1/222. Anaesthesia for caesarean section in the presence of severe primary pulmonary hypertension.We describe the case of a pregnant woman, 35 weeks' gestation, with primary pulmonary hypertension and coarctation of the aorta requiring emergency Caesarean section under general anaesthesia. The patient had a pulmonary artery catheter inserted before operation which revealed pulmonary artery pressures in excess of 80/40 mm Hg. These were lowered using an infusion of glyceryl trinitrate. After delivery of the baby and administration of oxytocin, pulmonary artery pressures were more difficult to control. An infusion of prostacyclin was substituted which stabilized pulmonary pressures. After operation, she was transferred to the intensive care unit where prostacyclin was administered by an "aerosolized" route. Her trachea was extubated after 48 h and she made an uneventful recovery.- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
2/222. Inhaled nitric oxide therapy in pregnancy complicated by pulmonary hypertension.The use of nitric oxide as an agent to reduce pulmonary artery pressure in a pregnancy complicated by pulmonary hypertension is reported for the first time. This therapy can reduce pulmonary vascular resistance and therefore potentially enable the right ventricle to better compensate for the physiologic changes of pregnancy.- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
3/222. cesarean section in a mother with uncorrected congenital coronary to pulmonary artery fistula.PURPOSE: We report a case of a 33 yr old woman with pulmonary hypertension secondary to uncorrected right coronary artery to pulmonary artery fistula who underwent two successful operative deliveries under general anesthesia. CLINICAL FEATURES: This woman underwent an emergency Caesarean section at 32 wk gestation because she presented in NYHA Class IV, heart failure and premature labour. She did not have antenatal follow-up. For her second pregnancy, she was managed from the first trimester of pregnancy by the cardiologist, obstetrician and anesthesiologist. She received oral furosemide and digoxin from eight weeks gestation. pregnancy was managed to term before she progressed to NYHA Class IV and cardiac failure at 37 wk gestation. She had a Caesarean section under general anesthesia. She received rapid sequence induction of anesthesia and tracheal intubation with 0.1 mg x kg(-1) etomidate, 2 mg x kg(-1) succinylcholine and maintenance with nitrous oxide 50% in oxygen, isoflurane 1% and 0.1 mg x kg(-1) vecuronium. fentanyl, 2 microg x kg(-1) helped to obtund the hypertensive response to intubation. analgesia was provided with 1 mg x kg(-1) morphine. Glyceryl trinitrate infusion, 10-30 microg x min(-1) was used in addition to the anti-heart failure therapy. End-tidal capnography, electrocardiogram, pulse oximetry, continuous arterial blood pressure and pulmonary arterial catheter provided hemodynamic monitoring. The lungs were mechanically ventilated for 24 hr postoperatively. She received anti-heart failure therapy which she continued after discharge. She was NYHA class II upon discharge. She defaulted from further follow-up. CONCLUSION: Although the literature advocates, in this situation, controlled vaginal delivery utilising epidural analgesia, we describe the successful outcome for operative delivery under general anesthesia in a patient with secondary pulmonary hypertension and heart failure.- - - - - - - - - - ranking = 0.4keywords = hypertension (Clic here for more details about this article) |
4/222. The management of hypertension in a diabetic pregnancy.pregnancy in a woman with Type 1 diabetes poses several clinical challenges. In addition to meticulous glycaemic control, careful attention must be paid to the management of developing and pre-existing diabetic complications which may progress in severity during pregnancy. pregnancy-induced hypertension is more common in women with diabetes and especially in those with diabetes of long duration. Diabetic renal disease is associated with hypertension which often deteriorates during pregnancy. The management of hypertension is difficult because of limited therapeutic options and the need to consider the implications for the developing fetus as well as the mother. This case report details the clinical management of a young woman with Type 1 diabetes whose pregnancy was complicated by the development of hypertension.- - - - - - - - - - ranking = 1.6keywords = hypertension (Clic here for more details about this article) |
5/222. The location of chronic pregnancy hypertension on the vasoconstriction-volume spectrum: working hypothesis.OBJECTIVE: The purpose of this study was to examine whether volume loading is a factor in chronic pregnancy hypertension. STUDY DESIGN: Five patients with chronic hypertension performed home self-monitoring daily with a noninvasive pressure transducer from a fingertip. Determinants of mean arterial pressure were computed from the pressure data and a concurrent electrocardiogram. For this study blood pressure and rapid ejection time, which is an empiric indicator of arterial compliance, were evaluated during antihypertensive therapy. Data were transmitted by facsimile to the hospital. RESULTS: One patient with hypertension who was admitted to the study at 10 weeks' gestation became normotensive with a diuretic (furosemide) alone. Medication was discontinued at 23 weeks' gestation. This patient remained normotensive until delivery at 41 weeks' gestation. blood pressure was controlled with furosemide combined with nifedipine and labetolol in the other 4 cases. Three patients were studied with concurrent blood pressure and rapid ejection time measurements made before and after antihypertensive medication. All 3 showed decreases in these measurements with medication. CONCLUSION: Both volume excess and vasoconstriction should be considered in the pathogenesis of chronic pregnancy hypertension.- - - - - - - - - - ranking = 1.6keywords = hypertension (Clic here for more details about this article) |
