Regional anaesthesia for caesarean section in severe preeclampsia: spinal anaesthesia is the preferred choice

Abstract

Three clinical investigations together with a combined editorial and review of the cardiovascular physiology of spinal anaesthesia in normal and preeclamptic pregnancy form the basis of a thesis to be submitted for the degree of Doctor of Medicine at the University of St Andrews. First, the longstanding consensus that spinal anaesthesia could cause severe hypotension in severe preeclampsia was examined using three approaches. The doses of ephedrine required to maintain systolic blood pressure above predetermined limits were first compared in spinal versus epidural anaesthesia. The doses of ephedrine required were then similarly studied during spinal anaesthesia in preeclamptic versus normal control subjects. The principal outcome of these studies, that preeclamptic patients were resistant to hypotension after a spinal anaesthetic, was then further investigated by studying pulse transit time (PTT) changes in normal versus preeclamptic pregnancy. PTT was explored both as beat-to-beat monitor of cardiovascular function and also as an indicator of changes in arterial stiffness. The cardiovascular physiology of obstetric spinal anaesthesia was then reviewed in the light of the three clinical investigations, developments in reproductive vascular biology and the regulation of venous capacitance. It is argued that the theory of a role for vena caval compression as the single cause of spinal anaesthetic induced hypotension in obstetrics should be revised.

Effect of magnesium sulphate on quality of subarachnoid block in terms of onset and duration of motor and sensory block, APGAR score of the neonate and haemodynamic status of the patient

“…The need for ephedrine due to hypotension was similar between the spinal and epidural groups. A retrospective study by Hood et al 3 and a prospective study by Sharwood smith et al 4 agreed with this findings.…”

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]. Recently, spinal anesthesia became a major anesthetic technique for the cesarean section of HDP patients in our hospital, and it is preferred to obstetricians because it offers the advantage of rapid onset and complete muscle relaxation.…”

Cardiovascular alterations in the parturient undergoing cesarean delivery with neuraxial anesthesia

“…However, recent, prospective studies have challenged this belief, indicating that the frequency and severity of hypotension associated with spinal anesthesia was less in preeclamptic women than in healthy women [117][118][119]. Furthermore, some prospective and Review retrospective studies have shown no significant differences in hemodynamic shifts when spinal and epidural local anesthetic techniques for CD have been compared [120][121][122]. Moreover, some of these studies have indicated that the hypotension produced was short-lived, easily treated and did not affect neonatal outcomes [123].…”