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OBSTETRIC ANESTHESIA

Patients with Severe Preeclampsia Experience Less Hypotension During Spinal Anesthesia for Elective Cesarean Delivery than Healthy Parturients: A Prospective Cohort Comparison

Division of Anesthesiology, Pain Management, Emergency and Critical Care Medicine, University Hospital, Nîmes, France

Address correspondence to Antoine G. M. Aya, MD, PhD, Fédération Anesthésie-Douleur-Urgences-Réanimation, CHU Gaston Doumergue, 5 rue Hoche, 30029 Nîmes Cedex 04, France. Address e-mail to guy.aya{at}chu-nimes.fr Reprints will not be available from the author.

In this prospective cohort study, we compared the incidence and severity of spinal anesthesia (SA)-associated hypotension in severely preeclamptic (n = 30) versus healthy (n = 30) parturients undergoing cesarean delivery. After the administration of IV fluids, SA was performed with hyperbaric 0.5% bupivacaine, sufentanil, and morphine. Blood pressure (BP) was recorded before and at 2-min intervals for 30 min after SA. Clinically significant hypotension was defined as the need for ephedrine (systolic BP decrease to <100 mm Hg in healthy parturients or 30% decrease in mean BP in both groups). Despite receiving a smaller fluid volume (1653 ± 331 mL versus 1895 ± 150 mL; P = 0.005) and a larger bupivacaine dose (10.5 ± 0.9 mg versus 10.0 ± 0.7 mg; P = 0.019), the severely preeclamptic patients had a less frequent incidence of clinically significant hypotension (16.6% versus 53.3%; P = 0.006), which was less severe and required less ephedrine. The risk of hypotension was almost six times less in severely preeclamptic patients (odds ratio, 0.17; 95% confidence interval, 0.05–0.58; P = 0.006) than that in healthy patients.

IMPLICATIONS: This prospective cohort study shows that the incidence and severity of hypotension are less in severely preeclamptic patients, as compared with healthy parturients, undergoing spinal anesthesia for cesarean delivery. However, larger studies are required to meaningfully document the safety of spinal anesthesia in this setting.

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