Haemodynamic responses to laryngoscopy and intubation in patients with pregnancy-induced hypertension: effect of intravenous esmolol with or without lidocaine

Bansal, Sujesh; Pawar, Mridula

doi:10.1054/ijoa.2001.0918

Cited by 40 publications

(25 citation statements)

References 20 publications

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“…This response is dramatically intensified in pre-eclamptic and eclamptic patients; therefore, efforts need to be made to try to attenuate this response and prevent such complications as cerebral hemorrhage and cardiac failure with pulmonary edema. 18 Fifty-four percent (34/63) of deaths from pre-eclampsia and eclampsia from 1999 to 2008 were caused by intracranial hemorrhage. 1 It is not known from the literature source if laryngoscopy contributed to the hemorrhages from 2006 to 2008; however, there are cases reported from 2003 to 2005 where there were significant rises in blood pressure postintubation and these women had radiological evidence of intracranial hemorrhage and subsequently died.…”

Section: Discussionmentioning

confidence: 99%

“…Recommended drugs in addition to an induction agent and a depolarizing muscle relaxant to reduce the intubating response include esmolol 1.5 mg/kg, esmolol 1 mg/kg, lidocaine 1.5 mg/kg, or an opioid such as remifentanil. 18,20,21 Whichever drug the anesthesiologist uses, it is important that they are familiar with the drug in terms of onset time and desired effect and are not using it for the first time in an event when precise timing in relation to laryngoscopy is critical. Extubation is also a critical time when drug modification(s) need to be considered to avoid an acute rise in blood pressure.…”

Section: Discussionmentioning

confidence: 99%

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Simulation Study Assessing Healthcare Provider’s Knowledge of Pre-Eclampsia and Eclampsia in a Tertiary Referral Center

Hilton

Daniels

Carvalho

2016

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare

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Our results show widespread magnesium sulfate utilization; however, the use of antihypertensive medication is not universally administered in compliance with current guidelines. The importance of blood pressure management to reduce maternal morbidity and mortality in the setting of pre-eclampsia needs to be emphasized. Interestingly, availability of a cognitive aid did not ensure its utilization in this scenario. Findings suggest that for cognitive aids to be effectively used, it is essential that staff has been trained and become familiar with them before an emergent event.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Simulation Study Assessing Healthcare Provider’s Knowledge of Pre-Eclampsia and Eclampsia in a Tertiary Referral Center

Hilton

Daniels

Carvalho

2016

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare

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show abstract

“…Various drugs have been deployed including topical and intravenous lidocaine, narcotics, inhaled anesthetics, magnesium sulfate, beta adrenergic blockers, vasodilators, and alpha agonists. [ 5 6 7 8 ] The search for the perfect premedication is ever important. All the drugs being used have their own positive and negative aspects.…”

Section: Discussionmentioning

confidence: 99%

Premedication dilemmas, is Pregabalin the answer?

et al. 2015

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Objective:Laryngoscopy and intubation are associated with sympathetic stimulation which can prove deleterious in patients with cardiovascular compromise; so, various methods have been tried to obtund this pressor response. In this study, we have assessed the efficacy of pregabalin in attenuating the pressor response to laryngoscopy and intubation.Methods:This prospective randomized study included 80 patients with American Society of Anesthesiologists physical status grades I-II, in the age group of 18–60 years of age. The patients were randomized into two groups of 40 patients each. Group A received the placebo orally, 90 min prior to surgery. Group B received 150 mg of pregabalin orally, 90 min prior to surgery. These patients were assessed in terms of sedation with Ramsay sedation scale (RSS). In the operation theatre, the heart rate (HR), systolic blood pressure, diastolic blood pressure, mean arterial pressure, and oxygen saturation recorded at baseline and 1, 3, 5, and 10 min after intubation. The rate pressure product (RPP) was calculated for these time intervals. In the postoperative period, patients were assessed for complications like dizziness, nausea, and blurred vision. Statistical analysis was performed using Chi-square and ANOVA tests.Findings:The group receiving 150 mg of pregabalin as premedication was found to be adequately sedated at 1 h post-premedication with 52% patients having a RSS score of 3 compared to 4% with the same RSS score in the placebo group (P < 0.0001). Hemodynamics was more stable post-intubation with significant stability in the HR (P = 0.002) and RPP (P = 0.004) in the pregabalin group.Conclusion:Pregabalin when given as a premedication provides adequate sedation and obtunds the pressor response seen with intubation.

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“…It was reported that uterine contractions might decrease the flow in the umbilical cord, and might lead to bradycardia and hypoglycaemia in the neonate (3,7). The use of esmolol, a short acting b blocker, in pregnant women is controversial (13). Nitroglycerin, labetalol and hydralazine are being mentioned among the antihypertensive agents that can be used; however, sodium nitroprusside is not recommended as it can lead to cyanide toxicity in foetus (7).…”

Section: Discussionmentioning

confidence: 99%

Anaesthesia for Caesarean Delivery in a Pregnant with Acute Type B Aortic Dissection

Kayhan¹,

Gülhaş²,

Şahin³

et al. 2013

Turk J Anesth Reanim

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Case Report 178About 50% of aortic dissections in women younger than 40 years occur during pregnancy; mostly in the 3rd trimesters and postpartum period. Aortic dissection in pregnancy creates a serious mortality risk for both mother and the foetus. The ultimate goal is to ensure the safety of both the mother and the foetus. In such cases, the best method of anaesthesia for caesarean delivery is still controversial. The first aim of anaesthetic management is to reduce the effect of cardiovascular instability on the dissected aorta. Here, we report the anaesthetic management of a 36 year-old pregnant woman who developed acute type B aortic dissection in the 30 th gestational weeks and scheduled for caesarean section. Since hemodynamic stability could not be achieved despite nitro-glycerine and esmolol infusions, together with invasive arterial monitoring, the decision for caesarean delivery was taken. A team of Cardiovascular Surgeons and an operating room were prepared because of the risks of aortic rupture and hemodynamic collapse during operation. Combined-spinal epidural anaesthesia was administered using 5 mg hyperbaric bupivacaine and 20 μg fentanyl given at the L3-4 spinal level in the side lying position. After achieving T4 sensory block level, the operation proceeded and a baby weighing 1432 grams was delivered in 4 min with a median subumbilical incision. Epidural patient controlled analgesia was applied to the patient during follow-up with medical treatment at postoperative period. In pregnant women with acute Type B aortic dissection, if adequate sensory block level cannot be achieved despite using a combination of low dose local anaesthetic (spinal use) and opioids, we are in the opinion that combined spinal-epidural anaesthesia, which allows the use of additional doses can be a decent choice.

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Haemodynamic responses to laryngoscopy and intubation in patients with pregnancy-induced hypertension: effect of intravenous esmolol with or without lidocaine

Cited by 40 publications

References 20 publications

Simulation Study Assessing Healthcare Provider’s Knowledge of Pre-Eclampsia and Eclampsia in a Tertiary Referral Center

Simulation Study Assessing Healthcare Provider’s Knowledge of Pre-Eclampsia and Eclampsia in a Tertiary Referral Center

Premedication dilemmas, is Pregabalin the answer?

Anaesthesia for Caesarean Delivery in a Pregnant with Acute Type B Aortic Dissection

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