title: Hypertensive crisis after a successful placement of an epidural anesthetic in a hypertensive parturient. Case report.
abstract: OBJECTIVE
  The use of epinephrine-containing local anesthetic solutions in pre-eclampsia is controversial. While epinephrine in local anesthetic solutions has been used without complications in this setting, a hypertensive reaction remains a concern among many clinicians.
  
  
  METHODS
  An epidural anesthetic containing epinephrine was administered to a hypertensive parturient for cesarean delivery. When a hypertensive crisis developed, the radial artery was cannulated and administration of sodium nitroprusside was initiated. Arterial blood samples were evaluated for plasma norepinephrine and serum lidocaine concentrations.
  
  
  RESULTS
  The introduction of lumbar epidural anesthesia for cesarean delivery using 30 mL 2% lidocaine with 1:200,000 epinephrine resulted in a profound hypertensive reaction, in the patient with pre-eclampsia, despite an adequate level of epidural anesthesia.
  
  
  CONCLUSIONS
  Epinephrine-containing local anesthetic solutions may place a hypertensive parturient at significant risk of an acute hypertensive reaction.
authors.affiliation: Department of Anesthesiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York 10019, USA.
authors.forename: A
authors.initials: A
authors.lastname: Hadzic
authors.forename: J
authors.initials: J
authors.lastname: Vloka
authors.forename: N
authors.initials: N
authors.lastname: Patel
authors.forename: D
authors.initials: D
authors.lastname: Birnbach
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects; D002585:Cesarean Section; D004837:Epinephrine / Q000009:adverse effects*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology; D008012:Lidocaine; D009638:Norepinephrine / Q000097:blood; D011225:Pre-Eclampsia / Q000503:physiopathology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000503:physiopathology*
chemical_list: D008012:Lidocaine; D009638:Norepinephrine; D004837:Epinephrine