Abstract
We present two cases of automatic hyperreflexia (AH) during labour in women with spinal cord damage, in whom AH developed before and after delivery. The AH was successfully controlled using epidural anaesthesia in Case #1, but failed in Case #2. The blood pressure was controlled with nicardipine. However, overdose of nicardipine produces vasodilatation and its side effects include headache, flushing and palpitation similar to AH1. Considering these effects, we recommend epidural anaesthesia to control AH, because epidural anaesthesia does not only reduce BP, but also blocks the noxious stimuli and relieves the symptoms of AH. Our experience suggests that the epidural catheter can be placed two to three weeks before the date of predicted childbirth, because the onset of labour in a patient with spinal cord damage is difficult to predict and can proceed very rapidly. Also, the epidural catheter is available after the delivery. We recommended the epidural catheter is maintained for 24–48 hr postpartum.
Résumé
Les auteurs présentent deux cas d’hyperréflexie autonome (HA) survenue pendant le travail de parturientes souffrant de lésion de la moelle épinière. Dans un cas, l’HA est apparue avant l’accouchement, et dans l’autre, après l’accouchement. Dans le premier cas, l’HA a été contrôlée efficacement avec une anesthésie épidurale. Dans le deuxième, on a réussi à contrôler la pression artérielle (PA) avec de la nicardipine. Cependant, une surdose de nicardipine a produit, comme il survient au cours de l’HA, une vasodilatation et des effets secondaires dont de la céphalée, des rougeurs et des palpitations. A cause des effets secondaires de la nicardipine, les auteurs recommandent l’anesthésie épidurale pour le contrôle de l’HA, parce que l’anesthésie épidurale ne contrôle pas seulement la PA, mais bloque aussi les stimuli nocifs et atténue les symptômes de l’HA. Les auteurs suggèrent d’insérer le cathéter épidural deux ou trois semaines avant la date prédite de l’accouchement, parce que le début du travail est difficile à prédire chez les patientes qui souffrent d’une lésion de la moelle épinière et parce qu’il peut se dérouler très rapidement. De plus le cathéter épidural reste disponible après l’accouchement. Les auteurs recommandent le maintien du cathéter pendant les 24 à 48 heures du postpartum.
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Kobayashi, A., Mizobe, T., Tojo, H. et al. Autonomic hyperreflexia during labour. Can J Anaesth 42, 1134–1136 (1995). https://doi.org/10.1007/BF03015101
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DOI: https://doi.org/10.1007/BF03015101