JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS
AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
A&A International Anesthesia Research Society
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a colleague
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (5)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Williams, J. H.
Right arrow Articles by Hepner, D. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Williams, J. H.
Right arrow Articles by Hepner, D. L.

Anesth Analg 2004;98:240-241
© 2004 International Anesthesia Research Society

OBSTETRIC ANESTHESIA

Risperidone and Exaggerated Hypotension During a Spinal Anesthetic

James H. Williams, MD, PhD, and David L. Hepner, MD

From the Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, and the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts

Address correspondence to: David L. Hepner, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115. Address email to dhepner{at}partners.org

Antipsychotic medications are often continued through pregnancy and may have important anesthetic interactions. For example, risperidone is an antipsychotic medication with therapeutic effects mediated by dopaminergic and serotonergic antagonism. However, it also possesses potent {alpha}-1 adrenergic antagonism. Here we report a case of a parturient with bipolar disease, controlled with lithium and risperidone, undergoing a spinal anesthetic for a cesarean delivery. The parturient developed exaggerated hypotension, refractory to conventional treatment with ephedrine and IV fluids, that eventually responded to large doses of phenylephrine. Risperidone {alpha}-antagonism should be a consideration for any patient receiving this medication during neuraxial anesthesia. Treatment of significant and refractory hypotension with an {alpha}-1 agonist such as phenylephrine may be warranted.

IMPLICATIONS: Parturients receiving neuraxial blocks may be taking antipsychotic medications. Although the therapeutic effects of antipsychotic medications are mediated by dopaminergic and serotonergic antagonism, many possess alpha-adrenergic antagonist properties. We report a case of exaggerated hypotension during a spinal anesthetic for cesarean delivery that may have been a result of the alpha-adrenergic antagonism of risperidone.




This article has been cited by other articles:


Home page
 Canadian J. AnesthesiaHome page
A. A. Tarres and A. Villalonga
Severe hypotension following spinal anesthesia in a patient treated with risperidone
Can J Anesth, March 1, 2005; 52(3): 334 - 335.
[Full Text] [PDF]


Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2004 by the International Anesthesia Research Society.