Spinal anesthesia in severe preeclampsia: a historical analysis of a reappraisal

Spinal anesthesia has recently been reported acceptable in women with severe preeclampsia. For example, taken together, a randomized study and a large retrospective review, comparing epidural and spinal for Cesarean, confirmed average reductions in MAP were mild (15-25%) for both epidural and spinal. Only moderate fluid loads administered without iatrogenic pulmonary edema, and total ephedrine dose was similar in each study without severe pressor response to a small IV bolus. In the past, the recommendation to avoid spinal was based on physiological changes leading to these concerns centered on fear of severe hypotension induced by sympathetic blockade, extreme sensitivity to pressors, and matemal hypovolemia of a variety of causes. Rapid infusion of large volumes of crystalloid or colloid given to correct severe hypotension has been implicated as a cause of pulmonary edema. In the early 1980s, a landmark comparative study of anesthesia for Cesarean by Hodgkinson showed the stable hemodynamics of epidural in contrast to the severe pressor responses with general. In the 1990s, reappraisal of spinal has occurred with advances in technology. Spinal has become popular and found to be cost-effective. In addition, a nationwide study of anesthesia-related matemal mortality identified significantly increased risk with general anesthesia, as compared to spinal and epidural. (C) 2002 Elsevier Science B.V. All rights reserved.