Impact of Adding Midazolam to Bupivacaine 0.5 in Regional Spinal Anesthesia on Maternal Middle Cerebral Artery Velocimetry in Parturients with Severe Preeclampsia

摘要

Severe preeclampsia is a challenging issue facing both intensivist and anesthetic team carrying both maternal and fetal morbidity and mortality. Termination of pregnancy after blood pressure control is the golden key in management. Cerebral complications due to diffuse cerebral vasospasm are most common and serious. Intrathecal midazolam with its gamma amino butyric action may antidote glutamate mediated sympathetic surge and decreasing cerebral vasospasm. Temporal view transcranial Doppler imaging maternal middle cerebral artery is used to examine blood flow indices namely pulsatility index and resistive index. One hundred ladies with severe preeclampsia scheduled for urgent caesarian section were recruited in 2 groups, both received 10 mg bupivacaine 0.5%, Midazolam group received 1 mg midazolam and the other group received 0.2 ml sterile saline 0.9% NaCl. All vascular indices were significantly better in midazolam group, less ICU stay.