International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 1995
Bradycardia and asystole following atropine-neostigmine administration after caesarean section in a parturient receiving methyldopa for pregnancy-induced hypertension.
We report one case of bradycardia and asystole immediately after the administration of 1 mg atropine and 2 mg neostigmine after the completion of an urgent caesarean section. We attribute this adverse reaction to the treatment of pregnancy-induced hypertension with methyldopa, perhaps facilitated by other drugs employed. Similar reactions have been reported relating to beta-receptor antagonists and tricyclic antidepressants, but not to methyldopa.
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Emergent attainment of uterine relaxation is an occasional need in obstetric practice. Various agents, from amyl nitrate through volatile anesthetics have been used to relax the uterus, with varying degrees of success and side-effects. ⋯ We have used a new sublingual aerosol spray of NTG, at an initial dose of 0.8 mg, in 7 patients for rapid uterine relaxation and have not observed adverse side-effects. Prolonged shelf life, ready availability and ease of use make the sublingual spray attractive for urgent tocolysis.