Hypertensive and Catecholamine Response to Tracheal Intubation in Patients With Pregnancy-Induced Hypertension

Abstract

The pressor and catecholamine responses to laryngoscopy and intubation were studied in nine patients with pregnancy-induced hypertension (PIH) and in eight normotensive controls. Five of the PIH patients had received oral labetalol as antihypertensive therapy. Mean arterial pressure (MAP) increased significantly from the pre-induction value in all groups 1 min after intubation, and also at 3 min in those with PIH who had not received labetalol. Arterial pressure was significantly greater in both PIH groups than in the control group at all times. However, the percentage increase in MAP on intubation was significantly less in the labetalol treated group than in either the untreated or the control groups. There were no significant differences between the groups in plasma concentrations of either noradrenaline or adrenaline; noradrenaline concentration increased significantly after intubation only in the control group. Labetalol appears to confer some protection against the pressor response to intubation in parturients with PIH.

Spinal anesthesia for lower segment Cesarean section in patients with stable eclampsia

“…No ideal pharmaceutical regimen is available to prevent the hemodynamic response to laryngoscopy and intubation, which can precipitate intracranial hemorrhage and pulmonary edema [7,10]. This is in addition to the known risks of general anesthesia in pregnancy (difficult intubation, pulmonary aspiration of gastric contents [10], and impaired intervillous blood supply [6]).…”

“…The clinical spectrum of a patient with eclampsia varies considerably from hemodynamically stable, conscious cooperative women to comatose women with uncontrolled hypertension, anuria, and coagulopathy. It would be illogical to apply general recommendations of anesthetic care to these patients [7][8][9]. General anesthesia may be associated with risks of difficult intubation, aspiration, severe hemodynamic response to laryngoscopy and intubation, and multiple drug interactions [10][11][12].…”

Analytical study of effects of intravenous lignocaine on pressor response during laryngoscopy and intubation

“…These methods include deep general anaesthesia, adrenoreceptor blockers [5][6], calcium channel blockers [7][8], opioids [9][10] and vasodilators [11]. These above mentioned drugs have their own side effects like excess sedation, respiratory depression IJBR (2015) 6 (02) www.ssjournals.com and hypotension.…”

Epidural compared with general anaesthesia for caesarean delivery in conscious women with eclampsia

“…The combination of severe labile hypertension, intravascular volume depletion, and multiple organ dysfunction demands a haemodynamically stable technique. General anaesthesia may be associated with a severe haemodynamic response to laryngoscopy and intubation that might increase the risk of intracranial haemorrhage and pulmonary oedema 3,4 . This is in addition to the known risks associated with general anaesthesia in pregnancy (e.g.…”

“…It would seem inappropriate to apply a general recommendation of anaesthetic care to such a wide clinical spectrum. The use of regional anaesthesia for the otherwise stable eclamptic may avoid the known hazards of general anaesthesia 3,15,16 .…”