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Area of Science:

  • Anesthesiology
  • Pharmacology
  • Obstetrics

Background:

  • Antipsychotic medications are frequently used during pregnancy.
  • These drugs can interact with anesthetic management.
  • Risperidone has alpha-1 adrenergic antagonism properties.

Purpose of the Study:

  • To report a case of exaggerated hypotension during spinal anesthesia in a parturient on risperidone.
  • To highlight the potential anesthetic implications of risperidone's alpha-antagonism.

Main Methods:

  • Case report of a parturient with bipolar disease undergoing cesarean delivery.
  • Spinal anesthesia was administered.
  • Hypotension was managed with conventional treatments and phenylephrine.

Main Results:

  • The parturient experienced exaggerated hypotension refractory to ephedrine and IV fluids.
  • Hypotension eventually responded to large doses of phenylephrine.
  • This suggests a potential role for risperidone's alpha-antagonism.

Conclusions:

  • Antipsychotic medications, including risperidone, can cause significant hypotension during neuraxial anesthesia.
  • Alpha-adrenergic antagonism of risperidone should be considered in such cases.
  • Phenylephrine may be an effective treatment for refractory hypotension.