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Re: EclampsiaFrom: Lynn D. Montgomery (apgar10@ionet.net)Thu Mar 28 12:44:33 1996
Dr. Anthony,
I have included the last paragraph of my previous post for your review. As
you will note I stated "when one has a choice". I have no intention of
being as dogmatic as to the choice of patient therapy as either you or Dr.
Lisse. I simply pointed to the apparent benefit of regional analgesia in
the preeclamptic/eclamptic patient.
>> In conclusion, given these proven facts, it would seem that when one has a But I feel that I must repond to your use of the literature. You chose to quote the article by Allen, et al: Attenuation of the pressor response to tracheal intubation in the hypertensive proteinuric pregnant patients by lignocaine, alfentanil and magnesium sulfate. In that study, following intubation, six of 24 mothers in the alfentanil group, six of 21 in the lignocaine group and one of 24 in the magnesium group exhibited a systolic arterial pressure greater than 180mm Hg sustained for 2 min. or more. The alfentanil group had significant fetal depression. In another study (Rout CC, Rocke DA: Effects of alfentanil and fentanyl on induction of anaesthesia in patients with severe pregnancy-induced hypertension. Br J Anaesth (England), Oct 1990, 65(4) p468-74) both drugs attenuated the response of intubation, but neither abolished it in all patients. Therefore I would question this approach, both for maternal as well as fetal considerations. Further in an article by Chadwick HS, Easterling T: Anesthetic concerns in the patient with preeclampsia. Semin Perinatol (United States), Oct 1991, 15(5) p397-409; it states, "lumbar epidural blockade is the preferred method for providing analgesia and anesthesia." This is indeed an opinion as is that of Clark's in his text. However, yours is an opinion as well. Certainly not doctrine. Regards, Lynn Montgomery, M.D. Maternal-Fetal Medicine Tulsa, Oklahoma
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