Interesting OB Case

[militarymd]

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the lurkers can read the articles...look up the references and read them too....

Patient population maybe different....the study population actually has a HIGHER risk of hypotension as compared to the one here...

But the point is that epidurals has less hemodynamic effect...easier to control, etc...than spinals is one of JET' S Myths of anesthesia.

 

[Planktonmd]

the lurkers can read the articles...look up the references and read them too....

Patient population maybe different....the study population actually has a HIGHER risk of hypotension as compared to the one here...

Wrong again.

But the point is that epidurals has less hemodynamic effect...easier to control, etc...than spinals is one of JET' S Myths of anesthesia.

I am beginning to wonder if you actually know how to properly administer epidural anesthesia.

 

[militarymd]

The reason that pre-eclamptics are chosen as a population to study is because they are at higher risk of hypotension.....

hence the myth that epidural's are safer than spinals in them....because you have time to deal with the hemodynamic changes...

the studies have shown that epidural/spinal hemodynamic changes are similar....and in comparison to healthy patients.

just the facts.

 

[Planktonmd]

The reason that pre-eclamptics are chosen as a population to study is because they are at higher risk of hypotension.....

Incorrect!
Severe preeclamptics have less hypotension under regional anesthesia than healthy parturients:

http://www.anesthesia-analgesia.org/cgi/content/abstract/97/3/867

You can't compare this population to a patient that is normotensive initially and has a R to L shunt.

 

[militarymd]

Incorrect!
Severe preeclamptics have less hypotension under regional anesthesia than healthy parturients:

http://www.anesthesia-analgesia.org/cgi/content/abstract/97/3/867

You can't compare this population to a patient that is normotensive initially and has a R to L shunt.

man....you are DENSE

 

[Planktonmd]

man....you are DENSE

Again, you prove my point:
You have nothing meaningful to say!

Let me try to articulate what you are trying to say:
Since it's OK to give a spinal to a preeclamptic patient then it's OK to give a spinal to a normotensive parturient with R-L shunt!
And since the hemodynamic changes in severely preeclamptic women receiving spinals are not worse than those changes in pre eclamptic women receiving epidurals then we conclude that giving a spinal to a nonpreeclamptic parturient with ebsteins's anomaly must be as safe as giving an epidural!
All these conclusions make sense to you don't they?

 

[Noyac]

Plank is right here. The Aya article compares hypotension from spinal b/w the severe preeclamptics and the normotensive parturant having c/s. The incidence and severity of hypotension were greater when spinal was administered to the normotensive parturant. So this article states that the normotensive which would be our pt here had more hypotension from spinal anesthesia.

 

[Noyac]

But the point is that epidurals has less hemodynamic effect...easier to control, etc...than spinals is one of JET' S Myths of anesthesia.

It depends on the pt.

Hood et al, saw no significant difference b/w epidural and spinal for c/s in severe preeclamptics except that the the women receiving spinals received more fluid. Therefore, outcomes were the same and the spinal was shown to be safe in preeclampsia but it did require more treatment.