Anesthetic modification of hemodynamic and neuroendocrine stress responses to cesarean delivery in women with severe preeclampsia.

Abstract

We conducted a prospective evaluation of the comparative effects of lumbar epidural and general anesthesia on the hemodynamic and neuroendocrine stress response to cesarean delivery in 21 women with severe preeclampsia. In the epidural group (n = 11), anesthesia extending to the T-4 dermatome level was obtained using 2% plain lidocaine in divided doses. In the general anesthesia group (n = 10), anesthesia was induced after pretreatment with labetalol or nitroglycerin. In the epidural group, mean arterial pressure (MAP) gradually decreased from 133.3 +/- 5.6 mm Hg to 119 +/- 4.4 mm Hg (P less than 0.002). After pretreatment with labetalol or nitroglycerin, MAP in the general group decreased from 131.5 +/- 4.9 mm Hg to 112.2 +/- 3.5 mm Hg (P less than 0.001). At skin incision (after tracheal intubation), MAP increased from 112.2 +/- 3.5 mm Hg to 143 +/- 5.4 mm Hg (P less than 0.001); however, this was not significantly different from baseline MAP. In the epidural group, there were no further changes in MAP. The difference in MAP at skin incision and postpartum period between the two groups was significant (P less than 0.004 and P less than 0.009, respectively). In the general anesthesia group, both adrenocorticotropic hormone and beta-endorphin-like immunoactivity increased significantly from base levels at skin incision. The catecholamines also increased significantly and remained so throughout the study period. In the epidural group, the concentrations of these hormones decreased or remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)