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首页> 外文期刊>International journal of obstetric anesthesia >Estimation of infant dose and exposure to pethidine and norpethidine via breast milk following patient-controlled epidural pethidine for analgesia post caesarean delivery.
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Estimation of infant dose and exposure to pethidine and norpethidine via breast milk following patient-controlled epidural pethidine for analgesia post caesarean delivery.

机译：剖腹产后患者控制硬膜外哌替啶镇痛后，估计婴儿剂量以及通过母乳接触哌替啶和去甲乙啶的镇痛效果。

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BACKGROUND: There is no information about the distribution of pethidine into breast milk and/or exposure of the breastfed infant during pethidine patient-controlled epidural analgesia after caesarean delivery. METHODS: We conducted an observational study among 20 women. The mean (95% confidence interval) pethidine dose administered was 670 (346-818) mg over 41 (35-46) h. Maternal plasma and milk and neonatal plasma were collected near the time of pethidine cessation and 6h later. Absolute and relative infant doses via milk and infant exposure were calculated. Infant behaviour was assessed using the Neurologic and Adaptive Capacity Score. RESULTS: At first and second sampling times, mean absolute infant doses for pethidine were 20 (14-27) mug/kg/day and 10 (7-13) mug/kg/day, while mean relative infant doses were 0.7 (0.1-1.4)% and 0.3 (0.1-0.5)% respectively. Similar values for norpethidine (expressed as pethidine equivalents) were 21 (16-26) mug/kg/day and 22 (12-32) mug/kg/day; and 0.7 (0.3-1)% and 0.6 (0.2-1)% respectively. Mean pethidine and norpethidine concentrations in neonatal plasma were 3 (0-6.1) mug/L and 0.6 (0.2-1) mug/L. Compared with a time-matched maternal sample, the infant's exposure was 1.4 (0.2-2.8)% for pethidine and 0.4 (0.2-0.6)% for norpethidine. The mean (95% confidence interval) neurologic and adaptive capacity score was 33.6 (32.2-34.9). CONCLUSION: The combined absolute infant dose of pethidine and norpethidine received via milk was 1.8% of the neonatal therapeutic dose and the combined relative infant dose was below the 10% recommended safety level. Breastfed infants are at low risk of drug exposure when mothers self-administer epidural pethidine after caesarean delivery.
机译：背景：在剖宫产后由哌替啶患者控制的硬膜外镇痛过程中，没有关于哌替啶在母乳中的分布和/或母乳喂养婴儿暴露的信息。方法：我们在20名妇女中进行了一项观察性研究。在41（35-46）小时内，给予的哌替啶平均剂量（95％置信区间）为670（346-818）mg。停用哌替啶时和6h后收集母体血浆，牛奶和新生儿血浆。计算了通过牛奶和婴儿暴露的婴儿绝对剂量和相对剂量。使用神经学和适应能力评分评估婴儿行为。结果：在第一个和第二个采样时间，哌替啶的平均婴儿绝对剂量为20（14-27）大杯/千克/天和10（7-13）大杯/千克/天，而婴儿的平均相对剂量为0.7（0.1- 1.4）％和0.3（0.1-0.5）％。去甲吡啶的相似值（表示为哌替当量）为21（16-26）杯/千克/天和22（12-32）杯/千克/天;和0.7（0.3-1）％和0.6（0.2-1）％。新生儿血浆中的哌替啶和去甲吡啶的平均浓度为3（0-6.1）杯/升和0.6（0.2-1）杯/升。与时间匹配的母体样品相比，哌替啶的婴儿暴露率为1.4（0.2-2.8）％，去甲乙啶的暴露率为0.4（0.2-0.6）％。神经和适应能力评分的平均值（95％置信区间）为33.6（32.2-34.9）。结论：通过牛奶接受的哌替啶和去甲吡啶的绝对婴儿绝对剂量为新生儿治疗剂量的1.8％，相对婴儿绝对剂量低于建议的安全水平10％。当母亲在剖腹产后自行给予硬膜外哌替啶时，母乳喂养的婴儿暴露于药物的风险较低。

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