Pharmacokinetics and transplacental distribution of fentanyl in epidural anesthesia for normal pregnant women

@article{Moiss2005PharmacokineticsAT,
  title={Pharmacokinetics and transplacental distribution of fentanyl in epidural anesthesia for normal pregnant women},
  author={Elaine Christine Dantas Mois{\'e}s and Luciana de Barros Duarte and Ricardo de Carvalho Cavalli and Vera Lucia Lanchote and Geraldo Duarte and S{\'e}rgio Pereira Da Cunha},
  journal={European Journal of Clinical Pharmacology},
  year={2005},
  volume={61},
  pages={517-522}
}
BACKGROUND: Fentanyl is an opioid drug widely used as a co-adjuvant in abdominal delivery, a fact that justifies its pharmacokinetic study under these conditions. OBJECTIVE: Our objective was to investigate the pharmacokinetics and placental transfer of fentanyl in parturients whose pregnancies were resolved by cesarian section with epidural anesthesia. PATIENTS and METHODS: Ten clinically normal parturients who delivered at term received 5 ml of 2% lidocaine hydrochloride without a… 
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References

SHOWING 1-10 OF 19 REFERENCES
[Fentanyl in peridural obstetrical analgesia. Evaluation after 4 years' use].
TLDR
A pharmacokinetic study shows that the levels in the mother and the fetus begin to coincide more with the number of doses that are given and pass, and analgesia is earlier, more complete and more prolonged when fentanyl is added.
Maternal and neonatal blood concentrations of bupivacaine
TLDR
Studying the concentrations of bupivacaine and lignocaine both in the foetal blood at delivery and in the maternal blood at intervals during the administration of lumbar extradural analgesia in obstetrics found that the risk offoetal intoxication cannot be ruled out with a new local analgesic.
Obesity and the Cephalad Spread of Analgesia following Epidural Administration of Bupivacaine for Cesarean Section
TLDR
It is concluded that higher levels of epidural block should be anticipated in obese obstetrical patients in proportion to their obesity.
Clinical Pharmacokinetics of Alfentanil, Fentanyl and Sufentanil
TLDR
Alfentanil has the most rapid analgesic onset and time to peak effect as well as the shortest distribution and elimination half-lives, while the volume of distribution and total body clearance of this agent are smaller when compared with those of fentanyl and sufentanin.
Pharmacodynamics, pharmacokinetics, and clinical uses of fentanyl, sufentanil, and alfentanil.
TLDR
Fentanyl, sufent anil, and alfentanil are potent synthetic opioids that are used for anesthesia and postoperative analgesia and the advantages of these opioids compared with morphine are short duration of action, lack of hyperglycemic response to surgery, decrease in catecholamine levels, and high lipid solubility.
Pharmacodynamics, pharmacokinetics, and clinical uses of fentanyl, sufentanil, and alfentanil
TLDR
Fentanyl, sufent anil, and alfentanil are potent synthetic opioids that are used for anesthesia and postoperative analgesia and the advantages of these opioids compared with morphine are short duration of action, lack of hyperglycemic response to surgery, decrease in catecholamine levels, and high lipid solubility.
A randomized, double-blind comparison of lumbar epidural and intravenous fentanyl infusions for postthoracotomy pain relief. Analgesic, pharmacokinetic, and respiratory effects.
TLDR
Both groups demonstrated a similar degree of mild to moderate respiratory depression postoperatively, which was assessed with continuous respiratory inductance plethysmography and sequential arterial blood gas analysis.
Pharmacokinetic Changes During Pregnancy and Their Clinical Relevance
TLDR
The dynamic physiological changes that occur in the maternal-placental-fetal unit during pregnancy influence the pharmacokinetic processes of drug absorption, distribution and elimination, as well as the fetal exposure to the drugs taken by the mother.
Pharmacokinetics during pregnancy: evidence-based maternal dose formulation.
  • B. Little
  • Medicine, Biology
    Obstetrics and gynecology
  • 1999
Pharmacokinetics of Opioids in Liver Disease
TLDR
Although glucuronidation is thought to be less affected in liver cirrhosis, the clearance of morphine was found to be decreased and oral bioavailability increased, and the disposition of a few opioids, such as fentanyl, sufent anil and remifentanil, appears to be unaffected in liver disease.
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