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

Abstract

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.

Attenuation of cardiovascular response to direct laryngoscopy and intubation, comparative study of lignocaine, nifedipine, and placebo during general anesthesia

“…1977), abnormal rhythms (Burnstein et al ., 1950, and Kunneral, 1967), and myocardial ischemia (Prys-Roberts, 1971). [15161718]…”

Attenuation of the Pressor Response to Tracheal Intubation in Severe Preeclampsia: Relative Efficacies of Nitroglycerine Infusion, Sublingual Nifedipine, and Intravenous Hydralazine

“…Significant elevations in serum levels of norepinephrine and epinephrine subsequent to the laryngoscopy, with and without tracheal intubation, have been reported ( 22 - 24 ). The pressor response to laryngoscopy and intubation increases myocardial oxygen requirement and risk of cerebrovascular accidents, decreases uterine blood flow, and induces cardiac arrhythmias and pulmonary edema ( 1 , 2 , 5 , 25 ). Many drugs have been used for attenuation of these responses, but their relative efficacies have not been assessed ( 26 , 27 ).…”

“…Consequently, there is an increased risk of morbidity and mortality of both mother and baby ( 5 ). In order to reduce the occurrence and severity of these hemodynamic complications, many drugs such as hydralazine ( 6 ), magnesium sulfate ( 7 ), labetalol ( 8 ), fentanyl ( 5 ), trimethaphan ( 2 ), sodium nitroprusside ( 9 ), lidocaine ( 10 ), nitroglycerin ( 11 , 12 ), and nifedipine ( 13 ) have been used with varying degrees of success. Hydralazine has been the antihypertensive of choice for women with severe hypertension in pregnancy for many years ( 14 , 15 ).…”

Inverted Takotsubo-Like Left Ventricular Dysfunction with Pulmonary Oedema Developed after Caesarean Delivery Complicated by Massive Haemorrhage in a Severe Preeclamptic Parturient with a Prolonged Painful Labour

“…However, in our case, general anaesthesia was chosen because a delay in establishing regional anaesthesia would not be ethically justifiable in an emergency surgery. Instead, we used remifentanil 1.0  μ g/kg to prevent a pressor response to tracheal intubation which is our routine in parturients with severe preeclampsia, since an abrupt increase in arterial pressure, although transient, can lead to cerebral oedema and haemorrhage, and cardiac failure with pulmonary oedema [19]. Remifentanil may be ideally suited for use in obstetrics because of an extremely short duration of its action [20].…”