Baraka A, Siddik S, Assaf B
Department of Anesthesiology, American University of Beirut, Beirut-Lebanon.
Can J Anaesth. 1998 Jul;45(7):631-4. doi: 10.1007/BF03012091.
Tramadol has been recommended for analgesia in parturients undergoing vaginal delivery. The present report investigated the effect of tramadol versus fentanyl on umbilical vein (UV) blood gases and Apgar scores of neonates delivered via elective Caesarean section under general anaesthesia.
Forty ASA I or II parturients undergoing elective Caesarean section were included in a randomized double-blinded study. The patients were divided into a tramadol (n = 20) and fentanyl groups (n = 20). During preoxygenation, one group received 100 mg tramadol i.v., while the second received 100 micrograms fentanyl. Anaesthesia was induced in both groups by 3 mg.kg-1 thiopentone and 1.5 mg.kg-1 succinylcholine was given to facilitate tracheal intubation. Anaesthesia was maintained during the induction-delivery period with nitrous oxide 50% in oxygen.
The umbilical vein PO2 was higher in the fentanyl (34 +/- 5 mmHg) than in the tramadol group (24 +/- 6 mmHg) (P < 0.01), while the UV PCO2 was higher in the tramadol group (50 +/- 5 vs 45 +/- 4 mmHg) (P < 0.01). The Apgar scores at one and five minutes were not different between the two groups. Post operatively, two patients in the tramadol group recalled the crying of their newborn at delivery.
Tramadol is associated with a high incidence of intraoperative maternal recall and can result in lower umbilical vein PO2 and higher PCO2 than in the fentanyl group.
曲马多已被推荐用于经阴道分娩产妇的镇痛。本报告研究了曲马多与芬太尼对在全身麻醉下择期剖宫产分娩新生儿脐静脉（UV）血气和阿氏评分的影响。
40例美国麻醉医师协会（ASA）分级为I或II级的择期剖宫产产妇纳入一项随机双盲研究。患者被分为曲马多组（n = 20）和芬太尼组（n = 20）。在预充氧期间，一组静脉注射100 mg曲马多，另一组静脉注射100 μg芬太尼。两组均用3 mg·kg-1硫喷妥钠诱导麻醉，并给予1.5 mg·kg-1琥珀酰胆碱以利于气管插管。在诱导至分娩期间用50%氧化亚氮和氧气维持麻醉。
芬太尼组脐静脉PO2（34±5 mmHg）高于曲马多组（24±6 mmHg）（P<0.01），而曲马多组UV PCO2较高（50±5 vs 45±4 mmHg）（P<0.01）。两组1分钟和5分钟时的阿氏评分无差异。术后，曲马多组有2例患者回忆起分娩时新生儿的哭声。
曲马多与术中产妇回忆发生率高相关，并且与芬太尼组相比可导致更低的脐静脉PO2和更高的PCO2。
