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Retrospective Review of Peri-induction Hypertension in 58 patients with Preeclampsia
Abstract Number: T-47
Abstract Type: Original Research
Cerebrovascular complications are the most common cause of major disability and death in women with preeclampsia. Systolic blood pressure (SBP) of > 160 mm Hg is a risk factor for stroke in preeclampsia.¹Spinal or epidural are preferred for cesarean delivery(CD),general anesthesia(GA) may become necessary for fetal or maternal indications. Laryngoscopy may be accompanied by an acute rise in blood pressure (BP) putting the patient at risk for intracerebral hemorrhage or pulmonary edema. Antihypertensive agents have been studied to blunt the hypertensive response to intubation. The goal should be to control the maternal blood pressure to 140/90 mm Hg prior to induction.² The 2005 CEMACH 2003-2005, UK) reported two deaths from intracranial hemorrhage that were attributed to the hypertensive response to tracheal intubation in preeclamptic patients.³
In preeclamptic patients undergoing GA, laryngoscopy and intubation have been noted to be associated with dangerous levels of hypertension. In a review of this subject by Pant,in 2014¹, adjuncts were reviewed to control the BP response to intubation. Recommended were esmolol, or nitroglycerin, labetalol and short acting opioids.Previous studies were performed with thiopental for induction agent,now propofol is the most widely used induction agent in the US.
The anesthesia records of all women with a diagnosis of preeclampsia, HELLP syndrome, and chronic HTN with superimposed preeclampsia, who underwent Cesarean delivery under general anesthesia from 2011-2014 were reviewed. A similar number of control patients without HTN who underwent Cesarean with GA were reviewed during the same time period were reviewed retrospectively. IRB approval was obtained. Basic demographics, age, parity, gestational age, APGAR scores were recorded. Heart rate HR, SBP, mean MBP, and diastolic blood pressure DBP were recorded as listed below:
T1: highest BPin first 10 min after induction
T2: BP and HR at 20 min after induction
T3: BP and HR at extubation
58 cases with preeclampsia and 50 nonhypertensive cases having GA for CD were studied.
Results:Peri-induction beta blockers were given in 3 % and fentanyl in 22 %.Induction was with propofol in 91% and etomidate in 9%. SBP was >160 mm Hg in 57% of cases in the first ten min after intubation, but remained >160 at 20 min in only 3% of cases. Factors associated with increased SBP response to intubation were: baseline SBP > 160 and diagnosis of HELLP syndrome. Addition of fentanyl to propofol decreased SBP at all intervals, but failed to reach statistical significance. Two patients remained intubated post-op for pulmonary edema, four with PRES syndrome, and four had seizures including two post-delivery, and no CVA.
Discussion:SBP after intubation increased more with baseline SBP>160, and HELLP, and was largely back to baseline at 20 min.
¹Anesth Analg 2014; 119:1350-1356
²Chestnutt’s Obstetric Anesthesia 2009:995