==================================HSR32================================== 32. The use of epidural anesthesia for cesarean section - contraindications, complications. Responsibility of the surgeon in verifying level of anesthesia before surgery. 1 UI - 87123307 AU - Ponte J ; Collett BJ ; Walmsley A TI - Anaesthetic temperature and shivering in epidural anaesthesia. AB - The mechanism of shivering during epidural analgesia remains unclear. This study investigates the role of the temperature of the local anaesthetic injected extradurally. Forty patients admitted for elective caesarean section under epidural anaesthesia were studied; 20 were given bupivacaine warmed to 37 degrees C (warm group) and 20 were given bupivacaine stored at 4 degrees C (cold group); the occurrence of shivering in both groups was recorded. The overall incidence of shivering was 27.5%; two patients of the warm group and nine patients of the cold group shivered. This difference was statistically significant (P less than 0.03). The results suggest that there are thermosensory mechanisms in the human spinal canal. In our view, epidural anaesthetic solutions should be warmed to body temperature prior to injection to reduce the incidence of shivering. MH - Adult ; *Anesthesia, Epidural ; Bupivacaine/*ADVERSE EFFECTS ; *Cesarean Section ; Female ; Human ; Pregnancy ; *Shivering ; Spinal Canal/ INNERVATION ; Temperature ; Thermoreceptors/PHYSIOLOGY SO - Acta Anaesthesiol Scand 1986 Oct;30(7):584-7 2 UI - 87106279 AU - Gale R ; Slater PE ; Zalkinder-Luboshitz I TI - Neonatal advantage of epidural anesthesia in elective and emergency cesarean sections: a report of 531 cases. AB - In 147 elective and 384 non-elective cesarean sections, the need for neonatal respiratory assistance at birth was significantly greater for babies born under general anesthesia compared to epidural anesthesia, and the differences could not be explained by differences in pre-operative risk factors. For 114 babies on whom blood gas data were gathered prospectively, a greater proportion born under general anesthesia were acidemic and hypercarbic. Our results complement a growing body of retrospective and clinical data suggesting that epidural anesthesia is preferable to general in all but a few cesarean sections. Ideally, this suggestion should be tested in a randomized clinical trial. MH - Acid-Base Imbalance/*ETIOLOGY ; Acidosis/ETIOLOGY ; Anesthesia, Epidural/ *ADVERSE EFFECTS ; Anesthesia, General/ADVERSE EFFECTS ; Anesthesia, Obstetrical/*ADVERSE EFFECTS ; Anoxia/*ETIOLOGY ; Carbon Dioxide/BLOOD ; *Cesarean Section ; Comparative Study ; Female ; Fetal Blood/ANALYSIS ; Human ; Hydrogen-Ion Concentration ; Hypercapnia/ETIOLOGY ; Infant, Newborn ; Oxygen/BLOOD ; Pregnancy ; Prospective Studies SO - Eur J Obstet Gynecol Reprod Biol 1986 Dec;23(5-6):369-77 3 UI - 87074144 AU - Webster NR ; Lyons G ; Macdonald R TI - Sleep and comfort after caesarean section. AB - To compare postoperative well-being after general and epidural anaesthesia, 58 women undergoing Caesarean section were divided into a general anaesthetic group receiving intramuscular opioid postoperatively (26), and an epidural group receiving morphine via the epidural route (32). The epidural group required less analgesia (p less than 0.01 at 0.5 and 8 hours, p less than 0.001 at 4 hours). There was no difference in the use of oral analgesics. At 1, 4 and 24 hours after delivery more patients in the general anaesthesia group described themselves as very comfortable (p less than 0.05). More in the epidural group had a very good night's sleep during each night studied. Patients in the epidural group were slower to use the ward toilet (p less than 0.01) and had more itching (p less than 0.001). Our conclusion is