Hydralazine Does Not Restore Uterine Blood Flow during Cocaine-induced Hypertension in the Pregnant Ewe

Vertommen, J. D.; Hughes, Samuel C.; Rosen, Mark A.; Shnider, Sol M.; Espinoza, M. I.; Messer, Cheryl P.; Johnson, Judy L.; Parer, Julian T.

doi:10.1097/00000542-199204000-00015

Cited by 22 publications

(12 citation statements)

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“…For this reason labetalol 16 , which antagonizes ␣ and ␤ adrenergic receptors, and esmolol 17 , the short-acting ␤1 selective antagonist, may be more appropriate agents to use. Hydralazine controls hypertension but does not restore uterine blood flow 18 . Arrhythmias are best treated with the ␤ adrenoceptor antagonists labetalol or esmolol.…”

Section: Discussionmentioning

confidence: 98%

Unrecognized “crack” cocaine abuse in pregnancy

Campbell

Parr

Shutt

1996

British Journal of Anaesthesia

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SummaryWe report a case of "crack" cocaine abuse in a pregnant patient associated with haematuria, proteinuria, haemolytic anaemia, renal impairment, thrombocytopenia and pulmonary oedema. The case illustrates the problems for clinicians where unrecognized cocaine abuse interferes with the diagnosis and management of a complicated pregnancy. In addition, we discuss the principles for the safe conduct of anaesthesia in the pregnant cocaine abuser. (Br. J. Anaesth. 1996;77:553-555) Key words Anaesthesia, obstetric. Complications, cocaine abuse. Pregnancy."Crack" cocaine abuse in pregnancy is well recognized in the USA. In the UK the level of awareness to this increasingly common problem needs to be improved 1 . This case illustrates the difficulties in differentiating the effects of cocaine abuse from the more usual complications of pregnancy. Cocaine has complex effects on many systems. It was not apparent until post-partum that the patient continued to abuse crack cocaine even while an inpatient. In retrospect the relationship between drug abuse and the course of her illness became clear.Crack cocaine abuse increases maternal morbidity, fetal morbidity and death [2][3][4] . It is likely that maternal crack cocaine abuse will be an increasing problem in the UK and at present the clinical effects may not be fully recognized. Case reportA 32-yr old, gravida 5, para 3, Afro-Caribbean woman presented to her general practitioner for antenatal assessment at 10 weeks' gestation. Her haemoglobin concentration was 10.1 g dl 91 and the blood film showed macrocytosis. Cervical and high vaginal swabs were infected with Gonococcus and Trichomonas. Her infection was treated and she attended again at 19 weeks' gestation when urinalysis showed moderate haematuria and mild proteinuria. Arterial pressure was 120/70 mm Hg.She did not attend again until 31 weeks' gestation when she complained of fatigue and dyspnoea on exercise. On physical examination her conjunctivae were pale, arterial pressure was 125/70 mm Hg and she had bilateral pitting oedema of the ankles. Cardiovascular and respiratory system examinations were otherwise unremarkable. Abdominal examination was consistent with a 31-week pregnancy with normal fetal heart sounds and movements. Urinalysis showed excessive blood and moderate protein. The full blood count result a week later showed haemoglobin 6.8 g dl 91, mean cell volume 110 fl and platelets 63 10 9 litre 91, and therefore hospital admission was arranged.In hospital, physical examination revealed an apical ejection systolic murmur. Deep tendon reflexes were normal. Her blood film showed a reticulocyte count of 4.9%. Serum creatinine concentration was 99 mmol litre 91 , which is high for a pregnant patient. Urea and electrolyte concentrations, liver function tests, uric acid and clotting screen were within normal limits. Autoimmune profile, lupus and platelet antibodies and haemosiderin were within normal limits but haptoglobin concentrations were low at 0.2 g litre 91. The 24-h urine volume was 2125 ml and p...

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Section: Discussionmentioning

confidence: 98%

Unrecognized “crack” cocaine abuse in pregnancy

Campbell

Parr

Shutt

1996

British Journal of Anaesthesia

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“…Em gestantes, o fluxo sangüíneo uterino diminui durante a exposição. A hidralazina é utilizada para o tratamento da hipertensão arterial materna, mas não está demonstrado que restaure o fluxo sangüíneo uterino 41 . Em gestantes com eclampsia e pré-eclampsia pode ser muito difícil diferenciar as convulsões causadas pela cocaína.…”

Section: Anestesiaunclassified

“…In pregnant women, uterine blood flow is decreased during the exposure to cocaine. Hydralazine is used for the treatment of maternal hypertension, but it has not been demonstrated that it restores uterine blood flow 41 . It can be very difficult to differentiate convulsions caused by cocaine in pregnant women with eclampsia and preeclampsia.…”

Section: Anesthesiamentioning

confidence: 99%

Anestesia no paciente usuário de cocaína

Luft

Mendes

2007

Rev. Bras. Anestesiol.

