Anaesthetic Considerations in Hypertensive Disorders

Important areas to consider:

For all: ensure recent bloods done to review haematology, within 6hrs for pre-eclamptics.

  • In labour - recommend early epidural to aid control of BP, typically peaks of hypertension seen with both contractions and pushing.

  • For elective, and emergency caesarians with no epidural, regional anaesthesia is far preferable.

    • BP control intra-operatively

    • avoid intubation (oedmatous airways, hypertensive surge at both intubation and extubation)

    • allows neurology to be monitored

    • frequently associated with IUGR babies, or may be premature IOL or decision for LSCS, where GA for baby ideally avoided

    • continue magnesium maintenance infusion in theatre

  • Where GA is unavoidable, stability of BP should be the aim prior to LSCS

    • intravenous antihypertensives

    • loading with magnesium

    • 2nd anaesthetist

    • induction should include rapid onset opioid such as alfentanil

    • in the high risk, consider arterial line

  • For all careful consideration regarding uterotonics and fluid balance is vital.

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