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LETTER TO THE EDITOR

Is Ephedrine the Best Vasopressor for Treating Spinal Anesthesia-Induced Hypotension in Patients with Pre-Eclampsia?

Inova Loudoun Hospital; Leesburg, VA; mslack.ILH.org{at}mac.com

To the Editor:

I enjoyed your recent articles regarding spinal anesthesia and pre-eclampsia (1,2). Both studies used ephedrine to treat spinal anesthesia-induced hypotension.

On December 30, 2003, the Food and Drug Administration released a Consumer Alert (P03-106) alerting the public about the risks of ephedra and its active ingredient, ephedrine. The risk of seizures with ephedra and ephedrine is well documented (3–6).

If ephedrine evokes seizures, perhaps it is not the best vasopressor for treating spinal anesthesia-induced hypotension in patients with pre-eclampsia. A significant percentage of pre-eclamptics develop eclampsia after delivery (7). Is it possible that the treatment of spinal anesthesia-induced hypotension with ephedrine is lowering the seizure threshold in these patients, predisposing them to seizures?

REFERENCES

1. Aya GMA, Vialles N, Issam TI, et al. Spinal anesthesia-induced hypotension: a risk comparison between patients with severe pre-eclampsia and healthy women undergoing preterm cesarean delivery. Anesth Analg 2005;101:869–75.[Abstract/Free Full Text]
2. Visalyaputra S, Oraluxna RO, Wanna SW, et al. Spinal versus epidural anesthesia for cesarean delivery in severe pre-eclampsia: a prospective randomized, multicenter study. Anesth Analg 2005;101:862–8.[Abstract/Free Full Text]
3. Haller CA, Benowitz NL. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. N Engl J Med 2000;21 343:1833–8.
4. Shekelle P, Morton SC, Maglione M, et al. Ephedra—is it worth the risk? RAND Health Research Highlights, 2003. RB-4556. Available at www.rand.org/publications/RB/RB4556/.
5. Haller CA, Meier KH, Olson K, et al. Seizures reported in association with use of dietary supplements. Clin Toxicol (Phila) 2005;43:23–30.
6. Doughty C. Herbal mind altering substances: an unknown quantity? Emerg Med J 2004;21:253–5.[Free Full Text]
7. Hughes SC, et al. Shnider and Levinson’s anesthesia for obstetrics. 4th ed. 297.

This article has been cited by other articles:

				A. G. M. Aya, N. Vialles, and J. Ripart Is Ephedrine the Best Vasopressor for Treating Spinal Anesthesia-Induced Hypotension in Patients with Pre-Eclampsia? Anesth. Analg., December 1, 2006; 103(6): 1584 - 1584. [Full Text] [PDF]

				S. Visalyaputra Is Ephedrine the Best Vasopressor for Treating Spinal Anesthesia-Induced Hypotension in Patients with Pre-Eclampsia? Anesth. Analg., December 1, 2006; 103(6): 1584 - 1585. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (2) Citing Articles via Google Scholar Google Scholar Articles by Slack, M. R. Search for Related Content PubMed PubMed Citation Articles by Slack, M. R.