Preeclampsia (PE) : Colligative - Practical Wisdom in Anesthesia, Surgery, and Medicine.

Dec 13, 2014

1

Severe hypertension is defined as systolic >160 mmHg or diastolic >110mmHg and should be treated (Level III-2).
See attachment - Obstetric Anaesthesia Scientific Evidence - First Edition 2008

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , Pieter Peach , more...

Private

only

Dec 13, 2014

1

Severe preeclampsia (PE) is defined as mild PE plus one of:
1. SBP>160 mmHg or DBP>110 mmHg on 2 occasions at least 6 hours apart.
2. Proteinuria > 5g/24hr, or more than 3+ on 2 random urine samples collected >4 hrs apart.
3. Pulmonary edema or cyanosis
4. Oliguria (< 400mL/24hrs)
5. Persistent headaches
6. Epigastric pain and/or impaired liver function
7. Thrombocytopenia
8. Oligohydramnios, decreased fetal growth, or placental abruption emedicine.medscape.com/ar...

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , Pieter Peach , more...

Private

only

Dec 13, 2014

Cancel

0

Mnemonics

Cancel

0

Patient history

Cancel

0

Examination

Cancel

0

Investigations

Cancel

2

Associated conditions

1

HELLP syndrome may be seen in up to 50% of cases of severe preeclampsia #ref

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , Pieter Peach , more...

Private

only

Dec 13, 2014

Consider the risk of liver/hepatic rupture if HELLP syndrome is suspected and the patient becomes haemodynamically unstable

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Dec 13, 2014

Periprocedural medication management

Cancel

0

Relevant procedures

Cancel

0

Cancel

2

Disease management

1

MgSO4 infusion is the first line therapy for eclamptic seizure refl.in/1j

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , Pieter Peach , more...

Private

only

(1 comment)

Oct 02, 2011

2-4g intravenously over 3-5 mins

Edit | (delete)

1

MgSO4 should be used for seizure prophylaxis in women with severe pre-eclampsia, and considered in those with mild pre-eclampsia. Monitor levels if coexisting renal impairment. refl.in/1j

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , Pieter Peach , more...

Private

only

(1 comment)

Oct 16, 2011

MgSO4 4g IV over 20min then 1-2g/hr IV infusion. refl.in/hw

Edit | (delete)

Preprocedure optimisation, Postponement

Cancel

0

Cancel

0

Explanation, Patient Instructions

Cancel

0

Premedication

Cancel

0

IV access

Cancel

0

Monitoring

Cancel

0

Positioning, Protection

Cancel

0

Temperature

Cancel

2

Analgesia, Anesthesia, Antiemesis

1

Minimise the risk of intracerebral haemorrhage at intubation. When general anaesthesia is required, measures should be taken to ensure the hypertensive response to intubation is adequately ablated. refl.in/1j

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , Pieter Peach , more...

Private

only

Oct 02, 2011

Lumbar epidural analgesia in the absence of contraindications is beneficial during labour. Limits hypertensive responses to pain & can be utilised for caesarean section refl.in/1j

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Dec 13, 2014

Cancel

0

Airway, Ventilation

Cancel

3

Cardiovascular, Fluids

1

Elevated blood pressure should be lowered to levels of systolic blood pressure 140-150 mmHg and diastolic blood pressure 90-100 mmHg at a rate of 10-20 mmHg every 10-20 minutes. refl.in/1j

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , Pieter Peach , more...

Private

only

May 25, 2011

Acute pulmonary oedema is a significant cause of morbidity and mortality in pre-eclampsia. Intravenous fluid management should be monitored very closely (Level II). refl.in/1j

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Aug 19, 2011

There is an inverse relationship between the degree of hypertension and intravascular volume.
ceaccp.oxfordjournals.org..., if ref not working refl.in/k1.
See relationship between CVP and diastolic blood pressure and volume requirements to achieve a CVP of 6-8 refl.in/k5 from Relationship of CVP & Epidural Analgesia. Anesthesiology Sept 1979, Vol 51, Issue 3, ppg S298

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

May 02, 2012

Haematological, Blood products

Cancel

0

Endocrine, Electrolytes

Cancel

1

1

Neuraxial anesthesia: If platelet count is acceptable and is stable, check coagulation and proceed.

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , Pieter Peach , more...

Private

only

(1 comment)

Aug 19, 2011

CEACCP - platelet count of 50-100x10^9/L if no other coagulopathy refl.in/29, ANZCA - no significant risk above 75 refl.in/1j

Edit | (delete)

Special drug considerations

Cancel

5

Ergometrine should be avoided due to its propensity to cause a hypertensive crisis. refl.in/1j

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Dec 13, 2014

Labetalol may precipitate bronchospasm in asthmatic patients.

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Dec 13, 2014

Antihypertensive drugs that can be safely used include labetalol, nifedipine and hydralazine. The choice should be made on clinician familiarity and experience with a particular agent (Level I). refl.in/1j

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Dec 13, 2014

If general anaesthesia is required in the patient on a magnesium infusion, consider that high serum magnesium concentrations increases the sensitivity to both depolarising and non-depolarising muscle relaxants. Ensure adequate reversal if used in the case. Miller 7th Ed Chapt 69 #safety

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Feb 25, 2012