[Influence of fetal position on respiratory function and its modification by epidural anesthesia in supine pregnant women].

We investigated the influence of fetal position on respiratory function and its modification by epidural anesthesia in supine pregnant women. We found that supine pregnant women in whom the fetus was in the right occipital anterior position (ROA) had lower inspiratory reserve volume (IRV) and vital capacity (VC) than controls in whom the fetus was in the left occipital anterior position (LOA). When the analgesic level was up to Th7 or lower, epidural anesthesia increased the VC of women with a ROA fetus and also increased IRV. With higher analgesic levels up to Th4-Th6, tidal volume (TV) and VC increased independently of fetal position. We speculate that the pressure caused by the ROA fetus on thorax of the mother is stronger and that after epidural anesthesia this pressure decreases even though the analgesic level is low, and with the analgesic level up to Th4-Th6, the level used for Cesarean section, the displacement of the uterus makes respiration during rest easier regardless of fetal position.

[Efficacy and side effects of epidural opioids depending on the site of surgery].

We reported the requirement of supplemental analgesics following epidural opioids including Opial 5mg and 10mg, and morphine HCl 2.5mg, for 24 hours in postoperative period after surgery of body surface, and lower and upper abdominal surgeries. Incidence of their side effects was also observed. Opial contains 50% morphine HCl and other opioids such as codeine, thebaine, papaverine, and noscapine etc. After upper abdominal surgeries, patients required additional analgesics more frequently. Kinds and doses of opioids used, suggest that epidural administration of other opioids contained in Opial has some analgesic effect. After the surgery of body surface the opioid requirement may be influenced by the intraoperative anesthetic technics and the state of mind of the patient. Urinary retention was the most interesting side effect observed and our data suggest that papaverine contained in Opial may have favorable effect and morphine HCl may have adverse effects regarding its incidence.