title: Spinal anesthesia for postpartum tubal ligation after pregnancy complicated by preeclampsia or gestational hypertension.
abstract: OBJECTIVE
  The American College of Obstetricians & Gynecologists has opposed postpartum tubal ligation (PPTL) in patients whose pregnancies have been complicated by a medical condition, including hypertension. A prospective study was conducted to assess the appropriateness of spinal anesthesia for PPTL in patients with hypertensive disorders of pregnancy.
  
  
  METHODS
  After institutional review board approval and written informed consent, women scheduled for PPTL were enrolled. The hypertensive group (n = 25) consisted of women whose pregnancies were complicated by gestational hypertension, preeclampsia, or chronic hypertension with superimposed preeclampsia. For each hypertensive patient, a matched control was designated by selecting the next consenting normotensive patient scheduled for PPTL. After an intravenous bolus of lactated ringers solution 500 mL, spinal anesthesia was induced with hyperbaric lidocaine. Hemodynamic measurements were recorded every 2 minutes for 20 minutes after spinal injection. Ephedrine IV was administered for systolic blood pressure < or =90 mm Hg.
  
  
  RESULTS
  The mean preoperative mean blood pressure (MAP) was 107+/-17 mm Hg in the hypertensive group and 85+/-11 mm Hg in the controls, P<.0001. The hypertensive group sustained a more profound percentage decrease in MAP than did their control counterparts during spinal anesthesia (29%+/-12% v. 15%+/-8%, P<.0001). However, the lowest intraoperative MAP was similar in both groups. Thirty-five percent of hypertensive patients and 24% of the controls received ephedrine IV.
  
  
  CONCLUSIONS
  PPTL during spinal anesthesia in patients whose pregnancies have been complicated by hypertension had results comparable with patients with uncomplicated pregnancies; however, further studies are needed to ascertain its safety.
authors.affiliation: Medical University of South Carolina, Charleston 29425, USA. suelto@musc.edu
authors.forename: M D
authors.initials: MD
authors.lastname: Suelto
authors.forename: R D
authors.initials: RD
authors.lastname: Vincent
authors.forename: J E
authors.initials: JE
authors.lastname: Larmon
authors.forename: P F
authors.initials: PF
authors.lastname: Norman
authors.forename: C F
authors.initials: CF
authors.lastname: Werhan
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D016022:Case-Control Studies; D004809:Ephedrine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D007275:Injections, Intravenous; D007552:Isotonic Solutions; D008012:Lidocaine / Q000008:administration & dosage; D016343:Monitoring, Intraoperative; D049590:Postpartum Period; D011225:Pre-Eclampsia / Q000150:complications*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011312:Pressure; D011446:Prospective Studies; D000077325:Ringer's Lactate; D012449:Safety; D013246:Sterilization, Tubal; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000779:Anesthetics, Local; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D004809:Ephedrine