Anesth Analg 2006;103:1584-1585
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000246444.65298.54
LETTER TO THE EDITOR
Editor-in-Chief Steven L. Shafer
Is Ephedrine the Best Vasopressor for Treating Spinal Anesthesia-Induced Hypotension in Patients with Pre-Eclampsia?
Shusee Visalyaputra, MD
Department of Anesthesia; Siriraj Hospital; Mahidol University; Bangkok, Thailand; sisps{at}mahidol.ac.th
In Response:
I appreciate the concerns expressed by Dr. Slack (1) about our use of ephedrine in patients with eclampsia (2).
After reviewing the adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra (ephedrine alkaloids) (3), the Food and Drug Administration banned all dietary supplements containing ephedrine alkaloids (4). Seizure activity was reported after chronic ingestion of a dietary supplement containing both ephedra alkaloids and caffeine (5).
The use of ephedrine to treat hypotension in pre-eclamptic patients has been documented in at least 11 studies involving about 600 patients (6–15). These studies used IV doses of ephedrine ranging from 6 to 30 mg, which were associated with rapid restoration of arterial blood pressure and heart rate. None of these studies reported seizure activity during ephedrine administration. Ephedrine has also been used to treat hypotension in a parturient with seizure activity because of cerebral vascular disease (16).
Although a recent study supports the use of phenylephrine during regional anesthesia in uncomplicated term pregnancy (17), ephedrine increases uterine and placental circulation after epidural anesthesia-induced hypotension more than phenylephrine (18). Because feto-placental circulation may be compromised in severe pre-eclampsia, ephedrine might have more benefit to the newborn than phenylephrine.
No evidence suggests that treating anesthetic-induced hypotension with ephedrine increases the risks of seizures in patients with pre-eclampsia. Considering the potential benefits to feto-placental circulation, I believe ephedrine is the drug of choice to treat hypotension in severe pre-eclampsia.
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