that patients progressed well in both groups. MH - Adolescence ; Adult ; Analgesics/THERAPEUTIC USE ; *Anesthesia, Epidural ; *Anesthesia, General ; *Anesthesia, Obstetrical ; *Cesarean Section ; Comparative Study ; Female ; Human ; Pain, Postoperative/DRUG THERAPY ; Pregnancy ; Sleep SO - Anaesthesia 1986 Nov;41(11):1143-5 4 UI - 87074112 AU - Crawford JS ; Davies P ; Lewis M TI - Some aspects of epidural block provided for elective caesarean section. AB - We present here clinical data from 993 patients who were destined to undergo elective Caesarean section under epidural analgesia. In 29 cases the attempt to provide an epidural was abandoned before the operation started. In regard to this, the importance of monitoring the fetal heart rate during initiation of the epidural is emphasised. In 10 cases general anaesthesia was induced after delivery, and in a further 108 cases supplemental analgesia was administered, either systemically, by inhalation or by an additional epidural top-up, after delivery. Satisfactory analgesia throughout the operation was achieved in 87.8%. In an appreciable proportion of cases the recommended maximum dose of bupivacaine, and the recommended maximum rate of bupivacaine administration, were exceeded without apparent complication. There was a tendency for the volume of Hartmann's solution infused intravenously before and during initiation of the epidural to be increased throughout the period under review (1971-85). The prevalence of hypotension diminished during that period. Characteristics of the data did not permit a close analysis of the main factors which could have led to an episode of maternal hypotension. However, it did appear that such an episode could be ascribed to too brief an interval between the first and second, or the second and third top-up doses. The frequency with which blood was transfused during operation was markedly lower than that noted in a concurrent series of elective sections conducted under general anaesthesia.(ABSTRACT TRUNCATED AT 250 WORDS) MH - *Anesthesia, Epidural/ADVERSE EFFECTS ; Anesthesia, General ; *Anesthesia, Obstetrical/ADVERSE EFFECTS ; Blood Transfusion ; Bupivacaine/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS ; Central Nervous System/DRUG EFFECTS ; *Cesarean Section ; Female ; Human ; Hypotension/ ETIOLOGY ; Intraoperative Complications/ETIOLOGY ; Pregnancy SO - Anaesthesia 1986 Oct;41(10):1039-46 5 UI - 87026490 AU - Loughran PG ; Moore J ; Dundee JW TI - Maternal stress response associated with caesarean delivery under general and epidural anaesthesia. AB - The maternal stress response to caesarean delivery with either general or epidural anaesthesia was investigated. Patients given a general anaesthetic showed statistically significant increases in blood pressure, heart rate, and levels of plasma catecholamines, cortisol and glucose. Epidural anaesthesia, to at least the T6 dermatome, obtunded these responses. The significance of these findings to the choice of method of anaesthesia is discussed. MH - Anesthesia, Epidural/*ADVERSE EFFECTS ; Anesthesia, General/*ADVERSE EFFECTS ; Anesthesia, Obstetrical/*ADVERSE EFFECTS ; Blood Glucose/ ANALYSIS ; Blood Pressure ; Catecholamines/BLOOD ; *Cesarean Section ; Female ; Human ; Hydrocortisone/BLOOD ; Insulin/BLOOD ; Labor/BLOOD ; Pregnancy ; Stress/*ETIOLOGY SO - Br J Obstet Gynaecol 1986 Sep;93(9):943-9 6 UI - 87026398 AU - Abouleish E ; Goldstein M TI - Migration of an extradural catheter into the subdural space. A case report. AB - After repeated, successful extradural injections in a parturient, the extradural catheter migrated into the subdural space. The injection of 3% chloroprocaine 10 ml resulted in an extensive block, which extended to the cranial nerves and paralysed