[Drug therapy of eclampsia. An obstetric-anesthesiologic problem in the intensive care unit]

The study presented was based on the concept, that the eclamptic convulsions reflect multiple damages of the central nervous system. Primary damage occurs in the cerebral vessels, which leads to 1. volume overload of the cerebral tissue, 2. loss of fluid out of the vascular system, 3. intracranial pressure fluctuation caused by the loss of cerebral autoregulation. All of these damages combined with an additional metabolically induced decreased convulsive threshold could provoke convulsions. A new therapy is therefore suggested combining dexamethasone and a highly concentrated albumin-solution together with a careful stabilization of blood pressure to reduce the intracranial overload of volume and to avoid intracranial pressure fluctuation. Additionally phenytoin normalizes the generalized decreased convulsive threshold. This method has been successfully applied in clinical treatment since 1977. By omitting strong sedatives like diazepam the patient is mentally alert and more cooperative during therapy, which is important in order to avoid further post partum complications. Compared to the currently preferred magnesium-therapy, the new method does not include the danger of neuromuscular block of transmission resulting in acute respiratory arrest. Furthermore the application of multiple individual substances allows a better adaptation of the therapy to the clinical situation.