Document Detail


Distribution of fentanyl in the placental intervillous space and in the different maternal and fetal compartments in term pregnant women.
MedLine Citation:
PMID:  19330322     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Fentanyl is used in obstetrical practice to promote analgesia and anesthesia during labor and in cesarean delivery, with rapid and short-term effects. OBJECTIVE: To determine fentanyl concentrations in maternal plasma, in the placental intervillous space, and in the umbilical artery and vein in term pregnant women. PATIENTS AND METHODS: Ten healthy pregnant women underwent epidural anesthesia with fentanyl plus bupivacaine and lidocaine, and fentanyl concentrations were determined in the various maternal and fetal compartments, including the placental intervillous space, which has not been previously studied in the literature. RESULTS: The ratios of fentanyl concentrations in the various maternal and fetal compartments revealed an 86% rate of placental fentanyl transfer. The highest fentanyl concentrations were detected in the placental intervillous space, being 2.19 times higher than in maternal plasma, 2.8 times higher than in the umbilical vein and 3.6 times higher than in the umbilical artery, with no significant differences between the umbilical vein and artery, demonstrating that there was no drug uptake by fetal tissues nor metabolism of the drug by the fetus despite the high rates of placental transfer. CONCLUSION: The present study demonstrated that the placental intervillous space acted as a site of fentanyl deposit, a fact that may be explained by two hypotheses: (1) the blood collected from the placental intervillous space is arterial and, according to some investigators, the arterial plasma concentrations of the drugs administered to patients undergoing epidural anesthesia are higher than the venous concentrations, and (2) a possible role of P-glycoprotein (P-gp).
Authors:
Luciana de Barros Duarte; Elaine Cristine Dantas Mois?s; Ricardo Carvalho Cavalli; Vera L?cia Lanchote; Geraldo Duarte; S?rgio Pereira da Cunha
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-03-28
Journal Detail:
Title:  European journal of clinical pharmacology     Volume:  65     ISSN:  1432-1041     ISO Abbreviation:  Eur. J. Clin. Pharmacol.     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-07-24     Completed Date:  2009-10-06     Revised Date:  2010-05-06    
Medline Journal Info:
Nlm Unique ID:  1256165     Medline TA:  Eur J Clin Pharmacol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  803-8     Citation Subset:  IM    
Affiliation:
Deparment of Gynecology and Obstetrics, Faculty of Medicine of Ribeir?o Preto, University of S?o Paulo, Ribeir?o Preto, Brazil. lbdmedi@msn.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Analgesia, Obstetrical / methods
Analgesics, Opioid / administration & dosage,  blood,  pharmacokinetics*
Anesthesia, Obstetrical / methods
Anesthetics, Intravenous / administration & dosage,  blood,  pharmacokinetics*
Chorionic Villi / metabolism
Female
Fentanyl / administration & dosage,  blood,  pharmacokinetics*
Fetus / metabolism*
Humans
P-Glycoprotein / drug effects,  metabolism*
Placenta / metabolism*
Pregnancy
Chemical
Reg. No./Substance:
0/Analgesics, Opioid; 0/Anesthetics, Intravenous; 0/P-Glycoprotein; 437-38-7/Fentanyl

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