Re: Eclampsia
From: JOHN ANTHONY (anthonyj@uctgsh1.uct.ac.za)
Thu Mar 28 22:23:27 1996
Dear Dr Montgomery
OK, so we maybe we should agree to dis-agree; perhaps the most
important point to emerge from the discussion being that there is a
lot of opinion in the area and little basis for making firm
recommendations.
You seem to have missed the point about the Allen article which seeks
to establish that bolus dose magnesium sulphate at the time of induction
of anaesthesia is an effective way of obtunding the pressor response
to intubation and has become the standard anaesthetic technique
with regard to the induction of general anaesthesia in pre-eclamptic
patients at Groote Schuur Hospital. If the patient is to have a
general anaesthetic we regard this approach as both safe and
desirable for mother and child
Unfortunately I will be out of Town & off the list in the next week
and therefore likely to miss out on whatever further discussion may
follow. Thank you for the debate nevertheless - I find the experience
of others of immense interest.
Kind regards
--
John Anthony
> Date: Thu, 28 Mar 1996 13:45:59 -0600 (CST)
> Reply-to: ob-gyn-l@listserv.bcm.tmc.edu
> From: apgar10@ionet.net (Lynn D. Montgomery)
> To: anthonyj@uctgsh1.uct.ac.za
> Subject: Re: Eclampsia
> 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
> >> choice between regional or general anesthetic in a preeclamptic/eclamptic
> >> patient, the logical choice would be regional.
>
> 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
>
Dr John Anthony
Maternal and Fetal Medicine Unit
Groote Schuur Hospital
Department of Obstetrics and Gynaecology
University of Cape Town
Telephone 021 404 2380
Fax 021 448 6921
