Changes in maternal middle cerebral artery blood flow velocity associated with general anesthesia in severe preeclampsia

Jaya Ramanathan, John J. Angel, Andrew J. Bush, Phyllis Lawson, Baha Sibai

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

In women with severe preeclampsia, significant increases in mean arterial pressures (MAP) are common after rapid induction of general anesthesia (GA) and tracheal intubation. The objectives of this prospective study were to assess the effects of the rapid induction-intubation technique on middle cerebral artery (MCA) flow velocity in severe preeclampsia and to examine the correlation between mean MCA flow velocity (Vm) and MAP. Eight women with severe preeclampsia (study group) and six normotensive women at term (control group) scheduled to undergo cesarean section under GA were studied. Before induction, patients in the study group received IV labetalol in divided doses to lower diastolic pressures to <100 mm Hg. Anesthesia was induced with pentothal 4-5 mg/kg, followed by succinylcholine 1.5 mg/kg to facilitate tracheal intubation. A transcranial Doppler was used to measure Vm. Both Vm and MAP were recorded before induction and every minute for 6 min after intubation. In the study group, after the administration of labetalol, MAP decreased from 129 ± 9 to 113 ± 9 mm Hg (P < 0.05), and Vm decreased from 59 ± 11 to 54 ± 10 cm/s (P < 0.05). After intubation, MAP increased from 113 ± 9 to 134 ± 5 mm Hg (P < 0.001), and Vm increased from 54 ± 10 to 70 ± 10 cm/s (P < 0.001). In the control group, while MAP increased significantly from 89 ± 6 to 96 ± 4 mm Hg (P < 0.05) after intubation, the concurrent increase in Vm from 49 ± 5 to 54 ± 7 cm/s was not significant. There was a significant positive pooled correlation between Vm and MAP (r = 0.5, P < 0.0006) in the study group but not in the control group (r = 0.24). After induction and intubation, both Vm and MAP values were significantly increased in the study group patients at all observation points compared with the control group patients. The findings indicate that Vm increases significantly after rapid-sequence induction of GA and tracheal intubation in women with severe preeclampsia, and there seems to be a direct relationship between MAP and Vm. Implications: In women with severe preeclampsia, rapid- sequence induction of general anesthesia and tracheal intubation can cause severe hypertension. Our results indicate that the increase in blood pressure is associated with a significant increase in maternal cerebral blood flow velocity and that there is a significant correlation between these two variables.

Original languageEnglish (US)
Pages (from-to)357-361
Number of pages5
JournalAnesthesia and Analgesia
Volume88
Issue number2
DOIs
StatePublished - Feb 1 1999

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Cerebrovascular Circulation
Blood Flow Velocity
Middle Cerebral Artery
Pre-Eclampsia
Intubation
General Anesthesia
Arterial Pressure
Mothers
Labetalol
Control Groups
Blood Pressure
Succinylcholine
Thiopental
Cesarean Section
Anesthesia

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine

Cite this

Changes in maternal middle cerebral artery blood flow velocity associated with general anesthesia in severe preeclampsia. / Ramanathan, Jaya; Angel, John J.; Bush, Andrew J.; Lawson, Phyllis; Sibai, Baha.

In: Anesthesia and Analgesia, Vol. 88, No. 2, 01.02.1999, p. 357-361.

Research output: Contribution to journalArticle

Ramanathan, Jaya ; Angel, John J. ; Bush, Andrew J. ; Lawson, Phyllis ; Sibai, Baha. / Changes in maternal middle cerebral artery blood flow velocity associated with general anesthesia in severe preeclampsia. In: Anesthesia and Analgesia. 1999 ; Vol. 88, No. 2. pp. 357-361.
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