HYPERTENSIVE DISORDERS OF PREGNANCY

Spinal anesthesia for lower segment Cesarean section in patients with stable eclampsia

STUDY OBJECTIVE

To report the use of spinal anesthesia in stable eclamptic patients.

DESIGN

Prospective case series.

SETTING

Emergency operating room of a metropolitan hospital.

PATIENTS

12 "stable" eclamptic parturients.

INTERVENTIONS

Subarachnoid block was instituted with hyperbaric 0.5% bupivacaine 1.7 mL with fentanyl 25 μg.

MEASUREMENTS

Intraoperative maternal hypotension, episodes of convulsion, the need to convert to general anesthesia, and Apgar scores at 1 and 5 minutes were recorded.

MAIN RESULTS

Only one of the 12 parturients had an episode of hypotension (treated by intravenous ephedrine), while no patient had a convulsion over the 48 hours after delivery. The sensory level achieved was T₅-T₆ and none of the cases was converted to general anesthesia. Median Apgar scores at 1 and 5 minutes were 8 and 9, respectively.

CONCLUSION

Spinal anesthesia avoided the known risks of general anesthesia and was not associated with any major complications.

Epidural compared with general anaesthesia for caesarean delivery in conscious women with eclampsia

OBJECTIVE

To compare retrospectively the outcome of caesarean section under epidural anaesthesia with that of general anaesthesia in "stable" women with eclampsia.

DESIGN

Retrospective review.

METHOD

Over the five-year study period, there were 533 women with eclampsia and of these 66 women (12.4%), fulfilled the criteria of being 'stable'. Of the 66 women, 37 received epidural, 27 general, and 2 spinal anaesthesia.

RESULTS

There were no major complications with either general or epidural anaesthesia. Epidural anaesthesia was associated with higher one-minute Apgar scores.

CONCLUSION

This study indicates that both maternal and neonatal outcomes are not affected adversely by the use of epidural anaesthesia in selected cases of eclampsia.