الفهرس 
Vertebral Column AnatomyOnly 14 pages are availabe for public view
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Abstract
The deep concern of anesthesiologists is to provide a state of the art analgesia for labor process,
which has the features of being painless, and devoid of any maternal or fetal complications.
Although most parturients are young and healthy, they are still considered as a potentially high
risk group patients. from that point of view the anesthetic strategy for a parturient is
fundamentally based on the precise understanding of both the maternal and fetal physiological
aspects.
Regional, analgesia especially epidural anesthesia is considered to be one of the most popular and
safe techniques for obstetric anesthesia in our modem practice.
The goal of modem epidural analgesia in labor is to achieve an optimum sensory blockade without
disturbing motor blockade.
The problems encountered with the currently available local anesthetics such as, cardiovascular and
central nervous ·system complications were the motive for developing ROPIVACAINE.
Ropivacaine is a new aminoamide local anesthetic; the monohydrate of the hydrochloride salt of
1-propyl-2,6- pipecoloxylidide and is prepared as the pure S-enantiomer. ropivacaine possess some
structural similarity with bupivacaine, with a less intense motor blockade characteristics.
It has a lower toxic profile and an intermediate depressant action on the Vmax of cardiac papillary
muscle and Purkinje fibers.
The potency of ropivacaine in terms of sensory and motor blockade has been determined in clinical
use. In equivalent doses, ropivacaine and bupivacaine have a similar degree of sensory block with a
favorable lower motor blocking profile observed with ropivacaine. The higher degree of differential
block demonstrated in ropivacaine, when used in central neural blockade (e.g. lumbar extradural
block) made the drug a good substitute for bupivacaine in cases of obstetric extradural analgesia.
Its use in central neural blockade emphasized its effectiveness in both surgical analgesia and
postoperative pain control.
Ropivacaine readily crosses the placenta. The degree of plasma protein binding in the fetus is less
than that of the mother, resulting in lower plasma concentration in the fetus.
Ropivacaine is extensively metabolized m the liver, predominantly by aromatic hydroxylation
mediated by cytochrome P4501A. The major metabolite is 3-hydroxy ropivacaine.
One of the effective methods for evaluating the newborn is the neuroadaptive capacity scoring
system, which helps in meticulous evaluation for the effects of anesthetic medications in order to
detect central nervous system depression from drugs used with delivering parturient. Also to
differentiate these effects from those found after birth trauma and perinatal asphyxia.