inner-banner-bg

Journal of Anesthesia & Pain Medicine(JAPM)

ISSN: 2474-9206 | DOI: 10.33140/JAPM

Impact Factor: 1.8

Comparison of Spinal Versus General Anesthesia for Caesarean Section in Patients with Severe Preeclampsia

Abstract

Ushma H Thakar, Gauri M Panjabi, Dev Desai and Vismit Gami

Preeclampsia is a potentially fatal and multi-system disorder with significant maternal, fetal and neonatal morbidity and mortality. Preeclampsia is a triad of new onset of hypertension (BP>140/90mmhg), proteinuria (>0.3gm/day) and nondependent oedema after 20 weeks of pregnancy while severe preeclampsia is defined as BP > 160/110 mm of hg. The goals are optimization of maternal BP, cardiac output, and uteroplacental perfusion and prevention of seizures and stroke. Risk-benefit considerations strongly favor neuraxial techniques over GA for caesarean.

Aim: Compare hemodynamic stability & feto-maternal outcome.

Objectives: This study aims to investigate intra-operative complications, assess total intravenous fluid and vasopressor requirements, analyze post-operative complications, evaluate Apgar scores, and explore fetomaternal morbidity and mortality.

Methodology: Observational prospective study

Inclusion criteria: Severe preeclampsia ASA grade II/III/IV 18-40 years

Exclusion criteria: Coagulopathy Impending eclampsia HELLP Syndrome Associated cardiovascular & pulmonary disease. After explaining and taking informed written consent taken. Non-invasive monitors applied. In general anesthesia Etco2 monitor was also applied. Before induction, pre-operative vitals noted. The patients were randomized in to two equal groups (n=30) GROUP S: Spinal anesthesia GROUP G: General anesthesia

Results: All vital parameters decreased after giving SA in Group S, while it was increased in Group G(p<0.001). Intraoperative bradycardia, hypotension and vasopressor requirement was more common in Group S. Postop complications were more in Group G. Fetomaternal outcome was better in Group S than Group G.

Conclusion: Relative risk of general and regional anesthesia must be properly assessed. Spinal anesthesia could be considered as better alternative to GA for severe preeclampsia patients undergoing caesarean section without coagulopathy.

PDF