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Critical Care Obstetrics part 65

Critical Care Obstetrics part 65 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Fetal Effects of Drugs Commonly Used in Critical Care pancuronium. In the fetal therapy literature there is a well-documented short-term fetal response to the administration of pancuronium to the fetus. In addition to decreased movement a decrease in heart rate variability and accelerations is observed 43 . It has been reported that fetal heart variability can be reduced by 60 44 . These changes are temporary and revert to normal after the fetus has recovered from the drug. Although not statistically significant pancuronium proves to have a more significant neonatal effect on 15-min Neurologic Adaptive Capacity Scores than vecuronium with 29 of those neonates exposed to pancuronium having normal NACS versus 73 of those born exposed to vecuronium 45 . Pancuronium can be used during pregnancy. There are no reports on pancuronium and human lactation. Vecuronium Like pancuronium vecuronium is a non-depolarizing curaremimetic neuromuscular blockade agent. It has a similar mechanism of action and is used in general anesthesia protocols for surgeries including cesarean sections. Vecuronium is also used for fetal immobility during intrauterine blood transfusions. There is a report of in utero use of vecuronium for fetal MRI 46 . In term pregnant women the half-life of vecuronium is an average of 36 minutes with an onset of action of 125-175 seconds 40 . Vecuronium has a lower mean cord to maternal venous concentration ratio than pancuronium with average ratios between 0.11 and 0.14 40 . The decreased fetal uptake of vecuronium gives it an advantage over pancuronium in the treatment of parturients. In direct comparisons between pancuronium and vecuronium retrospective data shows that vecuronium displayed no fetal heart rate changes 47 . As with pancuronium there are no reports of human congenital malformations linked to vecuronium. There are no studies evaluating vecuronium and human lactation. Cardiovascular drugs Acute or chronic cardiovascular disease poses a significant