RANDOMIZED COMPARISON OF GENERAL AND REGIONAL ANESTHESIA FOR CESAREANDELIVERY IN PREGNANCIES COMPLICATED BY SEVERE PREECLAMPSIA

Objective: To evaluate the maternal and fetal effects of three anesthe tic methods used randomly in women with severe preeclampsia who requir ed cesarean delivery. Methods: Eighty women with severe preeclampsia, who were to be delivered by cesarean, were randomized to general (26 w omen), epidural (27), or combined spinal-epidural (27) anesthesia. The mean preoperative blood pressure (BP) was approximately 170/110 mmHg, and all women had proteinuria. Anesthetic and obstetric management in cluded antihypertensive drug therapy and limited intravenous (IV) flui d and drug therapy. Results: The mean gestational age at delivery was 34.8 weeks. All infants were born in good condition as assessed by Apg ar scores and umbilical arterial blood gas determinations. Maternal hy potension resulting from regional anesthesia was managed without exces sive IV fluid administration. Similarly, maternal BP was managed witho ut severe hypertensive effects in women undergoing general anesthesia. There were no serious maternal or fetal complications attributable to any of the three anesthetic methods. Conclusion: General as well as r egional anesthetic methods are equally acceptable for cesarean deliver y in pregnancies complicated by severe preeclampsia if steps are taken to ensure a careful approach to either method.