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Spinal anesthesia is reasonable for patients

Aug 30, 2013 with severe preeclampsia for caesarean
delivery.
By J. LANCE
LICHTOR
in OBSTETRIC
A NESTHESIOLOGY Should spinal anesthesia be used for caesarean
delivery in a patient with preeclampsia,? Spinal
anesthesia was once considered contraindicated
because the ensuing hypotension would SEARCH
compromise uteroplacental blood flow. This has
not been supported by evidence, and indeed Search
spinal anesthesia is a reasonable treatment
method. Dr. Vanessa G. Henke, Department of
RECENT POSTS
Anesthesia, Stanford University School of
Medicine, Stanford, California and colleagues Anesthesia Information Sy stem Use in
recently reviewed the controversy in their Academic Practice March 1 7 , 201 4
manuscript Spinal Anesthesia in Severe Liv er transplantation, blood requirement,
Preeclampsia in this months Anesthesia & and outcome March 1 4, 201 4
Analgesia.
The nonparametric test for hy pothesis
Image: Outcome is no w orse testing: the Kruskal-Wallis test and
Clinical Pearls
w hen spinal anesthesia is used bey ond March 1 2, 201 4
for caesarean delivery (Image
source: Thinkstock) What is the evidence that shows hypotension is Remifentanil instead of epidural
not an issue when spinal anesthesia is used for analgesia: are the two both efficacious and
safe? March 1 0, 201 4
patients with severe preeclampsia?

In one study, hypotension risk and need for ephedrine for preeclampsia patients was less ARCHIVES
than for healthy patients. In that study, mean gestational age and fetal weight were
significantly lower in the severely preeclamptic group so aorto-caval compression could Select Month
have been less in the preeclamptic patients. In a second study, there were similar
findings and similar issues as with the first study. In a third study, normotensive and CATEGORIES
preeclamptic patients gestational age was controlled and hypotension risk and need for
Select Category
ephedrine use was less in the patients with preeclampsia compared to normotensive
patients.
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Is spinal anesthesia as safe as epidural anesthesia for patients with severe
preeclampsia?

A rigorous multicenter randomized, controlled trial that involved 100 severely

SUBSCRIBE
preeclamptic parturients, showed that although hypotension was greater after spinal
anesthesia compared to epidural anesthesia, the differences were most likely not Email:
clinically significant.
SUBSCRIBE
When should spinal anesthesia be considered for patients undergoing caesarian Cr eated b y W eb f i sh.

delivery?

Spinal anesthesia should be considered, in an emergency, if there is no epidural catheter

in place, and if there is a contraindication to a neuraxial technique (coagulopathy or
eclampsia with persistent neurologic deficits).

Why is general anesthesia problematic for patients with preeclampsia?

Although the absolute risk of general anesthesia is low, patients with preeclampsia who
receive general anesthesia can become hypertensive. The risk of difficult or failed
 laryngoscopy and intubation is greater in preeclampsia patients compared with
normotensive patients, perhaps because of greater pregnancy associated swelling of
pharyngeal and glottis tissue.

How can risk of hypotension after spinal anesthesia be lowered?

Fluid management or prophylactic phenylephrine infusions have not specifically been

studied in this population. Hypotension due to spinal anesthesia is dependent on dose of
spinal anesthetic. Hypotension after a combined spinal-epidural is less than after a single
shot spinal anesthetic, although combined spinal anesthesia has not been compared with
spinal anesthesia in patients with severe preeclampsia.

How should hemodynamics be monitored in patients with preeclampsia?

Theres no evidence to show that invasive hemodynamic monitoring improves outcome

in patients with severe preeclampsia.

Does coagulopathy affect risk of spinal/epidural anesthesia?

Smaller needles are used for spinal anesthesia, so risk of hematoma may be less. Theres
no specific rule for a safe platelet count, yet many feel that the platelet count should be
at least 75,000 /l and partial thromboplastin and prothrombin should be normal if the
platelet count is < 150,000 /l before spinal anesthesia is used.

Read the article in its entirety for much more detail on this subject.

OpenAnesthesia has a discussion on anesthesia for caesarean delivery.

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Avoid hypoxia, hypercarbia and hypotension! A lower dose of epidural morphine is as

effective as the standard dose but with fewer
side effects

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