Anestesia na Pré-Eclâmpsia

Eliana Marisa Ganem; Yara Marcondes Machado Castiglia

doi:10.1590/S0034-70942002000400013

Review Article

Anestesia na Pré-Eclâmpsia

Anesthesia in Pre-Eclampsia

Eliana Marisa Ganem; Yara Marcondes Machado Castiglia

http://dx.doi.org/10.1590/S0034-70942002000400013 Braz J Anesthesiol, vol.52, n4, p.481-497, 2002

PDF

Downloads: 0

Resumo

JUSTIFICATIVA E OBJETIVOS: Embora a pré-eclâmpsia acometa pequena porcentagem da população obstétrica, ela é responsável por considerável morbidade e mortalidade maternas. Assim sendo, o controle anestésico adequado deste grupo de pacientes ainda hoje é um desafio para os anestesiologistas. Este artigo tem a finalidade de apresentar a fisiopatologia, o tratamento farmacológico e as opções anestésicas para o parto normal ou cirúrgico, em pacientes com pré-eclâmpsia. CONTEÚDO: Estão descritos a classificação e terminologia da hipertensão arterial induzida pela gestação, a fisiopatologia, as alterações nos diversos órgãos e sistemas, os princípios gerais no controle das pacientes e as opções anestésicas para o parto normal e cirúrgico. CONCLUSÕES: O conhecimento, pelo anestesiologista, da fisiopatologia, das formas de tratamento e das características farmacológicas das drogas utilizadas para o controle da hipertensão arterial e a profilaxia das convulsões, assim como sua interação com as drogas e técnicas anestésicas, possibilita a redução das complicações peri-operatórias e da mortalidade materna e fetal.

Palavras-chave

ANESTESIA, ANESTESIA

Abstract

BACKGROUND AND OBJECTIVES: Although affecting a small obstetric population, pre-eclampsia is responsible for considerable maternal morbidity and mortality. Therefore, the adequate anesthetic control of this group is yet a challenge for anesthesiologists. This paper aimed at presenting pathophysiology, pharmacological treatment and anesthetic options to normal or surgical delivery in pre-eclampsia patients. CONTENTS: Classification and terminology of pregnancy-induced arterial hypertension, its pathophysiology, changes in different systems and organs, general principles for patients control and anesthetic options for normal or surgical delivery are described. CONCLUSIONS: The anesthesiologists knowledge of the pathophysiology, treatment options, and pharmacological characteristics of drugs used to control arterial hypertension and prevent seizures, as well as their interactions with anesthetic drugs and techniques, may decrease perioperative complications and maternal and fetal mortality.

Keywords

ANESTHESIA, ANESTHESIA

Referencias

Boxer LM, Malinow AM. Pre-eclampsia and eclampsia. Current Opinion in Anaesthesiology. 1997;10:188-198.

Hypertension in Pregnancy. 1996.

Hibbard BM, Anderson MM, ODrife JO. Report on Confidential Enquiries into Maternal Deaths in the United Kingdom, 1992-1993. 1996:1-31.

Weitzner RM, Malinow AM. The eclamptic patient: Anesthetic management. Anesthesiol Clin North Am. 1998;16:323-348.

Sibai BM, Ramadan MK. Acute renal failure in pregnancies complicated by hemolysis, elevated liver enzymes, and low platelets. Am J Obstet Gynecol. 1993;168:1682-1687.

Martin JN, Perry KG, Miles JF. The interrelationship of eclampsia: HELLP syndrome and prematurity. Br J Obstet Gynaecol. 1993;100:1095-1100.

Sibai BM, Ramadan MK, Usta I. Maternal morbidity and mortality in 442 pregnancies with HELLP syndrome. Am J Obstet Gynecol. 1993;169:1000-1006.

Dekker GA, Sibai BM. Etiology and pathogenesis of preeclampsia: current concepts. Am J Obstet Gynecol. 1998;179:1359-1375.

Sharma SK. Pre-eclampsia and eclampsia. Semin Anesth Perioper Med Pain. 2000;19:171-180.

Morris NH, Eaton BM, Dekker G. Nitric oxide, the endothelium, pregnancy and preeclampsia. Br J Obstet Gynaecol. 1996;103:4-15.

Pettersson A, Hedner T, Milsom I. Increased circulating concentrations of asymmetric dimethyl arginine (ADMA), an endogenous inhibitor of nitric oxide synthesis, in preeclampsia. Acta Obstet Gynecol Scand. 1998;77:808-813.

