Randomised Comparison of General Anaesthesia & Subarachnoid Block for Caesarean Delivary in Pregnancies Complicated by Eclampsia

Abstract

General anaesthesia & subaracnoid block were used randomly in women with eclampsia who required caesarian delivery to evaluate the maternal and foetal effects of the two anaesthetic methods. The haemodynamic parameters, level of consciousness of the mothers and APGAR scores of the neonates were assessed. A total 60 women with eclampsia underwent caesarean section were allocated randomly received either of the techniques. Both the techniques provided good quality anaesthesia. At arrival in OT, there was no significant difference of MAP between two groups. But following induction there developed significant difference between two groups & within the same group. There was no significant difference of neurological status between two groups within 24 hours after operation. There were significant difference of Apgar scores in 1 min. after birth & at 5 min. no significant difference were found between the two groups. Out of 30 infants of GA group II had to resuscitate with Ambu-mask ventilation & 6 babies had to sent special care unit. From SAB group 2 infants received resuscitation & one baby had to sent special care unit. In the context of Bangladesh, General anaesthesia as well as Subaracnoid block are equally acceptable for LUCS in eclamptic mothers, if steps are taken to ensure a careful approach to either method. Journal of BSA, Vol. 19, No. 1 & 2, 2006 p.44-50

Spinal anaesthesia in a restless eclamptic with undiagnosed second twin: case report

“…We also did not have difficult or failed spinal anaesthesia. This finding was in support of findings of Singh et al and Basu et al who had no difficult or failed spinal anaesthesia amongst the eclamptic patients who had spinal aneasthesia [ 5 , 6 ]. The procedure which was performed by a consultant anaesthetist was not associated with any form of difficulty in passing spinal needle nor spinal haematoma.…”

“…General anaesthesia would have been a technique of choice in this patient with unstable eclampsia, but the presence of features suggestive of difficult airway did not favour it. In the face of difficult intubation, the attendant hypoxia (desaturation), aspiration pneumonitist, aggravated laryngeal oedema, pressor response to laryngoscopic and intubation can be exaggerated in this eclamptic parturient [ 5 , 6 ]. Although Mallampati assessment could not be carried out, the patient has short neck, large and swollen tongue and more swollen face due to significant tissue edema.…”

“…For most centres, the lowest acceptable platelet count for subarachnoid block is still a subject of controversy. However some authors peg the minimal allowable count at 100 × 10 9 cells/L [ 4 – 6 ]. Basu et al reported that 11 out of 30 neonates in eclamptics with general anesthesia group had resuscitatation with Ambubag-mask ventilation compared to 2 in spinal anaesthesia [ 6 ].…”

“…Spinal anaesthesia in stable eclampsia is no longer new [ 1 – 6 ]. Eclampsia is said to be unstable if there are associated complications such as thrombocytopenia, raised intra cranial pressure, uncontrollable convulsions, restlessness, fetal distress, unconsciousness (GCS < 9), respiratory failure and haemorrhage [ 4 , 5 ].…”

“…Eclampsia is said to be unstable if there are associated complications such as thrombocytopenia, raised intra cranial pressure, uncontrollable convulsions, restlessness, fetal distress, unconsciousness (GCS < 9), respiratory failure and haemorrhage [ 4 , 5 ]. Studies have demonstrated some benefits of sub-arachnoid block over general anaesthesia in stable eclamptic [ 1 , 2 , 4 – 6 ]. The use of sub-arachnoid block in a restless eclamptic has not been documented.…”