Abstract
Background: Anaesthetic approach to caesarean section in severely pre-eclamptic patients has considerably changed during the last few decades. Spinal anesthesia is widely regarded as a reasonable anesthetic option for cesarean delivery in severe preeclampsia, provided there is no indwelling epidural catheter or contraindication to neuraxial anesthesia. The aim of this study was to compare the haemodynamics between normal healthy parturients and patients with severe pre-eclampsia undergoing LSCS under spinal anaesthesia.
Materials and Methods: Spinal anesthesia was performed in two groups of parturients (31 in each group) with singleton pregnancy posted for elective LSCS. Heart rate and blood pressure were recorded before spinal anesthesia and thereafter at 3 minute intervals upto 60 minutes. Hypotension was defined as MAP <30% of the baseline or a decrease in SBP to < 100 mm Hg over the same time interval and was treated with 50 mcg phenylephrine i.v.
Results: The incidence rate of hypotension among the preeclamptic patients was lower than that of the healthy parturients (P <0.05). The total doses of IV Phenylephrine for treating hypotension were significantly lower among the preeclamptic patients (72 mcg in preeclamptic patients versus 188 mcg in normotensive patients) (P <0.05). There was no statistical difference in the neonatal outcome and APGAR score in the study groups.
Conclusion: Spinal anaesthesia in preeclampsia patients is associated with better perioperative hemodynamic stability, less hypotension and less vasopressor consumption.
Keywords: Preeclampsia, Cesarean, Anaesthesia, Spinal, Hypotension.
References
- Bourne TM, deMelo AE, Bastianpillai BA, May AE. A survey of how British obstetric anaesthetists test regional anaesthesia before caesarean section. Anaesthesia 1997;52:901–3.
- Antoine G. M. Aya et al: Spinal Anesthesia-Induced Hypotension: A Risk Comparison Between Patients with Severe Preeclampsia and Healthy Women Undergoing Preterm Cesarean Delivery: Anesth Analg 2005; ;101:869-75.
- Antoine G. M. Aya, Roseline Mangin, Nathalie Vialles, Jean-Michel Ferrer, Colette Robert, Jacques Ripart, and Jean-Emmanuel de La Coussaye, et al : Patients with Severe Preeclampsia Experience Less Hypotension During Spinal Anesthesia for Elective Cesarean Delivery than Healthy Parturients: A Prospective Cohort Comparison. Published in AnesthAnalg 2003;97:867–72
- Pritchard JA, Cunningham FG, Pritchard SA. The Parkland Memorial Hospital protocol for treatment of eclampsia: evaluation of 245 cases. Am J Obstet Gynecol 1984;148:951–63
- Hood DD, Curry Ret al Spinal versus epidural anesthesia for cesarean section in severely preeclamptic patients: a retrospe-ctive survey: Anesthesiology 1999:90: 1276-82
- Chiu CL, Mansor M, Ng KP, Chan YK. Retrospective review of spinal versus epidural anaesthesia for caesarean section in pre-eclamptic patients. Int J Obstet Anesth 2003;12:23-7.
- National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy, Bethesda, Maryland, january 2000
- Global burden of hypertensive disorders of pregnancy in the year 2000: Carmen Dolea, Carla Abou Zahr - Evidence and Information for Policy (EIP),World Health Organization, Geneva, July 2003 report
- Morgan and Mikhail’s Clinical Anesthesiology 4thed 2009
- Dona Saha, Sarmila Ghosh, Susmita Bhattacharyya, Suchismita Mallik, Rajib Pal1, Mousumi Niyogi, Amit Banerjee. Comparison of hemodynamic response and vasopressor requirement follo wing spinal anaesthesia between normotensive and severe preeclamptic women under-going caesarean section: A prospective study Journal of Obstetric Anaesthesia and Critical Care / Jan-Jun 2013 / Vol 3 | Issue 1
- H Ishrat, A Raja: Spinal anesthesia in preeclamptic parturients ; The Internet Journal of Anesthesiology. 2006; Voume 14 Number 2.
- Clark VA, Sharwood-Smith GH, Stewart AV. Ephedrine requirements are reduced during spinal anaesthesia for caesarean section in preeclampsia. Int J ObstetAnesth 2005;149-13
- Alan C. Santos and David J. Birnbach; Spinal Anesthesia for Cesarean Delivery in Severely Preeclamptic Women: Don’t Throw Out the Baby with the Bathwater! Anesth Analg 2005; 101:859–61.
- Dyer, Robert A; Joubert, Ivan A ; Low-dose spinal anaesthesia for Caesarean section published in Current Opinion in Anaesthesiology: August 2004 - Volume 17 - Issue 4 - pp 301-308:
- Dennis ; Management of pre-eclampsia: issues for anaesthetists Anaesthesia 2012 review article Sep;67(9):1009-20.
- Shusee Visalyaputra, MD, Oraluxna Rodanant, MD, Wanna Somboonviboon, MD, Kamthorn Tantivitayatan, MD, Somboon Thienthong, MD, and Wanawimol Saengchote, MD et al ; Spinal Versus Epidural Anesthesia for Cesarean Delivery in Severe Preeclampsia: Prospective Randomized, Multicenter Studyin Anesth-Analgesia 2005 sept; 101:862-8.
- Sujata Chaudhary and Rashmi Salhotra et al Subarachnoid block for caeserean section in severe preeclampsia.J Anaesthesiol Clin Pharmacol. 2011 Apr-Jun;27(2):169-173.
Corresponding Author
Dr Arbind Kr Ray
Assistant Professor, Dept of Anaesthesiology and Critical Care, Gauhati Medical College and Hospital
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i8.41
