Abstract
Ankylosing spondylitis presents challenges for the obstetric anesthesiologist in administering
neuraxial anesthesia or managing the airway. A pregnant patient with ankylosing spondylitis,
cardiomyopathy and preeclampsia requiring cesarean delivery was managed with an awake
nasotracheal fiberoptic intubation. The use of topical cocaine, epinephrine, phenylephrine,
and oxymetazoline to produce nasal vasoconstriction is discussed. Selective alpha-2
agonists that can potentially provide nasal mucosa vasoconstriction and placental
vasculature vasodilation are also discussed.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to International Journal of Obstetric AnesthesiaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Successful direct laryngoscopy assisted by posture in a patient with ankylosing spondylitis.Anesth Analg. 1998; 87: 1436-1437
- A modified method for intubation of a patient with ankylosing spondylitis using intubating laryngeal mask airway—a case report.Acta Anaesthesiol Sin. 2001; 39: 179-182
- A modification of retrograde wire-guided, fiberoptic-assisted endotracheal intubation in a patient with ankylosing spondylitis.Anesth Analg. 1996; 82: 1290-1291
- Large cervical osteophyte—another cause of direct flexible fiberoptic intubation.Anaesthesia. 1994; 49: 512-514
- Unsuspected cervical fractures: a common problem in ankylosing spondylitis.Anesthesiology. 1989; 70: 869-870
- Epistaxis and nasotracheal intubation—prevention with vasoconstrictor spray.Ir J Med Sci. 1994; 163: 58-60
- A comparison of cocaine, lidocaine with epinephrine, and oxymetazoline for prevention of epistaxis on nasotracheal intubation.J Clin Anesth. 1990; 2: 16-20
- A suitable substitute for 4% cocaine before blind nasotracheal intubation: 3% lidocaine–0.25% phenylephrine nasal spray.Anesth Analg. 1984; 63: 915-918
- Pain during awake nasal intubation after topical cocaine or phenylephrine/lidocaine spray.Anaesthesia. 2003; 58: 777-780
- Cocaine or phenylephrine/lignocaine for nasal fibreoptic intubation?.Eur J Anaesthesiol. 1996; 13: 577-581
- A comparison of cocaine and ‘co-phenylcane’ local anaesthesia in flexible endoscopy.Clin Otolaryngol. 2002; 27: 192-196
- Topical nasopharyngeal anaesthesia with vasoconstriction in preeclampsia-eclampsia.Can J Anaesth. 1988; 35: 641-643
- Norepinephrine sensitivity of mesenteric veins in pregnant rats.Am J Physiol. 1990; 259: R753-R759
- Resistance artery smooth muscle function in pregnancy and preeclampsia.Am J Obstet Gynecol. 2002; 186: 148-154
- Pregnancy increases cardiovascular toxicity to cocaine.Am J Obstet Gynecol. 1990; 162: 529-534
- Effect of cocaine on uterine blood flow and fetal oxygenation.JAMA. 1987; 257: 957-961
- Fetal effects of cocaine: an updated meta-analysis.Reprod Toxicol. 2001; 15: 341-369
- Cocaine decreases uteroplacental blood flow in the rat.Neurotoxicol Teratol. 1999; 21: 559-565
- Cocaine alters placental production of thromboxane and prostacyclin.Am J Obstet Gynecol. 1994; 171: 965-969
- The effect on uteroplacental blood flow of epidural anaesthesia containing adrenaline for caesarean section.Acta Anaesthesiol Scand. 1990; 34: 85-89
- Uteroplacental and fetal circulation during extradural bupivacaine-adrenaline and bupivacaine for caesarean section in hypertensive pregnancies with chronic fetal asphyxia.Br J Anaesth. 1993; 71: 348-353
- Effects of equipotent ephedrine, metaraminol, mephentermine, and methoxamine on uterine blood flow in the pregnant ewe.Anesthesiology. 1974; 40: 354-370
- An evaluation of vasopressor therapy for maternal hypotension during spinal anesthesia.Anesthesiology. 1970; 33: 25-34
- A randomized double-blinded comparison of phenylephrine and ephedrine infusion combinations to maintain blood pressure during spinal anesthesia for cesarean delivery: the effects on fetal acid-base status and hemodynamic control.Anesth Analg. 2008; 107: 1295-1302
- Placental transfer and fetal metabolic effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery.Anesthesiology. 2009; 111: 506-512
- Ephedrine and phenylephrine for the treatment of maternal hypotension in a chronic sheep model of increased placental vascular resistance.Br J Anaesth. 2006; 96: 231-237
- Divergent effects of ephedrine and phenylephrine on cardiovascular hemodynamics of near-term fetal sheep exposed to hypoxemia and maternal hypotension.Acta Anaesthesiol Scand. 2007; 5: 922-928
- The nasal airways in normal subjects to oxymetazoline spray: randomized double-blind placebo-controlled trial.Br J Clin Pharmacol. 1999; 48: 53-56
- Uterine and fetal Doppler flow changes from a single dose of a long-acting intranasal decongestant.Obstet Gynecol. 1990; 76: 180-182
- Bradycardia, hypotension, and near-syncope associated with afrin (oxymetazoline) nasal spray.N Engl J Med. 1983; 309: 73
- Could the absence or malfunction of the vascular endothelium precipitate the occurrence of vasospasm?.J Mol Cell Cardiol. 1986; 18: 679-689
- Pharmacological characterization of postjunctional alpha-adrenoceptors in human nasal mucosa.Am J Rhinol. 2005; 19: 495-502
- Pregnancy alters adrenergic mechanisms in uterine arterioles of rats.Anesth Analg. 2002; 94: 1304-1309
Article info
Publication history
Published online: February 11, 2011
Accepted:
November 28,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
