Article

Pharmacogenetics: Implications for obstetric anesthesia

Service d'Anesthésiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
International Journal of Obstetric Anesthesia (Impact Factor: 1.6). 11/2005; 14(4):316-23. DOI: 10.1016/j.ijoa.2005.03.005
Source: PubMed
1 Follower
 · 
6 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Recent literature on the anaesthetist's role in the management of the patient with severe pre-eclampsia is reviewed, with particular emphasis on the role of regional anaesthesia. Laboratory findings in pre-eclamptic women include increased levels of markers of oxidative stress and circulating tyrosine kinase 1, and inflammatory activation of leucocytes. Magnesium sulphate is the most effective agent for seizure prophylaxis. The optimal pharmacological agents for acute control of blood pressure remain controversial. The benefits of epidural analgesia in labour are well established. Single-shot spinal anaesthesia for caesarean section is safe in the absence of contraindications. Successful use of combined spinal-epidural anaesthesia has been described. Most studies on maternal haemodynamics have employed heart rate and blood pressure data as surrogate measures of cardiac output. Noninvasive cardiac output studies provide further insight into the haemodynamic response during neuraxial techniques for caesarean section. The value of regional anaesthesia cannot be over-emphasized. Recent research into spinal anaesthesia for caesarean section suggests a lower susceptibility to hypotension and probably less impairment of cardiac output than in healthy parturients. Noninvasive cardiac output measurement may also have advantages in critical care management.
    Full-text · Article · Jul 2007 · Current Opinion in Anaesthesiology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Die Präeklampsie ist mit einer Inzidenz von bis zu 5% eine schwangerschaftsassoziierte Multisystemerkrankung, die sich ab der 20. Schwangerschaftswoche (SSW) manifestiert und durch eine mütterliche Hypertonie (RR >140/90 mmHg) und eine Proteinurie (>300 mg/Tag) charakterisiert ist. Weltweit ist die Präeklampsie eine der Hauptursachen der Frühgeburtlichkeit. Für den Zustand der Mutter und des Feten sind eine zügige Diagnosestellung und prompte Therapie essenziell. Das Management beinhaltet suffiziente blutdrucksenkende Maßnahmen, um schwerste Komplikationen wie eine intrazerebrale Hämorrhagie der Mutter zu verhindern. Dabei müssen potenzielle, medikamenteninduzierte Veränderungen der uteroplazentaren Perfusion und die daraus resultierenden Konsequenzen für den Feten berücksichtigt werden. Magnesium spielt die Schlüsselrolle zur Prävention und Kontrolle eklamptischer Anfälle. Aus geburtshilflicher Sicht ist bei schweren Verläufen die Sectio caesarea (>34. SSW) die kausale Therapie. Regionalanästhesiologische Verfahren zur Kaiserschnittentbindung bei präeklamptischen oder eklamptischen Patientinnen bieten gegenüber der Allgemeinanästhesie Vorteile für die Mutter und den Feten und stellen unter Berücksichtigung von Kontraindikationen die Methoden der Wahl dar.
    No preview · Article · Dec 2007 · Der Anaesthesist
  • [Show abstract] [Hide abstract]
    ABSTRACT: Preeclampsia is a pregnancy-associated illness affecting multiple organ systems. Symptoms typically occur after the 20th week of gestation and consist of hypertension (>140/90 mmHg) and proteinuria (>300 mg/day). It is one of the leading causes of premature birth worldwide and early diagnosis and treatment are essential for both fetal and maternal health. Therapy is aimed at lowering blood pressure sufficiently to prevent the most severe complications such as intracranial hemorrhages. At the same time attention must be paid to the possible untoward effects of blood pressure medications on uteroplacental perfusion and fetal well being. Magnesium is the cornerstone for both prevention and control of eclamptic cerebrovascular events. In cases of severe preeclampsia and eclampsia prompt delivery is indicated, often carried out by Cesarean section (>34 weeks of gestation). Compared to general anesthesia, regional anesthesia techniques offer certain advantages to both mother and fetus and in the absence of contraindications are the methods of choice.
    No preview · Article · Feb 2008 · Der Anaesthesist
Show more