Cesarean Section and Primary Pulmonary Hypertension: The Role of Intravenous Dexmedetomidine

Toyama, Hiroaki; Wagatsuma, Toshihiro; Ejima, Yutaka; Matsubara, Masaki; Kurosawa, Satoshi

doi:10.1097/01.aoa.0000370551.37318.95

Cited by 7 publications

(13 citation statements)

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“…Potentially useful features of dexmedetomidine have expanded the off-label use of the drug outside of the ICU, including adjunctive for spinal and epidural anesthesia for Cesarean section (5-7), sedation for eclampsia (31), anxiolysis during laboring or Cesarean section (32,33). Potential advantages of α 2 -agonists during obstetric practice bring the need to further assess the pharmacological effects and safety of dexmedetomidine on the uterus, placenta and the umbilical circulation.…”

Section: Discussionmentioning

confidence: 99%

In vitro vasoactive effects of dexmedetomidine on isolated human umbilical arteries

Arun¹,

Taylan²,

Duman³

et al. 2019

BLL

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OBJECTIVE: We aimed to investigate the vasoactive effects of dexmedetomidine on isolated human umbilical arteries and possible mechanisms involved. METHODS: Human umbilical artery strips were suspended in Krebs-Henseleit solution and dose-response curves were obtained for cumulative dexmedetomidine before and after incubation with different agents; propranolol, atropine, yohimbine, prazosin, indomethacin, verapamil. Effects of calcium on cumulative dexmedetomidineinduced contractions were also studied. RESULTS: Cumulative dexmedetomidine resulted in dose dependent contraction responses. Incubation with propranolol (Emax: 93.3 ± 3.26 %), atropine (Emax: 92.0 ± 6.54 %), or indomethacin (Emax: 94.25 ± 2.62 %), did not attenuate dexmedetomidine-elicited contractions (p > 0.05). There were signifi cant decreases in the contraction responses of cumulative dexmedetomidine with yohimbine (Emax: 12.1 ± 11.9 %), prazosin (Emax: 28.8 ± 4.6 %) and verapamil (Emax: 11.2 ± 13.6 %) (p < 0.05). In Ca +2 free medium contraction responses to cumulative dexmedetomidine was insignifi cant (Emax: 5.20 ± 3.42 %). Addition of cumulative calcium to the Ca +2 free medium resulted in concentration dependent increase in contractions (Emax: 64.83 ± 37.7 %) (p < 0.05). CONCLUSION: Dexmedetomidine induces vasoconstriction in endothelial-free umbilical arteries via both, α 1and α 2-adrenergic receptors and also extracellular Ca +2 concentrations play a major role. β-adrenergic receptors, muscarinic cholinergic receptors, and inhibition of cyclooxygenase enzyme are not involved in this vasoconstriction

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Section: Discussionmentioning

confidence: 99%

In vitro vasoactive effects of dexmedetomidine on isolated human umbilical arteries

Arun¹,

Taylan²,

Duman³

et al. 2019

BLL

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“…Shah and co-workers [20] used dexmedetomidine (a loading dose of 1 lg kg À1 over 10 min followed by a maintenance infusion at 0.7 lg kg À1 h À1 ) as sedative during awake fiberoptic intubation in pregnant female with history of Klippel-Feil Syndrome with congenital fusion of their cervical vertebrae posted for caesarean section. Toyama and colleagues [21] used dexmedetomidine for attenuation of hemodynamic response during induction and emergence of general anesthesia in pregnant female 32 weeks' gestation with history of primary pulmonary hypertension during caesarean section.…”

Section: Discussionmentioning

confidence: 99%

Intubation stress responses: Pre-anesthetic dexmedetomidine versus fentanyl in pre-eclamptic patients undergoing caesarean delivery: A prospective double blind randomized study

