Oxford Textbook of Obstetric Anaesthesia
Contents
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Introduction: clinical pharmacology in special populations Introduction: clinical pharmacology in special populations
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Maternal pharmacokinetics Maternal pharmacokinetics
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Pharmacokinetic alterations due to physiological changes during pregnancy Pharmacokinetic alterations due to physiological changes during pregnancy
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Applications in the field of obstetric anaesthesia Applications in the field of obstetric anaesthesia
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Transplacental transport Transplacental transport
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Clinical pharmacology in neonates: limited size, extensive variability Clinical pharmacology in neonates: limited size, extensive variability
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Neonatal clinical pharmacology: an introduction Neonatal clinical pharmacology: an introduction
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Applied neonatal pharmacology: obstetric anaesthesia and breastfeeding Applied neonatal pharmacology: obstetric anaesthesia and breastfeeding
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Opioids Opioids
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Intravenous and inhalational anesthetics Intravenous and inhalational anesthetics
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Benzodiazepines Benzodiazepines
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Non-opioid analgesics Non-opioid analgesics
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Local anaesthetics Local anaesthetics
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Conclusion Conclusion
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References References
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5 Maternal, fetal, and neonatal pharmacokinetics
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Published:September 2016
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Abstract
Most drugs are not thoroughly evaluated for use during pregnancy, delivery, or postpartum (e.g. breastfeeding). The same holds true for early infancy, and results in extensive off-label, unlicensed pharmacotherapy in these specific subpopulations. At present, most drug labels do not contain any instructions for use during pregnancy, in infancy, or during breastfeeding, yet these are the main concerns of healthcare providers considering medical treatment. Anaesthetists commonly treat pregnant women with similar dosing regimens recommended for use in adults and subsequently titrate to effect. The (dis)continuation of breastfeeding in the postpartum period following anaesthesia is commonly based on opinions instead of scientific evidence. This chapter describes the alterations in pharmacokinetics (absorption, distribution, metabolism, elimination) in pregnant women with specific emphasis on placental drug transport, and in neonates, with additional emphasis on breastfeeding. Drugs commonly administered by anaesthetists to women in the peripartum period are discussed with particular reference to the changed pharmacodynamics in both mother and infant.
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