Hypotension epidural anaesthesia

CALCIUM CHANNEL BLOCKERS ANAESTHETICS - LOCAL Case reports of severe 1 BP when bupivacaine epidural was administered to patients on calcium channel blockers Additive hypotensive effect both bupivacaine and calcium channel blockers are cardiodepressant in addition, epidural anaesthesia causes sympathetic block in the lower limbs, which leads to vasodilatation and 1 BP Monitor BP closely. Preload intravenous fluids prior to the epidural... 

Extradural (epidural) anaesthesia is used in the thoracic, lumbar and sacral (caudal) regions. Lumbar epidurals are used widely in obstetrics and low thoracic epidurals provide excellent analgesia after laparotomy. The drug is injected into the extradural space where it acts on the nerve roots. This technique is less likely to cause hypotension than spinal anaesthesia. Continuous analgesia is achieved if a local anaesthetic, often mixed with an opioid, is infused through an epidural catheter. 

Ephedrine hydrochloride 3 mg/mL solution, reversal of hypotension from spinal or epidural anaesthesia by slow intravenous injection adult dose 3-6 mg repeated every 3-4 minutes according to response to max. 30 mg. 

Severe hypotension and bradycardia have been seen in patients taking captopril or verapamii when they were given epidurai anaesthesia with bupivacaine. Acute hypotension aiso occurred in a man taking prazosin when he was given epidurai anaesthesia with bupivacaine. Cionidine may increase the duration of caudal block with bupivacaine, aithough there are reports of reduced plasma levels of lidocaine with concurrent cionidine. Verapamil does not appear to interact with epidural lidocaine. 

Foetal depression during spinal and epidural obstetric anaesthesia occurs secondary to maternal hypotension or as a result of placental transfer of the local anaesthetic agent (8, 10 -, 13 ). In this respect, bupivacaine was found to have a low foeto-maternal drug concentration ratio (16 -). When caudal anaesthesia is used, direct injection of the local anaesthetic drug into the foetus is possible (13, Other causes... 

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