The hemodynamic effects of intubation during nitroglycerin infusion in severe preeclampsia

The effectiveness of intravenous nitroglycerin infusion in lowering maternal blood pressure and in blunting the hemodynamic responses to endotracheal intubation was evaluated in six primigravid women with severe preeclampsia. Monitoring consisted of continuous electrocardiogram monitoring, arterial cannulation, and flow-directed pulmonary arterial catheterization in each patient. All patients underwent oxytocin induction of labor and crystalloid and/or colloid expansion to produce a pulmonary capillary wedge pressure of 10 to 15 mm Hg and a colloid osmotic pressure of >17 mm Hg. Intravenous nitroglycerin was administered before induction of general anesthesia. The hemodynamic effects associated with endotracheal intubation revealed a change in the heart rate from 104 ± 10 to 133 ± 17 beats/min, an increase in mean arterial pressure from 134 ± 12 to 164 ± 32 mm Hg, and an increase in systemic vascular resistance from 1262 ± 342 to 1351 ± 259 dynes-sec-cm −5 that was accompanied by a small change in the cardiac index from 4.5 ± 1.2 to 4.5 ± 0.9 L · min −1 · m −2 .