Patients with Severe Preeclampsia Experience Less Hypotension During Spinal Anesthesia for Elective Cesarean Delivery than Healthy Parturients: A Prospective Cohort Comparison

Abstract

In this prospective cohort study, we compared the incidence and severity of spinal anesthesia (SA)-associated hypotension in severely preeclamptic (n = 30) versus healthy (n = 30) parturients undergoing cesarean delivery. After the administration of IV fluids, SA was performed with hyperbaric 0.5% bupivacaine, sufentanil, and morphine. Blood pressure (BP) was recorded before and at 2-min intervals for 30 min after SA. Clinically significant hypotension was defined as the need for ephedrine (systolic BP decrease to <100 mm Hg in healthy parturients or 30% decrease in mean BP in both groups). Despite receiving a smaller fluid volume (1653 +/- 331 mL versus 1895 +/- 150 mL; P = 0.005) and a larger bupivacaine dose (10.5 +/- 0.9 mg versus 10.0 +/- 0.7 mg; P = 0.019), the severely preeclamptic patients had a less frequent incidence of clinically significant hypotension (16.6% versus 53.3%; P = 0.006), which was less severe and required less ephedrine. The risk of hypotension was almost six times less in severely preeclamptic patients (odds ratio, 0.17; 95% confidence interval, 0.05-0.58; P = 0.006) than that in healthy patients.

Magnesium sulfate enhances non-depolarizing muscle relaxant vecuronium action at adult muscle-type nicotinic acetylcholine receptor in vitro

“…The choice of anesthetic techniques for Cesarean sections in such patients is the subject of intense debate [1][2][3] . Although anesthesiologists prefer epidural anesthesia in hypermagnesemic parturients, the risk of coagulopathy or hemodynamic catastrophe often requires anesthesiologists to proceed with urgent general anesthesia.…”

Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: Continuing Professional Development

“…53 Except for the usual contra-indications of neuraxial anesthesia, spinal anesthesia involving usual clinical doses of bupivacaine is now regarded as a safe approach for pre-eclamptic patients requiring Cesarean delivery. [53][54][55][56][57] Experimental data show that the incidence of hypotension induced by the spinal anesthestic and the requirement for vasopressors are reduced in this population compared with healthy parturients. 54,55 Although spinal blockade is responsible for an approximately 20% decrease in systolic blood pressure, both in healthy parturients and pre-eclamptic patients, blood pressure values meeting the definition of arterial hypotension are seen less frequently in pre-ecamptic patients, therefore treatment is required less often.…”

“…[53][54][55][56][57] Experimental data show that the incidence of hypotension induced by the spinal anesthestic and the requirement for vasopressors are reduced in this population compared with healthy parturients. 54,55 Although spinal blockade is responsible for an approximately 20% decrease in systolic blood pressure, both in healthy parturients and pre-eclamptic patients, blood pressure values meeting the definition of arterial hypotension are seen less frequently in pre-ecamptic patients, therefore treatment is required less often. Moreover, sympathetic blockade causes only a modest decrease in peripheral vascular resistance in pre-eclamptic women, and this may explain the lower incidence of hypotension in these patients.…”

“…[54][55][56]58 As the intravascular compartment may be contracted in this condition, it is suggested that selected patients (especially those with oliguria) may benefit from moderate volume loading. 55 However, pulmonary edema is the most frequent complication in this patient population, in part because of altered pulmonary capillary permeability associated with pre-eclampsia; so cautious volume loading is advised.…”

Obstetrical aspects of perioperative medicine

“…A várandós állapotának felmérése során az elrendelt laboratóriumi vizsgálatok segítségével (vér-kép, máj-és veseműködés, alvadási status) nyilvánva-lóvá válhat egyéb szervek esetleges érintettsége is. Ma már több vizsgálat is igazolta, hogy ebben a betegcsoportban is a neuraxialis érzéstelenítés a választandó eljárás, sőt a vazopresszort igénylő hypotensio előfordu-lása ritkább a normotensiós betegekhez képest [5,6,7]. Tromboelasztogramos vizsgálatok azt mutatták, hogy 100 000/μl thrombocytaszám felett nincs igazolható véralvadási zavar.…”