Subarachnoid block for caesarean section in severe preeclampsia

Abstract

Pregnancy-induced hypertension constitutes a major cause of morbidity and mortality in developing nations and it complicates about 6–8% of pregnancies. Severe preeclampsia poses a dilemma for the anesthesiologist especially in emergency situations where caesarean deliveries are planned for uninvestigated or partially investigated parturients. This article is aimed to review the literature with regards to the type of anesthesia for such situations. A thorough search of literature was conducted on PubMed, EMBASE, and Google to retrieve the articles. Studies on parturients with severe preeclampsia, undergoing caesarean section, were included in this article. There is growing evidence to support the use of subarachnoid block in such situations when the platelet counts are >80,000 mm-3. Better hemodynamic stability with the use of low-dose local anesthetic along with additives and better neonatal outcomes has been found with the use of subarachnoid block when compared to general anesthesia.

Comparison of hemodynamic change following spinal anesthesia in preeclamptic and non-preeclamptic parturients undergoing cesarean section at University of Gondar comprehensive specialized hospital, Northwest Ethiopia.

“…However, this difference was not statistically significant (p =0.550). Even though our study does not quantify it, studies found that hypotension requiring vasopressor medication(ephedrine and phenylephrine) following spinal anesthesia was less common in parturients with preeclampsia than in non-preeclamptic parturients [12,17,25,37,38,41,42]. The limitation of this study was the small sample size, observational study design which was difficult to control all possible cofounders(like oxytocin), and inability to quantify vasopressor consumption; due to lack of standardized vasopressor(ephedrine and phenylephrine)usage in the practice, which could affect the trends of hemodynamic change over time.…”

Retrospective Analysis of Anesthesia for Cesarean Section of the Patients with Hypertensive Disorders in Pregnancy for 15 Years

“…However, many clinical studies proved that spinal anesthesia could be performed safely in the cesarean section for severe preeclampsia patients [14][15][16], and the incidence of hypotension and ephedrine requirement were lower than healthy parturient group [17,18]. In one previous study spinal anesthesia was reported to be more favorable choice of anesthesia than epidural anesthesia because of quality of analgesia and time efficiency even though both of them did not induce severe hypotension and neonatal depression in preeclampsia [19].…”

Pregnancy With Severe Mitral Stenosis With Post Cesarean Pph– A Challenge

“…Often concern of profound hypotension after subarachnoid block deters the anaesthetist from choosing spinal anaesthesia . 13 Epidural anaesthesia is safer option .General anaesthesia has the disadvantage of increased pulmonary arterial pressure and tachycardia during laryngoscopy and tracheal intubation. Moreover, the adverse effects of positive-pressure ventilation on the venous return may ultimately lead to cardiac failure.…”