Estimation of infant dose and exposure to pethidine and norpethidine via breast milk following patient-controlled epidural pethidine for analgesia post caesarean delivery

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 6 h 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) μg/kg/day and 10 (7-13) μg/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) μg/kg/day and 22 (12-32) μg/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) μg/L and 0.6 (0.2-1) μg/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.     

酮咯酸氨丁三醇联合盐酸哌替啶治疗肾绞痛的临床观察

目的:观察酮咯酸氨丁三醇联合盐酸哌替啶治疗肾绞痛的临床疗效。方法:将我院2008年5月-2010年5月收治的中、重度疼痛的肾绞痛患者120例随机均分为3组,均采取肌肉注射药物进行镇痛治疗。其中,Ⅰ组应用酮咯酸氨丁三醇60mg;Ⅱ组应用盐酸哌替啶100mg;Ⅲ组应用酮咯酸氨丁三醇30mg+盐酸哌替啶50mg。记录用药前以及用药后3h内(0、0.5、1、1.5、2、2.5、3h)的疼痛强度、疼痛强度差、疼痛缓解度以判断镇痛效果,并观察各组治疗中的不良反应情况。结果:用药后,3组均在0.5h起效,在中度疼痛的镇痛方面,Ⅲ组在用药3h内的所有观察点均优于Ⅰ、Ⅱ组(P<0.05),在2h时差异最为显著(P<0.01);在重度疼痛的镇痛方面,Ⅲ组在用药1.5、2、2.5、3h时效果优于Ⅰ、Ⅱ组(P<0.05);Ⅲ组的中度以上疼痛缓解程度除0.5h外,其余各点与Ⅰ、Ⅱ组比较,差异均有统计学意义(P<0.05)。Ⅲ组不良反应的发生率小于其他2组(P<0.05)。结论:酮咯酸氨丁三醇联合盐酸哌替啶治疗肾绞痛效果显著,同时可减少盐酸哌替啶的使用量,并可延长镇痛时间,且安全性较好。     

氢化可的松和哌替啶对剖宫产蛛网膜下腔麻醉后寒战反应的疗效

目的：评价氢化可的松和哌替啶对椎管内麻醉后寒战的治疗作用。方法：选择剖宫产初产妇术后,Wrench分级2级及其2级以上患者80例,分为氢化可的松2.0mg/kg组、哌替啶0.05mg/kg组和生理盐水10ml组。术中监测心电图（ECG）、脉搏氧饱和度（SpO2）、血压（BP）、心率（HR）、肛温（T）。记录各组寒战发生时（T1）,寒战后10min（T2）、30min（T3）、60min（T4）体温,对以上4个时间点的寒战进行评分,并观察不良反应的发生情况。结果：3组患者术后随访发现,哌替啶组恶心、呕吐发生率较氢化可的松高（P〈0.05）。哌替啶组和氢化可的松组患者麻醉后寒战缓解迅速,寒战持续时间较短,症状较轻。结论：氢化可的松治疗麻醉后寒战较少引起恶心、呕吐等副作用,可用于剖宫产麻醉后寒战的治疗。     

曲马多和氟哌利多辅助硬膜外阻滞对胆囊切除术牵拉反应的防治

观察20例硬膜外阻滞下施行胆囊切除手术病人辅用曲马多和氟哌利多(曲氟合剂)对内脏牵拉反应的抑制效果,并与哌替啶和氟哌利多(哌氟合剂,n=20)或芬太尼和氟哌利多(芬氟合剂,n=20)比较。结果显示,曲氟合剂抑制内脏牵拉反应效果与哌氟、芬氟合剂相同,但曲氟组病人用药后SpO_2和RR变化轻微(P>0.05),哌氟组和芬氟组则显著下降(P<0.01),提示胸段硬膜外阻滞时辅用曲氟合剂较哌氟或芬氟合剂安全。     

3组辅助用药减少硬膜外麻醉下胆系牵拉反应的比较

目的研究哌替啶加氟哌利多(度氟合剂)、度氟合剂加芬太尼、哌替啶加异丙嗪(度非合剂)用于硬膜外麻醉下实施胆系手术抑制内脏牵拉反应(胆-心反射),减少对循环的影响。方法60例ASAⅠ~Ⅲ行胆系手术病人,随机分成Ⅲ组。Ⅰ组:辅用哌替啶加氟哌利多;Ⅱ组:哌替啶加氟哌利多和芬太尼;Ⅲ组:哌替啶加异丙嗪。结果Ⅱ组病人牵拉内脏时恶心及牵拉痛明显轻于Ⅰ组和Ⅲ组。结论硬膜外麻醉下实施胆系手术时,辅用哌替啶加氟哌利多和芬太尼,并在手术探查前加用阿托品可有效减轻胆-心反射。     

LC-MS determination of MPTP at sub-ppm level in pethidine hydrochloride

An HPLC-MS with electrospray ionisation method for the determination of MPTP at sub-ppm level in pethidine hydrochloride has been developed and validate. Ionisation is performed by positive-ion electrospray and the quadrupole filter mass spectrometer is operated in the single ion recording mode. Chromatographic separation was achieved in gradient elution using a symmetry C18, 5 μm, 150 mm × 2.1 mm i.d. The mobile phase comprised water containing 0.1% formic acid (v/v) and acetonitrile containing 0.1% formic acid (v/v). The method showed to be linear in the range between 0.2 and 2.2 ng/ml, the estimated LOD was lower than 0.1 ng/ml and the LOQ was lower than 0.2 ng/ml.     

哌替啶、哌氟合剂及曲马多治疗硬膜外麻醉合并寒战的临床观察

目的：对比观察硬膜麻醉合并寒战的药物治疗效果与不良反应。方法：60例ASAⅠ级行下胸,腰段硬膜外麻醉合并寒战患者随机分为I组（静注派替啶）,Ⅱ组（静注哌替啶＋氟哌啶）和Ⅲ组（静注曲马多）。记录用药后寒战停止所需的时间。结果：三组消除寒战的总有效率分别为85％,95％和95％。Ⅱ、Ⅲ组制止寒战所需时间显著快于I组（P＜0．01）,寒战消除后动脉血氧饱和度（SpO2)均明显改善（P＜0．01）,结论：三组药物均可用于治疗硬膜外麻醉期间发生的寒战,但曲马多镇静作用弱,安全性高,尤其适用于有心,肺功能疾患的病人。     

哌替啶在人工流产中的止痛作用

目的观察哌替啶在人流中的止痛作用以寻找一种有效的人流止痛药。方法以病例对照方法观察2003-01~2004-01共378例早孕妇女随机将用哌替啶止痛的194例分为1组,未用哌替啶的184例作为对照组进行比较。结果显示哌替啶在人流中有明显的止痛作用,不增加术中出血量,并能减少人流综合征的发生。结论哌替啶在人流中的止痛效果好,简便易行,并且不需要麻醉医生的参与。     

国内麻醉药品用药现状与展望

目前,我国麻醉药品医疗消耗量低、用药结构不甚合理,地区差异较大,总体水平不高,直接影响着我国癌痛患者的生活质量.医患观念保守、成瘾恐惧的心理束缚、政策制度执行不畅,都是导致用药水平不高的重要因素.要实现"让癌痛患者无疼痛"的目标还需要付出很多的努力,唯有更新用药观念,强化用药意识、改善用药结构,才能使我国麻醉药品用药水平得到进一步的提高.