RESUMO
The physiological changes occurring during pregnancy and labour may reveal or exacerbate the symptoms of hypertrophic obstructive cardiomyopathy (HOCM). We describe the management of labour in a patient with severe HOCM during which esmolol, a short-acting beta adrenergic antagonist, was used together with extradural analgesia and invasive cardiovascular monitoring to achieve an assisted vaginal delivery with minimal haemodynamic disturbance. The effects on the infant are described and the literature on the use of esmolol in pregnancy is reviewed.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Cardiomiopatia Hipertrófica/tratamento farmacológico , Trabalho de Parto/fisiologia , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Propanolaminas/uso terapêutico , Adulto , Analgesia Epidural , Analgesia Obstétrica , Feminino , Humanos , GravidezRESUMO
Drugs with a depolarizing action at the myoneural junction may cause a rise in intracranial pressure. Neostigmine, which is commonly used to reverse residual myoneural blockade, has a depolarizing action, and yet its effect on intracranial pressure is unknown. Lumbar cerebrospinal fluid pressure, which mirrors intracranial pressure, was determined in 12 patients undergoing cerebral aneurysm surgery. Cerebrospinal fluid pressure was measured during dense myoneural blockade and after its reversal with neostigmine. These effects on cerebrospinal fluid pressure were compared with those produced when the arterial partial pressure of carbon dioxide (PaCO2) rose from 4 to 5 kPa. After reversal of myoneural block, there was a small (non-significant) change in cerebrospinal fluid pressure from 3.6 to 4.3 kPa and a larger (significant) rise in cerebrospinal fluid pressure to 9.7 kPa when the PaCO2 was allowed to rise. In this group of patients, reversal of myoneural blockade with neostigmine causes no significant change in cerebrospinal fluid pressure.