the respiratory muscles. The position of the catheter tip was confirmed by fluoroscopy. Subdural injection should always be suspected when tests for subarachnoid injection are negative, but an extensive block occurs gradually within 15-20 min. Respiration and circulation should be supported until the block regresses. MH - Adult ; Anesthesia, Epidural/*ADVERSE EFFECTS ; Anesthesia, Obstetrical/ *ADVERSE EFFECTS ; Case Report ; Cesarean Section ; Female ; Human ; Paralysis, Obstetric/*ETIOLOGY ; Postoperative Complications/ETIOLOGY ; Pregnancy ; Respiratory Muscles ; Subdural Space SO - Br J Anaesth 1986 Oct;58(10):1194-7 7 UI - 86321150 AU - Gibbs CP ; Krischer J ; Peckham BM ; Sharp H ; Kirschbaum TH TI - Obstetric anesthesia: a national survey. AB - To assess obstetric anesthesia in the United States, and to determine why more anesthesia personnel are not involved in this subspecialty, a questionnaire was sent to the heads of obstetric and anesthesia services in 1,200 hospitals. Both obstetric and anesthesia respondents agreed on several characteristics of obstetric anesthesia that inhibit more participation by anesthesia personnel. Among others, they identified that: the unpredictability of labor and delivery makes scheduling difficult; obstetricians tend to dictate type and timing of anesthesia; the risk of malpractice claims is increased for obstetric anesthesia; and, finally, larger obstetric services would make it more practical to provide anesthesia services. Regarding availability of personnel and procedures, obstetric units with less than 500 deliveries per year were considerably more under-staffed than the larger units in most areas studied. When general anesthesia was used for cesarean section in these units, it was provided by, or given under the direction of, an anesthesiologist only 44% of the time, whereas in the hospitals with more than 1,500 deliveries per year, an anesthesiologist was present 86% of the time. Likewise, in the small units, personnel classified as "others: were responsible for newborn resuscitation in 24% and 43% of instances after cesarean section and vaginal delivery, respectively. In the hospitals with more than 1,500 deliveries, comparable figures were 4% and 2%, respectively. MH - Anesthesia, Epidural ; *Anesthesia, Obstetrical/ECONOMICS ; Anesthesia, Spinal ; Anesthesiology/MANPOWER ; Cesarean Section ; Female ; Human ; Labor ; Pregnancy ; Support, U.S. Gov't, P.H.S. SO - Anesthesiology 1986 Sep;65(3):298-306 8 UI - 86321000 AU - Matthews AJ ; Halshaw J TI - Epidural anaesthesia in von Hippel-Lindau disease. Management of childbirth and anaesthesia for caesarean section. AB - The management of childbirth, including epidural anaesthesia for Caesarean section is described in a patient with von Hippel-Lindau disease. The reasons for the choice of epidural anaesthesia are explained and the anaesthetic significance of the disease is discussed. MH - Adult ; *Anesthesia, Epidural ; *Anesthesia, Obstetrical ; Angiomatosis/ *COMPLICATIONS ; Case Report ; Cesarean Section ; Female ; Hippel-Lindau Disease/*COMPLICATIONS ; Human ; *Labor Complications ; Pregnancy SO - Anaesthesia 1986 Aug;41(8):853-5 9 UI - 86266413 AU - Thind GS ; Wells JC ; Wilkes RG TI - The effects of continuous intravenous naloxone on epidural morphine analgesia. AB - Forty-five patients undergoing Caesarean section under epidural anesthesia with bupivacaine were randomly allocated to three groups. Group 1 received 4 mg of epidural morphine immediately postoperatively and 2 mg naloxone by intravenous infusion for 12 hours postoperatively; group 2 was treated as group 1 but without naloxone infusion; group 3 received 10 mg morphine intramuscularly and 20 ml epidural saline after delivery of the baby. Epidural