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Sufentanil transfer in the human placenta during in vitro perfusion
B R Krishna1, M I Zakowski, G J Grant
1Department of Anesthesiology, New York University Medical Center, NY 10016, USA.
Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|September 26, 1997
Summary
Sufentanil crosses the placenta via passive diffusion, with placental tissue acting as a drug depot. Fetal acidosis increases transfer, while maternal plasma proteins decrease it, making sufentanil a potential choice for imminent delivery.
Area of Science:
- Pharmacology
- Obstetrics
- Neonatal Medicine
Background:
- Sufentanil, a potent lipophilic opioid, is utilized for labor and Cesarean section analgesia.
- Potential for neonatal depression necessitates understanding its placental transfer dynamics.
Purpose of the Study:
- To investigate factors influencing the placental transfer of sufentanil in human placentas.
- To elucidate the mechanisms and kinetics of sufentanil transfer across the placenta.
Main Methods:
- Utilized a single-pass (open) in vitro human placental perfusion model.
- Investigated effects of varying sufentanil concentrations and fetal pH on transfer.
- Assessed placental metabolism and impact of maternal protein content using a recirculated (closed) system.
Main Results:
- Sufentanil transfer reached a plateau of 12% by 45 minutes, indicating slow initial transfer due to placental accumulation.
- Placental transfer was reduced by maternal plasma proteins but not by albumin.
- Decreasing fetal pH significantly increased maternal-to-fetal transfer of sufentanil.
Conclusions:
- Sufentanil undergoes passive diffusion and accumulates in the placenta, acting as a drug reservoir.
- Maternal plasma proteins attenuate transfer, whereas fetal acidosis enhances it.
- Low initial umbilical vein concentrations suggest sufentanil's suitability for analgesia when delivery is imminent (within 45 minutes).