Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942002000100012
Brazilian Journal of Anesthesiology
Review Article

Passagem transplacentária e efeitos embriofetais de drogas usadas em anestesia

Placental transfer and embryo-fetal effects of drugs used in anesthesia

Márcio Leal Horta; Ione Pellegatti Lemonica

http://dx.doi.org/10.1590/S0034-70942002000100012 Braz J Anesthesiol, vol.52, n1, p.101-113, 2002
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Resumo

JUSTIFICATIVA E OBJETIVOS: A anestesia da paciente grávida engloba situações diversas e que devem ser analisadas com muita propriedade. Além da exposição do feto e de uma possível ação tóxica dos agentes a serem utilizados na anestesia, devem ser considerados o período gestacional, as características de cada droga e as doses a serem utilizadas. A falta de informações adequadas sobre o risco do uso de drogas na gestação torna difícil ao anestesiologista uma opção segura quando se vê diante da necessidade de anestesiar uma paciente grávida, tanto para cirurgia não obstétrica, como em cirurgia obstétrica. No primeiro caso, é importante evitar o parto prematuro (ou o aborto) e o aparecimento de alterações permanentes no feto. No segundo caso, não deve haver interferência na contratilidade uterina nem depressão significativa no feto. A finalidade desta revisão é atualizar os conhecimentos sobre a passagem transplacentária e os efeitos maternofetais das drogas usadas em anestesia. CONTEÚDO: São revisados os mecanismos de passagem transplacentária de drogas, os princípios fundamentais de embriofetotoxicidade e analisados alguns aspectos importantes sobre efeitos embriofetais das drogas utilizadas na anestesia. Também é apresentada a classificação de risco teratogênico, de acordo com o FDA, das drogas que o anestesiologista mais utiliza durante o ato anestésico. CONCLUSÕES: Embora ainda persistam muitas dúvidas em relação à escolha de drogas para a anestesia de pacientes grávidas, o anestesiologista dispõe hoje de novas drogas e de informações que lhe permitem oferecer maior segurança para o binômio mãe-feto.

Palavras-chave

COMPLICAÇÕES, DROGAS, FISIOLOGIA

Abstract

BACKGROUND AND OBJECTIVES: Anesthesia for pregnant patients has several peculiarities that need to be adequately analyzed. Besides fetus exposure and possible toxic effects of anesthetic agents, gestational age, drug properties and doses should be considered. The lack of adequate information about the risk of using drugs during gestation turns it difficult for anesthesiologists to make a safe choice when facing the need to anesthetize a pregnant patient, both for non-obstetric or for obstetric surgery. In the former case, it is important to avoid premature labor (or abortion) and permanent fetus abnormalities; in the latter, there should be neither interference on uterine contractility nor significant fetus depression. This review aimed at updating information on placental transfer of anesthetic drugs and maternal-fetal effects of anesthetic drugs. CONTENTS: The mechanisms of placental transfer of drugs and the basic principles of embryo-fetotoxicity are reviewed and important aspects of embryo-fetal effects of anesthetic drugs are analyzed. FDA’s classification of drugs most frequently used in anesthesia is presented, according to their teratogenic risk. CONCLUSIONS: There are still many issues involving the choice of anesthetic drugs to be used in pregnant patients, but today there are new drugs and information allowing anesthesiologists to grant greater security to both mother and fetus.

Keywords

COMPLICATIONS, DRUGS, PHYSIOLOGY

References

Koren G, Pastuszak A, Ito S. Drugs in pregnancy. New Engl J Med. 1998;338:1128-1137.

Glosten B. Anesthesia for Obstetrics. Anesthesia. 2000:2024-2068.

Smith BE. Teratology in anesthesia. Clin Obstet Gynecol. 1974;17:145-163.

Katayama M, Jacob MTRJ. Passagem placentária de drogas. Rev Bras Anestesiol. 1985;35:375-390.

Abboud T. Nonobstetric surgery during pregnancy. Seminars in Anesthesia. 1992;XI:51-54.

Rezende J, Montenegro CAB. Trocas Materno-Ovulares. Obstetrícia. 1998:80-92.

Di Pirro JM, Thompson AC, Kristal MB. Amniotic-fluid ingestion enhances the central analgesic effect of morphine. Brain Res Bull. 1991;26:851-855.

Cooper J, Jauniaux E, Gulbis B. Placental transfer of fentanyl in early human pregnancy and its detection in fetal brain. Br J Anaesth. 1999;82:929-931.

Douglas MJ. Perinatal Physiology and Pharmacology. Obstetric Anesthesia. 1999:113-134.

Lemonica IP. Embriofetotoxicidade. Fundamentos de Toxicologia. 1996:87-94.

Federal Register. 1980;44:37434-37436.

Zanini AC, Basile AC, Martin MIC. Guia de Medicamentos. 1995.

Herman NL. Surgery During Pregnancy. Obstetric Anesthesia. 1999:161-185.

Steinberg ES, Santos AC. Surgical anesthesia during pregnancy. Internat Anesthesiol Clin. 1990;28:58-66.

