Lower, Variable Intrathecal Opioid Doses, and the Incidence of Prolonged Fetal Heart Rate Decelerations After Combined Spinal Epidural Analgesia for Labor: A Quality Improvement Analysis.

التفاصيل البيبلوغرافية
العنوان:	Lower, Variable Intrathecal Opioid Doses, and the Incidence of Prolonged Fetal Heart Rate Decelerations After Combined Spinal Epidural Analgesia for Labor: A Quality Improvement Analysis.
المؤلفون:	Hembrador S; Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, Box 356540, Seattle, WA 98195, USA.; Present Address: Department of Anesthesiology, Virginia Mason Medical Center, 1100 9th Ave, Seattle, WA 98101, USA., Delgado C; Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, Box 356540, Seattle, WA 98195, USA., Dinges E; Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, Box 356540, Seattle, WA 98195, USA., Bollag L; Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, Box 356540, Seattle, WA 98195, USA.
المصدر:	Romanian journal of anaesthesia and intensive care [Rom J Anaesth Intensive Care] 2020 Dec; Vol. 27 (2), pp. 27-33. Date of Electronic Publication: 2020 Dec 31.
نوع المنشور:	Journal Article
اللغة:	English
بيانات الدورية:	Publisher: Clusium Country of Publication: Romania NLM ID: 101681752 Publication Model: Print-Electronic Cited Medium: Print ISSN: 2392-7518 (Print) Linking ISSN: 23927518 NLM ISO Abbreviation: Rom J Anaesth Intensive Care Subsets: PubMed not MEDLINE
أسماء مطبوعة:	Original Publication: Cluj-Napoca : Clusium, [2014]-
مستخلص:	Background: Combined spinal-epidurals with low-dose intrathecal opioids and local anesthetics are commonly used to initiate labor analgesia due to the fast onset of analgesia and good patient satisfaction. Intrathecal fentanyl has been associated with fetal bradycardia, and the rate may be higher at doses of 25 mcg and above. As such, our institution limits intrathecal fentanyl doses to less than 15 mcg for labor. Prompted by a few incidents of prolonged fetal bradycardia at even these low doses, we sought to audit the side effects associated with varying low doses of intrathecal fentanyl. Methods: After IRB approval, a retrospective review was performed on 555 labor records from May-December, 2016. All the patients received combined spinal epidurals for labor analgesia. Intrathecal medication consisted of 1 mL of 0.25% bupivacaine, and varying fentanyl doses: 2.5, 5, 10, and 15 mcg. The incidences of prolonged fetal heart rate decelerations, emergent cesarean delivery, magnitude of pain reduction, pruritus requiring treatment, and hypotension were compared. Results: Demographic variables were equivalent between the groups. There were no differences in the rates of prolonged fetal decelerations (in order of increasing fentanyl dose: 4.4%, 2.3%, 7.6%, 3.0%, p-value = 0.11), emergent cesarean delivery, magnitude of pain reduction, pruritus, or maternal hypotension. Conclusions: In conclusion, the rates of prolonged fetal heart rate decelerations after combined spinal epidural with intrathecal bupivacaine and fentanyl does not differ for fentanyl doses of 15 mcg and below. Competing Interests: Conflict of interest: None of the authors have any conflict of interest to declare. (© 2020 Sheena Hembrador et al. published by Sciendo.)
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فهرسة مساهمة:	Keywords: Fentanyl; combined spinal-epidural; fetal bradycardia
تواريخ الأحداث:	Date Created: 20210531 Latest Revision: 20220423
رمز التحديث:	20240829
مُعرف محوري في PubMed:	PMC8158318
DOI:	10.2478/rjaic-2020-0015
PMID:	34056130
قاعدة البيانات:	MEDLINE

الوصف
تدمد:	2392-7518
DOI:	10.2478/rjaic-2020-0015