Transfer and uptake of alfentanil in the human placenta during in vitro perfusion.

Alfentanil, a short-acting lipophilic opioid, is used for labor analgesia and cesarean section and may cause neonatal depression. However, direct placental alfentanil transfer has not been studied. We measured placental alfentanil transfer and uptake during in vitro perfusion. Placenta lobules from healthy parturients were perfused with biophase at pH 7.4, 95%:5% O2:CO2. Maternal to fetal (MTF, n = 10) and fetal to maternal (FTM, n = 10) transfer were examined during perfusion with alfentanil 10 ng/mL, antipyrine, and creatinine for 1 h. Thereafter, both MTF and FTM placentas were assayed for alfentanil content (n = 3), or perfused with biophase for 1 h to determine drug washout and then assayed for alfentanil content (n = 3). After the 1 h washout, the remaining MTF placentas (n = 4) were then perfused MTF with high-dose alfentanil 1000 ng/mL to assess saturability of placental transfer. The remaining FTM placentas (n = 4) were then perfused with alfentanil 10 ng/mL in the MTF direction to verify that the same alfentanil transfer characteristics found between placentas were valid when the direction of drug transfer was reversed in the same placenta. Alfentanil was rapidly transferred (< 5 min) across the placenta both MTF and FTM. During MTF transfer, fetal effluent reached a plateau at 2.2 ng/mL between 35 and 55 min, and was unmeasurable 30 min into washout. During FTM transfer, maternal effluent reached a plateau at 1.9 ng/mL at 25-45 min, and was absent after 20-45 min of washout.(ABSTRACT TRUNCATED AT 250 WORDS)