Fentanyl-Droperidol Supplementation of Rapid Sequence Induction in the Presence of Severe Pregnancy-Induced and Pregnancy-Aggravated Hypertension

Dose-related attenuation of cardiovascular responses to tracheal intubation by intravenous remifentanil bolus in severe pre-eclamptic patients undergoing Caesarean delivery

“…2 3 The abrupt increase in arterial pressure, although transient, can lead to cerebral oedema and haemorrhage, and cardiac failure with pulmonary oedema, increasing morbidity and mortality in both the mother and child. 4 In addition, an increase in maternal plasma catecholamine concentrations at the induction of anaesthesia for Caesarean delivery can cause uteroplacental vasoconstriction and hence adversely affect the neonate. 5 -8 Therefore, close control of stress responses during induction of anaesthesia for Caesarean delivery can have both fetal and maternal benefits in preeclamptic patients.…”

Nifedipine attenuates the hypertensive response to tracheal intubation in pregnancy-induced hypertension

“…~,2 Transient but severe hypertension during tracheal intubation has been associated with increased maternal intracranial pressure, cerebral haemorrhage and cardiac failure with pulmonary oedema, resulting in increased morbidity and mortality in both mother and child. 3 Various drugs and techniques have been used to attenuate these haemodynamic responses but none has been shown to be superior. Nifedipine, a calcium channel blocker has been used in the management of non-gravid hypertension both acutely 4 and in the long term.…”

Anesthetic considerations in HELLP syndrome

“…General anesthesia in these patients is at high cardiovascular risk and may cause a cardiovascular response disproportionately with intubation by producing cerebral hemorrhaging and an edema, or cardiovascular decompensation by causing a pulmonary edema and, therefore, increases materno‐fetal morbidity and mortality . In addition, a disproportionate pressor response to intubation may increase the concentration of circulating plasmatic catecholamines in the mother, which could be harmful for uteroplacental blood flow …”