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RESUMOLuft A, Mendes FF -Anestesia no Paciente Usuário de Cocaína. JUSTIFICATIVA E OBJETIVOS:A cocaína é a droga ilícita mais freqüentemente associada a óbitos, e suas implicações perioperatórias nos pacientes agudamente intoxicados ou com história de uso crônico precisam ser bem conhecidas pelos anestesiologistas. O conhecimento da neurofisiologia, da farmacologia e das conseqüências fisiopatológicas decorrentes do uso da cocaína poderá facilitar o cuidado desses pacientes. O objetivo deste trabalho foi revisar as informações sobre a cocaína e suas interações com a anestesia. CONTEÚDO:O artigo discute a farmacologia da cocaína, as conseqüências fisiopatológicas decorrentes do seu uso e as interações com a anestesia. CONCLUSÕES:A compreensão e o reconhecimento precoce das complicações associadas ao uso de cocaína são essenciais para o manuseio adequado de pacientes usuários desta droga. O anestesiologista deve estar preparado, pois tanto as anestesias regionais quanto a geral apresentam riscos significativos nesses pacientes. Unitermos: COMPLICAÇÕES: drogas ilícitas; DROGAS: cocaína. SUMMARYLuft A, Mendes FF -Anesthesia in Cocaine Users. BACKGROUND AND OBJECTIVES:Cocaine is the illicit drug most frequently associated with death, and the anesthesiologist should be aware of the perioperative complications of this drug in patients with acute intoxication or with a history of chronic use. The knowledge of the neurophysiology, pharmacology, and physiopathological consequences of cocaine abuse may facilitate the care of these patients. The objective of this work was to review the information on cocaine and its interactions with anesthesia.CONTENTS: This paper discusses the pharmacology, physiopathological consequences of cocaine use, and its interactions with anesthesia. CONCLUSIONS:The knowledge and early recognition of the complications associated with the use of cocaine are essential for the adequate management of cocaine users. The anesthesiologist should be prepared because both regional and general anesthesia carry significant risks in those patients.

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“…73 The pathogenesis of cocaine-related myocardial ischemia is multi-factorial and includes an increased myocardial oxygen demand in the face of a fixed or limited supply caused by pronounced vasoconstriction of the coronary arteries and enhanced platelet aggregation and thrombus formation. 6 Although thrombi are not the only cause of cocaine-induced myocardial infarction, thrombolytic therapy has been used successfully to dissolve intraluminal coronary thrombi in patients with acute infarction temporaly related to cocaine use.…”

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“…73 The mechanism of action of this drug includes vasodilation and a decrease in systemic vascular resistance, leading to reflex tachycardia, which may not always be desirable in the patient who is already tachycardic from cocaine intake. 73 Labetalol, a combined non-selective beta and alpha-adrenergic blocker rapidly restores blood pressure without affecting heart rate or uterine blood flow and has been recommended by many in cocaine toxicity. 74,75 Gay et al reported the successful management of hypertensive cocaine crises with the administration of labetalol.…”

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confidence: 99%

The cocaine abusing parturient: a review of anesthetic considerations

Kuczkowski

2004

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : The prevalence of recreational drug abuse among young women, including in pregnancy, has increased markedly over the past two decades. Cocaine remains the drug commonly used for recreational purposes in pregnancy. However, there appears to be an absence of uniform guidelines for obstetric and anesthetic management of pregnant patients with a history of cocaine abuse.S So ou ur rc ce e: : A Medline search for articles highlighting drug abuse in pregnancy, with particular emphasis on cocaine abuse in pregnancy, the drug's impact on the fetus and implications for administration of obstetrical anesthesia was performed.M Ma ai in n f fi in nd di in ng gs s: : Because the pharmacological actions of cocaine are complex, the clinical picture can be very unpredictable, the diagnosis often difficult, and management at times controversial. The diverse clinical symptomatology of cocaine intake combined with physiologic changes of pregnancy, and pathophysiology of coexisting pregnancy specific disease may lead to life-threatening complications and significantly impact the management of obstetrical anesthesia.C Co on nc cl lu us si io on ns s: : In the absence of uniform anesthetic guidelines for pregnant patients with a history of cocaine abuse the decision regarding the administration of peripartum analgesia or anesthesia should be individualized and conducted on a case-by-case basis. This article will attempt to heighten the awareness of cocaine use and abuse in pregnancy and review the perioperative anesthetic management of these high-risk parturients. Objectif : La prévalence d'abus occasionnel de drogues par les jeunes femmes, incluant les femmes enceintes, a beaucoup augmenté pendant les deux dernières décennies. La cocaïne est la

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Hydralazine Does Not Restore Uterine Blood Flow during Cocaine-induced Hypertension in the Pregnant Ewe

Cited by 22 publications

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Unrecognized “crack” cocaine abuse in pregnancy

Unrecognized “crack” cocaine abuse in pregnancy

Anestesia no paciente usuário de cocaína

The cocaine abusing parturient: a review of anesthetic considerations

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