
Anaesthetic Considerations in Hypertensive Disorders
Important areas to consider:
For all: ensure recent bloods done to review haematology, within 6hrs for pre-eclamptics.
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In labour - recommend early epidural to aid control of BP, typically peaks of hypertension seen with both contractions and pushing.
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For elective, and emergency caesarians with no epidural, regional anaesthesia is far preferable.
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BP control intra-operatively
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avoid intubation (oedmatous airways, hypertensive surge at both intubation and extubation)
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allows neurology to be monitored
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frequently associated with IUGR babies, or may be premature IOL or decision for LSCS, where GA for baby ideally avoided
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continue magnesium maintenance infusion in theatre
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Where GA is unavoidable, stability of BP should be the aim prior to LSCS
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intravenous antihypertensives
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loading with magnesium
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2nd anaesthetist
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induction should include rapid onset opioid such as alfentanil
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in the high risk, consider arterial line
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For all careful consideration regarding uterotonics and fluid balance is vital.