Comparison of Spinal Versus General Anesthesia for Cesarean Delivery in Patients with Severe Preeclampsia

摘要

This study examined both markers of neonatal condition and maternal hemodynamic in severely preeclamptic patients receiving spinal or general anesthesia. Sixty patients were randomized to general (n = 30) or spinal anesthesia (n = 30). The general anesthesia group received thiopental 4-5 mg kg^-1, succinylcholine 1 mg kg^-1 for rapid sequence induction, followed by 50% nitrous oxide in oxygen and 0.5-0.75% halothane, 0.15 mg atracurium after intubation and 1 μg kg^-1 fentanyl after delivery. Spinal group received 2 mL of 0.5% hyperbaric bupivacaine plus 10 μg fentanyl intrathecaly. Bradycardia and any alteration in blood pressure in the range of 30% from baseline were treated with Atropine, Ephedrine (hypotension) and Nitroglycerine infusion (hypertension), respectively. After delivery, neonatal 1st and 5th apgar scores were evaluated and umbilical arterial blood gas samples were taken and analyzed. There was not any significant deference in blood pressure changes in the range of higher than 30% from baseline between two groups (p = 0.95). 1st and 5th apgar scores (p>0.05) and umbilical arterial blood gas markers (pH, PCO₂, HCO₃, BE) showed no deference between two groups (p>0.05). Also postoperative complications (nausea, vomitingand hypertension) were higher in general anesthesia group (p = 0.04). The use of spinal anesthesia in severe preeclamptic patients has no significant effect of maternal hemodynamic and therefore on utero-placental perfusion. Also neonatal apgar score and umbilical arterial blood markers which have predictive value on neonatal outcome are not influenced with it. Besides using spinal anesthesia do not expose the mothers to the hazards of general anesthesia.