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Re: EclampsiaFrom: Terrence.Jones@ncal.kaiperm.orgThu Mar 28 14:40:24 1996
Lynn, your discussions are refreshingly evidence-based, please continue! Re: regional anes and preeclampsia/eclampsia-mediated vasospasm, it would seem segmental epidural with careful attn to fluid loading, in the hands of an anesthesiologist well versed and comfortable with the technique, is an acceptable method. To the extent this method is practiced PREFERentially in any given institution, it could well become the BETTER/SAFER method, as individuals become BETTER versed and MORE comfortable. (Kinda' like left lateral position for scalp pH I suppose). :) For those pts requiring GA with intubation, our anes will use short-acting B-blocker. As we are getting input from Dr. Anthony, AND Dr. Tregoning,this might be a good time to review the results, if any, of the 15 center nimodipine study (2 centers of which were from S. Africa) mentioned by Dr. Belfort in his letter 1/5/95. As Dr. (Jimmy) Walker mentioned in his f/u letter 4/24/95, Dr. Dommisse (Co-author - Dr. Anthony) has data questioning the efficacy of MgSO4 in seizure prophylaxis in preeclampsia. I wonder if anyone has made note of blunting of the hyper- tensive response to intubation in these pts (on nimodipine) when GA is selected? Apparently (Dr. Belfort mentions) there is a selective cerebral vasodilatory effect. I suppose it's too early to demonstrate any FX on seizure prevention as yet due to the (comparatively) low occurrence. Regarding tamoxifen and atypical myometrial FX, isn't there anyone out there with some/any experience. If not, does anyone have access to, or know of, a listserv for breast Ca with particular emphasis on clinical/experimental discussion. This pt's due for a sono-guided biopsy, and I have a feeling there might be an alternative, such as monitoring activity after cessation (temporary) of tamoxifen. Terry Jones Kaiser San Fran Ob/Gyn
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