| Identificación de la parturienta con abuso de múltiples substancias |
Identification of polysubstance abuse in the parturient.
Birnbach DJ, Browne IM, Kim A, Stein DJ, Thys DM.
Department of Anesthesiology and Obstetrics and Gynecology, St Luke's-Roosevelt Hospital Center, College of Physicians and Surgeons of Columbia University, 1000 Tenth Ave., New York, NY 10019, USA.
Br J Anaesth. 2001 Sep;87(3):488-90.
Abstract
Illicit drugs are widely used by inner city patients and their use by pregnant women has increased in recent years. The aim of this study was to determine the prevalence of polysubstance abuse among parturients at our institution who received no prenatal care ('unbooked') and to determine the accuracy of the Ontrak TesTcup an in vitro immunodiagnostic assay. We prospectively analysed urine from 50 'unbooked' parturients and found that 26 (52%) tested positive for cocaine. Of these, six patients (23%) were also positive for morphine. All TesTcup results were confirmed by the hospital laboratory using alternate chemical methods. When comparing TesTcup to the hospital laboratory, there were no false positive or negative results. Given the high frequency of concomitant opioid abuse in cocaine-abusing parturients, anyone suspected of cocaine abuse should be tested for other illicit substances. TesTcup is a clinically accurate test that allows the rapid assessment of several drugs of abuse, which may impact on anaesthetic care
http://bja.oxfordjournals.org/content/87/3/488.full.pdf+html |
| Reducción de la duración de analgesia con sufentanil intratecal en parturientas que usan cocaína |
Reduced duration of intrathecal sufentanil analgesia in laboring cocaine users.
Ross VH, Moore CH, Pan PH, Fragneto RY, James RL, Justis GB.
Department of Anesthesiology, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia, USA. vhross@wfubmc.edu
Anesth Analg. 2003 Nov;97(5):1504-8.
Abstract
On the basis of our previous clinical experience, we hypothesized in this study that the duration and/or quality of labor analgesia produced by intrathecal sufentanil was less in cocaine-abusing parturients compared with nonabusing parturients. Ten micro g of sufentanil was given intrathecally as part of a combined spinal-epidural (CSE) technique to two groups of laboring parturients: 1). those whose urine tested positive for cocaine (cocaine group), and 2). those whose urine tested negative for cocaine (control group). The epidural catheter was not injected with local anesthetic until the patient requested additional pain relief. The time from injection of intrathecal sufentanil until patient request for additional pain relief was defined as duration of analgesia. Baseline visual analog pain score (VAPS) and cervical dilation were measured before the CSE was performed. After injection of intrathecal sufentanil, VAPS was recorded at specific intervals. Cervical dilation was again documented when the patient requested additional analgesia. We found that both groups reported high baseline VAPS and a marked decrease in VAPS after injection of sufentanil that did not differ between groups. Geometric mean duration of pain relief with adjustment for cervical dilation was 87 min in the cocaine group compared with 139 min in the control group (P = 0.019). All patients experienced itching. We conclude that intrathecal sufentanil produces a similar quality but shorter duration of analgesia in cocaine-abusing parturients compared with nonabusing parturients. IMPLICATIONS: Intrathecal sufentanil administered as part of a combined spinal-epidural technique produces similar quality but reduced duration of labor analgesia in cocaine-abusing parturients compared with nonabusing parturients.
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| Madres adictas a cocaína: efectos potenciales en el cuidado materno y el desarrollo infantil |
Cocaine addiction in mothers: potential effects on maternal care and infant development.
Strathearn L, Mayes LC.
The Meyer Center for Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas 77030-2399, USA. lanes@bcm.edu
Ann N Y Acad Sci. 2010 Feb;1187:172-83.
Abstract
Maternal cocaine addiction is a significant public health issue particularly affecting children, with high rates of reported abuse, neglect, and foster care placement. This review examines both preclinical and clinical evidence for how cocaine abuse may affect maternal care and infant development, exploring brain, behavioral, and neuroendocrine mechanisms. There is evidence that cocaine affects infant development both directly, via in utero exposure, and indirectly via alterations in maternal care. Two neural systems known to play an important role in both maternal care and cocaine addiction are the oxytocin and dopamine systems, mediating social and reward-related behaviors and stress reactivity. These same neural mechanisms may also be involved in the infant's development of vulnerability to addiction. Understanding the neuroendocrine pathways involved in maternal behavior and addiction may help facilitate earlier, more effective interventions to help substance-abusing mothers provide adequate care for their infant and perhaps prevent the intergenerational transmission of risk.
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| Sexo por comercio y el uso reciente de drogas inyectables entre mujeres embarazadas dependiente de opiáceos y cocaína bajo tratamiento: el significado de comorbilidad psiquiátrica. |
Recent sex trade and injection drug use among pregnant opiate and cocaine dependent women in treatment: The significance of psychiatric comorbidity.
Cavanaugh CE, Latimer WW.
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Addict Disord Their Treat. 2010 Mar;9(1):32-40.
Abstract
OBJECTIVES: This study examined whether opioid and cocaine dependent pregnant women with psychiatric comorbidity were at elevated risk for infectious disease by virtue of recent sex trade and injection drug use that overlapped with pregnancy. We hypothesized that opioid and cocaine dependent women with psychiatric comorbidity would have greater odds for engaging in recent sex trade and injection drug use. METHODS: Eighty-one, HIV-seronegative pregnant women (59.3% African-American, 37% white, and 3.7% other) who were enrolled in drug treatment in Baltimore, Maryland were recruited into an HIV prevention intervention study, provided informed consent, and attended an in-person, baseline assessment administered by trained clinicians. Assessments included the The Structured Clinical Interview for DSM-IV-TR Axis I Disorders, the HIV Risk Behavior Interview, and a demographic questionnaire. The majority of women had lifetime histories of opioid and/or cocaine dependence (93.8%) and those with an additional lifetime non-substance-related Axis I disorder comprised the psychiatric comorbidity group. RESULTS: Thirty-percent reported recent sex trade and/or injection drug use that overlapped with pregnancy. While psychiatric comorbidity was associated with 6 times the odds of opioid and cocaine dependent pregnant women having recently traded sex it was not associated with recent injection drug use. CONCLUSIONS: Findings underscore the need to (1) treat comorbid psychiatric disorders among pregnant women in treatment for cocaine and opioid dependence and (2) integrate HIV prevention interventions into drug dependence treatment for pregnant women, particularly those with psychiatric comorbidity given their elevated risk for infectious disease.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909669/pdf/nihms117898.pdf |
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