COMPARISM BETWEEN THE EFFECTS OF SPINAL ANESTHESIA IN PATIENTS WITH PRE-ECLAMPSIA AND HEALTHY PATIENTS DURING CESAREAN SECTION

Dr. Duraid Jameel Kareem*, Dr. Khlood Ahmad Shihab and Dr. Raed Majeed Yaseen

ABSTRACT

Background: Spinal anesthesia is widely regarded as a reasonable anesthetic option for cesarean delivery in severe pre-eclampsia, provided there is no contraindication to neur-axial anesthesia, Despite controversies about the safest anesthetic technique for cesarean delivery in severely preeclamptic women, there is evidence that supports the use of spinal anesthesia in this group of patients. In this review, we describe the advantages and limitations of spinal anesthesia in the setting of severe preeclampsia and the evidence guiding intraoperative hemodynamic management. Objectives: This prospective randomized clinical trial was designed to determine the hemodynamic effects of low-dose spinal bupivacaine and the incidence of spinal anesthesia-associated hypotension in severely preeclamptic and healthy part urients undergoing cesarean sections. Patients and Methods: In our study we performed: Spinal anesthesia with 7.5 mg (= 1.5 mL) hyperbaric 0.5% bupivacaine plus 25 μg fentanil in two groups of patients after they received 500 mL of IV lactated Ringer’s solution. At start, heart rate and blood pressure were recorded before spinal anesthesia and at two minutes intervals for 15 minutes after the block, and then every five minutes until the end of the surgery, Hypotension was defined as more than 25% of decline in the mean arterial blood pressure compared to the baseline in both groups (or systolic blood pressure < 100mm Hgin healthy parturients) and was treated with 5 mg IV ephedrine. We have been recorded the total amounts of intravenous administered fluid and the total doses of ephedrine for each patient as well. Results: For both groups, the incidence rate of hypotension among the pre-eclamptic patients was lower than that of the healthy parturients, despite the former group receiving smaller volumes of intravenous fluids (P< 0.05). Compared with healthy part urients, those with severe preeclampsia experience less frequent, less severe spinal-induced hypotension. However, this hypotension is typically easily treated and short lived, and no studies have demonstrated clinically significant differences in outcomes when spinal anesthesia is compared with epidural or general anesthesia. The total doses of IV ephedrine for treating hypotension were significantly lower among the pre-eclamptic patients (2.8mgin preeclamptic patients versus 7mgin normotensive patients) (P = 0.02), The one-minute Apgar score was significantly lower for the pre-eclamptic parturients (8.4_0.7 versus 7.2_1.5) (P = 0.001), but there was no significant difference in the five-minute Apgar scores between the two groups. Conclusions: In my study, the results confirm that low-dose bupiva caine spinal anesthesia is associated with a lower risk of hypotension than previously believed, and it can therefore be safely used in severe pre-eclamptic women undergoing cesarean delivery.

Keywords: Preeclampsia, Anesthesia, Spinal, Cesarean Section, Hypotension.