General anaesthesia

General anaesthesia may be necessary if there is great urgency to deliver the mother or if regional anaesthesia is contraindicated by coagulopathy or major haemorrhage. Extreme prematurity does not contraindicate regional anaesthesia and nor does eclampsia.

The additional risks of general anaesthesia for Caesarean section are compounded in the pre-eclamptic woman by the potential for a significantly compromised airway and the hypertensive response to intubation and extubation. There may also be potential drug interactions, especially between magnesium sulphate and neuromuscular blocking agents.

Laryngeal oedema is uncommon but may be sufficient to obscure all normal anatomy at laryngoscopy. Each obstetric theatre should include microlaryngeal tracheal tubes on the intubation trolley for this eventuality.

Uncontrolled hypertension in response to tracheal intubation may provoke cardiac arrhythmias, myocardial ischaemia or cerebrovascular catastrophe. Numerous agents have been used to attenuate this response but the most commonly used agents in the UK are fentanyl 1-4 mg/kg or alfentanil 7-10 mg/kg and labetalol 10-20 mg. Other opioids, b-blockers and lidocaine may be used; magnesium sulphate 30 mg/kg also appears to be effective.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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