Key result
Administration of 200 μg nitroglycerin and fundal pressure during cesarean delivery in a woman with preeclampsia led to severe bradycardia, loss of consciousness, and cardiac arrest.
Case Report (n=1)
Nitroglycerin administration combined with fundal pressure during cesarean delivery under spinal anesthesia in a patient with preeclampsia can trigger severe neurally mediated syncope and cardiac arrest.
Alerts to possible arrest risk with nitroglycerin and fundal pressure in preeclamptic cesarean delivery; hypothesis-generating and should not change practice.
A 28-year-old woman with preeclampsia at 32 weeks of gestation underwent a cesarean delivery under spinal anesthesia. Administration of nitroglycerin at 200 μg to relax uterine smooth muscles and the application of fundal pressure led to severe bradycardia and loss of consciousness, followed by cardiac arrest. Delivery was completed immediately and recovery was achieved 10 seconds later following cardiopulmonary resuscitation. Neurally mediated syncope was considered the cause of cardiac arrest. Anesthetists should be aware of the potential risk during cesarean delivery following the administration of nitroglycerin, fundal pressure, regional anesthesia, and hypovolemia because of preeclampsia.
No takes yet. Share an insight, caveat, or question.
Sato et al. (2017) conducted a case report in Preeclampsia undergoing cesarean delivery (n=1). Nitroglycerin and fundal pressure was evaluated on Cardiac arrest due to neurally mediated syncope. Administration of 200 μg nitroglycerin and fundal pressure during cesarean delivery in a woman with preeclampsia led to severe bradycardia, loss of consciousness, and cardiac arrest.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: