Epidural lidocaine for cesarean delivery of the distressed fetus.

Lidocaine with epinephrine and sodium bicarbonate has a rapid onset of action. We therefore wished to compare its use with that of chloroprocaine for urgent cesarean delivery. Thirty parturients for cesarean section under epidural anesthesia were divided into three groups. Group 1 required elective cesarean section and served as the control group for neonatal lidocaine levels. Groups 2 and 3 had been receiving epidural infusions of 0.125% bupivacaine with epinephrine 1:400,000 and required urgent cesarean section. They were randomized to receive either 1.5% lidocaine with epinephrine or 3% chloroprocaine, both with sodium bicarbonate 2 ml in a total volume of 25 ml. All patients had adequate anesthesia and none required supplementation. The time from completion of injection to the achievement of a T4 sensory level was significantly shorter in the chloroprocaine group (3.1 vs. 4.4 min). There were no differences in Apgar scores or Neurologic and Adaptive Capacity Scores between the lidocaine and chloroprocaine groups. Lidocaine was detectable in maternal serum from four of the urgent cases and all of the elective cases. It was detectable in five neonates from the elective group but none from the emergency group. In parturients with preexisting epidural catheters and a baseline epidural infusion to maintain a T10 sensory level, chloroprocaine is faster in onset than lidocaine, but the difference in this study was only 1.3 min, and both agents provided excellent anesthesia.

Anaesthesia with ICI 35,868 monitored by the cerebral function analysing monitor (CFAM).

Ten patients who received bolus doses of the cremophor formulation of ICI 35,868 were monitored using the Cerebral Function Analysing Monitor (CFAM). Visual inspection of the traces obtained showed an easily recognizable pattern which was associated with an increasing depth of anaesthesia. Statistical analysis showed a high correlation between venous blood levels of the drug and changes recorded by the CFAM, although there was marked inter-patient variation. It is suggested that this variation is due to the effect of a time-lag between changes in drug concentration in the brain and venous blood.