Spinal anesthesia resulted in similar maternal blood pressure declines compared to epidural anesthesia in severely preeclamptic women, despite greater crystalloid administration (1780 vs 1359 ml).
Cohort (n=138)
Does spinal anesthesia cause greater blood pressure declines compared to epidural anesthesia in severely preeclamptic patients requiring cesarean section?
Spinal anesthesia appears to have similar blood pressure effects and maternal/fetal outcomes compared to epidural anesthesia in severely preeclamptic patients undergoing cesarean section.
BACKGROUND: Selection of spinal anesthesia for severely preeclamptic patients requiring cesarean section is controversial. Significant maternal hypotension is believed to be more likely with spinal compared with epidural anesthesia. The purpose of this study was to assess, in a large retrospective clinical series, the blood pressure effects of spinal and epidural anesthesia in severely preeclamptic patients requiring cesarean section. METHODS: The computerized medical records database was reviewed for all preeclamptic patients having cesarean section between January 1, 1989 and December 31, 1996. All nonlaboring severely preeclamptic patients receiving either spinal or epidural anesthesia for cesarean section were included for analysis. The lowest recorded blood pressures were compared for the 20-min period before induction of regional anesthesia, the period from induction of regional anesthesia to delivery, and the period from delivery to the end of operation. RESULTS: Study groups included 103 women receiving spinal anesthesia and 35 receiving epidural anesthesia. Changes in the lowest mean blood pressure were similar after epidural or spinal anesthesia. Intraoperative ephedrine use was similar for both groups. Intraoperative crystalloid administration was statistically greater for patients receiving spinal versus epidural anesthesia (1780 +/- 838 vs. 1359 +/- 674 ml, respectively). Neonatal Apgar scores and incidence of maternal intensive care unit admission or postoperative pulmonary edema were also similar. CONCLUSION: Although we cannot exclude the possibility that the spinal and epidural anesthesia groups were dissimilar, the magnitudes of maternal blood pressure declines were similar after spinal or epidural anesthesia in this series of severely preeclamptic patients receiving cesarean section. Maternal and fetal outcomes also were similar.
Hood et al. (Sat,) conducted a cohort in Severe preeclampsia requiring cesarean section (n=138). Spinal anesthesia vs. Epidural anesthesia was evaluated on Changes in the lowest mean blood pressure. Spinal anesthesia resulted in similar maternal blood pressure declines compared to epidural anesthesia in severely preeclamptic women, despite greater crystalloid administration (1780 vs 1359 ml).