6/222. ovarian hyperstimulation syndrome and benign intracranial hypertension in pregnancy after in-vitro fertilization and embryo transfer: case report.ovarian hyperstimulation syndrome (OHSS) is a dangerous and sometimes life-threatening complication of ovulation induction with exogenous gonadotrophins. While many complications of severe OHSS are recognized we have only identified one review detailing neurological problems. This report concerns a 32-year-old patient with bilateral tubal blockage who achieved her first pregnancy following in-vitro fertilization (IVF) and embryo transfer. Shortly after embryo transfer she developed clinical signs of moderate OHSS with symptoms which were later diagnosed as benign intracranial hypertension (BIH). The BIH was treated effectively using repeated lumbar puncture and diuretics. Spontaneous labour and delivery occurred at 40 weeks' gestation. There was no neurological sequel and no recurrence of the BIH 2 years after the pregnancy. The possible link between OHSS and BIH is discussed as well as the risks of further pregnancy.- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
7/222. Management of labor in Eisenmenger syndrome with inhaled nitric oxide.Administration of nitric oxide by means of inhalation during the labor of a woman with Eisenmenger's syndrome caused by an atrial septal defect resulted in improved oxygenation and initial pulmonary arterial pressure. She gave birth to a live infant at 34 weeks' gestation but died of worsening pulmonary hypertension and heart failure 21 days post partum.- - - - - - - - - - ranking = 0.2keywords = hypertension (Clic here for more details about this article) |
8/222. pregnancy and renal tubular acidosis.Renal tubular acidosis (RTA) is uncommonly encountered in pregnancy. The risk for these women to develop pregnancy-induced hypertension has not been previously described. The renal defect noted in these women, aggravated by the normal hypervolemia of pregnancy, may predispose to hypertension. Three pregnancies in two women with RTA type 1 developed persistent diastolic hypertension in the third trimester. Mild renal insufficiency was noted in each woman as defined by serum creatinine of 0.9-1.1 and 1.4-1.6 mg/dL, respectively. Vaginal delivery was achieved in each without complications. Blood pressures returned to normal following each pregnancy. pregnancy-induced hypertension developed in each of three pregnancies in two patients with RTA type 1. The risk for these women to develop pregnancy-induced hypertension may be associated with the higher reported risk in women with underlying renal disease.- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
9/222. Emergency repair of incidentally diagnosed ascending aortic aneurysm immediately after caesarean section.A 36-yr-old pregnant woman with a history of hypertension presented at term for elective Caesarean section because of breech position. At preoperative examination, a diastolic murmur was found and transoesophageal echocardiography (TOE) revealed a large, 8.1-cm diameter ascending aortic aneurysm with severe aortic regurgitation and moderate pericardial effusion. Surgical repair was not considered to be urgently required. The patient was delivered electively by Caesarean section under epidural anaesthesia using invasive arterial pressure monitoring. TOE performed 6 h post-partum showed progressing pericardial effusion, for which emergency replacement of the aortic valve and ascending aorta were indicated. The epidural catheter was removed 4 h before starting the cardiopulmonary bypass procedure. arterial pressure was controlled by a titrated infusion of esmolol and clonidine. To improve uterine tone, the patient received an i.v. infusion of oxytocin throughout surgery. After implantation of an aortic composite graft and weaning from cardiopulmonary bypass, the patient was transferred to the intensive care unit. Awake and receptive to neurological evaluation, her trachea was extubated 4 h after surgery. Mother and baby made an uneventful recovery.- - - - - - - - - - ranking = 0.2keywords = hypertension (Clic here for more details about this article) |
10/222. Combined spinal-epidural anesthesia for cesarean section in a patient with Takayasu's disease.We describe a successful episode of anesthesia management in a parturient affected with Takayasu's disease who underwent elective cesarean section under combined spinal-epidural anesthesia. Takayasu's disease is characterized by chronic occlusive inflammation of the arteries (panarteritis) of unknown origin that usually involves the aorta and its main branches. Progression of the disease may be marked by aneurysmal dilation of the affected arteries and may lead to a fatal outcome, usually from cerebral ischemia or heart failure. The impact of pregnancy on Takayasu's disease is unclear, but worsening of ischemic symptoms, cardiac failure, aggravation of hypertension and cerebral hemorrhage have been reported in sufferers who are in the later stages of pregnancy. Nonetheless, anesthesia management of a parturient with advanced Takayasu's disease presents a challenge to anesthetists.- - - - - - - - - - ranking = 0.2keywords = hypertension (Clic here for more details about this article) |
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