Randomized Comparison of General and Regional Anesthesia for Cesarean Delivery in Pregnancies Complicated by Severe Preeclampsia

Wallace, Don; Leveno, Kenneth J.; Cunningham, F. Gary; Giesecke, A. H.; Shearer, Vance E.; Sidawi, J. E.

doi:10.1016/0029-7844(95)00139-i

Cited by 203 publications

(79 citation statements)

References 19 publications

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“…산화질소는 강력한 혈관 확장물질로서 임신 시에 산화질소는 태아-태 반 관류에서 혈압을 낮게 유지하는 데 필요하다 [3]. 자간전증 환자에서 NOS가 감소하여 산화질소의 생성이 감소할 거라고 예측하였지만 [4] 다 른 연구에서는 보상기전에 의해서 산화질소는 오히려 증가하고 [5] 증가 한 산화질소는 활성화되지 않는다고 보고하였다 [6]. 이러한 보고들은 산화질소의 부족이 자간전증의 원인일 거라고 생각 했던 많은 가설들과는 다른 결과여서 산화질소가 자간전증에 미치는 영 향에 대해서는 추가적인 연구의 필요가 요구된다.…”

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Gene expression ofheme oxygenase-1andnitric oxide synthaseon trophoblast of preeclampsia

Choi

Hwang

et al. 2011

Korean J Obstet Gynecol

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ObjectiveThe aim of this study was to evaluate the gene expression of heme oxygenase-1 (HO-1), inducible nitric oxide synthase (iNOS) and endothelial nitric oxide synthase (eNOS) in placenta of preeclampsia. MethodsPlacenta were obtained from women with normal pregnancies (n=15) and severe preeclamptic (n=15) after informed consent and under the approval of IRB of Kangwon National University Hospital. The severe preeclampsia was diagnosed as high blood pressure and proteinuria. High blood pressure was defi ned as systolic blood pressure of >160 mm Hg or diastolic pressure of >110 mm Hg and proteinuria was defi ned as urine protein of >2 g/24 hr. We investigated mRNA expression of HO-1, iNOS and eNOS in both groups by real time polymerase chain reaction and immunohistochemistry. The Student's t-test was used for statistical analysis with SPSS ver. 12.0. P<0.05 was considered to be statistically signifi cant. ResultsThere were no signifi cant differences in maternal age (P=1.181) and gestational age (P=0.30) between the two groups. Fetal birth weight from women with preeclampsia was signifi cantly lower than that from normal pregnant women (P=0.002). We detected differences in mRNA expression of placenta between both groups. Expression of HO-1 was decreased in placenta of preelamptic pregnancies compared to that from normal. However, expression of iNOS and eNOS was higher in preeclamptic group compared to normal. ConclusionWe suggest that preeclampsia is associated with a decreased expression of HO-1 and increased expressions of iNOS and eNOS in placenta.

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Gene expression ofheme oxygenase-1andnitric oxide synthaseon trophoblast of preeclampsia

Choi

Hwang

et al. 2011

Korean J Obstet Gynecol

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“…Both spinal & epidural were avoided in women with severe pre-eclampsia & eclampsia and most investigators advocate general anaesthesia 4 . Randomised comparison of general anaesthesia & regional anaesthesia for caesarian delivery in pregnancies complicated by severe preeclampsia & eclampsia has been done with appreciable results 5 . But there is lack of studies on caesarean section of eclamptic patients under subaracnoid block.…”

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confidence: 99%

Randomised Comparison of General Anaesthesia & Subarachnoid Block for Caesarean Delivary in Pregnancies Complicated by Eclampsia

Basu¹,

Begum

Karim³

et al. 2009

j Bangladesh Soc Anaesthesiologists

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General anaesthesia & subaracnoid block were used randomly in women with eclampsia who required caesarian delivery to evaluate the maternal and foetal effects of the two anaesthetic methods. The haemodynamic parameters, level of consciousness of the mothers and APGAR scores of the neonates were assessed. A total 60 women with eclampsia underwent caesarean section were allocated randomly received either of the techniques. Both the techniques provided good quality anaesthesia. At arrival in OT, there was no significant difference of MAP between two groups. But following induction there developed significant difference between two groups & within the same group. There was no significant difference of neurological status between two groups within 24 hours after operation. There were significant difference of Apgar scores in 1 min. after birth & at 5 min. no significant difference were found between the two groups. Out of 30 infants of GA group II had to resuscitate with Ambu-mask ventilation & 6 babies had to sent special care unit. From SAB group 2 infants received resuscitation & one baby had to sent special care unit. In the context of Bangladesh, General anaesthesia as well as Subaracnoid block are equally acceptable for LUCS in eclamptic mothers, if steps are taken to ensure a careful approach to either method. Journal of BSA, Vol. 19, No. 1 & 2, 2006 p.44-50