morphine 4 mg produced better postoperative analgesia than 10 mg of morphine intramuscularly (p less than 0.001) and the intravenous infusion of naloxone did not ablate the analgesic effects of epidural morphine. The incidence of itching and vomiting was higher in the epidural opioid groups (p less than 0.05) and intravenous naloxone, although it reduced the severity of the itching, did not reduce its overall incidence. Respiratory depression was not detected in any of the three groups. MH - Adolescence ; Adult ; Anesthesia, Epidural ; Cesarean Section ; Comparative Study ; Epidural Space ; Female ; Human ; Injections ; Injections, Intramuscular ; Morphine/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS/*THERAPEUTIC USE ; Naloxone/*PHARMACODYNAMICS ; Pain, Postoperative/*DRUG THERAPY ; Pregnancy SO - Anaesthesia 1986 Jun;41(6):582-5 10 UI - 86258354 AU - Chestnut DH ; Choi WW ; Isbell TJ TI - Epidural hydromorphone for postcesarean analgesia. AB - The efficacy of epidurally administered hydromorphone for postcesarean analgesia was evaluated in a prospective, randomized, double-blind study. Patients in group H (N = 26) received 1.0 mg of hydromorphone in preservative-free saline (total volume = 10 mL), administered epidurally. Patients in group B (N = 26) received 10 mL of 0.25% bupivacaine, administered epidurally. Both groups subsequently received intramuscular injections of hydromorphone as needed. There were significant differences between the two groups in pain score, patient assessment of analgesia quality, time to first analgesic intervention, and total dosage of hydromorphone during the first 24 hours. Nausea/vomiting and pruritis occurred more frequently in group H. No patient had a respiratory rate less than or equal to 10. There were no statistically significant differences between groups in mean times to first ambulation, first void, first passage of flatus, or hospital discharge. MH - Adult ; *Anesthesia, Epidural ; *Anesthesia, Obstetrical ; Bupivacaine/ ADMINISTRATION & DOSAGE/THERAPEUTIC USE ; *Cesarean Section ; Comparative Study ; Dihydromorphinone/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS/ *THERAPEUTIC USE ; Double-Blind Method ; Female ; Human ; Nausea/ CHEMICALLY INDUCED ; Pain, Postoperative/*DRUG THERAPY ; Pregnancy ; Prospective Studies ; Pruritus/CHEMICALLY INDUCED ; Random Allocation ; Time Factors ; Vomiting/CHEMICALLY INDUCED SO - Obstet Gynecol 1986 Jul;68(1):65-9 11 UI - 86212995 AU - Scott DB ; Aitken RE TI - Obstetric anaesthetic services in Scotland in 1982. AB - A recent survey of Scottish obstetric anaesthesia practice revealed that the majority of deliveries take place in the larger hospitals; these also have the highest epidural rates, both for relief of pain in labour and for Caesarean section. However, as epidural blockade is an essential part of modern obstetric practice, it is a matter of concern to achieve an equal standard in the medium-sized hospitals, whilst accepting that special arrangements are required in the very small obstetric hospitals. MH - Anesthesia, Epidural/UTILIZATION ; Anesthesia, General/UTILIZATION ; Anesthesia, Obstetrical/SUPPLY & DISTRIBUTION/*UTILIZATION ; Anesthesiology/MANPOWER ; Cesarean Section ; Delivery ; Female ; Hospital Bed Capacity ; Human ; Obstetrics and Gynecology Department, Hospital/ UTILIZATION ; Pregnancy ; Scotland SO - Anaesthesia 1986 Apr;41(4):370-4 12 UI - 86189197 AU - McMorland GH ; Jenkins LC ; Douglas MJ TI - A survey of obstetric anaesthesia practice in British Columbia. AB - Hospitals and anaesthetists in British Columbia were surveyed by means of questionnaires to assess patterns of obstetric anaesthesia practice, qualifications and numbers of obstetric anaesthesia personnel, hospital obstetric