[Epidural anesthesia and local administration of high-dose prostaglandin in obstetrics. A dangerous combination].
The use of high epidural anesthesia for cesarean section has generally been accepted as a safe and comfortable means of intra- and post-operative pain relief in recent years. However, the accompanying vasomotor blockade of the lower body and the sometimes impaired cardiac reflex activity restrict the use of concomitant--even local--medication. Described are the deleterious side effects on hemodynamic stability and patient comfort of an intramyometrically administered synthetic prostaglandin E (PGE2)-compound (dinoprostone) given to three female patients under high epidural anesthesia during cesarean section. Differentiation of the various symptoms is made in relation to their epidural or PGE origin or to a combination of the two. A striking therapeutic resistance of the hypotension of a sufficiently volume-expanded patient to even large doses of ephedrine is discussed as representing possible PGE-mediated suppression of peripheral norepinephrine release.
Klinik für Anaesthesiologie, Universitäre Krankenhäuser, Katholieke Universiteit Leuven.
L
L
Veeckman
E
E
Müller
H
H
Van Aken
D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D002585:Cesarean Section; D015232:Dinoprostone / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007267:Injections; D009215:Myometrium; D010146:Pain / Q000209:etiology; D011247:Pregnancy
D015232:Dinoprostone
Epiduralanaesthesie und lokale Anwendung hochdosierter Prostaglandine in der Geburtshilfe. Eine gefhrliche Kombination.