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Anesthetic considerations in preeclampsia
1Department of Anesthesiology, University of Tennessee, Memphis.
The successful anesthetic management of women with preeclampsia requires familiarity with the pathophysiology and hemodynamic changes characteristic of the disease process. Currently, overwhelming laboratory and clinical evidence attests to the safety and benefits of continuous lumbar epidural anesthesia in women with preeclampsia. For women with the milder form of the disease process, routine anesthetic care is sufficient. In those with severe preeclampsia, blood pressure should be controlled and intravascular volume status optimized with the aid of invasive monitoring. It is important to remember that decreased plasma proteins and presence of hepatic and renal dysfunction can influence maternal responses to drug therapy. The use of short-acting beta-adrenergic blocking agents, such as esmolol, and calcium entry-blocking agents, such as nifedipine, for blood pressure control before anesthetic induction and the role of epidural morphine and clonidine for postcesarean section pain relief are currently under investigation.
The successful anesthetic management of women with preeclampsia requires familiarity with the pathophysiology and hemodynamic changes characteristic of the disease process. Currently, overwhelming laboratory and clinical evidence attests to the safety and benefits of continuous lumbar epidural anesthesia in women with preeclampsia. For women with the milder form of the disease process, routine anesthetic care is sufficient. In those with severe preeclampsia, blood pressure should be controlled and intravascular volume status optimized with the aid of invasive monitoring. It is important to remember that decreased plasma proteins and presence of hepatic and renal dysfunction can influence maternal responses to drug therapy. The use of short-acting beta-adrenergic blocking agents, such as esmolol, and calcium entry-blocking agents, such as nifedipine, for blood pressure control before anesthetic induction and the role of epidural morphine and clonidine for postcesarean section pain relief are currently under investigation.