Can Epidural Fentanyl Control Autonomic Hyperreflexia in a Quadriplegic Parturient?

Ei, Abouleish; Es, Hanley; Sm, Palmer

doi:10.1213/00000539-198904000-00019

Cited by 36 publications

(9 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The resultant hypertension is sensed by receptors in the aortic arch, carotid sinus and cerebral vessels, often causing reflex bradycardia through intact vagus nerves. 25 Additionally, afferent outflow from the carotid sinus and aortic arch stimulates the vasomotor center, leading to vasodilatation in the head and neck. These regions are diaphoretic, warm and red while the remainder of the body is cool and dry.…”

Section: Discussionmentioning

confidence: 99%

“…3,8,[10][11][12]25,29 Epidural meperidine has been reported to be successful; 30 however, epidural fentanyl failed to control AH. 25 Management of AH with intravenous anxiolytics and hydralazine is, however, often ineffective. 31 In our series, the patients who had epidural analgesia for labor received a continuous infusion of 0.125% bupivacaine with fentanyl 2 lg/mL to prevent AH.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Anesthetic management of parturients with pre-existing paraplegia or tetraplegia: a case series

Sharpe

Arendt

Jacob

et al. 2015

International Journal of Obstetric Anesthesia

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Anesthetic management of parturients with pre-existing paraplegia or tetraplegia: a case series

Sharpe

Arendt

Jacob

et al. 2015

International Journal of Obstetric Anesthesia

View full text Add to dashboard Cite

“…Epidural fentanyl alone, however, has been unsuccessful presumably due to the lack of local anaesthetic action. 15 The combination of bupivacaine and fentanyl was described by Gunaydin et al 16 for caesarean section in such patients.…”

Section: Discussionmentioning

confidence: 99%

Epidural anaesthesia for caesarean section in a patient with quadriplegia and autonomic hyperreflexia

Burns

Clark

2004

International Journal of Obstetric Anesthesia

View full text Add to dashboard Cite

“…There are limited case reports of pre‐existing transverse myelitis during pregnancy and most had uneventful spontaneous vaginal delivery. However, conduction anaesthesia is still required for pain relief as well as control of autonomic hyperreflexia in patients with complete or partial cord transection during labour and delivery [3, 4, 8, 9]. General or regional anaesthesia are the options for Caesarean section, although there is some controversy in the literature about which technique should be preferred.…”

Section: Discussionmentioning

confidence: 99%

“…Although epidural bupivacaine alone could control autonomic hyperreflexia [12], we decided to add 50 µg of fentanyl to the epidural bupivacaine in order to improve the quality of block and contribute to the protective effect against autonomic hyperreflexia. Fentanyl alone has failed to control visceral nociceptive impulses caused by uterine contractions in a quadriplegic parturient [9]. We were surprised to find that the level of anaesthesia had reached as high as T 4 after 10 min with such a low dose of bupivacaine, but felt that this block was satisfactory for Caesarean section, as indeed it proved to be.…”

Section: Discussionmentioning

confidence: 99%

Epidural anaesthesia for Caesarean section in a patient with Devic's Syndrome

2001

View full text Add to dashboard Cite

SummaryWe describe the anaesthetic management of a 72-year-old man with myasthenic syndrome. Pre-operatively, he was treated with 3,4-diaminopyridine and showed a strong hand grip. During general anaesthesia with nitrous oxide and sevoflurane in oxygen, a mechanomyograph and two accelerographs were set up for the hands and left foot to monitor neuromuscular function. Insufficient force and acceleration of contraction with 1 Hz stimulation was observed in the hands. In the foot, the twitches produced by 1 Hz and train-of-four stimulation could barely be detected using the accelerograph, and the train-of-four ratio fluctuated between 70 and 100%. No neuromuscular blocking drugs were used during surgery. After discontinuation of sevoflurane, responses to train-offour stimulation remained small, but a strong response to tetanic stimulation was observed, with posttetanic facilitation. Extubation was successful, and recovery from anaesthesia was uneventful. Tetanic stimulation and post-tetanic facilitation are important in monitoring neuromuscular function in patients with myasthenic syndrome whose train-of-four responses are insufficient. Myasthenic syndrome (Eaton2Lambert or Lambert±Eaton syndrome), characterised by weakness of proximal limb muscles, may show abnormal sensitivity to both depolarising and non-depolarising neuromuscular blocking drugs [1]. As a result, administration of these agents can cause prolonged neuromuscular blockade [2±5]. Although monitoring of neuromuscular function during anaesthesia is considered necessary for patients with myasthenic syndrome, little information is available concerning the details of such monitoring. We describe a case of myasthenic syndrome in which monitoring of neuromuscular function during general anaesthesia was particularly difficult. Case historyA 72-year-old man with myasthenic syndrome was scheduled for thoracotomy for excisional biopsy of a suspected small-cell cancer of the lung. A coin lesion had been discovered in the left lung on a chest radiograph 2 months after the onset of neuromuscular symptoms. Electromyography (EMG) showed marked diminution of amplitude of the initial compound muscle action potential evoked by sural nerve stimulation. A decremental response was seen with lowfrequency repetitive stimulation (2 Hz), but up to 300% facilitation occurred with high-frequency repetitive stimulation (50 Hz). The patient was diagnosed with myasthenic syndrome based on these characteristic findings, absence of detectable antibodies to the acetylcholine receptor and a negative edrophonium test. At pre-operative assessment, the patient was 175 cm tall and weighed 63 kg. Weakness of the lower limbs precluded walking without assistance. Although he complained of weakness of the upper limbs, dynamometry showed a strong hand grip (. 30 kg). Other pre-operative investigations, including blood haematology and biochemistry screening, respiratory function tests and blood gas analysis, were unremarkable.The patient had taken 3,4-diaminopyridine 60 mg daily beginning 1 we...

show abstract

Can Epidural Fentanyl Control Autonomic Hyperreflexia in a Quadriplegic Parturient?

Cited by 36 publications

References 0 publications

Anesthetic management of parturients with pre-existing paraplegia or tetraplegia: a case series

Anesthetic management of parturients with pre-existing paraplegia or tetraplegia: a case series

Epidural anaesthesia for caesarean section in a patient with quadriplegia and autonomic hyperreflexia

Epidural anaesthesia for Caesarean section in a patient with Devic's Syndrome

Contact Info

Product

Resources

About