibliográficas PubMed, Science Direct, EbscoHost, MEDLINE; se excluyeron aquellos artículos que incluían únicamente población obstétrica. 63 artículos cumplieron los criterios. Conclusiones: los factores de riesgo identificados fueron edad, estado físico previo, hipertensión y obesidad. Aunque no hay consenso en el manejo, identificar pacientes en riesgo permite la intervencion preventiva y tomar decisiones que disminuyan complicaciones mayores. Los líquidos intravenosos como co-carga mantienen vigencia. El uso de vasopresores profilácticos debe limitarse en pacientes con factores de riesgo. Hypotension under regional spinal anesthesia in non-obstetric populationABSTRACT Introduction: regional subarachnoid anesthesia is a very useful technique. however, the leading side effect affects the cardiovascular system. Few studies regarding non-obstetric population are published. Comorbidities and the variety of patients make the diagnosis and management difficult to establish. Objective: to review physiopathology, and emphasize risk factors and management of hypotension under regional spinal anesthesia. Searching Methodology: literature search was performed using PubMed, Science Direct, EbscoHost and MEDLINE; those exclusively including obstetric population were excluded. 63 articles matched the criteria. Conclusions: the risk factors that were identified were age, physical status, hypertension and obesity. Although there is no consensus in the management protocol, identifying these patients at risk allows a preventive intervention and the taking of measures that avoid major complications. Intravenous fluids as co-loading still remain valid; vasopressors should be limited to patients at risk. MÉD.UIS. 2017;30(1):73-8.

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Differential Sensitivities of Mammalian Nerve Fibers during Pregnancy

Cited by 115 publications

References 0 publications

Toxicity of Bupivacaine and Ropivacaine in Relation to Free Plasma Concentrations in Pregnant Rats: A Comparative Study

Toxicity of Bupivacaine and Ropivacaine in Relation to Free Plasma Concentrations in Pregnant Rats: A Comparative Study

Effect of pregnancy on median and ulnar nerve conduction

Hipotensión bajo anestesia regional subaracnoidea en población no obstétrica

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