Anaesthetic management of labour and delivery in a woman taking long-term MAOI.

A case is presented of a woman who, for six years, had been treated for depression with 45 mg daily of the monoamine oxidase inhibitor (MAOI), phenelzine, and who continued taking the drug throughout her pregnancy and labour. Well-documented and potentially fatal interactions between MAOIs and opioids, notably meperidine, meant that her labour analgesia needed careful planning. Opioid- and epinephrine-free epidural bupivacaine analgesia was instituted early with small increments of bupivacaine 0.25% to produce a T10 block, after which an infusion of 8 ml.hr-1 bupivacaine 0.125% was used to maintain analgesia. After 14 hr labour, the epidural was extended uneventfully to allow Caesarean section to be performed for failure to progress. Pressor agents were avoided as indirect-acting drugs can produce severe hypertension. The child appeared normal and the mother had an uncomplicated postoperative course. Epidural analgesia contributed to the safe conduct of labour and Caesarean delivery.