Lee A. Coaldrake

Washington University Medical Center

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John B. Craft

American Cancer Society

Paul Mazel

George Washington University

Robin Gilman

George Washington University Hospital

Leslie Shokes

Rancho Los Amigos National Rehabilitation Center

Marta Mondino

Washington University Medical Center

W. A. Woolf

Washington University Medical Center

Jean C. Bolan

Washington University Medical Center

Michael F. Roizen

Case Western Reserve University

Peter D Livingstone

Royal Australasian College of Surgeons

Masahiro Yonekura

Nagasaki Medical Center

Cooperative Institutions

Washington University Medical Center

George Washington University

University of California, San Francisco

American Society of Anesthesiologists

MCPHS University

George Washington University Hospital

Washington University in St. Louis

University of Pennsylvania

University of Southern California

Children's Hospital of Philadelphia

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Placental Passage and Uterine Effects of Fentanyl

Anesthesia & Analgesia (1983)

John B. Craft Lee A. Coaldrake Jean C. Bolan Marta Mondino Paul Mazel

Using the chronic maternal–fetal sheep preparation, 27 pregnant ewes were studied to determine the effects of intravenous fentanyl on maternal and fetal physiology, with particular reference to its placental passage, and its effects on uterine blood flow and uterine tone. Three doses of fentanyl were studied-50, 75, and 100 μg. Maternal and fetal arterial blood was collected for determination of fentanyl levels. All blood levels, both maternal and fetal, were normalized to the 50-μg dose. The maternal normalized blood levels were found to fit a biexponential equation describing a two-compartment open model. The half-life of the maternal elimination phase was 42 ± 7.0 min with an overall elimination constant (K) of 0.21 min−1. Maternal plasma fentanyl levels decreased very rapidly in the first 10 min after injection, at which time only 9% of the peak value remained. Fentanyl was detectable in fetal blood as early as 1 min and levels peaked at 5 min. Once equilibrium was established between maternal and fetal blood, the maternal levels remained 2.5 times those of the fetal level from 5 min to 60 min after drug injection. Both maternal and fetal drug levels declined in an approximately parallel fashion. No significant deleterious changes were seen in any maternal or fetal cardiovascular or acid-base parameters, and uterine blood flow and uterine tone were also unaffected (P > 0.05).

Venous blood

10.1213/00000539-198310000-00007

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Citations (56)

Placental Passage and Uterine Effects of Fentanyl

Survey of Anesthesiology (1984)

John B. Craft Lee A. Coaldrake Jean C. Bolan Marta Mondino Paul Mazel

This excellent study is the first to report the kinetics of placental transfer of fentanyl using the chronic sheep model. In a dose of 50 μg. fentanyl produced no significant effects on maternal fetal blood gases, heart rate, or maternal uterine activity. However, one cannot extrapolate from the pregnant ewe not in labor to the human in labor who may rapidly deliver. Prolonged higher blood levels of the narcotic in the newborn could be maintained compared with the in vitro fetus. Fentanyl might cause prolonged respiratory depression and/or depressed neurobehavioral function that could equal that of other narcotics. Although fentanyl clinically appears unlikely to have significant effects on the contracting uterus, this fact has yet to be proven. Finally, the problem of buildup of fetal blood levels following repeated doses requires further investigation. It is conceivable that fentanyl could have the disadvantages of a short duration of maternal analgesia with a prolonged depressant effect on the fetus, similar to other narcotics such as meperidine.

Narcotic

10.1097/00132586-198406000-00064

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Ketamine, catecholamines, and uterine tone in pregnant ewes

American Journal of Obstetrics and Gynecology (1983)

John B. Craft Lee A. Coaldrake Masahiro Yonekura S. D. Dao E. G. Co

Transplacental

Respiratory acidosis

10.1016/0002-9378(83)90823-2

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Citations (36)

The Maternal and Fetal Cardiovascular Effects of Epidural Morphine in the Sheep Model

Survey of Anesthesiology (1983)

John B. Craft Jean C. Bolan Lee A. Coaldrake Marta Mondino Paul Mazel

CRAFT, J. B. JR.; BOLAN, J. C.; COALDRAKE, L. A.; MONDINO, M.; MAZEL, P.; GILMAN, R. M.; SHOKES, L. K.; WOOLF, W. A. Author Information

Craft

10.1097/00132586-198306000-00044

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Capnography Does Not Always Indicate Successful Intubation

Anaesthesia and Intensive Care (1995)

Lee A. Coaldrake

Capnography

10.1177/0310057x9502300517

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Citations (4)

The maternal and fetal cardiovascular effects of epidural morphine in the sheep model

American Journal of Obstetrics and Gynecology (1982)

John B. Craft Jean C. Bolan Lee A. Coaldrake Marta Mondino Paul Mazel

Epidural space

Opiate

10.1016/s0002-9378(16)32528-5

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Citations (23)

Myasthenia Gravis in Pregnancy

Obstetric Anesthesia Digest (1984)

Lee A. Coaldrake Peter D Livingstone

Une cesarienne est pratiquee sous bloc epidural a la lidocaine. Les premiers jours du postpartum sont marques par des fluctuations dans l'etat clinique avec des periodes de faible sommail. Les myastheniques sont sensibles aux hypnotiques, sedatifs et narcotiques. L'utilisation de curarisants non depolarisants n'est pas necessaire

10.1097/00132582-198406000-00032

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Citations (1)

Myasthenia Gravis in Pregnancy

Anaesthesia and Intensive Care (1983)

Lee A. Coaldrake Peter D Livingstone

10.1177/0310057x8301100314

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Citations (6)

I. Analgesics and Tranquilizers

Obstetric Anesthesia Digest (1984)

John B. Craft Lee A. Coaldrake Jean C. Bolan Marta Mondino Paul Mazel

Craft, J. B. Jr.; Coaldrake, L. A.; Bolan, J. C.; Mondino, M.; Mazel, P.; Gilman, R. M.; Shokes, L. K.; Woolf, W. A.; Hodgkinson, Robert M.D. Author Information

10.1097/00132582-198400410-00016

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Ketamine, Catecholamines, and Uterine Tone in Pregnant Ewes

Survey of Anesthesiology (1984)

John B. Craft Lee A. Coaldrake Masahiro Yonekura S. D. Dao E. G. Co

This study in the chronically instrumented pregnant ewe gives valuable new data on uptake and distribution of ketamine in both mother and fetus. It gives further credence, to that already obtained from clinical studies, that ketamine in doses of 1 mg. per kg. or less is safe for induction of general anesthesia, or in smaller doses for analgesia in the uncomplicated pregnancy. The associated increase in maternal arterial pressure is mild and is associated with an increased uterine blood flow. Likewise, the slight increase in uterine activity observed after these low doses is not coupled with fetal acidosis or compromised uterine blood flow. However, the safety of ketamine in pregnancies complicated by pregnancy-induced hypertension (PIH) has yet to be proved. In these conditions the maternal vasculature is constricted and hyperreactive, the uterine blood flow is reduced, and the uterus is markedly irritable. The benign response to ketamine in the uncomplicated pregnancy could be greatly exaggerated to the point of danger in both mother and fetus in PIH. Prudence demands that ketamine be avoided or used with caution in parturients with these disorders. Brett B. Gutsche, M.D.

10.1097/00132586-198406000-00062

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