Di Iorio R, Marinoni E, Emiliani S. Nitric oxide in preeclampsia: lack of evidence for decreased production. Eur J Obstet Gynecol Reproad Biol. 1998;76:65-70.

Benedetti TJ, Kates R, Williams V. Hemodynamic observations in severe pre-eclampsia complicated by pulmonary edema. Am J Obstet Gynecol. 1985;152:330-334.

Benedetti TJ, Carlson RW. Studies of colloid osmotic pressure in pregnancy: induced hypertension. Am J Obstet Gynecol. 1979;135:308-311.

Sibai BM, Mabie BC, Harvey CJ. Pulmonary edema in severe preeclampsia-eclampsia: analysis of 37 consecutive cases. Am J Obstet Gynecol. 1987;156:1174-1179.

Tarshis J. Hypertensive Disorders of Pregnancy. Problems in Anesthesia. 1999;11:366-379.

Mokriski BLK, Malinow AM, Gray WC. Topical nasopharyngeal anaesthesia with vasoconstriction in preeclampsia- eclampsia. Can J Anaesth. 1988;35:641-643.

Saftlas AF, Olson DR, Franks Al. Epidemiology of preeclampsia and eclampsia in the United States, 1976-1986. Am J Obstet Gynecol. 1990;163:460-465.

Douglas KA, Redman CW. Eclampsia in the United Kingdom. Br Med J. 1994;309:1395-1400.

Sibai BM, McCubbin JH, Garland D. Eclampsia I.: Observations from 67 recent cases. Obstet Gynecol. 1981;81:609-613.

Lubarsky SL, Barton JR, Friedman SA. Late postpartum eclampsia revisited. Obstet Gynecol. 1994;83:502-505.

Sibai BM. Eclampsia VI.: Maternal-perinatal outcome in 254 consecutive cases. Am J Obstet Gynecol. 1990;163:1049-1055.

Williams K, McClean C. Maternal cerebral vasospasm in eclampsia assessed by transcranial doppler. Am J Perinatol. 1993;10:243-244.

Barton JR, Sibai BM. Cerebral pathology in eclampsia. Clin Perinatol. 1991;18:891-910.

Sibai BM, Schneider JM, Morrison JC. The late postpartum eclampsia controversy. Obstet Gynecol. 1980;55:74-78.

Chang JK, Roman C, Heymann MA. Effect of endothelium: delivered relaxing factor inhibition on the umbelical placental circulation in fetal lambs in utero. Am J Obstet Gynecol. 1992;166:727-734.

Ferris TF. Pre-eclampsia and postpartum renal failure: examples of pregnancy induced microangiopathy. Am J Med. 1995;99:343-347.

Ventura JE, Villa M, Mizraji R. Acute renal failure in pregnancy. Ren Fail. 1997;19:217-220.

Haung J, Wang C, Chu J. Spontaneous rupture of the liver associated with pregnancy: a report of two cases. Chin J Med [Taipei]. 1994;54:265-269.

Leduc L, Wheeler JM, Kirshon B. Coagulation profile in severe preeclampsia. Obstet Gynecol. 1992;79:14-18.

Socol ML, Weiner CP, Louis G. Platelet activation in preeclampsia. Am J Obstet Gynecol. 1985;151:494-497.

Kambam JR, Entman S, Mouton S. Effect of preeclampsia on carboxyhemoglobin levels: a mechanism for decrease in P50. Anesthesiology. 1988;68:433-434.

Weinstein L. Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. Am J Obstet Gynecol. 1982;142:159-167.

Oosterhof H, Voorhoeve PG, Aanoudse JG. Enhancement of hepatic artery resistance to blood flow in pre-eclampsia in presence or absence of HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets). Am J Obstet Gynecol. 1994;171:526-530.

Suresh MS. HELLP syndrome: An Anesthesiologists Perspective. Anesthesiol Clin North Am. 1998;16:331-348.

Sibai BM, Taslimi MM, el-Nazer A. Maternal-perinatal outcome associated with the syndrome of hemolysis, elevated liver enzymes and low platelets in severe pre-eclampsia - eclampsia. Am J Obstet Gynecol. 1986;155:501-509.

Sibai BM. The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): Much ado about nothing?. Am J Obstet Gynecol. 1990;162:311-316.

Wilke G, Rath W, Schutz E. Haptoglobin as a sensitive markes of hemolysis in HELLP syndrome. Int J Gynaecol Obstet. 1992;39:29-34.

Miles Jr JF, Martin Jr JN, Blake PG. Postpartum eclampsia: a recurring perinatal dilemma. Obstet Gynecol. 1990;76:328-331.