facilities and facilities and protocols for neonatal resuscitation. It was apparent that a large proportion of the obstetric anaesthesia service in this province was being provided by physicians who were not trained, nor certified, as anaesthesia specialists. Preanaesthetic assessment in the obstetric units differed in attitude and practice from the standards expected in the general operating rooms. There was also in community hospitals a significant incidence of failure to follow certain accepted safe practices (in obstetric patients), such as preinduction hydration and oxygenation, cricoid pressure during intubation and prevention of aortocaval compression. However, administration of general anaesthesia without endotracheal intubation, was rare in this survey. Post-anaesthetic recovery facilities in obstetric units were conspicuously deficient, even in the larger hospitals. The majority of community hospitals lacked written protocols for neonatal resuscitation; and the number of institutions reporting that the neonatal heart rates and temperatures were not routinely monitored is of concern. It is recommended that minimum standards for training in obstetric anaesthesia should be clearly defined; and provision should be made for revision and upgrading of knowledge and skills for physicians practicing anaesthesia in smaller community hospitals. MH - Anesthesia, Epidural ; Anesthesia, General ; *Anesthesia, Obstetrical/ METHODS/STANDARDS ; Anesthesiology/MANPOWER ; British Columbia ; Cesarean Section ; Delivery ; Female ; Hospital Departments/*STANDARDS ; Hospitals, Community/STANDARDS ; Hospitals, University/STANDARDS ; Human ; Infant, Newborn ; Obstetrics and Gynecology Department, Hospital/ *STANDARDS ; Preanesthetic Medication ; Pregnancy ; Questionnaires ; Resuscitation SO - Can Anaesth Soc J 1986 Mar;33(2):185-94 13 UI - 86184648 AU - Workhoven MN TI - Intravenous fluid temperature, shivering, and the parturient. AB - The effect of warmed vs room-temperature intravenous fluids is examined for decreasing shivering in parturients undergoing epidural anesthesia for elective cesarean sections. Forty-four women were studied, 22 receiving warmed and 22 receiving room-temperature fluid therapy for preblock prophylaxis of hypotension and intraoperative maintenance and replacement. Of those given room-temperature balanced salt solutions, 64% shivered, as opposed to 14% in the warm fluid group, an observation significant at less than a P of 0.005 by chi 2-analysis. MH - Adult ; Anesthesia, Epidural ; Body Temperature ; *Cesarean Section ; Cold ; Comparative Study ; Female ; *Fluid Therapy ; Human ; Hypotension/ *PREVENTION & CONTROL ; Intraoperative Period ; Pregnancy ; *Shivering SO - Anesth Analg 1986 May;65(5):496-8 14 UI - 86184469 AU - Robson N ; Robertson I ; Whittaker M TI - Plasma cholinesterase changes during the puerperium. AB - Changes in plasma cholinesterase activity during the puerperium were studied in 16 women who received epidural analgesia for labour followed by vaginal delivery, and in five women who underwent elective Caesarean section under epidural analgesia. A consistent fall in cholinesterase activity was demonstrated during the first 2 to 3 days post partum, followed by a rise to approximately normal nonpregnant values by the end of the puerperium. An additional patient who manifested prolonged paralysis following an emergency Caesarean section under general anaesthesia, including a suxamethonium infusion, was also studied. Possible mechanisms by which the transient decrease in cholinesterase activity is produced, and its clinical significance, are discussed. MH - Anesthesia, Epidural ; Anesthesia, Obstetrical ; Cesarean Section ; Cholinesterases/*BLOOD ; Female ; Human ; Labor ; Pregnancy ; *Puerperium ; Support, Non-U.S. Gov't ; Time Factors SO - Anaesthesia 1986 Mar;41(3):243-9 15 UI - 86169470 AU - Bonds DR ; Crosby LO ; Cheek TG ; H:agerdal M ; Gutsche BB ; Gabbe SG TI - Estimation of human fetal-placental unit metabolic rate by application of the Bohr principle. AB - The Bohr Principle via continuous indirect calorimetry was used to estimate human fetal-placental unit metabolic rate in 12 normal women undergoing elective caesarean section under continuous lumbar epidural anaesthesia. Maternal oxygen consumption decreased after umbilical cord clamping and after placental removal. Fetal-placental unit oxygen consumption was 10.7 +/- 1.3 ml/min per kg (mean +/- SEM). Fetal oxygen consumption was 6.8 +/- 1.4 ml/min per kg. Placental oxygen consumption was 37 +/- 12 ml/min per kg. Fetal-placental unit carbon dioxide production was 9.2 +/- 1.2 ml/min per kg. These mean values agree favourably with measurements of uterine and fetal metabolism from other mammalian species. Maternal minute ventilation decreased with removal of the fetal-placental unit, and this decrease was found to be linearly related to the fetal-placental unit carbon dioxide production. MH - Adult ; Anesthesia, Epidural ; Anesthesia, Obstetrical ; Carbon Dioxide/ METABOLISM ; Cesarean Section ; Female ; Fetus/*METABOLISM ; Human ; Maternal-Fetal Exchange ; *Oxygen Consumption ; Placenta/*METABOLISM ; Pregnancy ; Respiration ; Support, U.S. Gov't, P.H.S. ; Uterus/METABOLISM SO - J Dev Physiol 1986 Feb;8(1):49-54 16 UI - 86156885 AU - Van Zundert A ; Vaes L ; Van der Aa P ; Van der Donck A ; Meeuwis H TI - Motor blockade during epidural anesthesia. AB - The effects of lumbar epidural anesthesia (LEA) on a previously described test of function of the rectus abdominalis muscle (the RAM-test) were compared with the effects of LEA on the Bromage test of muscle power in the hips and legs in 20 women having elective cesarean sections under LEA using 0.5% bupivacaine with epinephrine 1:200,000. The results showed no statistically significant correlation between the two tests. We conclude that zones of differential somatic motor blockade are present during LEA and that in obstetrics the RAM-test is the more appropriate test for evaluating the effects of LEA on somatic motor function. Use of the RAM-test is suggested in situations where one is interested in motor function of the abdominal wall muscles under LEA. MH - Abdominal Wall/*PHYSIOLOGY ; Adult ; *Anesthesia, Epidural ; *Anesthesia, Obstetrical ; Cesarean Section ; Female ; Human ; Pregnancy SO - Anesth Analg 1986 Apr;65(4):333-6 17 UI - 86119529 AU - R:ais:anen I ; Paatero H ; Salminen K ; Laatikainen T TI - Beta-endorphin in maternal and umbilical cord plasma at elective cesarean section and in spontaneous labor. AB - Concentration of beta-endorphin in relation to the mode of delivery and anesthesia was studied in maternal and umbilical cord plasma in 30 healthy women at term pregnancy. At elective cesarean section under epidural anesthesia, the mean maternal beta-endorphin level rose from 9.8 +/- 2.7 pmol/L (SE) before induction to 15.5 +/- 3.7 pmol/L at the time of delivery (P less than .02). Under general anesthesia the mean beta-endorphin level increased more, from 14.6 +/- 7.2 to 34.4 +/- 7.8 pmol/L (P less than .02), reaching the mean beta-endorphin value of the second stage of normal labor, 39.4 +/- 7.0 pmol/L. In the cord arterial and venous plasma, the mean beta-endorphin value was significantly higher after spontaneous labor (40.9 +/- 11 and 40.1 +/- 9.2 pmol/L, respectively) than at elective cesarean section under epidural (14.3 +/- 1.9 and 12.4 +/- 3.6 pmol/L, respectively) or general anesthesia (11.9 +/- 2.2 and 13.4 +/- 2.2 pmol/L, respectively). Thus cesarean