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Pre-eclampsia/C-Section/Regional From: BUCKY_C@TSJC.Colorado.EDU Wed Mar 27 22:24:26 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Roland Armstrong: "Re: 35w diabetic needing less insulin" Previous message: timothy fitzpatrick: "Re: Lack of Healthy Options?" >However, with induction of general anesthetic, they noted a increase in the >mean arterial pressure of 45mm Hg, in the mean pulmonary artery pressure of >20mm Hg and in the PCWP of 20mm Hg. (Hodgkinson, et al: Systemic and >pulmonary blood pressure during caesarean section in parturients with >gestational hypertension. Can Anaesth Soc J 1980; 27:389) Pretty old reference.... The bigger problem with general anesthesia under any condition for C-section is that it is not much "anesthesia" for surgery. It is amazing we don't hear of more awareness than we do, but we hear of lots of awareness from these generalized C-section moms. >There is significantly less risk of airway complications associated with >epidural anesthesia. Change "epidural" to "regional". >In regard to the time it takes to administer an epidural, this was studied >at the institution where I trained. Despite the notion that a general >anesthetic is faster, it indeed was no faster than administration on an >epidural. Gracious, is that true? I'm about as speedy as anyone you'll ever see (with regional or general) and I can move faster to surgical readiness with a general than with a regional presuming the same starting points. >In conclusion, given these proven facts, it would seem that when one has a >choice between regional or general anesthetic in a preeclamptic/eclamptic >patient, the logical choice would be regional. Yep. There is a rub to take into account, though. Pre-toxemic (do you use that term anymore?) patients have a substantially lowered seizure threshold. Epidural anal*ge*sia rarely pushes that threshold in terms of local anesthetic dosage. Epidural an*esthe*sia crowds that limit to the max. If there is no pre-existing labor epidural running and a C-section is prescribed, I'll do a spinal everytime. If there is already a pre-existing labor epidural running and it is C-section time, most folks I know will dose the epidural for the surgery, but an eye toward fitting will be warily maintained. In case anyone wanted to know.... Bucky (anesthetist) Next message: Roland Armstrong: "Re: 35w diabetic needing less insulin" Previous message: timothy fitzpatrick: "Re: Lack of Healthy Options?"

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