Experiences With Mecamylamine in Hypertensive Complications of Pregnancy

Agar, H.; Barrett, Cynthia T.; Exley, K. A.

doi:10.1111/j.1471-0528.1958.tb08518.x

Cited by 5 publications

(4 citation statements)

References 21 publications

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“…However, the group studied is small in number and watch must be kept for other toxic manifestations which have been discussed by Hamilton and Kopelman (1963). This is in contrast to the use of the ganglion-blocking hypotensive drugs, where the side-effects on the patient and the foetus may be considerable (Agar et al, 1958).…”

Section: Discussionmentioning

confidence: 90%

“…Both a peripheral action on sympathetic nerve endings (Oates et al>, 1960) and a central effect (Gillespie et alc., 1962) may play some part. Agar et al (1958) discussed the underlying theories of pre-eclamptic hypertension production in view of mecamylamine and the ganglion-blocking hypotensive agents being ineffectual in controlling this condition. Recently, Senior et al (1963) have suggested that 5-hydroxytryptamine (serotonin) may have some role in the production of toxaemia of pregnancy and that antagonists of this substance may be of value in treatment.…”

Section: Discussionmentioning

confidence: 99%

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Methyldopa in Treatment of Severe Toxaemia of Pregnancy

Hans¹,

Kopelman²

1964

BMJ

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Obstetric Analgesia-Gale et al. BRITISHRIt is known that 50% N20 and 50% 02 mixture is a safe and efficient analgesic for parturient women. The British Oxygen Company have produced single cylinders of premixed gases containing a 50/50 gas and oxygen mixture, which would be ideal for use in midwifery if they could be relied upon to dispense a constant 50/50 mixture.Composition changes in premixed gas and oxygen mixtures have been reported at low temperatures ; for this reason an experimental investigation has been conducted into the effects of cooling upon premixed cylinders of the recommended 50°% N20 and 50% 02 mixture.Under certain conditions of use partially filled cylinders of 50/50 N20 and 02 exposed to temperatures of -80 C. or below undergo partial stratification of the constituent gases. The result of this could be that the last fraction of gas obtained from the cylinder contains as little as 2 % 02.The conditions leading to this state of affairs are discussed and are thought to be unlikely to arise in practice (P=0.0001). The nature of the dispensing apparatus is such as to minimize the danger. The precautions necessary to prevent stratification appear to be so elementary as to fail to constitute a barrier to the domiciliary use of 50/50 N20 and 02 and trouble can be completely avoided by protecting the cylinders from very low temperatures.Nevertheless, in the event of a cylinder not being protected from frost before use, it is felt that the precautions of warming and agitating the cylinder should be taken, and would certainly prevent any dangerous deprivation of oxygen.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Methyldopa in Treatment of Severe Toxaemia of Pregnancy

Hans¹,

Kopelman²

1964

BMJ

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“…Furthermore Dixon and others have shown that hypotensives do not affect the choriodecidual blood flow. Agar, Barrett and Exley (1958) noted the failure of ganglion-blocking agents to produce improvement, and noted fatal ileus in a premature baby probably attributable to the mecamylamine which had been given. In fact all observers state that hypotensive drugs do not improve the prognosis for the child.…”

Section: Symptoms and Managementmentioning

confidence: 99%

The diagnosis and management of hypertension in pregnancy

Vartan

1966

Postgraduate Medical Journal

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“…Agar et al (1958) discussed the underlying theories of pre-eclamptic hypertension production in view of mecamylamine and the ganglion-blocking hypotensive agents being ineffectual in controlling this condition. Recently, Senior et al (1963) have suggested that 5-hydroxytryptamine (serotonin) may have some role in the production of toxaemia of pregnancy and that antagonists of this substance may be of value in treatment.…”

mentioning

confidence: 99%

Controlled Trial of Chlorothiazide in Treatment of Early Pre-eclampsia

Menzies¹

1964

BMJ

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MEDICALOURL 7391960) and a central effect (Gillespie et alc., 1962) may play some part. Agar et al. (1958) discussed the underlying theories of pre-eclamptic hypertension production in view of mecamylamine and the ganglion-blocking hypotensive agents being ineffectual in controlling this condition. Recently, Senior et al. (1963) have suggested that 5-hydroxytryptamine (serotonin) may have some role in the production of toxaemia of pregnancy and that antagonists of this substance may be of value in treatment. It is of interest that methyldopa interferes with the formation of serotonin in the body (Oates et al., 1960). SummaryMethyldopa and the chlorothiazide diuretics have been used in 15 patients with severe pre-eclamptic toxaemia. All but one showed a marked and satisfactory fall in blood-pressure, a diminution in proteinuria, and improvement in well-being.The foetus died early in treatment in three patients. All three had severe toxaemia occurring early in the third trimester and showed blood ureas above normal-one of them had the unsuccessful blood-pressure response. The other patients were able to continue with the pregnancies and all were delivered of healthy normal babies except one baby who died of an obstetric cause.The dose of methyldopa was relatively small and the only complication was a drug rash, but other drugs were being given at the same time. However, the number of patients was small and other side-effects may occur. No deterioration has been noted in following the condition of these patients.We should like to thank Mr. Alan Brews for permission to publish his cases. Gillespie, L., Oates, J. A., Crout, J. R., and Sjoerdsma, A. (1962).Circulation, 25, 281.Hamilton, M., and Kopelman, H. (1963). Brit. med. 7.,1, 151. Landesman, R., Ollstein, R. N., and Quinton, K. J. (1959 Pre-eclampsia remains a common complication of pregnancy in this country. Although the foetal wastage appears to be slightly less now than ten years ago, the figures from the National Birthday Trust Perinatal Mortality Survey show that in pregnancies resulting in stillbirth or neonatal death there is still a raised incidence of pre-eclampsia (D. G. Bonham, personal communication, 1963). It is also one of the three most common features of the history where the mother has died ; 18% of maternal deaths are associated with pre-eclampsia (Ministry of Health, 1963).In spite of the importance of the condition the cause remains obscure, and treatment, although relatively successful, is still largely empirical. Hypotensive drugs may have value if given early in pregnancy, but this treatment is possible only for those women who show early hypertension. In cases of non-toxaemic hypertension reserpine seems to have a place but does not reduce foetal loss (Landesman and Ollstein, 1958). In true preeclampsia hypotensive drugs can only be given late and the results are disappointing. A large number of clinicians still rely on prescribing a sedative and advising bed rest, and of these two methods rest in bed is the least empirical. It is kno...

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Experiences With Mecamylamine in Hypertensive Complications of Pregnancy

Cited by 5 publications

References 21 publications

Methyldopa in Treatment of Severe Toxaemia of Pregnancy

Methyldopa in Treatment of Severe Toxaemia of Pregnancy

The diagnosis and management of hypertension in pregnancy

Controlled Trial of Chlorothiazide in Treatment of Early Pre-eclampsia

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