Epidural meperidine does not cause hemodynamic changes in the term parturient

Abstract

Purpose: Meperidine has local anesthetic properties and, therefore, when given epidurally it has the potential to cause hemodynamic changes. Our objective was to study the hemodynamic effects of an analgesic dose of epidural meperidine (50 mg) in 34 ASA 1-2 term parturients scheduled for elective Cesarean section under epidural anesthesia. Methods: A lumbar epidural catheter was inserted and patients lay in the supine left wedge position. Intravenous fluid preload was withheld, and hemodynamic measurements comprising of mean arterial pressure, cardiac output and heart rate were made using automatic oscillotonometry (Dinamap 1486SX) and transthoracic electrical bioimpedance (Bomed NCCOM3). Following baseline measurements, the hemodynamic effects of sequential epidural injection of first, 10 ml saline, and 20 min thereafter, 50 mg meperidine diluted to 10 ml with saline, were recorded. Sensory blockade was assessed following each injection using loss of temperature discrimination to ice. Paired Student t tests were used to compare changes in hemodynamic variables.Results: Epidural meperidine produced a small increase from the saline values in the mean (SD) cardiac output of 5.81 ±1.44 to 6.04 ± 1.54 L·min -1 (P < 0.05), and mean arterial pressure of 77.1 ± 8.8 to 79.3 ± 9.9 mmHg (P < 0.05). Sensory changes, the upper level of which ranged from L1 to T1, were detected in 94% of patients given epidural meperidine. Epidural saline injection had no such hemodynamic effects, but produced a detectable sensory level in two patients. Conclusion: Epidural meperidine, 50 mg, caused minimal hemodynamic changes in term parturients.Objectif : La mépéridine présente les propriétés d'un anesthésique local et peut donc causer des changements hémo-dynamiques lorsqu'on en fait l'administration péridurale. Notre objectif était d'en étudier les effets hémodynamiques d'une dose analgésique de 50 mg chez 34 parturientes à terme, d'état physique ASA I-II, dont la césarienne était prévue sous anesthésie péridurale.Méthode : Un cathéter péridural lombaire a été inséré et les patientes ont été placées en décubitus dorsal, le flanc gauche soulevé par un coussin. Une précharge de liquide intraveineux n'a pas eu lieu et les mesures hémodynamiques comprenant la tension artérielle moyenne, le débit cardiaque et la fréquence cardiaque ont été réa-lisées par oscillométrie automatique (Dinamap 1486SX) et bio-impédance électrique transthoracique (Bomed NCCOM3). Les mesures de départ étant faites, on a mesuré ensuite les effets hémodynamiques de l'injection péridu-rale séquentielle de 10 ml de solution salée et, 20 min plus tard, de 50 mg de mépéridine diluée dans 10 ml de solution salée. Le blocage sensitif a été évalué après chaque injection en utilisant la perte de discrimination de la température de la glace. Les tests t de Student pour paires appariées ont été utilisés pour comparer les changements des variables hémo-dynamiques.Résultats : La mépéridine péridurale a produit une faible augmentation, à partir des valeurs provenant de la solution ...

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