Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-19T14:24:38.776Z Has data issue: false hasContentIssue false

Chapter 17 - A Bun in the Oven

How to Use TIVA in Obstetrics

Published online by Cambridge University Press:  18 November 2019

By
Pamela Flood  and
Jessica Ansari
Edited by
Michael G. Irwin ,
Gordon T. C. Wong  and
Shuk Wan Lam
Michael G. Irwin
Affiliation:
The University of Hong Kong
Gordon T. C. Wong
Affiliation:
The University of Hong Kong
Shuk Wan Lam
Affiliation:
The University of Hong Kong
Get access

Summary

The physiological changes of pregnancy result in significant changes to the PK and PD properties of drugs commonly used with TIVA; and drug effects on the fetus and the uterus are important determinants as to whether TIVA is the optimal anaesthetic technique for a given procedure. Also, some drugs used in TIVA have unique roles in labour analgesia in addition to surgical anaesthesia. However, it is important to realise that despite widespread use of these medications in pregnant patients, research data is limited. Many drugs are used off label in pregnancy and the contemporary regulatory milieu can make robust studies challenging, if not impossible, to perform. Nonetheless, the significant clinical experience with these medications over the years in many countries supports a useful and practical perspective of the role of these drugs in pregnancy.

Type
Chapter
Information
Taking on TIVA
Debunking Myths and Dispelling Misunderstandings
 , pp. 139 - 145
Publisher: Cambridge University Press
Print publication year: 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ansari, J., Carvalho, B., Shafer, S.L., Flood, P.. Pharmacokinetics and pharmacodynamics of drugs commonly used in pregnancy and parturition. Anesth Analg 2016; 122: 786–804.CrossRefGoogle ScholarPubMed
Leong, W.L., Sng, B.L., Zhang, Q., Han, N.L.R., Sultana, R., Sia, A.T.H.. A case series of vital signs-controlled, patient-assisted intravenous analgesia (VPIA) using remifentanil for labour and delivery. Anaesthesia 2017; 72: 845–52.CrossRefGoogle ScholarPubMed
Van de Velde, M., Teunkens, A., Kuypers, M., Dewinter, T., Vandermeersch, E.. General anaesthesia with target controlled infusion of propofol for planned caesarean section: maternal and neonatal effects of a remifentanil-based technique. Int J Obstet Anesth 2004; 13: 153–8.CrossRefGoogle ScholarPubMed
Higuchi, H., Adachi, Y., Arimura, S., Kanno, M., Satoh, T.. Early pregnancy does not reduce the C(50) of propofol for loss of consciousness. Anesth Analg 2001; 93: 1565–9.CrossRefGoogle ScholarPubMed
Siafaka, I., Vadalouca, A., Gatziou, B., Petropoulos, G., Salamalekis, E.. A comparative study of propofol and thiopental as induction agents for elective caesarean section. Clin Exp Obstet Gynecol 1992; 19: 93–6.Google Scholar
El-Tahan, M.R., Mowafi, H.A., Al Sheikh, I.H., Khidr, A.M., Al-Juhaiman, R.A.. Efficacy of dexmedetomidine in suppressing cardiovascular and hormonal responses to general anaesthesia for caesarean delivery: a dose-response study. Int J Obstet Anesth 2012; 21: 222–9.Google Scholar
Ala-Kokko, T.I., Pienimaki, P., Lampela, E., Hollmen, A.I., Pelkonen, O., Vahakangas, K.. Transfer of clonidine and dexmedetomidine across the isolated perfused human placenta. Acta Anaesthesiol Scand 1997; 41: 313–19.Google Scholar
Yoshimura, M., Kunisawa, T., Suno, M., et al. Intravenous dexmedetomidine for cesarean delivery and its concentration in colostrum. Int J Obstet Anesth 2017; 32: 28–32.CrossRefGoogle ScholarPubMed
Kan, R.E., Hughes, S.C., Rosen, M.A., Kessin, C., Preston, P.G., Lobo, E.P.. Intravenous remifentanil: placental transfer, maternal and neonatal effects. Anesthesiology 1998; 88: 1467–74.Google Scholar
Park, B.Y., Jeong, C.W., Jang, E.A., et al. Dose-related attenuation of cardiovascular responses to tracheal intubation by intravenous remifentanil bolus in severe pre-eclamptic patients undergoing Caesarean delivery. Br J Anaesth 2011; 106: 82–7.Google Scholar
Yoo, K.Y., Kang, D.H., Jeong, H., Jeong, C.W., Choi, Y.Y., Lee, J.. A dose-response study of remifentanil for attenuation of the hypertensive response to laryngoscopy and tracheal intubation in severely preeclamptic women undergoing caesarean delivery under general anaesthesia. Int J Obstet Anesth 2013; 22: 10–18.CrossRefGoogle ScholarPubMed
Weibel, S., Jelting, Y., Afshari, A., et al. Patient-controlled analgesia with remifentanil versus alternative parenteral methods for pain management in labour. Cochrane Database Syst Rev 2017; 4: Cd011989.Google Scholar
Chi, X., Li, M., Mei, W., Liao, M.. Comparison of patient-controlled intravenous analgesia with sufentanil versus tramadol in post-cesarean section pain management and lactation after general anesthesia: a prospective, randomized, double-blind, controlled study. J Pain Res 2017; 10: 1521–7.Google Scholar
Enato, E., Moretti, M., Koren, G.. The fetal safety of benzodiazepines: an updated meta-analysis. J Obstet Gynaecol Can 2011; 33: 46–8.CrossRefGoogle ScholarPubMed
Abraham, R.J., Sau, A., Maxwell, D.. A review of the EXIT (ex utero intrapartum treatment) procedure. J Obstet Gynaecol 2010; 30: 1–5.Google Scholar
Olutoye, O.A., Baker, B.W., Belfort, M.A., Olutoye, O.O.. Food and Drug Administration warning on anesthesia and brain development: implications for obstetric and fetal surgery. Am J Obstet Gynecol 2018; 218: 98–102.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×