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“…44 Although most anesthesiologists believe general anesthesia should be avoided, if possible, especially because of airway concerns, the literature does support appropriate use of general anesthesia in severe preeclamptic patients. 45,46 Thus, anesthesiologists should assess each patient and choose the form of anesthesia with which they are most comfortable and familiar. 47 …”

Section: Preeclampsiamentioning

confidence: 99%

Obstetric anesthesia practice in Canada

Breen

McNeil

Dierenfield

2000

Can J Anesth/J Can Anesth

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Purpose: To describe obstetric anesthesia in Canada as practiced in 1997: to identify practices at variance with the literature and the opinions of experts: and to identify questions for future research.Methods: In 1997, a detailed postal questionnaire asking about the practice of obstetric anesthesia was mailed to all 1,539 specialist anesthesiologist members of the Canadian Anaesthetists' Society residing in Canada. Nonresponders were mailed a second questionnaire three months later.Results: There were 865 completed questionnaires returned for analysis (56.2%). Of these, 522 anesthesiologists practiced obstetric anesthesia (60.3%). The data were subdivided into those from anesthesiologists with a full or part-time university based practice (40.1%) and those from a community based practice (59.9%). University based and community-based anesthesiologists have very similar patterns of practice. Specific areas where anesthesia practice was different from current recommendations included: (1) information provided when obtaining consent for labour epidural analgesia, (2) use of opioids and local anesthetics for initiation of epidural analgesia, (3) use of coagulation testing in preeclampsia, (4) the common use of cutting spinal needles, (5) use of neuraxial morphine and nonsteroidal anti-inflammatory agents after Cesarean deliveries, (6) optimal treatment of neuraxial opioid side effects, (7) when to insert an endotracheal tube for general anesthesia after delivery, and (8) withdrawing epidural catheters through epidural needles.Conclusions: This survey presents reference data on the practice of obstetric anesthesia in Canada in 1997. Anesthesiologists with university affiliation have very similar practices to those without university affiliations.Objectif: Décrire l'anesthésie obstétricale pratiquée au Canada en 1997; identifier les pratiques qui diffèrent des pratiques documentées et des opinions d'experts et proposer des sujets de recherches ultérieures.Méthode : En 1997, un questionnaire détaillé sur la pratique de l'anesthésie obstétricale a été posté aux 1 539 anesthésiologistes membres de la Société canadienne des anesthésiologistes résidant au Canada. Trois mois plus tard, un second questionnaire a été posté à ceux qui n'avaient pas encore répondu.Résultats : Il y a eu 865 questionnaires remplis et analysés (56,2 %). De ce nombre, 522 provenaient d'anesthé-siologistes pratiquant l'anesthésie obstétricale (60,3 %). Les données ont été subdivisées selon le lieu de pratique, en milieu universitaire à temps complet ou partiel (40,1 %) ou en d'autres centres (59,9 %). Les modèles de pratique étaient très similaires. Certaines activités spécifiques différaient des recommandations courantes : 1) l'information fournie pour obtenir le consentement à l'analgésie épidurale pendant le travail, 2) l'usage d'opioïdes et d'anesthésiques locaux pour amorcer l'analgésie épidurale, 3) l'utilisation d'épreuve de coagulation en préé-clampsie, 4) l'usage courant d'aiguilles rachidiennes tranchantes, 5) l'administration neuraxiale...

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Randomized Comparison of General and Regional Anesthesia for Cesarean Delivery in Pregnancies Complicated by Severe Preeclampsia

Abstract: General as well as regional anesthetic methods are equally acceptable for cesarean delivery in pregnancies complicated by severe preeclampsia if steps are taken to ensure a careful approach to either method.

Cited by 203 publications

References 19 publications

Gene expression ofheme oxygenase-1andnitric oxide synthaseon trophoblast of preeclampsia

Gene expression ofheme oxygenase-1andnitric oxide synthaseon trophoblast of preeclampsia

Randomised Comparison of General Anaesthesia & Subarachnoid Block for Caesarean Delivary in Pregnancies Complicated by Eclampsia

Obstetric anesthesia practice in Canada

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