Ralston DH, Shnider SM, De Lorimier AA. Effects of equipotent ephedrine, metaraminol, mephentermine and methoxamine on uterine blood flow in the pregnant ewe. Anesthesiology. 1974;40:354-370.

Tong C, Eisenach JC. The vascular mechanism of ephedrine’s beneficial effect on uterine perfusion during pregnancy. Anesthesiology. 1992;76:792-798.

Rosen MA. Management of anesthesia for the pregnant surgical patient. Anesthesiology. 1999;91:1159-1163.

Motoyama EK, Rivard G, Acheson F. The effect of changes in maternal pH and PCO2 on the PO2 of fetal lambs. Anesthesiology. 1967;28:891-903.

Tucker GT. Pharmacokinetics of local anesthetics. Br J Anaesth. 1986;58:717-731.

Abouleish E, Abboud T, Lechevalier T. Rocuronium (Org 9426) for cesarean section. Br J Anaesth. 1994;73:336-341.

Nilsson A, Engberg G, Henneberg S. Inverse relationship between age-dependent erythrocyte activity of methaemoglobin reductase and prilocaine-induced metahemoglobinaemia during infancy. Br J Anaesth. 1990;64:72-76.

Clark DA, Landaw SA. Bupivacaine alters red blood cell properties: a possible explanation for neonatal jaundice associated with maternal anesthesia. Pediatr Res. 1985;19:131-141.

Di Fazio C. Local anesthetics pharmacology: practical aspects. :7-25.

Philipson EH, Kuhnert BR, Syracuse CD. 2-Chloroprocaine for local perineal infiltration. Am J Obstet Gynecol. 1987;157:1275-1278.

Dick WF. Anaesthesia for caesarean section (epidural and general): effects on the neonate. Eur J Obstet Gynecol Reprod Biol. 1995;59(^sSuppl):S61-S67.

Datta S, Ostheimer GW, Weiss JB. Neonatal effect of prolonged anesthetic induction for cesarean section. Obstet Gynecol. 1981;58:331-335.

Warren TM, Datta S, Ostheimer GW. Comparison of the maternal and neonatal effects of halothane, enflurane, and isoflurane for cesarean delivery. Anesth Analg. 1983;62:516-520.

Gin T, Gregory MA, Chan K. Maternal and fetal levels of propofol at caesarian section. Anaesth Intensive Care. 1990;18:180-184.

Dailland P, Cockshot ID, Lirzin JD. Intravenous propofol during cesarean section: placental transfer, concentrations in breast milk, and neonatal effects. A preliminary study. Anesthesiology. 1989;71:827-834.

Yau G, Gin T, Kotur CF. Propofol for induction and maintenance of anaesthesia at caesarean section. Anaesthesia. 1991;46:20-23.

Djordjevic B, Stojiljkovic MP, Mostic T. Propofol and thiopentone in elective cesarean section: effect on the mother and neonate. Vojnosanit Pregl. 1998;55:601-604.

Moore J, Bill KM, Flynn RJ. A comparison between propofol and thiopental as induction agents in obstetric anaesthesia. Anaesthesia. 1989;44:753-757.

Celleno D, Capogna M, Tomassetti M. Neurobehavioral effects of propofol on the neonate following elective caesarean section. Br J Anaesth. 1989;62:649-654.

Shin Y, Kim Y, Collea J. Relaxant effects of propofol on contractility in isolated human pregnant uterine muscle. Anesthesiology. 1997;87:A921.

Kosaka Y, Takahashi T, Mark LC. Intravenous thiobarbiturate anesthesia for cesarean section. Anesthesiology. 1969;31:489-506.

Finster M, Morishima HO, Mark LC. Tissue thiopental concentrations in the fetus and newborn. Anesthesiology. 1972;36:155-158.

Finster M, Mark LC, Morishima HO. Plasma thiopental concentration in the newborn following delivery under thiopental-nitrous oxide anesthesia. Am J Obstet Gynecol. 1966;95:621-629.

Bach V, Carl P, Ravlo O. A randomized comparison between midazolam and thiopental for elective cesarean section anesthesia: III. Placental transfer and elimination in neonates. Anesth Analg. 1989;68:238-242.

Bland BAR, Lawes EG, Duncan PW. Comparison of midazolam and thiopental for rapid sequence induction for elective cesarean section. Anesth Analg. 1987;66:1165-1168.

Ravlo O, Carl P, Crawford ME. A randomized comparison between midazolam and thiopental for elective cesarean section anesthesia: II. Neonates. Anesth Analg. 1989;68:234-237.

Scher J, Hailey DM, Beard RW. The effects of diazepam on the fetus. J Obstet Gynaecol Br Commonw. 1972;79:635-638.

Dean M, Stock B, Patterson RJ. Serum protein binding of drugs during and after pregnancy in humans. Clin Pharmacol Ther. 1980;28:253-261.

Little B, Chang T, Chucot L. Study of ketamine as an obstetric anesthetic agent. Am J Obstet Gynecol. 1972;113:247-260.

Dich-Nielsen J, Holasek J. Ketamine as induction agent for caesarean section. Acta Anaesthesiol Scand. 1982;26:139-142.

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