Abstract
Twenty severely pre-eclamptic patients requiring caesarean section for delivery were allocated to two groups. One group received epidural anaesthesia consisting of either 20 ml of bupivacaine 0.75 per cent at L3-4 or 12ml at Ll-2. The other group received general anaesthesia consisting of thiopentone, 40 per cent nitrous oxide and halothane 0.5 per cent. Mean arterial pressure (MAP), pulmonary artery pressure (PAP), pulmonary wedge pressure (PWP), and central venous pressure (CVP) were recorded at five-minute intervals for at least 60 minutes before operation and at least every two minutes during anaesthesia. Patients receiving general anaesthesia had pressures recorded every minute during tracheal intubation and extubation. There was a mean increase of MAP of 45 mm Hg, of PAP 20 mm Hg, and PWP 20mm Hg during intubation and extubation. Apart from a slight mean fall in MAP the parturients receiving epidural anaesthesia showed little change in these cardiovascular parameters.
It is concluded that tracheal intubation of patients with gestational hypertension produces an increase in MAP, PAP, and PWP which can lead to a significant risk of cerebral haemorrhage and pulmonary oedema. The value and dangers of using short-acting hypotensive agents to prevent these episodes of hypertension has still to be assessed. With epidural anaesthesia there is a danger of hypotension which can be treated with intravenous fluid replacement and ephedrine.
Résumé
Vingt patients en pré-éclampsie grave ont été divisées au hasard en deux groupes avant ľaccouchement par césarienne. Celles du premier groupe ont été opérées sous péridurale (20 ml de bupivacaïne à 0.75 pour cent injectés à L3 L4 ou 12 ml du même agent à L1, L2). Une anesthésie générale (thiopental, protoxyde ďazote à 40 pour cent et halothane à 0.5 pour cent) a été administrée aux patients du second groupe. La pression artérielle moyenne, la pression de ľartère pulmonaire, la pression capillaire bloquée et la pression veineuse centrale, ont été enregistrées aux cinq minutes durant au moins une heure avant ľintervention et au moins aux deux minutes durant ľanesthésie. On a effectué les mesures aux minutes au cours de ľintubation et de ľextubation chez les patientes soumises à une anesthésie générale. Au cours de ľintubation et de ľextubation, on a observé des élévations moyennes de 5.99 kPa (45 mm Hg) de la pression systémique moyenne et de 2.66 kPa (20 mm Hg) dans les cas de la pression de ľartère pulmonaire et de la pression capillaire bloquée. On n’a observé qu’une légère diminution de la pression systémique moyenne chez les patientes opérées sous péridurale.
Donc, on retiendra que ľintubation trachéale chez les malades présentant une hypertension gravidique produit une élévation des pressions systémiques moyenne, pulmonaires et capillaires, avec un risque significatif ďhémorragie cérébrale et ďœdème aigu du poumon. Les avantages et les dangers liés à ľusage ďhypotenseurs ďaction courte restent à évaleur chez ces malades. Un dangerďhypotension existe avec ľanesthésie péridurale, hypotension qui se traite avec une charge liquidienne et ľéphédrine.
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Read at the joint meeting of the Obstetrical Anesthetists Association and the Society of Obstetric Anesthesia and Perinatology, Birmingham, England, October 1979.
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Hodgkinson, R., Husain, F.J. & Hayashi, R.H. Systemic and pulmonary blood pressure during caesarean section in parturients with gestational hypertension. Canad. Anaesth. Soc. J. 27, 389–394 (1980). https://doi.org/10.1007/BF03007461
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DOI: https://doi.org/10.1007/BF03007461