Therefore, epidurally administered epinephrine and clonidine have the potential to produce segmental analgesia. Clonidine produces hemodynamic disturbances and sedation, and this drug is Neostigmine, a cholinesterase inhibitor, potentiates the analgesic effect of acetylcholine in the spinal cord dorsal horn in response to painful stimulus. Intramuscular analgesics have traditionally been used, but these cause undue sedation and do not provide adequate analgesia. Some critically ill parturients develop coagulopathy or may be on anticoagulants such as heparin. It is important to examine the complications of central neural blockade in the presence of coagulopathy and anticoagulants.
Spinal hematomas are rare complications of spinal or epidural anesthesia.
Acute spinal cord compression from a hematoma in the epidural, subdural, or subarachnoid space can rapidly produce permanent paraplegia. Anticoagulation Therapy Warfarin is not used during pregnancy because of the risk of teratogenicity in early pregnancy and the risk of central nervous system abnormalities in the second and third trimesters. These effects are caused by alteration in the activity of drug metabolizing enzyme systems, excretion, secretion and transport process, changes in body composition, and alteration of protein binding. Most of the medications that are used during pregnancy reach the fetus to some degree, with the exception of highly charged polar compounds such as heparin. Exposure to certain drugs during the most critical period of organogenesis, during days 31 to 71 after the last menstrual period, can result in malformations.