Kalla

Abdullah

Elyazed

2017

Egyptian Journal of Anaesthesia

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Background: The cardiovascular response to laryngoscopy and endotracheal intubation occurs due to sympathetic stimulation. This effect is exaggerated in pre-eclamptic patients. The aim of this study is to evaluate the effects of dexmedetomidine given over 10 min and fentanyl 3 min before induction of anesthesia on the blood pressure and heart rate changes during laryngoscopy and tracheal intubation in sever pre-eclamptic patients, and their effect on the neonatal outcome. Methods: 88 sever pre-eclamptic undergoing elective caesarean section under general Anesthesia, were randomly assigned to receive either Dexmedetomidine (0.5 lg kg À1) over 10 min or fentanyl (1 lg kg À1) 3 min before induction of anesthesia. Systolic, diastolic and mean arterial pressure and heart rate were recorded just before initiating laryngoscopy and tracheal intubation and at 1 min intervals up to 5 min thereafter. The neonatal outcome was assessed by using Apgar score at 1, 5 and 10 min after delivery and analysis of umbilical artery blood gases. Results: Mean arterial pressure was significantly decreased after administration of the Dexmedetomidine from (112.89 ± 5.14) to (101.56 ± 3.89) mmHg, after endotracheal intubation (108.14 ± 3.21), the measured hemodynamic variables remained significantly lower than the baseline values (P < 0.05). In fentanyl group, the mean arterial pressure (118.07 ± 4.05) significantly increased after endotracheal intubation as compared to the baseline values (111.75 ± 5.15) (P < 0.05). Apgar score at 1, 5 and 10 min and umbilical artery blood gases analysis after delivery were statistically insignificant between both groups. Conclusions: Dexmedetomidine given over 10 min before induction of general anesthesia significantly reduced the measured hemodynamic variables compared to baseline values. Dexmedetomidine successfully attenuated the intubation stress response and provided a significant hemodynamic stability more than fentanyl which given 3 min before the induction of anesthesia in sever pre-eclamptic patients. Neither drug was associated with any harmful neonatal outcome. Pan African Clinical Trials Registry (PACTR201508001198128).

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“…Regional anaesthesia may be advantageous, but is not without complications (65). Regional nerve blocks are contraindicated in anticoagulated patients as sympathetic blockade can cause unstable hemodynamics (66,67). Regional anaesthesia for caesarean section may produce a large decrease in venous return because of a large sympathetic block (68).…”

Section: Delivery and Anaesthesiamentioning

confidence: 99%

“…To avoid myocardial depression and hypotension during induction of anaesthesia, some anaesthesiologists choose midazolam and fentanyl, which cause only modest cardiac depression and vasodilatation (66). Dexamedetomide, a central alpha agonist provides pain relief with less effects on hemodynamics during delivery and recovery from anaesthesia (66). Dobutamine administration can be used to help compensate for any negative cardiovascular effects (66).…”

Section: Delivery and Anaesthesiamentioning

confidence: 99%

“…Dexamedetomide, a central alpha agonist provides pain relief with less effects on hemodynamics during delivery and recovery from anaesthesia (66). Dobutamine administration can be used to help compensate for any negative cardiovascular effects (66). Adequate oxygen, slight hypocapnia, adequate anaesthesia level, continuous nitric oxide (NO) inhalation, and infusion of prostacyclin, may all be supportive and help to prevent right heart failure caused by the stress of tracheal intubation and the operation.…”

Section: Delivery and Anaesthesiamentioning

confidence: 99%

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The management of pregnancy and pregnancy-related medical conditions in pulmonary arterial hypertension patients

Hsu¹,

Gomberg‐Maitland²,

Glassner³

et al. 2011

International Journal of Clinical Practice

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Pulmonary arterial hypertension (PAH) is a complex disorder in which pulmonary arterial obstruction leads to elevated pulmonary arterial resistance and right ventricular failure. Normal physiologic changes that occur during pregnancy and immediately postpartum may produce fatal consequence in PAH patients. Pregnancy in patients with PAH has a high maternal mortality, estimated at 30-56%. Contemporary estimates of mortality are better but still prohibitively high. Current guidelines recommend that pregnancy be avoided or terminated early in women with PAH. Some patients, despite counselling by their physician, choose to continue with their pregnancy. In addition, some women first present with PAH during pregnancy leading to complex management issues in a high-risk patient. PAH-specific therapies may allow patients to better tolerate pregnancy. These patients should be treated by experienced physicians at tertiary care centres. This review article will focus on the management of the pregnant PAH patient and the preventative options available for this high-risk cohort.

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Cesarean Section and Primary Pulmonary Hypertension: The Role of Intravenous Dexmedetomidine

Cited by 7 publications

References 0 publications

In vitro vasoactive effects of dexmedetomidine on isolated human umbilical arteries

In vitro vasoactive effects of dexmedetomidine on isolated human umbilical arteries

Intubation stress responses: Pre-anesthetic dexmedetomidine versus fentanyl in pre-eclamptic patients undergoing caesarean delivery: A prospective double blind randomized study

The management of pregnancy and pregnancy-related medical conditions in pulmonary arterial hypertension patients

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