The effects of epidural anesthesia on the Doppler velocimetry of umbilical and uterine arteries in normal and hypertensive patients during active term labor

Ramos-Santos, Edgard; Devoe, Lawrence D.; Wakefield, Marsha L.; Sherline, Donald M.; Metheny, William P.

doi:10.1016/0020-7292(92)91005-9

Cited by 38 publications

(32 citation statements)

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“…Additional support for this hypothesis is derived from reports that lumbar epidural anesthesia blocks sympathetic nerve activities and thus improves the symptoms and biochemical parameters in preeclampsia. 14,31,32 The results of the present study are compatible with those of previous reports, since our data show that stimulation with bupivacaine impaired NE secretion more than stimulation with eclamptic plasma, suggesting that hyperstimulation of the sympathetic nervous system in the eclamptic condition improves with bupivacaine treatment.…”

Section: Discussionsupporting

confidence: 83%

Eclamptic Plasma Stimulates Norepinephrine Release in Cultured Sympathetic Nerve

et al. 1998

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Abstract-The purpose of the present study was to evaluate the effect of plasma from eclamptic and preeclamptic patients on cultured sympathetic nerve. Sympathetic neurons from 12-to 14-day-old chick embryos were cultured; the neurons were then stimulated with 50% plasma from eclamptic, preeclamptic, hypertensive, normotensive pregnant, hypertensive, and normotensive nonpregnant women (nϭ7). Similarly, neurons were individually incubated with mixtures of 50% corresponding plasma with 0.25% bupivacaine or bupivacaine only (nϭ7). Furthermore, the effects of 1%, 10%, and 50% plasma from eclamptic, preeclamptic, and normotensive pregnant patients (nϭ7) were also evaluated. Norepinephrine concentrations were measured by high-performance liquid chromatography. Electron microscopic studies of nerve cells were also performed. Stimulation with plasma from eclamptic and preeclamptic women significantly increased norepinephrine concentration (PϽ0.0001) compared with control. The release of norepinephrine was found to be concentration-dependent. Conversely, norepinephrine secretion was significantly hampered by bupivacaine treatment (PϽ0.0001). Electron microscopic studies in eclamptic and preeclamptic plasma-stimulated nerve cells showed that perikarya were in close contact with each other and with nerve cell processes. After treatment with bupivacaine, nerve cells were irregular in shape and the cell membranes were demyelinated. These results suggest that eclamptic and preeclamptic plasma has an excitotoxic effect on sympathetic nerve via axoplasmic membrane depolarization, thus increasing norepinephrine secretion that is blocked by bupivacaine. A preeclamptic condition may be improved by depression of sympathetic nerve stimulation. (Hypertension. 1998;31:1343-1349.)

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Section: Discussionsupporting

confidence: 83%

Eclamptic Plasma Stimulates Norepinephrine Release in Cultured Sympathetic Nerve

et al. 1998

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“…Epidural anaesthesia significantly improves the placental blood flow in toxaemic pregnancies 18 and has been recommended as the method of choice in pre-eclamptic labours. [16][17][18][19][20] We reported that the stimulation of the sympathetic nerve induced pre-eclampsia-like phenomenon. 13,14 Recently, we demonstrated that plasma from eclamptic and pre-eclamptic women stimulates the NE release in cultured sympathetic neuron and bupivacaine blunted the increase NE level that have been seen in stimulation with eclamptic and preeclamptic plasma.…”

Section: Discussionmentioning

confidence: 99%

“…15 Lumbar epidural anaesthesia, which blocks the abdominal sympathetic nerve, improves hypertension and biochemical parameters during pre-eclamptic labour. [16][17][18] Thus, epidural anaesthesia has been recommended by many authors as the analgesic method of choice in preeclamptic labour. 19,20 From these findings, we hypothesised that the stimulation of the abdominal sympathetic nerve is responsible for human preeclampsia.…”

Section: Introductionmentioning

confidence: 99%

A new treatment of severe pre-eclampsia by long-term epidural anaesthesia

et al. 1999

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We hypothesised that long term epidural anaesthesia suppresses sympathetic overactivity in pre-eclampsia. Two equal groups of severe pre-eclamptic patients were treated either with long-term epidural anaesthesia (epidural group) or bed rest, diet control, and an antihypertensive drug (control group). After 7 days of epidural block, mean arterial blood pressures decreased, platelet count and serum total protein increased in all cases while proteinuria decreased in four cases. All patients treated with a long-term epidural therapy continued their pregnancies for more than 3 weeks after admission. The infants in the epidural group had 1-min Apgar scores above 8, a body weight of 2240 ± 310 g (mean ± s.d.) and

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“…Neither epidural nor combined spinal-epidural, analgesia harms the fetus [405,408,409] or increases Caesarean delivery in severe preeclampsia [410,411].…”

Section: General Principlesmentioning

confidence: 99%

RETIRED: Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy

Magee

Pels

Helewa

et al. 2008

Journal of Obstetrics and Gynaecology Canada

421

218

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The effects of epidural anesthesia on the Doppler velocimetry of umbilical and uterine arteries in normal and hypertensive patients during active term labor

Cited by 38 publications

References 0 publications

Eclamptic Plasma Stimulates Norepinephrine Release in Cultured Sympathetic Nerve

Eclamptic Plasma Stimulates Norepinephrine Release in Cultured Sympathetic Nerve

A new treatment of severe pre-eclampsia by long-term epidural anaesthesia

RETIRED: Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy

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