This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lee, J. S. Articles by Ripart, J. Search for Related Content PubMed PubMed Citation Articles by Lee, J. S. Articles by Ripart, J.

---

LETTERS TO THE EDITOR

Spinal Anesthesia in Severe Preeclampsia

Women’s and Children’s Hospital, USC Medical Center, Los Angeles, CA

To the Editor:

We were interested in the study by Aya et al. (1) showing less hypotension after spinal anesthesia in patients with severe preeclampsia than in healthy parturients. The paper by Assali and Prystowsky (2) from more than 50 years ago supports this study. In a nonrandomized study, these authors administered 0.2% procaine via a continuous subarachnoid catheter to nonpregnant females, normotensive pregnant females and toxemic females. In brief their results showed:

"a) Negligible fall in the blood pressure of normotensive non-pregnant and toxemic subjects.

b) Marked hypotension with bradycardia and shock-like condition in the prepartum periods of normal term pregnancy."

Admittedly, uterine displacement was not used and was probably not yet described at the time.

Since neither Aya et al. (1) nor the accompanying editorial by Santos and Birnbach (3) referenced this article, we thought that readers who are unaware of its existence would enjoy reading it if only for historical interest.

Interestingly, the early 1950s must have been the dark ages for heeding the literature. At about the same time Hart and Whitacre (4) described Reduction in postspinal headaches using a pencil-point needle, and yet it took more than 30 years for this information to have an impact on anesthetic practice.

References

1. Aya AGM, Mangin R, Vialles N, et al. Patients with severe preeclampsia experience less hypotension during spinal anesthesia for elective cesarean delivery than healthy parturients: a prospective cohort comparison. Anesth Analg 2003; 97: 867–72.[Abstract/Free Full Text]
2. Assali NS, Prystowsky H. Studies on autonomic blockade. I. Comparison between the effects of tetramethylammonium chloride (TEAC) and high selective spinal anesthesia on blood pressure of normal and toxemic pregnancy. J Clin Invest 1950; 29: 1354–66.[Medline]
3. Santos AC, Birnbach DJ. Spinal anesthesia in the parturient with severe preeclampsia: time for reconsideration. Anesth Analg 2003; 97: 621–2.[Free Full Text]
4. Hart JR, Whitacre RJ. Pencil-point needle in prevention of postspinal headache. JAMA 1951; 147: 657–8.

Response

Fédération Anesthésie-Douleur-Urgences-Réanimation, Groupe Hospitalo-universitaire Caremeau, Nîmes, France

In Response:

We appreciate the interest of Lee and Harding in our study (1) and would like to take the opportunity to thank them for the information provided in their comment. We apologize for missing out the study by Assali and Prystowsky (2) in our references, as these authors showed a lesser sensitivity to hypotension of toxemic patients given local anesthetics spinally. Although the conditions of their study were far from the current "modern" practice of spinal anesthesia in obstetrics, one can note that the message of their findings was overlooked. In-deed, since, obstetric anesthesiologists were advised against the administration of spinal anesthesia (3–5) in preeclamptic patients in textbooks until the 1990s. Therefore, many colleagues still believe that preeclamptic patients are at a greater risk of hypotension when given spinal anesthesia than normotensive women. Fortunately, data are accumulating to show that the risk of spinal-induced hypotension is not greater and may be lower in preeclamptic patients compared with normotensive women. While the study by Assali and Prystowsky (2) should be read, at least for historical interest as suggested by Lee and Harding, studies from the late 1990s to date should have a greater impact and it can be expected that, in a near future, obstetric anesthesiologists will change their mind concerning the use of spinal anesthesia in the setting of severe preeclampsia.

Footnotes

Dr. Birnbach does not wish to respond.

References

1. Aya AGM, Mangin R, Vialles N, et al. Patients with severe preeclampsia experience less hypotension during spinal anesthesia for elective cesarean delivery than healthy parturients: a prospective cohort comparison. Anesth Analg 2003; 97: 867–72.[Abstract/Free Full Text]
2. Assali NS, Prystowsky H. Studies on autonomic blockade. I. Comparison between the effect of tetramethylammonium chloride (TEAC) and high selective spinal anesthesia on blood pressure of normal and toxemic pregnancy. J Clin Invest 1950; 29: 1354–66.[Medline]
3. Lechner RB, Chadwick HS. Anesthetic care of the patient with preeclampsia. Anesth Clin North Am 1990; 8: 95–114.
4. Cheek TG, Samuels P. Pregnancy-induced hypertension. In: Data S, ed. Anesthetic and obstetric management of high-risk pregnancy. St Louis: Mosby, 1996: 386–411.
5. Maresh M, James D, Neales K. Critical care of the obstetric patient. In: James DK, Steer PJ, Weiner CP, Gonik B, ed. High risk pregnancy: management options. London: WB Saunders, 1999: 1291–1321.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lee, J. S. Articles by Ripart, J. Search for Related Content PubMed PubMed Citation Articles by Lee, J. S. Articles by Ripart, J.