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The pressor and catecholamine responses to laryngoscopy and intubation were studied in nine patients with pregnancy-induced hypertension (PIH) and in eight normotensive controls. Five of the PIH patients had received oral labetalol as antihypertensive therapy. Mean arterial pressure (MAP) increased significantly from the pre-induction value in all groups 1 min after intubation, and also at 3 min in those with PIH who had not received labetalol. Arterial pressure was significantly greater in both PIH groups than in the control group at all times. However, the percentage increase in MAP on intubation was significantly less in the labetalol treated group than in either the untreated or the control groups. There were no significant differences between the groups in plasma concentrations of either noradrenaline or adrenaline; noradrenaline concentration increased significantly after intubation only in the control group. Labetalol appears to confer some protection against the pressor response to intubation in parturients with PIH.

Twenty-six patients manifesting severe pregnancy-induced (PIH) or pregnancy-aggravated (PAH) hypertension who presented for emergency Caesarean section under general anaesthesia were studied. All patients came from a previously identified high risk group--namely greater than 25 yr, multiparous and with diastolic arterial pressures sustained at greater than 120 mm Hg. Our standard accelerated induction technique for the management of severely hypertensive mothers was modified to include the use of fentanyl and droperidol before induction. This modification of the induction sequence produced a clinically significant amelioration of the reflex sympathetic hypertensive response to laryngoscopy and intubation in most mothers receiving antihypertensive therapy, without apparent deleterious effect in the immediate postoperative period to those neonates unaffected by intrauterine asphyxia.

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