BACKGROUND: There is a widespread belief that spinal anaesthesia in patients with preeclampsia might cause severe hypotension and decreased uteroplacental perfusion. This study aimed to evaluate the incidence and severity of spinal induced-hypotension in preeclamptics and healthy parturients.
METHODS: Total of 78 patients (40 healthy and 38 preeclamptic) undergoing a C-Section with spinal anaesthesia were included. Spinal anaesthesia was performed with a mixture of 8-9 mg isobaric 0.5% bupivacaine, 20 mcg fentanyl and 100 mcg morphine (total volume 2.2-2.4 ml). Blood pressures (BP)-SBP, DBP, MAP were recorded non-invasively before performing spinal anaesthesia and at 2.5 minutes after a spinal puncture.
RESULTS: The BP falls (%) from baseline were significantly greater in the healthy parturients compared to those with preeclampsia (25.8% ± 10.1 vs 18.8% ± 17.0 for SBP, 28.5% ± 8.8 vs 22.5% ± 10.4 for DBP, and 31.2% ± 14.2 vs 18.2% ± 12.6% for MAP, p < 0.05). The incidence rate of hypotension in the preeclamptics was 25% compared to 53% in healthy parturients (p < 0.001). Higher doses of vasopressors both ephedrine (16.5 ± 8.6 vs 6.0 ± 2.0 mg) and phenylephrine (105 ± 25 mg) in the healthy women were required. There was no need for phenylephrine treatment in the preeclamptic group.
CONCLUSION: This study showed that the incidence and severity of spinal-induced hypotension in preeclamptic patients are less than in healthy women. The use of low dose spinal anaesthesia also contributed to this statement.
Amifostine is a relatively new organic cytoprotective drug that is actually a prodrug aimed at reduction of cumulative renal toxicity induced by cisplatin repeated administration. The mechanism of amifostin nephroprotective effects has still not been clarified, but it is considered that this medicine has direct cytoprotective effect on kidney tubuli. The main aim of this study was to reveal the effect of amifostin in prevention of nephrotoxicity induced experimentally with long-term administration of cysplatin at dose of 2 mg/kg/b.w./per week during a period of 8 weeks. The results obtained have shown that amifostin, although not completely, but largely reduces nephrotoxicity induced with long-term administration of cisplatin.
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