A new born child developed respiratory depression in neonatal ward. Which of the following drug is the cause aEUR'
Opioids Epidural opioid (fentanyl) analgesia is commonly employed as a therapeutic modality in the management of pain during labour. The general perception is that administered drugs remain in the maternal epidural space and do not compromise the respiratory status of the newborn. Contrary to the widely held belief fentanyl diffuses freely from the epidural space into the maternal blood because of its high lipid solubility. Equilibrium is reached within 10-30 min. The drug is freely transpoed across the placenta with a slightly higher concentration in the, fetal compament because of a comparative acidic pH. There is no consensus on the dose of fentanyl causing respiratory depression in the newborn period. However, it appears that neonates are prone to respiratory depression at a lower concentration because of the immaturity of the respiratory centre. According to the Cochrane analysis Morphine, meperidine and fentanyl are the opioids that have been studied the most in labour analgesia research. These opioids as well as newer alternatives, such as nalbuphine have been associated with newborn respiratory depression at bih. - Opioids are known for their high lipid solubility which allows rapid transfer of the drug through the placenta and into the fetus. - The risk of respiratory depression is highest if bih occurs at the time of peak fetal uptake between 1-4 hours after administration of drug to the mother. - Repeated doses of opioids results in significant .fetal exposure and neonatal respiratory depression. Opioids are also used in neonates for pain management - They are the mainstay of pain management in newborn. - In newborns the clearance is diminished and elimination half lives are prolonged as compared to adults because of the immaturity of hepatic cytochrome system of the neonates. - Therefore opioid administration may result in opioid accumulation and respiratory depression.
Opioids
Barbiturates
Diazepam
Propofol