This prospective observational study compared the effects of general and spinal anesthesia in 173 severe preeclamptic women undergoing emergency cesarean section. 146 (84.5%) patients underwent spinal anesthesia (SA) and 27 (15.5%) patients had general anesthesia (GA). Most of the patients were primigravid and nulliparous. Intraoperatively SA group required more intravenous fluid and vasopressor support, while GA group required more preoperative labetalol injection for blood pressure control. Overall 13.3% of patients required critical care, particularly GA group (44.4% versus 7.5%; P < 0.001). Patients receiving GA had a higher mortality (25.9% versus 1.4%; P < 0.001). The length of hospital stay was comparable. Significantly more neonates of patients receiving GA were found to be preterm (77.8% versus 44.5%; P < 0.01) and required advanced resuscitation. GA group also had higher neonatal mortality (29.6% versus 11%; P < 0.05). To conclude, severe preeclamptic mothers receiving general anesthesia and their babies required more critical care support. Maternal as well as neonatal mortality was significantly higher with general anesthesia.

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BACKGROUND Dexmedetomidine provides excellent sedation with minimal cardiovascular instability or respiratory depression and this has been widely used to attenuate intubation surge. This drug may be a useful adjunct to facilitate smooth tracheal extubation. The aim of this study was to evaluate the ability of dexmedetomidine to attenuate the haemodynamic responses during extubation. METHODS 50 patients of ASA Grade I-II aged 20-50 years, were randomly allocated into two groups to receive either dexmedetomidine 0.75 μg/Kg in 100 ml normal saline (Group D) or 100 ml of normal saline (Group C) infusion over 15 minutes, initiated 15 mins., before anticipated end of surgery. Heart rate, systolic, diastolic and mean arterial pressures were assessed before, during and after extubation. Extubation quality was rated using 5-point scale. Sedation was rated using Ramsay Sedation Scale. Any adverse event was noted. Results were tabulated and statistically analysed using SPSS Software. RESULTS There was initially insignificant difference in mean (±SD) HR, SBP, DBP in both the groups. HR became significantly higher at and after 5 minutes of start of infusion till observation continued in Group C. SBP, DBP, MAP were significantly lower (p < 0.05) in group D than 10 min after starting of infusion and thereafter in all observation made up to 15 minutes postoperatively. Extubation quality score of the majority of patients was superior in group D than in group C. Sedation score of most patients was 3 in group D and 2 in group C. The incidence of adverse effects was statistically insignificant between the two groups (p valve>0.05). CONCLUSIONS Dexmedetomidine (0.75 mcg/Kg) infusion stabilizes haemodynamics and facilitates smooth extubation without causing undue sedation.

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