Can we give nalaxone to a twins whom their mother got an overdose of spinal local anesthesia ?

Question

A mother was given spinal anesthesia (Marcarine heavy 0.5 (Bupivacaine)) + fentanyl 25 mcg on a cesarean delivery and the babies were premature (less than 36 weeks). They were born on 15-FEB-2007 & today (15-April-2007) there age is 60 days. Can we give them Nalaxone (Narcan) to reduce the effect of opioids if we doubt that this has made them the respiratory depression. The babies (twins-non identical-female&Male) are facing a respiratory depression & they are on intubation. Will the Nalaxone help in removing the effect of the anesthesia overdoe ?

We are really not sure that this is an overdoes. This is only an assumption!

Answer 1

The amount of fentanyl that reaches the mother's systemic circulation from a spinal anesthetic is extremely low. 25mcg is a small dose, even if it was given directly i.v. (which it wasn't). Fentanyl is not your problem.

I seriously doubt that the babies' respiratory problems are related to the fentanyl. It is far more likely that they suffer from immature lungs.

The proper treartment would have been to give the babies betamethasone before delivery, and surfactant immediately after delivery. It is too late for that now.

The babies need intensive care by a neonatologist. Narcan is not going to help them, and may cause problems (it is associated with pulmonary edema in some cases).

Answer 2

If you are not sure this is an overdose, I would reccommend not giving medicine that nay not need be necessary to such small bodies.

I myself am a twin also born prematurely and we had initial respiratory problems, both having been intubated for several days, even weeks in my case. That however does not make me an expert. This is just my personal experience.

While the drugs that were given the mother are powerful, I'm guessing the risks to the children were considered prior to administering them. I would, despite your concerns, let the drugs leave their systems naturally. Throwing more drugs on top may not be the answer. Don't worry...they won't grow up to be junkies!

Answer 3

If they are 60 days old the opiods from an epidural will be long gone from their system. Most likely they simply have underdevelped lungs as a result of being premature. The lungs are always the last thing to mature, and most significantly premature babies will battle respiratory problems at first. Narcan given when you do not need it can cause seizures and it's effect only last for 4 hrs. It is strictly given to battle the immediate effect of opiods, which generally wear off themselves in a matter of hours.

Answer 4

Well I am not an expert but seems like a good idea, since their little bodies can get ride of the anesthetics, is a smart to think that they are still in their system and that is why they have problems breathing. I just know that in neonates Naloxone diminished its blood concentration in half in less than 4 hours, so they will excreat it pretty fast but, it also cause pulmonary edema and respiratory depression. I'll give you that much. It is definetly a neonatologist/pulmonologist/pediatrician/parent call. Hope it helps. Good luck!

Answer 5

a million) My mom and that i observed the comparable application that Nina did. It develop into on "60 minutes." It befell to Dennis Quaid's (the actor) and his spouse's twins. 2) My mom who's managerial nurse and greater effective than properly respected one at that, stated this: "mutually as errors take place "in many cases" (or atleast greater effective than one can think of) porgrams are obtainable to help scientific workers no longer make those errors.

Answer 6

Do you not think a real Doctor needs to be involved in this???

Answer 7

PLEASE DO NOT GIVE ANYTHING AS THIS IS A DANGEROUS SITUATION. ALLOW THE DOCTORS TO PRESCRIBE WHAT THEY KNOW ABOUT.