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Discussion

Beta Blockade during C-section

Pt in her early 20s had a history of "fast heart rates", not formally diagnosed by a physician. Becomes mildly symptomatic when it occurs at home... sits down until it goes away.

During c-section with SAB becomes tachycardic with HRs in the 180s. BP stable in the 110s to 120s, but pt states she is becoming dizzy and short of breath.

In my anesthesia drawer I have Esmolol, Metoprolol, and Verapamil. I also have Edrophomium and Neostigmine for those who favor a less traditional (or perhaps more traditional) approach.

Which of the afore mentioned medications would be my best bet for treating the patients tachycardia assuming vagal maneuvers had failed and why?

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ok...

the latest and greatest state that neo doesn't cause uterine artery constriction to the degree once thought and therefore is a safe first line treatment to hypotension just as ephedrine.

I have used beta blockers (lopressor specifically) in patients with eclampsia and pre-eclampsia. Stops the rapid HR, relieves the symptoms, and does not seem to have fetal/newborn effects. Often, this Mom may be on beta blockers for a period of time PP. Hope this helps! Amy

Good clinical scenario, Brenna's Dad. Thanks....

Just one perspective - there are many ways to skin a cat, as everybody knows. I probably would have done the exact same thing as you. By no means am I an expert (!) but it seems to me that we must be good at "tweaking"...trying something (that seems sane, safe and reasonable, of course...) and then watching what happens...then trying some else if need be. Anyway, thanks for a good discussion.....

i agree - i too would have had to ask what was the best med to use - haven't run into that scenario - thanks for the heads up.

For those of us ust starting our programs, but loving the clinical discussions can someone shed some light on why anticholinesterases inhibitors can't be used in this situation.

i agree - i too would have had to ask what was the best med to use - haven't run into that scenario - thanks for the heads up.

as per acls, you could have used the adenosine on the mother. the half life is quite beneficial in this case! followed by fluids, repostioning and o2.

additionally, beta blockers are ok.

ammioderone is ***NOT*** recommended in pregnant women for tachy arhythmias.

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