Randomized comparison of general and regional anesthesia for cesarean delivery in pregnancies complicated by severe preeclampsia

Objective: To evaluate the maternal and fetal effects of three anesthetic methods used randomly in women with severe preeclampsia who required cesarean delivery. Methods: Eighty women with severe preeclampsia, who were to be delivered by cesarean, were randomized to general (26 women), epidural (27), or combined spinalepidural (27) anesthesia. The mean preoperative blood pressure (BP) was approximately 170/110 mmHg, and all women had proteinuria. Anesthetic and obstetric management included antihypertensive drug therapy and limited intravenous (IV) fluid and drug therapy. Results: The mean gestational age at delivery was 34.8 weeks. All infants were born in good condition as assessed by Apgar stores and umbilical arterial blood gas determinations. Maternal hypotension resulting from regional anesthesia was managed without excessive IV fluid administration. Similarly, maternal BP was managed without severe hypertensive effects in women undergoing general anesthesia. There were no serious maternal or fetal complications attributable to any of the three anesthetic methods. Conclusion: General as well as regional anesthetic methods are equally acceptable for cesarean delivery in pregnancies complicated by severe preeclampsia if steps are taken to ensure a careful approach to either method.