REGIONAL ANESTHESIA IN PREECLAMPSIA

Abstract

Phyiological changes during pregnancy maintain a healthy environment for the fetus without compromising the mother's health. These modifications affect almost every organ system and influence the anesthetic and perioperative management of the pregnant woman. The physiologic changes of pregnancy, especially in the gastrointestinal and cardiovascular systems, directly influence the absorption, distribution, and elimination of drugs. Preeclampsia, a pregnancy specific disorder characterized clinically by new onset hypertension and proteinuria after 20 week of gestation, is the most frequently encountered medical complication during pregnancy affecting 3–5% of pregnant women worldwide. Historically known as the “disease of theories”. The mystery about the molecular pathogenesis of preeclampsia is beginning to be unraveled with a key discovery about alterations in placental antiangiogenic factors. These antiangiogenic factors produce systemic endothelial dysfunction, resulting in hypertension, proteinuria, and the other systemic manifestations of preeclampsia. The cornerstones of management of preeclampsia remain seizure prophylaxis, fluid and antihypertensive therapy, expeditious delivery and critical care management. Initial stabilization of the severe preeclamptic patient includes careful fluid therapy. Summary 101 Magnesium sulphate is the drug of choice for seizure prophylaxis. It is very safe in the setting of regional anesthesia. There is consensus that maternal risk, mainly for stroke, is decreased by antihypertensive therapy if hypertension is severe. There should be early consultation with an anesthesiologist, ideally antepartum, but certainly on admission to the labor ward of a woman with preeclampsia. Weight gain, breast engorgement, upper airway edema, and friability of the airway mucosa combine to make endotracheal intubation more problematic. All of these factors are often further exaggerated by preeclampsia, making regional anesthesia a preferable alternative to general anesthesia when feasible. However, when a fetal emergency arises, leaving little time for regional anesthesia, or when regional anesthesia is contraindicated, a general anesthetic may be unavoidable. Anesthetic management of preeclamptic patients requires appropriate monitoring and should at a minimum include blood pressure, pulse oximetry, and a Foley catheter. While not common, invasive monitoring is sometimes required. Single shot spinal anesthesia for cesarean section, employing similar doses as in the healthy patients, and an emphasis on vasopressors rather than fluid infusion to treat hypotension, is safe. Recent research into spinal anesthesia for cesarean section in preeclamptic patients suggests a lower susceptibility

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