HEMODYNAMIC-EFFECTS OF INTRATHECAL FENTANYL IN NONLABORING TERM PARTURIENTS

Study Objective: To determine the effect of intrathecal fentanyl on ma ternal hemodynamics. Design: Prospective. Setting: Labor and delivery suite of a university medical center. Patients: 23 ASA status I nonlab oring term parturients presenting for elective cesarean section. Inter ventions: Patients were given either 1,200 ml lactated Ringer's Soluti on (Group 1, n = 12) or no intravenous (IV) fluid (Group 2, n = 11). A combined spinal-epidural technique was then performed. Fentanyl 25 mu g was administered intrathecally through a 24-gauge Sprotte or 25-gau ge Whitacre spinal needle. After completion of the hemodynamic study, a catheter was threaded into the epidural space for local anesthetic a dministration. Measurements and Main Results: Baseline hemodynamic dat a [systolic (SBP), diastolic, and mean arterial pressure, heart rate, stroke volume, cardiac output, end-diastolic volume, and ejection frac tion] were obtained in triplicate using noninvasive blood pressure mon itoring and impedance cardiography After administration of intrathecal fentanyl, , hemodynamic measurements were recorded at 3-minute interv als for 30 minutes. These values were compared with baseline for both groups. Ten patients in each group completed the study. Intrathecal fe ntanyl administration did not result in any maternal hemodynamic chang es in Group 1, and a few small statistically significant changes in Gr oup 2. Measured SBP was always greater than 100 mmHg in all patients d uring the study. Conclusion: Intrathecal administration of fentanyl 25 mu g in nonlaboring term parturients does not produce clinically mate rnal hemodynamic changes.