section under general anesthesia proved to be more stressful for the mother than that under epidural anesthesia, when beta-endorphin release is used as the measure of stress. The mode of anesthesia did not seem to influence the plasma beta-endorphin level in the newborn infant. Normal delivery by vaginal route increased the release of beta-endorphin both to the maternal and the fetoplacental circulation. MH - Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Obstetrical ; *Cesarean Section ; Comparative Study ; Endorphins/*BLOOD ; Female ; Fetal Blood/*ANALYSIS ; Human ; Infant, Newborn ; *Labor ; Pregnancy ; Support, Non-U.S. Gov't SO - Obstet Gynecol 1986 Mar;67(3):384-7 18 UI - 86104011 AU - Kerr-Wilson RH ; McNally S TI - Bladder drainage for caesarean section under epidural analgesia. AB - Fifty patients undergoing elective caesarean section under epidural analgesia were randomized prospectively to be catheterized with an 'in-out' or an indwelling urethral catheter. Of the patients who had catheterization for the time of surgery alone 44% subsequently required recatheterization, whereas all patients with indwelling catheters voided spontaneously on their removal. The frequency of significant bacteriuria was the same in both groups. MH - Adult ; *Anesthesia, Epidural ; Bladder/PHYSIOPATHOLOGY ; Catheters, Indwelling ; *Cesarean Section ; Drainage ; Female ; Human ; Postoperative Period ; Pregnancy ; *Urinary Catheterization ; Urination Disorders/ETIOLOGY/*PREVENTION & CONTROL SO - Br J Obstet Gynaecol 1986 Jan;93(1):28-30 19 UI - 86101272 AU - Ramanathan J ; Bottorff M ; Jeter JN ; Khalil M ; Sibai BM TI - The pharmacokinetics and maternal and neonatal effects of epidural lidocaine in preeclampsia. AB - The pharmacokinetics and maternal and neonatal effects of epidural lidocaine were compared in ten preeclamptic and five normotensive women undergoing cesarean section at 36-40 weeks of gestation. Lumbar epidural anesthesia was achieved using 15-20 ml of 2% lidocaine without epinephrine. Serial venous samples for lidocaine levels were drawn from all the mothers during the procedure and up to 6 hr after the initial injection. Umbilical venous and arterial samples were drawn at delivery for measurement of neonatal acid-base status and lidocaine levels. There were no significant differences between normotensive and preeclamptic patients in the total dose of lidocaine, peak maternal plasma concentration, volume of distribution, maternal elimination half-life and umbilical vein/maternal vein ratios. The calculated area under the concentration time curve in preeclamptic patients (18.5 +/- 4.7 micrograms X hr X ml-1) was significantly greater than in normotensive mothers (14.1 +/- 1.3 micrograms X hr X ml-1) (P less than 0.02). Total maternal body clearance in preeclamptic patients (24.5 +/- 7.1 L/hr) was significantly lower than in normotensives (31.1 +/- 4.4 L/hr) (P less than 0.05). Neonatal outcome as evaluated by Apgar scores, umbilical arterial and venous blood gas tensions, umbilical vein/maternal vein ratios, and early neonatal neurobehavior scores at 4 hr and 24 hr after birth were similar in the two groups. The results indicate that the total maternal body clearance of lidocaine is prolonged in preeclampsia, and repeated administration of lidocaine can result in higher blood levels than in normotensive parturients. MH - Adult ; *Anesthesia, Epidural/ADVERSE EFFECTS ; *Anesthesia, Obstetrical/ ADVERSE EFFECTS ; Cesarean Section ; Female ; Fetus/*DRUG EFFECTS ; Human ; Infant, Newborn ; Kinetics ; Lidocaine/ADVERSE EFFECTS/*METABOLISM ; Liver/METABOLISM ; Liver Circulation ; Maternal-Fetal Exchange ; Metabolic Clearance Rate ; Pre-Eclampsia/*METABOLISM ; Pregnancy SO - Anesth Analg 1986 Feb;65(2):120-6