Hypertensive crisis after a successful placement of an epidural anesthetic in a hypertensive parturient

Admir Hadzic, Jerry Vloka, Nirmal Patel, David Birnbach

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background and Objectives. The use of epinephrine-containing local anesthetic solutions in pre-eclampsia is controversial. While epinephrine in local anesthetic solutions has been used without complications in this setting, a hypertensive reaction remains a concern among many clinicians. Methods. An epidural anesthetic containing epinephrine was administered to a hypertensive parturient for cesarian delivery. When a hypertensive crisis developed, the radial artery was cannulated and administration of sodium nitroprusside was initiated. Arterial blood samples were evaluated for plasma norepinephrine and serum lidocaine concentrations. Results. The introduction of lumbar epidural anesthesia for cesarean delivery using 30 mL 2% lidocaine with 1:200,000 epinephrine resulted in a profound hypertensive reaction, in the patient with pre-eclampsia, despite an adequate level of epidural anesthesia. Conclusions. Epinephrine-containing local anesthetic solutions may place a hypertensive parturient at significant risk of an acute hypertensive reaction.

Original languageEnglish (US)
Pages (from-to)156-158
Number of pages3
JournalRegional Anesthesia
Issue number2
StatePublished - Jan 1 1995
Externally publishedYes


  • lidocaine
  • local anesthetic solutions
  • pre-eclampsia

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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