Naloxone in respiratory depression caused by meperidine in analgesic labor
Arias, A.; Gutiérrez Díez, M.L.; Gracia Gasca, A.; Pérez Iglesias, F.; Esteban Caracedo, E.
Revista Espanola de Anestesiologia y Reanimacion 26(3): 255-263
1979
ISSN/ISBN: 0034-9356 PMID: 538312 Document Number: 4365
In 32 newborns through vaginal delivery, the mothers had received (i. v.) doses of 160-350 mg of meperidine. The assessment of the degree of respiratory depression wad done by means of the Apgar test and PaCO2 from arterialized capillary blood Naloxona was given to antagonize this effect at a dose of 20 µg (in umbilical vein). Subsequently the evolution of the Apgar Test was followed aswell as respiratory rate and PaCO2 until normalization of these variants. The response of the neonate to the i. v. injection of 20 µg was good, with reversion of the respiratory depression assessed by the increase in rate and depth of breathing or by means of stimuli to start the regularization of breathing movements, as well as the lowering of the PaCO2 to normal levels with the subsequent increase of the Apgar Values. The duration of the reversion of the respiratory oscillated in relation to the total doses of meperidine and the time elapsed from the i. v. injection of the last dose and the delivery. In those newborns whose mothers have received the last analgesic dose within 30 previous minutes, a rise in PaCO2 was still appreciated one hour after the injection of Naloxone although no clinical repercusion was manifest, at least through the Apgar Test. This rise in PaCO2 was still osirons two hours after delivery. When the total dose of meperidine had exceeded 300 mg we administered another 20 µg of Naloxone intramusculary, which showed to be sufficient to maintain the PaCO2 and respiratory rate within normal limits EEG studies -were carried out 24, 48 hours after birth. In the 24 hours EEG signs of diffuse cerebral disorders, which become normal 24 hours later, were observed in five cases. No significant neurological alterations appreciated as compared with the group of control. In six cases, reflex irritability during the first five hours was observed.
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