ANESTHETIC MANAGEMENT OF LABOR AND DELIVERY IN A WOMAN TAKING LONG-TERM MAOI

A case is presented of a woman who, for six years, had been treated fo r depression with 45 mg daily of the monoamine oxidase inhibitor (MAOI ), phenelzine, and who continued taking the drug throughout her pregna ncy and labour. Well-documented and potentially fatal interactions bet ween MAOIs and opioids, notably meperidine, meant that her labour anal gesia needed careful planning. Opioid- and epinephrine-free epidural b upivacaine analgesia war instituted early with small increments of bup ivacaine 0.25% to produce a T-10 block, after which an infusion of 8 m l . hr(-1) bupivacaine 0.125% was used to maintain analgesia. After 14 hr labour, the epidural was extended uneventfully to allow Caesarean section to be performed for failure to progress. Presser agents were a voided as indirect-acting drugs can produce severe hypertension. The c hild appeared normal and the mother had an uncomplicated postoperative course. Epidural analgesia contributed to the safe conduct of labour and Caesarean delivery.