Weinstein L. Preeclampsia/eclampsia with hemolysis, elevated liver enzymes, and thrombocytopenia. Obstet Gynecol. 1985;66:657-660.

Aarnoudse JG, Houthoff HF, Weits J. A syndrome of liver damage and intravascular coagulation in the last trimester of normotensive pregnancy: A clinical and histopathological study. Br J Obstet Gynaecol. 1986;93:145-155.

Egley CC, Gutlipth J, Bowes Jr WA. Severe hypoglycemia associated with HELLP syndrome. Am J Obstet Gynecol. 1985;152:576-577.

Neuman M, Ron-El R, Langer R. Maternal death caused by HELLP syndrome (with hypoglycemia) complicating mild pregnancy: induced hypertension in a twin gestation. Am J Obstet Gynecol. 1990;162:372-373.

Cunningham FG, Lowe T, Guss S. Erythrocyte morphology in women with severe preeclampsia and eclampsia: Preliminary observations with scanning electron microscopy. Am J Obstet Gynecol. 1985;153:358-363.

Kurzel RB, Rooholamini SA. Doppler velocimetry of hepatic blood flow in postpartum patients with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets). Am J Obstet Gynecol. 1996;176:1677-1678.

Spargo GH, Lichteg C, Luger AM. The Renal Lesions in Preeclampsia. Hypertension in Pregnancy. 1976:129-137.

Robertson WB, Brosens I, Dixon G. Uteroplacental vascular pathology. Eur J Obstet Gynecol Reprod Biol. 1975;5:47-65.

Arias F, Mancilla-Jimenez R. Hepatic fibrinogen deposits in preeclampsia-immunofluorescent evidence. N Engl J Med. 1976;295:587-582.

Dadak C, Ulrich W, Sinzinger H. Morphological chances in the umbilical arteries of babies born to preeclamptic mothers: an ultrastructural study. Placenta. 1984;5:419-426.

Brown MA, Zammit VC, Lowe SA. Capillary permeability and extracelular fluid volumes in pregnancy-induced hypertension. Clin Sci. 1989;77:599-604.

Fournie A, Monrozies M, Pontonnier G. Factor VIII complex in normal pregnancy: preeclampsia and fetal growth retardation. Br J Obstet Gynaecol. 1981;88:250-254.

Lazarchick J, Stubbs TM, Romein L. Predictive value of fibronectin levels in normotensive gravid women destined to become preeclamptic. Am J Obstet Gynecol. 1986;154:1050-1052.

Kirshon B, Wasserstrum N, Cotton DB. Should continuous hydralazine infusions be utilized in severe pregnancy-induced hypertension?. Am J Perinatol. 1991;9:206-208.

Kobayashi A, Mizoke T, Tojo H. Autonomic hyperreflexia during pregnancy. Can J Anaesth. 1995;42:1134-1136.

Barton JR, Hiett AK, Conover WB. The use of nifedipine during the postpartum period in patients with severe pre-eclampsia. Am J Obstet Gynecol. 1990;162:788-792.

Wasserstrum N. Nitroprusside in pre-eclampsia: Circulatory distress and paradoxical bradycardia. Hypertension. 1991;18:79-84.

Eisenach JC, Castro MI. Maternally administered esmolol produces fetal beta-adrenergic blockade and hypoxemia in sheep. Anesthesiology. 1989;71:718-722.

Eisenach , Castro MI, Dewan DM. Intravenous clonidine toxicity in pregnant ewes. Am J Obstet Gynecol. 1988;160:471-476.

Mehta N, Modi N. ACE inhibitors in pregnancy. Lancet. 1988;2:96-97.

Young PF, Leigthon NA, Jones PN. Fluid management in severe preeclampsia (VESPA): survey of members of ISSHP. Hypertens Pregnancy. 2000;19:249-259.

Robson SC, Pearson JF. Fluid restriction policies in preeclampsia are obsolete. Int J Obstet Anesth. 1999;8:49-55.

Wasserstrum N, Kirshon B, Willis RS. Quantitative hemodynamic effects of acute volume expansion in severe preeclampsia. Obstet Gynecol. 1989;73:545-550.

Chien PF, Khan KS, Arnott N. Magnesium sulphate in the treatment of eclampsia and pre-eclampsia: An overview of the evidence from randomized trials. Br J Obstet Gynaecol. 1996;103:1085-1091.

