Dh. Wallace et al., RANDOMIZED COMPARISON OF GENERAL AND REGIONAL ANESTHESIA FOR CESAREANDELIVERY IN PREGNANCIES COMPLICATED BY SEVERE PREECLAMPSIA, Obstetrics and gynecology, 86(2), 1995, pp. 193-199
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.