Hypertensive crisis after a successful placement of an epidural anesthetic in a hypertensive parturient. Case report
Hadzic, A.; Vloka, J.; Patel, N.; Birnbach, D.
Regional Anesthesia 20(2): 156-158
1995
ISSN/ISBN: 0146-521X PMID: 7605764 Document Number: 443242
Background and Objectives: 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.