Beilin Y, Zahan J, Comerford W. Safe epidural analgesia in thirty parturients with platelet counts between 69.000 and 98.000 mm-3. Anesth Analg. 1997;85:385-388.

Kelton JG, Hunter DJ, Neame PB. A platelet function defect in preeclampsia. Obstet Gynecol. 1985;65:107-109.

Sharma SK, Philip J, Whitten CW. Assessment of changes in coagulation in parturients with preeclampsia using thromboelastography. Anesthesiology. 1999;90:386-390.

Orlikowski CE, Rocke DA, Murray WB. Thrombo- elastography changes in pre-eclampsia and eclampsia. Br J Anaesth. 1996;77:157-161.

Abboud T, Artal R, Sarkis F. Sympathoadrenal activity, maternal, fetal, and neonatal responses after epidural anesthesia in the preeclampsia patient. Am J Obstet Gynecol. 1982;144:915-918.

Hawkins JL, Moore J, Westmore DM. Pregnancy-Induced Hypertension. Pain Relief Anesthesia in Obstetrics. 1996:531-545.

Moore TR, Key TC, Reisner LS. Evaluation of the use of continuous lumbar epidural for the hypertensive pregnant women in labor. Am J Obstet Gynecol. 1985:152.

Check TG, Samuels P. Pregnancy-Induced Hypertension. Anesthetic an Obstetric Management of High-Risk Pregnancy. 1996:400-401.

Heller PJ, Goodman C. Use of local anesthetics with epinephrine for epidural anesthesia in preeclampsia. Anesthesiology. 1986;65:224-226.

Leighton BL, Norris MC, Soisis M. Limitation of epinephrine as a marker of intravascular injection in laboring women. Anesthesiology. 1987;66:688-691.

Weiner CP, Martinez E, Chestnut DH. Effect of pregnancy on uterine and carotid artery response to norepinephrine, epinephrine, and phenylephrine in vessels with documented functional endothelium. Am J Obstet Gynecol. 1989;161:1605-1610.

Leighton BL, Norris MC, DeSimone CA. Pre-eclamptic and healthy term pregnant patients have different chronotropic responses to isoproterenol. Anesthesiology. 1990;72:392-393.

Colonna-Romano P, Lingaraju N, Godfrey SD. Epidural test dose and intravascular injection in obstetrics: sensitivity, specificity, and lowest effective dose. Anesth Analg. 1992;75:372-376.

Colonna-Romano P, Salvage R, Lingaraju N. Epinephrine-induced tachycardia is different from contraction-associated tachycardia in laboring patients. Anesth Analg. 1996;82:294-296.

Hogg B, Hauth JC, Caritis SN. Safety of labor epidural anesthesia for women with severe hypertensive disease. Am J Obstet Gynecol. 1999;181:1096-1101.

Hepner DL, Dalta S. Labor analgesia practices for the new millennium. Semin Anesth Perioper Med Pain. 2000;19:35-45.

Campbell DC. Low-dose epidural labor analgesia. Tech Reg Anesth Pain Manage. 2001;5:3-8.

Breen TW. Combined spinal-epidural analgesia for labor. Tech Reg Anesth Pain Manage. 2001;5:9-13.

Ferrante FM, Lu L, Tamison SB. - Patient-controlled epidural analgesia: demand dosing. Anesth Analg. 1991;73:547-552.

Cousins MJ, Mather LE. Intrathecal and epidural administration of opioids. Anesthesiology. 1984;61:276-310.

Hood DD, Curry R. Spinal versus Epidural anesthesia for cesarean section in severely preeclamptic patients. Anesthesiology. 1999;90:1276-1282.

Karinen J, Rasanen J, Alahuhta S. Maternal and uteroplacental haemodynamic state in preeclamptic patients during spinal anaesthesia for cesarean section. Br J Anaesth. 1996;76:616-620.

Atrash HK, Koonin CM, Lawson HW. Maternal mortality in the United State 1979-1986. Obstet Gynecol. 1990;76:1055-1060.

Fox EJ, Sklar GS, Hill CH. Complication related to the pressor response to endotracheal intubation. Anesthesiology. 1977;47:524.

Baraka A, Yazigi A. Neuromuscular interaction of magnesium with succinylcholine neuronium sequence in the eclampic parturient. Anesthesiology. 1987;67:806-808.

Anestesia na Pré-Eclâmpsia

Anesthesia in Pre-Eclampsia

Eliana Marisa Ganem; Yara Marcondes Machado Castiglia

Resumo

Palavras-chave

Abstract

Keywords

Referencias

Links

compartir

Braz J Anesthesiol