Epinephrine Does Not Alter Human Intervillous Blood Flow during Epidural Anesthesia

Albright, George A.; Jouppita, Ritta; Hollmén, A; Jouppila, Pentti; Vierola, H.; Koivula, A.

doi:10.1097/00000542-198102000-00006

Cited by 45 publications

(4 citation statements)

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“…26,27 In human studies using radioactive agents, Skjoldebrand et al 28 showed that the epidural epinephrine decreased in the maternal placental blood flow, while others showed stable placental blood flow with epidural epinephrine. [29][30][31] In our study, the resistance indices of the uterine and the umbilical artery remained within the normal range. 15,16 This resistance index is an estimation of the blood flow with Doppler velocimetry, and we are unable to obtain the exact values of the vascular resistance and blood flow.…”

Section: Discussionsupporting

confidence: 59%

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Effect of standard diluted epinephrine infusion on epidural anesthesia in labor

Okutomi

Amano²,

Morishima³

2000

Regional Anesthesia and Pain Medicine

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Section: Discussionsupporting

confidence: 59%

“…[23][24][25][26][27][28][29][30][31][32] Scientific concern is focused on whether the ␣-adrenergic effects of systemically absorbed epinephrine decrease uterine blood flow. In animal studies, a small dose of epidural 23 or intravenous 24,25 epinephrine produced a decrease in uterine blood flow.…”

Section: Discussionmentioning

confidence: 99%

Effect of standard diluted epinephrine infusion on epidural anesthesia in labor

Okutomi

Amano²,

Morishima³

2000

Regional Anesthesia and Pain Medicine

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“…More recently, using 133Xe technique, Albright et al (22) and Jouppila et al (23,24) found no sigruficant changes in intervillous blood flow when 40-100 pg of epinephrine was added to local anesthetics for lumbar epidural anesthesia in pregnant women.…”

Section: No Phmentioning

confidence: 99%

Safety and Efficacy of Epinephrine Added to Bupivacaine for Lumbar Epidural Analgesia in Obstetrics

Abboud

Sheik-ol-Eslam

Yanagi

et al. 1985

Anesthesia & Analgesia

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HAROUTUNIAN S. Safety and efficacy of epinephrine added to bupivacaine for lumbar epidural analgesia in obstetrics. Anesth Analg 1985;64:585-91.The effects of epidural bupivacaine with and without 1 :300,000 epinephrine on uterine activity, progress of labor, fetal heart rate, maternal blood pressure and heart rate, newborn Apgar scores, neonatal acid-base status, and Neurologic and Adaptive Capacity Scoring System (NACS) were compared in 32 parturients during labor and delivery. Patients in group l (n = 16) received 0.5% bupivacaine with 1:300,000 epinephrine and those in group 11 (n = 16) received 0.5% bupivacaine alone. Addition of epinephrine to bupivacaine had no significant effects on uterine activity, duration of first or second stages of labor, fetal heart rate and variability, or the incidence of abnormal fetal heart rate patterns. Maternal hypotension occurred less frequently in group I than in group 11 patients (P < 0.05). Apgar scores, neonatal acid-base status, and the NACS were equally good in the two groups. Duration of analgesia was significantly longer in group 1 than in group 11 (186.8 & 11.6 vs 85.3 & 6.1 (mean 2 SEM) min, P < 0.001). It is concluded that adding epinephrine to bupivacaine during epidural anesthesia in the normal parturient has no adverse effects on either mother, fetus, neonate, or the progress of labor; and that it significantly prolongs the duration of anesthesia and decreases the incidence of maternal hypotension.

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“…17 If injected intravenously, intervillous blood flow will decrease. 19 In sheep, this reduction in flow has been equated to that seen during strong uterine contractions. 20 Adrenaline also affects uterine contractility21 especially in large doses 22 ; this is considered significant in some circumstances.…”

Section: Injection Of a Test Dose Of Local Anaesthetic Andmentioning

confidence: 99%

Monitoring Epidural Analgesia in the Parturient

1990

Anaesthesia and Intensive Care

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Appropriate monitoring during obstetric epidural analgesia consists of 1. Indirect BP and pulse monitoring before epidural insertion, frequently after every dose, and intermittently thereafter. 2. The aspiration test before all injections. 3. Frequent clinical monitoring for signs of intravascular injection during administration of small intermittent doses (not more than 3-5 ml at a time). 4. Frequent clinical monitoringfor sympathetic, sensory and motor signs indicating upward extension of the block. ' 5. Frequent monitoring of the fetal heart rate (FHR) and other signs of fetal welfare. In many instances continuous tocogram with fetal heart rate (CTG) monitoring is useful. We do not believe CTG use is mandatory for epidural analgesia in the uncomplicated pregnancy, but we do advocate that it (and other appropriate fetal monitoring techniques) be used when risk factors or complications, either fetal or maternal, are present or suspected. The anaesthetist should be familiar with fetal monitoring techniques, their use and interpretation. He or she should be prepared to recommend their use when it is considered appropriate to do so.

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Epinephrine Does Not Alter Human Intervillous Blood Flow during Epidural Anesthesia

Cited by 45 publications

References 0 publications

Effect of standard diluted epinephrine infusion on epidural anesthesia in labor

Effect of standard diluted epinephrine infusion on epidural anesthesia in labor

Safety and Efficacy of Epinephrine Added to Bupivacaine for Lumbar Epidural Analgesia in Obstetrics

Monitoring Epidural Analgesia in the Parturient

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